by Dr Terence McLoughlin
Dr Terence McLoughlin, Emergency Medicine Consultant & Expert Witness
It is 2am in a busy emergency department. A critically unwell patient arrives unable to provide any medical history. Family members are unavailable. The ambulance crew have minimal background information about the patient. Somewhere within the NHS there may be previous admissions, clinic letters, investigations, medication records, and specialist opinions that could fundamentally alter management.
The information exists. The clinician just can’t see it.
That challenge is repeated thousands of times every day across the NHS. It sits at the heart of the government’s proposed NHS Modernisation Bill, which contains one of the most ambitious healthcare reforms seen in a generation: the creation of a Single Patient Record for everyone receiving health and social care in England.
The proposal is straightforward in principle. Information held by GPs, hospitals, community services, and social care providers would become accessible through a shared digital record, allowing clinicians to see a more complete picture of a patient’s medical history regardless of where they present for treatment.
Ministers claim the changes could prevent around 6,000 hospital admissions annually, reduce approximately 20,000 A&E attendances and save £20 million through reduced medication errors, duplicate prescribing, and better care coordination.
Few clinicians would argue with the ambition. The question is whether the NHS can deliver it.
As both an emergency medicine consultant and expert witness, I can immediately see the potential benefits. Every day, clinicians make decisions with incomplete information. Every year, expert witnesses review cases where fragmented communication, inaccessible or illegible records, delayed correspondence and disconnected systems contribute to poor outcomes. In many instances, the clinical question is not whether the right information existed, but whether it reached the right clinician at the right time.
Patient safety is often determined as much by the flow of information as the quality of clinical decision-making itself.
The idea that information could follow patients seamlessly throughout the NHS is not only attractive, but also transformative. It is something clinicians, patients, lawyers, and healthcare organisations have wanted for decades.
Yet if there is one lesson healthcare professionals have learned from previous attempts at digital transformation, it is that there is often a significant difference between a compelling vision and a workable reality.
The challenge is not building the technology. The challenge is getting the NHS to agree how to use it.
That may sound surprising to members of the public who understandably assume this problem was solved years ago.
In reality, healthcare information remains remarkably fragmented. Patients often assume that when they arrive in an emergency department, doctors can instantly access every aspect of their medical history. After all, we live in an age where online banking can provide a decade of financial information within seconds and retailers can identify purchases made years earlier.
The NHS does not work like that. The NHS does not have a data problem. It has a fragmentation problem.
As an expert witness, I find that this fragmentation is also frequently reflected in clinical negligence claims, where relevant information exists within the system but is held across multiple interfaces, organisations or timelines.
A patient presenting to A&E may generate information across numerous separate systems. Their assessment may be recorded in one application. Clinical notes may be stored elsewhere. Prescribing may occur through another platform entirely. Blood results may be accessed through a different system. Radiology images and reports may sit in another environment. Referrals may be made through separate software and specialist advice may arrive through yet another communication pathway.
To the public, this sounds extraordinary. For many frontline clinicians, it is entirely normal.
The public often imagines a single screen displaying a complete patient journey. The reality is frequently a clinician moving between multiple applications, multiple logins, and multiple interfaces simply to piece together the information required to make a safe clinical decision.
In healthcare, information delayed can be as dangerous as information unavailable.
When information is spread across multiple systems, important details can be missed, communication can break down and clinicians can find themselves making time-critical decisions with an incomplete picture of the patient in front of them.
As an expert witness, one recurring theme appears repeatedly in clinical negligence cases. Some cases arise because red flags are missed, investigations are not performed, abnormal results are not acted upon, or accepted standards of care are not met. Those cases will always exist, regardless of how sophisticated our technology becomes.
However, there is another category of case where communication failures, inaccessible records, fragmented systems, and delayed information contribute to the outcome. The information existed. The problem was that it was somewhere else. Another hospital. Another department. Another system.
From a medico-legal perspective, these are the cases where issues of documentation, communication and information accessibility frequently become central to questions of breach of duty and causation.
A Single Patient Record has the potential to address some of those longstanding challenges. It cannot replace clinical judgement, but it may help ensure that clinicians are making decisions with a more complete picture of the patient in front of them.
Much of the discussion surrounding healthcare technology assumes clinicians work from dedicated workstations in controlled environments with time to review information methodically. Emergency medicine is different.
An outpatient consultant may spend an entire clinic in one room with one computer and a list of scheduled patients. An emergency medicine doctor may assess patients in resuscitation, majors, minors, observation units, waiting areas and ambulance handover zones within the same hour. Clinical priorities change rapidly. Decisions are often made under significant time pressure and with incomplete information.
Computers are shared continuously with resident doctors, nurses and other healthcare professionals. There are rarely enough of them. Staff continually log in and out to satisfy governance requirements whilst simultaneously managing critically ill patients. The reality is that even accessing information can sometimes become a challenge.
This is why the practical implementation of a Single Patient Record matters just as much as the technology itself. A system that works perfectly in a clinic environment may prove cumbersome in a busy emergency department.
Emergency departments are the front door of the NHS.
Emergency clinicians interact with almost every specialty, every age group, and every category of patient. They are often the first point of contact for the sickest and most vulnerable patients in the healthcare system. For that reason, emergency medicine should have a central voice in the design of future digital systems.
If a system works in A&E, it will probably work anywhere. If it fails in A&E, it will fail where the consequences are greatest.
This brings us to perhaps the biggest misconception surrounding NHS digitisation.
Digital does not automatically mean integrated.
I have personally worked through the transition from largely handwritten systems to highly digitised organisations. The assumption was often that moving away from paper would solve communication problems. What actually happened in many places was that paper silos became electronic silos. Information moved from filing cabinets onto servers but often remained just as fragmented as before.
The NHS is one organisation in theory. In practice, it is a collection of tribes.
Everyone agrees information should be shared. Agreement on how it should be shared is where progress often stalls.
Different trusts have invested in different systems. Different specialties have developed different preferences. Some hospitals remain heavily dependent on paper records. Others are almost entirely digital. Many sit somewhere in between. The result is a patchwork of technology across the NHS, despite patients moving seamlessly between organisations every day. The challenge is not simply moving the NHS from paper to digital. In many cases it is attempting to connect organisations operating at entirely different stages of digital maturity.
This matters because patients do not receive care from one organisation. They move between primary care, acute hospitals, specialist centres, community services, mental health providers, and social care organisations.
Their journey is integrated.
The systems supporting that journey are not.
Digital systems also create new governance challenges. Tasks, referrals, and documentation can sometimes be assigned electronically in ways that create uncertainty around responsibility. Junior staff may generate work under a consultant’s name without that consultant necessarily being aware. These are not failures of medicine, but examples of how system design can influence accountability.
This is why simply purchasing new software is not the answer.
Some hospitals are already in line to receive major electronic patient record systems as part of substantial investment programmes. Such initiatives are often presented as transformative and, within individual organisations, they may well be.
However, replacing one system does not automatically solve the challenge of interoperability. Patients continue to move between sites, specialties, and providers. A hospital may have a state-of-the-art electronic patient record yet still struggle to share information effectively with neighbouring organisations, community services, or regional specialist centres.
The real prize is not digitisation. The real prize is connectivity.
Without connected and reliable data, the NHS cannot fully realise the benefits of emerging technologies such as artificial intelligence, regardless of how sophisticated those tools become.
We have spent years digitising healthcare. We have spent far less time connecting it.
The NHS has pursued versions of this vision before. Older clinicians will recognise that this is not the first attempt to create a connected NHS.
The National Programme for IT and NHS Spine were launched with many of the same aspirations: interoperability, shared information, and improved patient care.
Billions were spent. The technology was built. The transformation never arrived.
The ambition was national integration. The reality was often local digitisation.
The NHS became more digital. It did not necessarily become more connected. Some important infrastructure survived and continues to support NHS services today. Yet many of the original ambitions proved harder to achieve than expected.
The challenge was never simply technical. It involved governance, procurement policies, culture, clinician engagement, local autonomy and competing organisational priorities.
The lesson was that technology is often the easiest part.
People are harder.
Culture is harder.
Agreement? Even harder still.
Technology can be purchased. Cultural alignment cannot.
The challenge today is arguably even greater. The NHS is larger, more complex, and more digitally diverse than it was when those earlier programmes began.
No one should underestimate the scale of what is being proposed. We are not discussing a software upgrade.
We are discussing one of the largest digital transformation programmes in the history of British public services.
The cost is likely to run into billions of pounds. The implementation timeline could span multiple Parliaments. The benefits may not be fully realised for years, perhaps decades.
No government can build a Single Patient Record. Only successive governments can.
That raises an obvious question.
Who is prepared to commit to seeing it through?
Governments change. NHS leadership changes. Economic priorities change.
The danger is not that the vision is wrong.
The danger is that we create a more expensive version of the fragmentation we already have.
The Single Patient Record cannot become another chapter in that story.
If we are serious about creating a healthcare system where information follows patients seamlessly, this must become a national commitment rather than a political project. The lesson from previous programmes is not that national digital transformation cannot work. The lesson is that it cannot be imposed.
Success will require far more than technology. It will require trust. It will require collaboration. Most importantly, it will require those expected to use the system to help design it.
Doctors, nurses, allied health professionals, managers, patients, digital specialists, and policymakers all have a stake in its success.
Too often, major decisions about healthcare technology are made without fully understanding how healthcare is actually delivered. An emergency department at 3am does not function like an outpatient clinic on a Tuesday morning. A GP surgery does not operate like a regional trauma centre. The realities, pressures and workflows are fundamentally different.
A solution that works perfectly for one part of the NHS can create significant problems elsewhere.
The people who use the systems must help design the systems.
Otherwise, we risk spending billions creating something that works brilliantly in theory but struggles under the pressures of real-world clinical practice.
Yet the opportunity is equally enormous.
If the NHS can finally bring together its fragmented digital landscape, eliminate paper records, create a genuine audit trail of clinical decision-making, and allow information to follow patients wherever they receive care, the impact on patient safety, governance and accountability could be profound.
Yet despite these challenges, the potential benefits remain extraordinary. These challenges are not just operational issues for the NHS, they are also issues that regularly arise in clinical negligence litigation.
From a medico-legal perspective, this has the potential to significantly reduce a number of recurring issues seen in clinical negligence claims, particularly disputes around chronology, documentation gaps, and access to prior medical history. Many clinical negligence claims I am instructed in, involve disputes about chronology, communication, documentation, or the availability of information. Investigators, lawyers, and expert witnesses can spend months reconstructing events from fragmented records held across multiple organisations.
A comprehensive digital record could change that entirely.
Every access could be logged.
Every action time-stamped.
Every amendment tracked.
Every communication auditable.
Questions regarding missing notes, illegible handwriting or disputed timelines could become far less common.
The implications for governance are enormous.
For expert witnesses, lawyers and NHS Trusts, the audit trail alone could be transformative.
So too are the implications for patient safety.
Greater access to patient records could reduce diagnostic error and improve patient safety, particularly where previous investigations, medication histories, allergies, specialist correspondence, or safeguarding concerns are directly relevant to a patient’s presentation.
But it will also alter expectations.
If information is available, future negligence claims may increasingly ask why it was not reviewed, whether it was reasonably accessible, and whether the clinician should have acted upon it.
That does not mean an emergency physician can realistically review years of records before making urgent decisions. A Single Patient Record may reduce some claims while creating entirely new questions. Was the key information visible? Was it accurate? Was it outdated? Was it buried within hundreds of pages of electronic records? Did the system highlight relevant red flags or obscure them?
In future, medico-legal scrutiny may shift away from examining the actions of an individual clinician in isolation and towards understanding whether the wider digital system supported safe decision-making or made error more likely.
The standard of care has always been judged within the context of the information reasonably available to a clinician at the time. As access to patient records becomes more comprehensive, expectations may evolve accordingly. The debate may increasingly move from whether information was available to whether it was reasonable not to have reviewed it.
The future question may not be “What did the doctor do?” but “What did the system show them?”
For the first time, courts may increasingly find themselves examining not only clinical judgement, but software design, information architecture, digital workflows, and the way information is presented to clinicians under pressure.
If every previous admission, clinic letter, investigation, and medication history is theoretically available at the click of a button, where does reasonable access end and reasonable expectation begin?
Bolam and Hunter v Hanley may not change. The circumstances in which they are applied might.
A shared record only succeeds if clinicians trust the information it contains. An incorrect allergy, an outdated medication list or an inaccurate diagnosis can spread through an integrated system just as effectively as accurate information.
The challenge is not simply connecting data. The challenge is ensuring the data deserves to be connected.
None of this should be mistaken for cynicism.
The vision behind the Single Patient Record is compelling. Imagine eliminating handwritten notes entirely. Imagine immediate access to relevant patient information wherever care is delivered. Imagine reducing duplication, preventing medication errors, and improving continuity of care. Imagine the governance benefits, the audit capabilities, and the potential reduction in avoidable harm.
For patients, the benefits could be significant.
For clinicians, the ability to access the right information at the right time could improve decision-making and reduce unnecessary duplication.
For NHS Trusts, the governance opportunities are considerable.
For lawyers and expert witnesses, the ability to understand precisely what happened, when it happened and why it happened could fundamentally change how healthcare incidents are investigated. This has the potential to change how clinical negligence cases are investigated, analysed, and ultimately resolved.
The possibilities are genuinely exciting.
But we should also be honest about what is being proposed.
This is not an IT project.
It is one of the largest change-management exercises the NHS has ever attempted.
Success will require sustained political commitment over many years. It will require governments to think beyond electoral cycles and organisations to think beyond their individual interests. Most importantly, it will require the NHS to do something it has historically struggled to achieve:
Move together.
As an emergency medicine consultant and expert witness, I would welcome a system that genuinely allows relevant information to follow patients wherever they receive care. The potential benefits for patient safety, governance, audit, learning, and accountability are immense.
Yet ambition alone is not enough.
The NHS does not have a technology problem. It has a coordination problem.
The software can be purchased.
The servers can be built.
The data can be connected.
Getting thousands of organisations, specialties, and professionals to move in the same direction is the real challenge.
The Single Patient Record could become one of the most important advances in modern NHS history.
Or it could become another reminder that technology is often the easiest part of transformation.
The software can be built. The real question is whether the NHS can finally build consensus.
The opportunity is extraordinary.
So is the challenge.
Hospital Front Door: Uniting Emergency and Acute Medicine Conference
Dr Terence McLoughlin will open the Royal Society of Medicine’s ‘Hospital Front Door: Uniting Emergency and Acute Medicine‘ conference on 12th June 2026, bringing together experts from emergency medicine, acute medicine and NHS leadership to discuss improving patient flow, safety and front-door care.