What does physical records management cost the NHS?

January 20, 2025

Managing physical records is a significant expense for NHS Trusts in England. From March 2025, EDM Healthcare Consulting will kick off a six-month campaign aimed at raising awareness of how these records affect the digital transformation and spending of NHS organisations. Harry Pettet, EDM’s Managing Director and Lead Consultant, tells us more

Working in the NHS, we often hear comments from patients and the general public about their surprise that NHS Trusts are still heavily reliant on paper. In contrast, many who work in the NHS remain hesitant to state with any form of confidence that the NHS will ever be fully paperless. Some will even mock and scorn the idea of a truly ‘paperless’ NHS. Regardless of viewpoint, though, most will be taken aback at the idea that most NHS Trusts will operate or outsource the management of warehouses full of paper records. But how about the idea that over the last five years, NHS Trusts in England alone have spent over £1.163 billion on physical records management. At EDM Healthcare Consulting, we’ll be using Digital Health Rewired in March 2025 and April as the Records and Information Management Month to launch our six-month campaign to increase awareness of the impact physical records are having on NHS organisations’ digital transformation strategies and revenue expenditure profiles.

The NHS England ERIC Report ⁽¹⁾ provides information on 200 NHS Trusts Estates Returns Information for organisations geographically located in England. This excludes Ambulance Trusts, ICBs and GP practices.

The total expenditure on the health records estate over five years between FY2018/19 and FY2022/23 was reported at £1.163bn (£1,162,722,310), with £884mn (£884,483,435) spent on on-site health records storage and £278m (£278,283,875) spent on off-site health records storage. Twenty-four percent of the total cost incurred relates to off-site storage, and 76% relates to on-site storage.

So, are costs surely going down?

Not quite. Over the last five years, despite an increase in many NHS organisations’ digital maturity, the spend on the health records estate has increased net by £6m (£6,116,991), 0.5% (0.526%), driven by an increase in off-site storage of £16m (£16,159,928) but a welcomed reduction of on-site costs by £10m (£10,207,239).

What about Electronic Document Management Systems (EDMS)?

Of the 200 NHS Trusts, 65 are still reporting no Electronic Document Management System has been implemented to facilitate the digitisation of health records. These organisations represent £259m (£259,951,323) of the £1.163b, 22% (22.357%) of the total spend.

Which Trusts represent the majority of the spend?

Forty of the 200 NHS Trusts have reported a spend of £10m or more per Trust over the same five-year period, with costs for just these Trusts totalling £600m (£600,092,110). Whilst this only represents 20% of NHS Trusts in England, their expenditure represents 52% (51.611%) of total spend.

Furthermore, five NHS Trusts (2.5% of NHS Trusts in England) have each reported spending of £20m or more over the five years reported, with costs totalling more than £143m (£143,791,352), representing 12% (12.366%) of total expenditure.

How does the spend compare across regions?

When we look regionally, the spend of the 33 NHS Trusts located within the London Commissioning Region equated to £235m over the last five years (£235,431,314), representing 20% of the total five year spend across England (20.248%). Of the 33 Trusts in the region, 11 do not have an EDMS (33%).

In contrast, 55 NHS Trusts located in the Midlands and East of England incurred costs of £300m over the last five years (£300,296,873), 26% of the total five-year spend across England (25.827%). Of the 55 Trusts, 21 do not have an EDMS (38%).

Of the 63 NHS Trusts in the North of England, their combined spend over the last five years was £337m (£337,115,020), forming 29% of the total five-year spend (28.993%). Of these, 17 Trusts reported they are yet to implement an EDMS (26%).

The remaining 46 NHS Trusts located in the South of England also spent £289m (£289,879,103), representing 25% of the national spend over the last five years. Fourteen of these (30%) currently lack an EDMS.

What EDMS solutions currently make up the market?

Whilst not reported within the ERIC report, responses to Freedom of Information requests have highlighted that of the 200 NHS Trusts in England, 135 have reported an EDMS (Electronic Document Management System) is in place.

Of these 135 Trusts, 30 reported they are using Civica Cito or WinDip representing 22% of the market (22.222%), 23 reported they are using Kainos Evolve representing 17% of the market (17.037%), 18 reported they are using Mizaic MediViewer representing 13% of the market (13.333%), 14 have reported they are using CCube Solutions representing 10% of the market (10.370%), 13 reported they are using Hyland On-Base representing 10% (9.629%) of the market, nine reported they are using Fortrus Unity solutions representing 7% of the market (6.666%) and three reported using Ideagen Knowledge Worker representing 2% of the market (2.222%). The remaining 25, representing 19% of the market (18.518%), used a variety of MS Office, Inhouse Developed applications, VNAs and ‘other’ EDMS solutions.

How do we address this?

At EDM Healthcare Consulting, we’re committed to working with the NHS to reduce this spend. We believe outsourced storage, scanning, and digitisation all play their roles when used correctly. No one NHS Trust is the same, so careful analysis of the specific business drivers for each Trust should be undertaken to inform the investment objectives for any health records management project.

It’s not just about money, though, is it?

No. health records play a fundamental role in not only delivering safe, effective care but also in enabling and informing health research, data science and analytics. For some NHS Trusts, physical records present a fragmentation of the ‘complete, patient centric record’ due to the increased prevalence of digital systems and records. However, a recent audit undertaken by the EDM Healthcare Consulting team for a London-based NHS Trust found that of the records audited, 72% of the active records contents consisted of content printed from third-party systems. However, 87% of these documents included a physical signature and/or annotation. Thirty-one percent included more than one individual’s annotation.

What’s next?

Following the article by The Times Health Commission in October 2023 ⁽²⁾ and the analysis undertaken by Lord Richard Allan of Hallam, light has been shed on the extent of NHS expenditure for health records storage. At EDM Healthcare Consulting, we want to continue to drive focused interest in this subject, working with NHS Trusts and the records management vendor industry as a whole to deliver tangible benefits.

Want to know more?

Between the 18-19 March 2025, EDM Healthcare Consulting will be exhibiting at Digital Health Rewired at the Birmingham NEC (stand F40). Join us as Harry Pettet, our Lead Consultant, discusses our findings from the ERIC Report in detail and imparts Lessons Learnt from our experiences deploying records management solutions within the NHS. If you or your organisation are looking to attend, you can register by clicking here.