Fax machines in the NHS are a symptom of the underlying tech problem, not the cause of it

Profile picture for user ddpreez By Derek du Preez December 9, 2018
Health Secretary Matt Hancock announced this weekend - to much fanfare in the press - that the NHS will be phasing out fax machines. Whilst a good bit of PR, it’s not going to be the antidote that NHS Trusts need.

Fax NHS Matt Hancock Health
This weekend, Health and Social Care Secretary Matt Hancock did what he does best and played to the mainstream media with a news announcement that he knew would inevitably secure a tonne of headlines. Fax machines to be banned across the NHS!

‘Finally! It’s not the 90s anymore!’, cried the national media. And whilst I agree with the sentiment, fax machines aren’t *needed* anymore, I’d also suggest that the approach is somewhat misguided.

By way of background, Hancock took the job of Health and Social Care Secretary in a recent cabinet reshuffle, having been promoted from the Department of Digital, Culture, Media and Sport. During his time at DCMS was a keen advocate of all things digital, claiming to be one of the few politicians that actually knows about tech.

You may sense from my tone that I’ve not been entirely convinced by Hancock’s efforts. Whilst I applaud a politician that comes out and talks about technology investment publicly, I also hope that one does so with a bit of foresight about what hopes to be achieved.

Anyway, the announcement this weekend states that NHS Trusts will be required to invest in new technology to replace outdated systems. This means a ban on buying fax machines that comes into effect from January 2019 and that they will be phased out completely by 31 March 2020.

NHS organisations will be monitored on a quarterly basis until they declare themselves ‘fax free’.

The mandate was prompted following a freedom of information request that revealed in July that more than 8,000 fax machines are still being used by the NHS in England.

Why this isn’t the antidote

On the face of it, the fact that so many NHS Trusts across England are relying on fax machines for patient care does seem laughable. However, the reason I question the approach being carried out by Hancock & Co. is that I genuinely don’t believe that there are many doctors, nurses or hospital staff out there that actually *want* to be using fax machines.

I think it’s fair to assume that not many of those providing care across the NHS will use fax machines in their day-to-day lives, so why would they want to use them when they pitch up for work?

As such, I’d argue, that what Hancock should be asking is - why is the NHS still relying on fax machines? What are the underlying problems that facilitate this? I’m sure, part of it is cultural inertia, but I very much doubt that’s all of it.

For example, I have seen some doctors tweeting this weekend that the fax machines are the only reliable part of the NHS tech system - whilst other parts of it fall down, the hardy fax machine remains resilient. Another doctor stated this weekend that whilst Trust’s don’t want to be using them, they’re still in place because GPs and local authorities are insisting on them as a secure means of communication.

Another doctor blogged that emails aren’t the answer, for a number of reasons, some legal, some relating to the need for handwritten notes - and whilst not all of these may be true, wouldn’t care providers be using email if it was easier? If email isn’t the answer (which it probably isn’t), then what is?

Another point to note is that a big reason that the National Programme for IT failed so spectacularly - costing the taxpayer billions of pounds - is that the NHS didn’t respond well to being told what to use from the centre. Trusts have local needs and local requirements (and whilst I’m sure these needs and requirements aren’t reliant on fax machines), they need to be considered.

Banning a piece of outdated tech and pointing to that as the problem feels like the wrong approach in the wrong place. Do you think it would be sensible to ban on-premise infrastructure too? Whilst I’d argue that on-premise hosting is horribly outdated, I doubt many would argue a case for banning it outright from the get-go. Rather make the case for it, adopt principles and standards, put in place spend controls, push the case for user need and let users arrive at that decision on their own…

So, what is the answer?

Whilst I’m no fan of Hancock’s headline seeking announcements, which I believe may do more damage than good, I was fairly supportive of his recently announced technology strategy for the NHS.

Why? Because it focused on putting things in place from that centre that made sense and will allow NHS Trusts some scope and flexibility to find their way.

For example, it pushes a public cloud first approach, focuses on standards, addresses data registers and APIs, and argues that services should be designed around user needs.

These principles should be put in place and enforced from the centre, with rigour, and I then would imagine that as the NHS as a whole is forced to comply with these, fax machines would fade away regardless.

However, there are still elements that need to be addressed. For example, everything we’ve heard from Hancock thus far has placed technology front and centre. Which is fine, to a point. However, it’s very easy to say ‘fax machines are banned’, or to declare that the NHS is ‘paperless’ or ‘public cloud first’.

What’s harder is the enablement. The cultural change process, the governance, the upskilling, the resourcing, and the procurement reform. These points matter and they’re the pieces that will allow the NHS to comply with the enforceable standards.

As such, let’s get back to doing the hard work to ensure that the NHS remains free at the point of care and is a world leading digital organisation. And let’s avoid the click-bait announcements that demonise NHS organisations trying their best, who instead need guidance and strong leadership from the centre.