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A Matter of Fax: An Interview with NHS CIO, Lee Rickles

“The biggest challenge? Finding all the faxes and then axing them…looking in cupboards, under desks, behind cabinets…..people can be very imaginative!” Lee Rickles, CIO and Director of Yorkshire and Humber Care Record Programme

What is your goal in terms of removing fax machines from the organisation?

Improving the quality of information shared between services and organisations.

What are the benefits of axing the fax?

We have had technology for several years that removes the need to use fax machines. We are paperlite in our operational services and need good structure information so the system works effectively and helps staff do their job. If staff are scanning faxes into the electronic patient record, it makes it hard to find the information and in turn provide the best possible care for a patient.

It also takes time to print the paper copy, print a front sheet put it in a fax machine and check that it has arrived. This takes minutes but the new technologies only take seconds. So the removal of faxes and use of our existing electronic and secure systems will save time.

Aside from time savings, there will also be savings from not using faxes that come from removal of fax lines, repair and replacement.

Do you have any evidence of where being faxless is already working?

We are running new clinical service in Scarborough and Ryedale and they have no faxes, we removed them as part of the new service model. Information is sent electronically between systems or using NHSmail. The service hasn’t stopped for fallen over, it’s just got on with not using faxes. As a new service is was relatively easy to implement.

What are fax machines currently used for?

Sending and receiving information from primary care, secondary care and social care.

Why have you decided to Axe the Fax now?

You have to start somewhere and as we are now a paperlite organisation the use of faxes is detrimental for the provision of a quality electronic patient record. Also, as we have been able to run fax free in Scarborough and Ryedale there is no reason we cannot do the same across the rest of the Trust.

What is your strategy to Axe the Fax? What alternative solutions will you use?

We already have the policies and process in place to do this with NHSmail. We have switched on electronic communication with GPs using Lorenzo and SystmOne, which has reduced the use of faxes.

What are the biggest challenges in Axing the Fax?

Finding all the faxes and then axing them…looking in cupboards, under desks, behind cabinets…..people can be very imaginative!

It’s been a challenge to get partners to accept that we are removing faxes and for them to also change the way of working. We are still resolving problems with our partners, which we are working on. We need partners to work with us and they have to accept that the Trust is getting rid of faxes.

How have you dealt with the resistance?

We’ve definitely had resistance as we’re changing custom and practice which has been in place for a long time. A lot of the resistance has dropped off once we’ve shown the electronic methods are faster and more secure and save staff time. Also, once the staff start to realise that the quality issues in our electronic patient record is directly linked to scanning faxes and paper into the system they made the change.

We also have supporting policies and guidelines so that staff know the right way of using electronic communication and that is secure, safe and approved by the Board. The senior team are signed up to this and know that we don’t need to faxes anymore and need to get rid of them.

What advice would you give other organisations wanting to reduce/remove their fax machines?

You just need to be brave and do it and do it quickly. You do need to support our staff and partners in the change, but just get on with it.

The Axe the Fax campaign is about sharing best practice – If you would like more details from Lee Rickles, please contact and we will put you in touch.