Health Secretary Matt Hancock wants to ban pagers from the NHS, calling the devices "archaic". The problem? They save lives. And, in this instance, old technology really does work.
Just ask Simon Scott-Hayward. He's a GP who volunteers with a local ambulance service in Devon to reach patients in the rural area more quickly. In October, he was training on Dartmoor with a search and rescue group, and though he wasn't on call, he still carried his pager as his mobile had no signal.
The pager pinged on the walk back to the carpark: a 54-year-old woman was in cardiac arrest nearby. He got to her within four or five minutes of the 999 call, while the ambulance was still 20 minutes away. "She absolutely survived because of that pager message," he says. "Had that message gone to my mobile phone, we wouldn't have gotten it until we came back into range."
Hancock has demanded that NHS Trusts ditch pagers within the next two years. Using a "purgethepager" hashtag he’s called for the "archaic" and "outdated kit" to be replaced with secure messaging apps on mobile phones. While some staff could benefit from WhatsApp-style messages, that won't work in all cases.
Following the announcement, scores of NHS workers took to Twitter, laying out a host of reasons pagers remain popular: a deputy director of nursing at one trust explained that mobiles are banned in plenty of care situations; a registrar said plenty of staff don't want to use their own personal phone for work; while others pointed out that pagers have longer battery life, meaning they don't need to be recharged mid-shift.
A major plus point for pagers is network reliability, as hospitals are notorious Wi-Fi and mobile not-spots, as one consultant warned, while pagers run on dedicated radio-frequency networks that better penetrate buildings. That's particularly helpful at times of crisis: mobile networks fell over after the 7/7 bombings in London and the Boston Marathon bombing. As one doctor told the Boston Globe, during that incident: "All pagers continued to work."
And, there's an argument for having a dedicated device, says Scott-Hayward. His ambulance service messages also go to his smartphone, but it's not always on him – sometimes it's being charged, out of signal, or doesn't fit in his pocket. Plus, he gets other notifications on his mobile, meaning medical messages can get missed. "If the pager goes off, it's only going off for one purpose," he says.
None of these complaints mean newer systems are impossible or impractical, but sometimes pagers may simply be the best tool for the job. "In the NHS, we want to move to a position where we use technology in a better way, but to drive policy by banning things will cause problems for some parts of the health sector," says Scott-Hayward. Pagers are used in two ways inside hospitals. First, for general communications – getting the attention of a consultant, answering a quick question, sharing details of a patient, and so on – but also for so-called cardiac bleeps, urgent alerts that send consultants running. Both can be replaced by existing, newer systems, though the latter is a trickier job.
As an example on the merits of ditching pagers, the government pointed to a trial held at West Suffolk NHS Foundation Trust in 2017 that used the Medic Bleep system instead of pagers, citing savings of 21 minutes for nurses and 48 minutes for junior doctors per shift. That trial was limited to specific wards, but is now being rolled out across the West Suffolk Hospital site, a spokesperson said, with an aim to replace all pagers by April. All non-emergency pagers, that is — the trust hopes to eventually remove cardiac bleeps, but said it would "require more complex infrastructure to be in place before this is possible."
Even rolling out the non-emergency pagers required infrastructure spending, with a Wi-Fi update moved forward in order to support the Medic Bleep system. According to a case study of the trial, using Medic Bleep required introducing "trusted devices" to staff and ensuring there were enough charging stations, but would result in savings of £4.5 million for West Suffolk alone each year – remarkable given the government's own claim that pagers cost the entire NHS £6.6 million annually, though that saving was partially pinned on freeing up time of 18 full-time nurses and 18 full-time junior doctors per year and reducing litigation by up to 21 per cent.
For such non-emergency communications, a WhatsApp-style messaging system could be better than simpler pager devices, letting NHS staff create groups, send images, and so on – and we know this because plenty of medical staff are already using that Facebook-owned app and others like it. According to a paper in the British Medical Journal, a third of doctors use unofficial app-based messaging to send private medical data to their colleagues, while two-thirds use text messages. Giving those doctors and nurses a secure, specialist messaging app is a good idea, but it does require infrastructure investment and doesn't require ditching pagers. Medical staff need, and already use, both messaging apps and pagers – a fact clear from the West Suffolk trial the government chose to highlight.
Given all this, why would Hancock et al actively want to ditch pagers? Not only is it conflating emergency bleeps and day-to-day comms, but the figures the government cites are simply wrong. In a statement laying out Hancock's "purge the pager" plan, the government says: "The NHS uses around 130,000 pagers at an annual cost of £6.6 million. More than one in 10 of the world’s pagers are used by the NHS."
Those figures do not come from the government's own research, but from a report by CommonTime, a company that offers smartphone-based pager replacing systems. CommonTime's pager statistic, that 130,000 figure, is based on freedom of information requests sent to 141 of 219 NHS trusts that were then extrapolated – there's no reason to think this figure is inaccurate, but it’s hard to say for certain. For the second figure, the £6.6 million in annual spending, it's unclear where CommonTime sourced that number and the company did not respond to a request for more information. However, that figure isn't even all that much, suggesting the NHS pays £46 a year per pager. Scott-Hayward, the doctor in Devon, estimates the cost of a wide-area-network pager to be between £70 to £130 a year, suggesting the NHS may well be getting great value for money – or that the government-cited cost isn't accurate.
And then there's the claim the NHS uses more than 10 per cent of the world's pagers. That's based on a claim from CommonTime that only a million of the devices are used globally. Capita pointed to figures from the Critical Messaging Association suggesting there are tens of millions in use globally; Jack Uniglicht, Manager at PagersDirect, said there are at least two million in the US alone. “Although the NHS could possibly be the single largest user of pagers, they are not using 10 per cent of the world's pagers," he said.
Who else uses them? Other hospitals; surveys in the US suggest 90 per cent of American hospitals are also heavily reliant on pagers. They're also used by the Ministry of Defence, emergency services, utilities companies, and, perhaps most charmingly, by birdwatchers – there's two competing systems for bird alerts, BirdNet and SwiftAlert. The RNLI even built its own system for emergency callouts.
The government also states that “most mobile phone companies have phased out support for pagers, leaving only one provider in the UK” and claims a single device can cost up to £400. Capita is indeed the only wide-area, national pager network left covering the entire country, but like the RNLI has done, it's possible to set up your own network. Plus, hospitals using pagers for cardiac bleeps don't need national coverage, and there's plenty of suppliers who will set up a local network, including Multitone, Stanley Blick, Ascom and Swissphone.
Capita's PageOne says it provides fewer than ten per cent of the 130,000 pagers that are claimed to be in use by the NHS – and it doesn't charge £400 for any of its pagers, with most rented. Capita said its prices were commercially sensitive so couldn't share specific details, but said its pagers bought outright would cost less than a quarter of the cited £400.
Then there’s the issue of what pagers can and can’t do. The government claims that "pagers only offer a one-way form of communication" – untrue, as two-way pagers exist – and that "the recipient is unaware who is contacting them, the reasons why, or the level of urgency". That is perhaps true of very old-fashioned pagers, but not on all newer devices. Capita's have two-way paging, GPS location, and use three networks – paging, SMS, mobile data – for three-way resilience. Multitone's GP Pager has an RFID tag, GPS positioning and two-way messaging; other devices include voice messaging, though it also has the basic one-way devices that likely comes to mind when you think of a pager.
There is at least one part in the government's statement that's accurate: "NHS trusts will be allowed to keep some pagers for emergency situations, such as when Wi-Fi fails or when other forms of communication are unavailable." In other words, pagers will be kept where they're useful. This will, in reality, mean that NHS trusts continue their existing work rolling out secure messaging apps such as Medic Bleep and various other services, leaving them in exactly the situation as before Hancock made his eye-catching pager-killing pledge.
Despite the situation effectively not changing, and with no new funding being promised for any of this work, Hancock won plenty of tech-positive headlines. It was only December last year when he set a similar deadline for ending the use of fax machines. "There's many, many things in the NHS that are very broken and need fixing, and this is probably not the highest [priority]," Scott-Hayward says.
This article was originally published by WIRED UK