I recognise that a lot of people here are going to be the professionals that actually do the hard work of dealing with the transition from paper to digital records.

And so, I was going to use my 10 minutes just to describe five questions that I hope will help set you up for success

These are thoughts around the patient/payer view, professional bias, human bias, manager bias, and communicating complexity.

So, to take those in turn, starting with the patient/payer view.

The NHS is unusual. We are all of us, in this room and outside patients as we access its services as well as paying for them.

And I think that does give a special twist to the interests that we have.

We want the NHS’s money, our money, to be spent on the things that will maximise patient outcomes for patient benefit.

We are also aware that with the level of NHS resources it’s hard to deliver even essential services.

So, when we say we want to see waste minimised, we are talking from the perspective that waste in the NHS is a sin.

It’s not just a slightly unfortunate thing. It is wasting money that could otherwise go on services that people are not getting.

And so there are these two ideas that I think are critical to the way in which we have to think about expenditure in the NHS.

The benefits we get from expenditure on our medical records can be direct and indirect.

The direct benefit is that when I go and see a clinician, the clinician has a very good health record for me and therefore, my health care is better as a result. They’re not missing things.

But there are also some indirect benefits and these become critical in the medical records storage and management space.

This may be things like referring back to records for clinical audit. It’s not a direct benefit to me. But the fact that all of the outcomes from a particular clinician can be audited will have an indirect benefit.

One of the live areas in the medical records discussion is the extent to which we hold medical records for later legal action or inquiries. Legal action and inquiries, when they’re done well, should provide an indirect benefit.

As a patient, I want to ensure that the medical records are there for these purposes as well as for my direct benefit when I’m being treated. I also have an interest in them being there for improving the service overall.

Spending on space for paper records that are never accessed is just simple straightforward waste. That money is being spent to zero benefit.

But there can also be indirect costs if the records are being stored but in order to access them, you have to use the expensive method of a porter going down there and wheeling records out. That’s an indirect cost because every service that depends on it will be more expensive than would otherwise have been the case.

So, as a patient-payer I want to maximise the direct and indirect benefits, and to minimise the direct and indirect costs.

Thinking now about professional biases, there is an old saying - “if you’ve only got a hammer, everything looks like a nail” - that we should keep in mind. We all have a tendency to look at things through our area of expertise.

I’m a geek and I look at everything through the lens of “what kind of I.T system could I build to improve this thing?”

But digitisation should never be seen as an end goal in and of itself. It is rather a means to a particular end, and in this case, that end is good health outcomes at the best possible cost.

The digitisation is not the goal, however much I as a geek think that it is. So, what we often do in digital health is bring in clinicians to help out. And then we end up with something that’s a bit better because the geeks’ enthusiasm is tempered by the clinicians.

But the clinicians have their own hammer, as they naturally focus on the clinical treatments, and we may still need other tools for a complete solution.

I would suggest that what’s really important in the medical records management space is that we add the librarians into the mix. Librarians have a very particular hammer, which is that they are really good at cataloguing information so that it can be easily retrieved. They think about the whole chain.

By way of example, I am being treated for a foot fracture at the moment.

When I see them take an x-ray, my geek instinct is to think about “how technically might this be sent to my GP?”. Even if my GP likely has no need of the actual X-ray and would never look at it.

A clinician might say, “wouldn’t it be great to have lots of x-rays stored so that I can go back and look at them and do some research later”. That would meet their perceived need even though again they might never actually look at the stored material.

A librarian would think “how do I create the most efficient coding possible that transmits what happened to the GP so they can easily retrieve facts about the treatment episode?”

For any particular use case, we need all of those lenses to be applied, recognising the biases, to come up with the right solution.

As well as professional bias, we need to consider a key human bias. We have a tendency to overestimate the value of stuff, writ large, and we underestimate the cost of having stuff.

This is why Big Yellow storage units are a thriving business. They live from the fact that all of us, as humans, accumulate stuff and find it really difficult to get rid of stuff.

We pay to store that junk because we are convinced that somewhere in there is something that we may need at some time. And again you can see there’s very much in the medical record space where we accumulate everything “just in case”.

I’ve worked in Big Tech and I can tell you, it’s the same there. Tech companies collect lots of data with the logic that somebody thinks it may be useful at some point, so we’ll hang on to it.

And with due respect to AWS who are present here, there is a risk that AWS becomes the Big Yellow of digital where everyone pays for large storage buckets for stuff that they will never actually access. That’s good for AWS, but not great for the taxpayer.

The last area of bias we need to think about is manager bias. This is not to say that managers are not humans or professionals. They are both, but they also have additional concerns around risk and accountability.

And this is really good because we want managers to worry about risk and accountability. But we need to recognise that these otherwise positive biases can sometimes cause inertia especially when the status quo is settled.

So, if the budget for storing medical records in a particular way is not being challenged, then, for a manager, the question arises “why follow the riskier path?” This is particularly true when you’ve got all sorts of other competing priorities going on.

This is why we did the project at NHSTech.uk looking at existing spending on paper records. We did that to challenge those status quo budgets and get people to ask questions about them.

But we need to recognise that this is not an inherently bad bias. I want people who are managing things to think very carefully about risk and not jump too quickly, but we do still want them to jump when there’s a compelling case to do something.

We also need to think about communicating around this kind of change and getting people’s buy-in.

We have a habit of going for simple slogans. The simple slogan is “paper-free NHS”. It’s such a good slogan that it’s issued repeatedly every few years! We’re told about another initiative that will make the NHS paper-free by year X. And here we are in 2025, and none of them have happened.

The reality is that we actually need a much more granular approach underneath the headline slogan. And we should be able to get the public behind the idea that we need a range of different treatments for different records.

In some cases this will be simple deletion “we’ve got storage areas full of records that nobody’s used in 10 years and nobody is likely ever to use, and they’re going”.

In others, it will be expensive, manual hand coding of certain records that have to be individually reviewed. This is needed for records that are critical to someone’s treatment.

And there will be everything in between, from digitising and putting into cheap “cold” digital storage, through systems that allow for digitising, auto-encoding and connecting into an EHR.

We do then have all of those different treatments that I think are the solution that we actually need.

I will leave you with what I think is an appropriate Battle Cry. It’s not - “What do we want? A paper-free NHS now” - but rather - “What do we want? An appropriate treatment of classes of different records to minimise the cost and maximise their usefulness?”

Perhaps not quite as catchy, but I hope a reasonable framing for the discussions you’re going to have over the next couple of days.

I’m extremely grateful to EDM Healthcare Consulting for creating and curating this space. It allows us to think about some of the basics.

There’s lots of attention paid to all the wizzy AI stuff that’s great. But we can also gain huge value from sure that we maximise health benefits and minimise costs from the records that we all create day in day out, just by our usage of the NHS. I hope that’s helpful and good luck for the next few days.