Turning NHS digital investment into better patient flow

My clinical background means I judge digital change by what it makes possible for patients and the people caring for them. Can a team see what is holding up the next step? Is it clear who can act? Does the information reach the person who needs it in time?

Those questions shaped my thinking at the Alcidion and Silver Buck NHS leaders’ roundtable at The King’s Fund on 6 October. Clinical, operational and digital leaders met to discuss a hard problem: after years of investment in electronic patient records, why is patient flow still so difficult to improve?

The challenge: patients are waiting in the wrong place

The pressure on flow is not easing, and the harm falls on patients. England had 28.0 million A&E attendances in 2025–26, up 2.2% on the year before, and only 74.9% spent four hours or less in A&E (NHS England Digital). The constitutional standard is 95%, last met nationally in 2013–14.

The National Audit Office’s September 2026 report shows the problem sits behind the front door, in the whole hospital (NAO):

Indicator (England)	Figure
A&E attendances lasting 12 hours or more (Type 1 and 2), 2025–26	around 10%, up from around 3% before COVID-19
Average general and acute bed occupancy, 2025–26	92%, against the 85% RCEM considers safe
Average length of stay after admission from A&E	8.1 days in 2025–26, up from 7.3 days in 2019–20
Bed days used by people well enough to go home, April 2026	408,350 (14.7% of all bed days)
NHS England’s estimated cost of discharge delays, Aug 2025–Apr 2026	£2 billion

These are not abstract numbers. The NAO cites ONS analysis suggesting that people who wait 12 hours or more in A&E are twice as likely to die within 30 days as those who wait two hours. It also heard of frail patients deteriorating in hospital because their discharge was delayed. Every bed occupied by someone ready to leave is a bed the next patient in A&E cannot reach.

The figures describe the scale of the problem. They do not, on their own, explain why a particular patient is waiting or what will resolve that wait, and that is where the next question begins.

Why investment alone has not closed the gap

More resource has not bought proportionate improvement. Between March 2021 and March 2025, A&E consultant numbers rose 26% and nurse numbers 23%, and CT and MRI activity grew by around half. Four-hour performance moved only modestly. The NAO concludes that the answer is not just more resource but how it is deployed across the whole hospital.

The NAO also found that NHS England does not routinely collect national data on how patients progress through hospital. Reasons for delayed discharge are recorded only for people who have stayed seven days or more. The system is managing flow without a clear view of it.

NHS leaders at the roundtable described how the problem has changed. A decade ago, the barrier was often missing digital information. Today most acute trusts can see where patients are, but far fewer can consistently influence where they need to go next.

The barrier has shifted from a digital one to a data and workflow one: which information is relevant, whether it can be trusted, and how to surface it where a decision is made. In some trusts the same operational information is recorded in several places, creating competing versions of the truth. In a follow-up conversation, a CCIO working across acute and community NHS care drew a useful distinction between data that is unavailable and data that is difficult to access. Shared Care Records and GP Connect already hold a great deal, but finding it is slow and fragmented.

So a ward can know a patient is medically ready to leave and still be waiting for:

a diagnostic result
medication to take home
transport
a care package
a decision from another service

Much of that information sits outside the systems acute teams use. Knowing that a care package is ready, or that a patient’s home is unsuitable for their return, can matter as much to discharge as anything in the EPR.

Fixing the hospital alone is not enough either. Better discharge processes or fewer beds will not resolve flow pressures without community capacity and accessible alternatives to hospital care; otherwise demand simply shifts elsewhere. Social care capacity remains a major barrier, and digital tools cannot create services that are not there. The gap technology can close is the one between seeing a delay and acting on it.

The solution: follow the patient, and make the next step visible

The published roundtable summary captures the ambition in a simple phrase: “follow the patient” across organisational boundaries. Participants were clear about what the operational layer beyond the EPR needs to deliver. In practice, that means five things.

One trusted view of the patient and what is holding them up. That includes discharge blockers, outstanding diagnostics, community and social care dependencies, and the alternatives to an inpatient stay. It should show what is outstanding and who owns it, not just where the patient is.
Capture once, use everywhere. Information should be recorded as part of the work and reused, not re-entered. A discharge summary that auto-populates lets clinicians validate rather than recreate it, and lets pharmacy prepare medicines earlier.
Connect information to the person who can act, and close the loop. A dashboard that shows a delay but leaves staff to chase several systems has not solved the problem. Staff also need to see how the information they enter is used.
Move from reacting to anticipating. Predictive insight could support patient streaming, admission risk and operational planning. The harder part is designing services and workflows that act on a prediction, not building the model.
Keep accountability beyond the hospital door. Care coordination often weakens once a patient leaves. Better patient navigation can connect services around the person and support access to the right care and self-management.

The NAO points the same way. The higher-performing hospital it visited had a patient record that followed the patient from admission to discharge, showed bed availability, and let everyone see what to prioritise. It recommends trusts use end-to-end flow tools more consistently, embedded in normal working practice.

NHS trusts using Miya Flow report early results along these lines:

Herefordshire and Worcestershire Health and Care NHS Trust introduced Miya Flow journey boards across seven community hospitals. The Trust reported that average length of stay fell by around five days (more than 15%) between March 2025 and March 2026, with improved discharge planning and fewer estimated discharge date breaches. Marisa Manning, deputy associate director, said the information helps teams “better plan discharges and quickly identify whether medication, transport and onward care arrangements are in place.”
Royal Bolton Hospital uses Miya Flow journey boards for a live view of bed status and patient movement. The Trust describes flow teams needing to phone wards less often to check capacity. Dawn Devine, head of clinical systems, said “Information only needs to be entered once by staff before it becomes immediately available to support key decisions.”

These are Trust-reported results over an implementation period, alongside changes in process and capacity. They should not be read as evidence that software alone caused the change. What they show is what becomes possible when information is current, trusted and connected to an action.

Staff also need to see how the information they enter is used. When ward data helps a coordinator arrange support, a pharmacy team prepare earlier, or a system partner resolve a barrier, its value is visible and it is more likely to stay accurate. And because safe discharge depends on services beyond the acute setting, an operational view that stops at the hospital ‘back door’ will miss part of the patient’s journey.

Measure the result in patients’ journeys

I came away with a straightforward test for digital investment: does it help teams resolve barriers earlier and make the next step clearer for patients? Going live is not the measure. Trusts and their partners should track:

delayed days, and time from ready for discharge to leaving
avoidable duplicate recording
staff time spent chasing updates
whether patients reach the right care setting safely

An EPR remains an essential foundation. The opportunity now is to make the information held across digital systems useful where clinical and operational decisions are made. The leaders at the roundtable put the focus on the whole journey: connect the information, make responsibilities visible, and help people act together. As the roundtable concluded, improving flow means moving from knowing where a patient is to understanding, and actively enabling, where they need to be next. That is how digital investment starts to show up in the experience of patients and staff.