The NHS’ Ten-Year Health Plan has productivity at its core. Trusts have been given a target of increasing productivity by 2% every year, pushing them to make the most of the tools they already have.
Health Secretary Wes Streeting has said this in no uncertain terms: “With relentless focus on productivity, the NHS can be sustainable for taxpayers and deliver for patients once again.”
Such improvements are easier said than done.
Chief Executive Officer of Apogee Corporation.
Studies from the Health Foundation have shown that NHS productivity still hasn’t reached pre-COVID levels.
The NHS Staff Survey found that barely half of NHS workers (56%) felt they had adequate equipment to do their work.
That’s also backed by research from The King’s Fund, which points to unreliable technology and fragmented processes as dragging down hard-working practitioners.
The emphasis here isn’t on a lack of technology, but its effective deployment. The NHS needs to be able to see its investments deliver meaningful capacity into the system.
The cost of lost minutes
More than anything, productivity within the NHS is measured in time. How long does it take to start work — to log into your device, to find the information you need, to understand what a patient needs from you?
These are small, incremental delays. But at scale, they produce some terrifying numbers.
Data from 244 Freedom of Information responses from NHS Trusts that Apogee submitted has found that these lost seconds account for eight minutes of time per day, per staff member. That’s the equivalent of 35 million patient hours each year, or more than £1 billion in undelivered productivity.
This is the NHS productivity gap, and it needs to be closed. Simply having technology is not enough to deliver useable, invaluable hours back to the frontline.
Where NHS time is lost
The productivity gap manifests itself in three ways. All three are closely linked.
The first is simply getting staff to work; a kind of ‘start-of-shift friction’ in which time is lost in things like logging in, booting slow devices, or battling connection issues. These minutes lost to small everyday irritations, but are so common that they cost trusts an immense amount of time. If staff start trying to work around these losses by breaching protocol, e.g. sharing devices, good intentions can make things even worse.
The second is moving information throughout the trust. Healthcare in the NHS runs on a complex combination of physical and digital processes unique to each trust, producing data to match. The time spent trying to manage this data — keeping it safe, consistent, accurate, and accessible to those who need it across the system — is time not spent delivering care. Given that the NHS has to manage over a billion physical records, this is a complex, painstaking task for some trusts.
Thirdly, there’s the art of reaching patients themselves. With almost 38 million appointment communications issued by post or hybrid mail, equivalent to more than half of the UK population, crucial medical information and procedures are relying on slow, fragmented processes. Healthwatch England found last year that 14% of referrals were vanishing into “an NHS black hole” as a result.
When these processes fail, the cost is in NHS capacity — tighter schedules, wasted resources, and additional effort. The news that NHS users can now access their appointments through the NHS App is a sign that the government has themselves recognized the cost of not acting here.
The data the NHS cannot see
What exacerbates all of these things is that these productivity losses are often invisible.
The bespoke, sometimes chaotic nature of the technology stacks within each trust mean that there are some limitations as to how they measure themselves. Many trusts struggle to quantify performance metrics that are crucial to the areas we’ve explored already.
Some are unable to confirm how many pages enter Electronic Patient Record (EPR) systems in a year. Some are unable to confirm how many outpatient communications they send by post. Some even struggle to tell you how many hours they’ve lost to IT outages.
This tells us that some trusts are operating with digital blinkers on, unable to identify the underlying reasons for the problem. The incredible volumes of data that the NHS produces, both physical and digital, isn’t being captured in a way that supports a constructive solution.
From diagnosis to reform
Taken together, these patterns are impossible to ignore. They account for a huge amount of recoverable time and resource within the NHS, while at the same time demonstrating the structural failures that have allowed them to accrue in the first place.
The NHS bleeds time everywhere: when staff start work, when they try to access information, and when they interact with patients. These are distinct issues, symptomatic of an organisation that is fighting tooth and nail to improve, but without the awareness and direction to do so effectively in many cases.
Trusts need to understand themselves at a deeper level than the systemic. They need to understand how work flows throughout each process, what’s slowing practitioners down, and how that time is demonstrated within the trust.
Once that’s established, they can begin to prioritize:
1. Reducing the time lost in accessing devices and accounts to use systems
2. Eliminate or modernize the redundant processes that obscure the data needed to work
3. Improve the communications channels that patients rely on to interact with the NHS effectively
All of these areas are connected. Fixing one can potentially shift inefficiency elsewhere. But if these focus areas are worked on in tandem, a rising tide lifts all boats. Work begins when it should, based on the information that practitioners need to execute it, and working in harmony with the patient who needs treatment.
This is how time is recovered, and how the NHS could hit its productivity goals. At scale, reclaiming the billions of pounds and millions of hours lost could be revolutionary for the healthcare service.
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