DIGITISATION
Patient records and the hidden cost of paper
Drawing on his work with the Association for Intelligent Information Management (AIIM) and the Information and Records Management Society (IRMS), Andrew Graham, business development manager at PFU (EMEA) Limited, offers a realistic view of how Trusts can turn paper archives into accessible digital assets, supporting the wider goals of the NHS 10 Year Health Plan.
NHS Trusts have spent two decades investing heavily in Electronic Patient Record (EPR) and Electronic Health Record (EHR) systems. Funding has been committed to digital transformation, software integration, and network infrastructure across acute Trusts, community facilities, and outpatient clinics. Yet, across the health service, a vast proportion of the patient story still lives on paper. While national targets for EPR implementation have
expanded under the government’s drive toward a Single Patient Record (SPR), hospital estates continue to run a massive, silent legacy system: paper. Paper is rarely labelled as a legacy system in NHS IT
strategies, yet it is the oldest, most fragmented and most space-consuming infrastructure in the health service. It has no search function, no automated audit trail, no access controls beyond a lock and key, and no ability to be updated in real time by more than one clinician at once. Because paper management often gets siloed into IT and digitisation projects, estate directors, facilities managers, building engineers, and healthcare architects are left to deal with the fallout. For them, paper is a space problem. Filing cabinets, active medical record libraries, basement stores, and off-site archives consume thousands of square metres of high-value estate that could otherwise be used for clinical consultations, bed capacity, diagnostic suites, or staff wellbeing facilities. While the financial savings are huge, this is ultimately about patient outcomes. For the nurses, doctors, and NHS workers trying to deliver care every day, clearing out paper is what gives them faster access to complete information and puts time back at the bedside. Connecting legacy paper with digital systems at the point of capture is one of the most direct ways to free up physical space across the NHS estate without requiring costly capital construction.
The reality of system-hopping When EPR and EHR systems are properly integrated, the result is a single, coherent view of a patient history, diagnoses, medications, test results, correspondence, and clinical notes. This unified view makes information portable and secure. Authorised clinicians can pull up a patient record from any location, whether a ward, an outpatient clinic, or a community home visit, without reliance on a central paper filing room or a courier service. Without full integration and complete digital capture, clinical teams are stuck system-hopping. They have to open three, four, or five different screens just to piece together a single patient history: one for imaging, another for pathology, another for historical referral letters, and then
paper files tucked into ward drawers. Every login and mismatched format eats up time during a shift, leaving staff to constantly reconcile fragmented data while patients wait. Recent sector analysis
by Future Health
Intelligence (FHI) found no statistically significant link between a high digital maturity score and a reduction in paper spend. This means that digitally advanced Trusts are often just as likely to be big spenders on physical records as those at the start of their journey.1 In England alone, FHI data demonstrates that NHS Trusts spent approximately £230m on paper records in a single financial year. When factoring in off-site storage fees, transport, courier logistics, and manual retrieval labour, total annual expenditure rises to £250m. FHI’s research shows that individual hospital Trusts can realise annual savings of over £1m simply by diverting day-forward paper away from off-site storage into automated digital ingestion streams.
Freeing up clinical space from off-site storage IT strategies modernise servers, cloud hosting, and front-end software. Meanwhile, filing cabinets full of correspondence, consent forms, and historical notes operate as they did fifty years ago, unmanaged within the information governance strategy. Paper records are rarely confined to a central,
purpose-built medical records archive. They occupy dozens of ad hoc filing cabinets tucked into back-office corners, ward nursing stations, consultation rooms, and departmental corridors across hospital sites. This expansion represents passive dead space across high-cost acute footprints where every square metre carries real capital and operational maintenance value. A standard four-drawer filing cabinet occupies roughly 0.6 square metres of floor space, but when accounting for drawer extension, drawer clearance and mandatory aisle access, the actual footprint doubles to at least 1.2 square metres. In dense static racking systems or roller-
October 2026 Health Estate Journal 125
AdobeStock / mnirat
Trusts are still spending millions on paper files.
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