Purpose – This paper aims to report on the interlending and document supply activity across the North West of England carried out by health libraries in the National Health Service (NHS). NHS libraries provide a service to NHS staff and students on clinical placement and provide access to the latest published evidence contained in specialist periodicals and textbooks. Design/methodology/approach – Data were analysed over an extended period from 1 April 2005 to 31 March 2015. These data are provided annually in the form of a statistical return and are collated regionally. Data were obtained by all library services for both document supply activity and inter-library loans. Findings – During the period of the analysis, there has been a significant drop in activity for both document supply and inter-library loans. In 2005/2006, there were 45,147 articles supplied via document delivery networks, this had fallen to 8,642 in 2014/2015. Similarly, in 2005/2006, there were 5,627 inter-library loans supplied, this has also fallen to 3,732 in 2014/2015. Originality/value – The observed drop in document supply and inter-library loans across the NHS North West occurred during the time of significant change in how NHS staff and students access the latest evidence. In 2005/2006, many NHS libraries were still investing in print journals and textbooks. Over the past 10 years, there has been a substantial increase in access to consortia purchased online journals in addition to a growth in the availability of open access content.