David Oliver: Hunt’s call to cut time spent on NHS paperwork is a hypocritical soundbite

September saw newspaper reports of the chancellor, Jeremy Hunt, asking government departments to report on how much time frontline staff in key public services were spending on “non-core work” such as administration paperwork and “red tape.”1 He reiterated this in his Tory Party conference speech.2 He argued that the time spent on such tasks harmed productivity, even with extra resources, and that taxes might have to double if it wasn’t tackled.

Such calls are not new. Most recently, the NHS England workforce plan explicitly called for productivity gains in exchange for expanding staff numbers.3 And in every spending round the Treasury calls for efficiencies in exchange for funding uplifts, or indeed to compensate for cuts. Other public servants such as police officers or teachers often complain about the paperwork burden that stops them from focusing on their core job.

NHS clinicians are no exception. We’ve led initiatives before such as the “productive wards” initiative,4 to try to reduce admin and free us up for patients. One of the concerns raised repeatedly by NHS doctors about their morale, training, and retention is the time spent on admin jobs that add little value or don’t require the skills of a qualified doctor at the top of their grade.56

Dig deeper, however, and we can see that some paperwork is essential to professional practice and can’t just be disposed of in Hunt’s virtual shredder. And much of the rest is created by the government’s own actions.

For doctors, essential tasks include writing in a patient’s notes, reviewing and commenting on results, and corresponding with patients, families, and clinical colleagues about referrals, for instance. We also prepare reports for coroners’ inquests, respond to formal complaints, carry out reviews on serious incidents and preventable harms, and prepare discharge letters and prescriptions, as well as supervising and teaching junior doctors, students, and other staff groups and documenting their progress. And if doctors are involved in medical management and clinical leadership these roles require non-clinical admin time.

I realise that some of this work could be reduced or made more efficient—for instance, by using voice recognition software or scribes, using artificial intelligence to flag abnormal results, or avoiding duplication and relying on existing documentation.78 But much of it does require a skilled professional’s expertise and accountability.