In an NHS hospital somewhere in the UK, a doctor is standing over to a fax machine waiting for a patient’s medical records to arrive from a GP surgery.
The machine finally whirrs into life – only to be halted midway through delivering its life-saving message because of a paper jam.
This isn’t a scene from a 1980s TV medical drama. It is happening right now in hospitals across 21st century Britain.
But could the end be in sight for these electronic dinosaurs? The Health and Social Care Secretary, Matt Hancock, ordered NHS trusts in England to ban the fax machine by the end of next month.
NHS is forced to face fax
Launching his “tech vision” in 2018, Mr Hancock said that hospitals should be using modern communication methods long taken for granted by UK businesses “such as secure email, to improve patient safety and cyber security” by 1 April this year. It is a deadline unlikely to be met.
“We’ve got to get the basics right,” he said, “like having computers that work and getting rid of the archaic fax machines still used across the NHS when everywhere else got rid of them years ago.”
His announcement came after a report by the Royal College of Surgeons revealed the NHS to be the world’s largest purchaser of fax machines – with one hospital trust alone using more than 600 of them.
A portable fax machine is unveiled in 1990 (Photo: Holger Hollemann /DPA /AFP/Getty)
In 2018, there were at least 10,000 of the devices across the NHS – 8,000 in England, 1,200 in Scotland, 1,000 in Wales and an unknown number in Northern Ireland – through which doctors were sending crucial information about patients, with experts warning that lives were being put at risk in critical situations such as in accident and emergency care.
Stories have since emerged of urgent requests for patient records being sent to a fax machine in a locked room, and of a machine spilling requests behind a cupboard for years.
There have also been reports of frontline doctors being so frustrated by delays that they have been sending sensitive information via non-sanctioned smartphone platforms such as WhatsApp.
Improving the service
Richard Kerr, the chairman of a commission on the future of surgery sponsored by the Royal College of Surgeons, has told i the body is proud to have “exposed the Jurassic practise of buying more and more fax machines in the NHS”.
“The rest of the world has moved on from the fax and it is high time the NHS does the same,” he said. “Matt Hancock’s initiative to banish the machines is welcome and progress is being made.
”But just scrapping the old is not enough. We know that digital technologies, such as artificial intelligence, genomics and complex imaging for healthcare are going to play an increasingly important role in how we deliver patient care.
“Endless exchanges of letters, by fax and mail, are inadequate to support these developments.
“The NHS is in desperate need of new systems for effective, integrated, secure data sharing between GPs and hospitals, and across hospital trusts. Too much time and money is presently wasted on everybody writing to everybody else. As we enter the 2020s, this must be sorted out for the benefit of both patients and professionals.”
Hospitals have been told to get rid of their fax machines (Photo: Isabel Infantes/AFP/Getty)
One trust that has been leading the charge against the old technology is the Leeds Teaching Hospitals NHS Trust, which launched its own “Axe the Fax campaign” in the months before Mr Hancock’s ban in 2018.
It said staff reacted positively to the idea of getting rid of the 345 machines that had kept them ”living in the dark ages“ and which had been banished by other industries for decades.
Andy Webster, a consultant in emergency medicine and the trust’s chief clinical information officer, said: ”We took on the challenge of replacing fax machines with more modern secure technology by changing the way our teams do their business and transforming how they work.
“As a result we’ve already eliminated over half of the 345 machines we identified and are continuing to work towards replacing the rest to help improve the quality of services that we provide for patients and the experiences of our staff using technology.”
The dark ages
The Royal College of Surgeons has called for an integrated system for case notes (Photo: Christopher Furlong/Getty)
The trust is now piloting an eFax service that allows medics to receive faxes via email. It even set up an online toolkit with the help of digital health PR and marketing specialists Silver Buck to help other NHS organisations do the same.
Silver Buck has carried out its own research, asking trusts why they are still using the machines and why it has been difficult to phase them out.
It says many NHS staff are resistant to removing “bulletproof” faxes as they mistrust the ability of ephemeral new technology to deal with important documents securely, with faxing also easier than getting to grips with a new digital service.
Changing technology can also create access issues for staff and patients and there is a wider problem of many rural GP practices and care homes being ill equipped to adopt a new technology.
Another major stumbling block is the decision about which digital tools to deploy, with researchers last year finding that NHS trusts were using at least 21 different electronic medical record systems. More than two in five trusts are still using paper records.
A report last autumn by Silver Buck, with less than half a year left before next month’s deadline, found that only 42 percent of fax machines had been axed by hospital trusts.
‘Too much time and money is wasted on everybody writing to everybody else’
Two trusts, Mid Yorkshire Hospitals and South Tees Hospitals, said they now had more machines than in 2018.
Epsom and St Helier University Hospitals in Surrey, however, had cut its number from 212 to three, which were being saved for emergency use. And the Newcastle upon Tyne NHS Foundation Trust, which had more than 600 machines in 2018, is now down to 208.
Missing the target
Sarah Bruce, director of Silver Buck, said the campaign started as a grass-roots movement that became mandatory when Mr Hancock imposed his deadline. “However,” she said, “the lack of proper guidance, funding or support, has led to just pockets of progress, and many trusts look set to miss the target.”
She added: “The campaign will continue to offer guidance to NHS organisations indefinitely and we urge those struggling to remove fax machines to get in touch. With more than half of medical errors resulting from miscommunication, it is clear that axing the fax will lead to a safer, more efficient NHS.”
A spokesman for the Department of Health and Social Care said: “As the Health Secretary has made clear, relying on paper records and outdated technology like fax machines risks patient safety, is expensive, and frustrates hard-working staff.
“We expect all NHS organisations to replace fax machines with modern alternatives and they have already been removed from the NHS buying catalogue, so trusts cannot purchase further machines.”