NHS trusts in England are still using pen and paper for record keeping in four fifths of cases, according to a recent BMJ report that highlights how slowly digital change is moving across parts of the health service. The finding comes 25 years after the first digitisation push, raising fresh questions about efficiency, patient safety, and the pace of modernization in the NHS.
Paper systems remain deeply embedded in care delivery
The BMJ says the scale of continued paper use remains striking given repeated national efforts to move services toward digital record keeping. The report notes that many trusts are still dependent on manual processes for storage and handling of patient records, despite long-standing policy ambitions to replace them with electronic systems.
That persistence has financial implications as well. The BMJ reported on August 17, 2026, that NHS spends £240m a year storing patient records, with ongoing paper use driving high costs. The newer report on pen-and-paper record keeping adds another layer to the debate by suggesting that digitisation has not yet translated into consistent front-line practice across the service.
Why the issue matters for patients and staff
Paper-based systems can slow access to information, complicate handovers, and increase administrative work for clinical teams. While the BMJ report focuses on record-keeping practices rather than specific incidents, the broader concern is that fragmented information systems can make it harder for staff to work quickly and accurately in busy NHS settings.
The report arrives amid wider scrutiny of NHS digital projects and data systems. In recent weeks, The BMJ has also covered controversy around Palantir’s federated data platform, showing how closely digital transformation, procurement, and public trust remain linked in the health service.
A wider pattern of pressure on NHS modernization
The latest findings sit alongside other BMJ coverage pointing to strains across the service, from staffing pressures in mental health centres to the challenges of implementing new systems at scale. Taken together, the reports suggest that the NHS is still grappling with how to modernize infrastructure while maintaining safe, reliable care.
For policymakers, the message is clear: digital transformation is not just a technology project, but an operational one. Without better implementation, funding, and integration, the shift away from paper may continue to lag behind the ambitions set for the NHS more than two decades ago.
Source: The BMJ News
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