Nearly a quarter-century after the first major push to modernise hospital record keeping, a new BMJ report suggests that many NHS trusts in England are still relying on paper for routine clinical work. The findings come at a time when health leaders are under pressure to improve efficiency, reduce errors and make better use of digital tools across the service.
Paper systems remain widespread despite long-running digitisation efforts
The BMJ reported on August 5, 2026, that four fifths of NHS trusts are still using pen and paper for record keeping. The story adds fresh scrutiny to the pace of digital transformation in the NHS, where electronic systems have long been promoted as a way to improve patient safety, speed up information sharing and reduce administrative burden.
The report arrives alongside broader concerns about whether existing technology investments are delivering practical gains on the ground. In recent BMJ coverage, other NHS-related stories have also focused on implementation challenges, including delayed discharge tools and the use of AI in clinical settings, underscoring that adoption is often more difficult than policy announcements suggest.
What the latest findings mean for patient care
Paper records can slow the transfer of information between departments and organisations, particularly when patients move between primary care, emergency services and hospitals. They can also make it harder for staff to access a complete and up-to-date picture of a patient’s history, especially in busy settings where time is limited and decisions must be made quickly.
While the BMJ item does not by itself measure the clinical impact of paper-based systems, the continued dependence on manual records points to a service still operating with mixed infrastructure. That creates risks of duplication, lost information and avoidable delays, particularly in trusts that have not fully integrated digital workflows.
Pressure builds for faster NHS modernisation
The report is likely to intensify debate over how the NHS should balance large-scale digital ambitions with day-to-day operational reality. For managers and clinicians, the central issue is not simply whether digital systems exist, but whether they are usable, interoperable and consistently adopted across the frontline.
With health services facing persistent workload pressures, the question now is whether the NHS can move beyond partial digitisation and deliver systems that genuinely reduce friction for staff and improve care for patients. The BMJ’s findings suggest that, for many trusts, that transition is still unfinished.
Source reporting from The BMJ indicates the issue remains live, and further attention from NHS leaders will likely be needed if paper processes are to be reduced in a meaningful way.
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