UK Edition
“Pointless” bureaucracy is helping hospitals grind to a halt, a leading doctor has warned.
Dr Gordon Caldwell, who has just retired after 40 years as an NHS hospital consultant, said “horribly inefficient” paperwork around patients moving in and out of wards is fuelling record delays.
The senior doctor took a photograph of all the forms required for one medical admission to an NHS hospital, laid against his 5ft 10in frame.
Dr Caldwell said promises by the NHS to “digitise” the health service had simply seen needless bureaucracy transferred on to poor computer systems that were often incompatible with each other.
The specialist in general medicine and diabetes endocrinology said: “A few years ago there were estimates that nurses were spending around 50 per cent of their time on paperwork; now I’d say it’s closer to 70 per cent.”
“It’s bureaucratic and it’s very slow and horribly inefficient,” he said.
Dr Caldwell said the rise of unthinking officialdom was one of the factors that led to his recent retirement.
Too often, dozens of forms were produced with little thought given to duplication, or how to obtain the key information quickly. He said the issue is one of the reasons why whole days are lost to admission and discharge of patients.
Latest figures show almost six in 10 patients who were well enough to be discharged were stuck in hospital in the week ending Jan 15.
Meanwhile, monthly data shows more than 55,000 A&E patients endured trolley waits of more than 12 hours to get a bed, after the decision was taken to admit them.
Slowing down processes at every turn
Dr Caldwell said time spent completing forms that duplicate each other, and waiting for pharmacies to issue prescriptions, was slowing down processes at every turn.
“Even when they are replaced with digital forms the problem is the same, there is very bad software that often doesn’t link up with other software – so there’s time wasted with pharmacists typing in information and then having to retype into another system for the labels. As well as being a waste of time it’s adding risks at every stage.”
“A lot of hospitals are washing their hands of responsibility for the delays, saying that it’s all people who can’t get social care. But, in fact, the vast majority of patients go home independently; even if you get them home in two to four hours, that could have a big effect on the number of people held in the system.
“I would have patients ready to go home at 9am but because they need a prescription they would be left waiting until 3pm, just for that,” he said.
“Why are we wasting hours and hours filling in pointless forms?” said Dr Caldwell, who has long campaigned on the issue.
“Generally all they do is take those horrible papers and make them into a digital form, without anyone asking if this is the best way to do it. And there is so much information in so many different places that it increases the risk that something important gets missed.”
Poor design of systems
The leading consultant said poor design of systems meant staff were forced to answer a catalogue of questions, however irrelevant.
In 2019, when working at Lorn and Islands hospital, Oban, Argyll, Scotland, Dr Caldwell took a photograph of all the forms required for one medical admission with diabetes in need of intravenous antibiotics.
When he laid against them on the floor, even one side of each two-sided sheet stretched long beyond his frame.
He said the bureaucratic demands were typical for an NHS hospital – and getting worse.
When working in Worthing hospital, nurses complained it was taking them 40 minutes to document their assessment of an admission to the acute medical unit. The senior consultant introduced an alternative format, which cut the process to around 10 minutes.
Spiralling bureaucracy getting worse
Dr Caldwell said the spiralling bureaucracy was getting worse, with little oversight to streamline demands, and instead a separate form for each issue.
“Too often there is a new form for everything. We don’t want deep-vein thrombosis, we don’t want pressure sores, we don’t want falls, of course we don’t. But each has been allowed to throw a new form into the system until you could literally spend all your time filling in forms,” he said.
“I used to carry a stopwatch around with me but I’ve never known anybody measure time other than myself. The NHS doesn’t seem to indulge in the simplest forms of time-and-motion studies,” added Dr Caldwell.