A few years ago, I broke my arm playing football. During my visit to A&E I was given an appointment at the fracture clinic. I arrived 15 minutes before the appointment, as my letter requested, only to be asked if I’d had an x-ray. I hadn’t (as my letter never mentioned it), which prompted the nurse to arrange one on the spot. A 10- minute walk to the relevant department, 15 minutes for the x-ray and another 10 minute walk back, and all of a sudden I was late for my original appointment.
This scenario and similar examples are unfortunately playing out across the NHS on massive scale. Patients missing crucial information about their appointments and clinicians in a rush to organise on-the-day resolutions whilst juggling other important tasks. It is an untenable situation for both, and tends to be caused by the NHS’ dated and manual approach to admin.
Recent news headlines often feature details of ground-breaking progress in digital technology, particularly generative AI. And with the growing pressures of staff burnout, patient backlogs and growing clinician vacancies, trusts and their workforce are crying out for this type of digital support with appointment booking and patient communications.
Now is an opportune time to make these changes – Lord Darzi’s Review of the NHS, which is intended to give “an honest appraisal of the current state of the health service”, will hopefully give the new Labour government the impetus to take a data-driven, digital-enabled approach to healthcare policy. They just need to know where to prioritise.
Clinicians dominated by admin
A recent survey from the RCNi showed that 42% of nurses spend at least half their working week (20 hours) on non-clinical admin tasks – a mammoth amount of time to spend on duties that could be automated or easily completed by someone with less specialised training. The same survey, which was supported by SPS, also found most nurses (64%) work at least six hours of overtime every week.
A direct impact of this workload is that clinicians’ face-to-face time with patients is limited. However, there are less visible, indirect effects too. Just like the nurse that rushed to book me an x-ray before my fracture clinic appointment, much of the day is spent manually correcting flaws in the admin process. That nurse may have to manually book ten more x-rays or turn more people away that haven’t completed diagnostics. The time spent doing this, which is wholly avoidable, reduces the number of patients they can see or extends their day by hours. The clinical role that nurses are trained to do is unfortunately diluted by admin.
And the same applies to other clinicians, who are in desperate need of admin support that can be eased by technology. For example, The Guardian reported how staff are “babysitting” patients and working 16-hour shifts. NHS England also logged an absence rate of 5.6% last year – equivalent to losing nearly 75,000 staff to illness (including burnout).
Embracing automation
Digital technology is capable of making a huge impact on clinicians’ admin workloads, for example by helping with notetaking using digital dictation, and makes for a logical next step. Forbes also recently highlighted how healthcare vendors have gone one step further to integrate ambient listening tools using generative AI. Rather than taking manual notes or even dictating them yourself, these tools allow clinicians to be fully present with their patients while transcribing key details – even potentially sharing them with the patient after their consultation.
Digital automation could also be introduced directly into the clinician admin process, logically coordinating appointments (such as booking diagnostics before consultations) and communicating directly with a patient. The letter templates currently used by the NHS are not flexible enough to communicate a patient journey that can sometimes involve multiple appointments across multiple specialities or even multiple hospital sites; resulting in the ad-hoc manual overhead we see today. More than 33% of patients in hospitals are treated by more than one department.
This may seem like an ambitious upgrade, but the new government has committed to a modernised, patient-centric health service in its manifesto, including a renewal of the NHS app. While the Chancellor has warned that public spending may be limited, research has shown that placing the current admin workload on nurses costs an estimated £13 billion. Releasing this workload to admin specialists or automation could generate billions of pounds in savings for the NHS every year, with the added benefit of improving the patient experience and letting clinical staff focus on their day jobs.
Change from the ground up
The NHS has attempted to introduce digital technologies before without mass adoption and full-scale success. Investments have tended to focus on high-cost solutions that, when bolted onto the NHS’ rigid processes, have resulted in more work than they have alleviated. Overcoming the admin challenges facing clinicians requires a bolder approach than the optimisation that has been attempted in the past.
For the government to achieve the change its aiming for across the NHS – and action the feedback that doctors and nurses have given since Covid – a true reengineering is required. What I call ‘Optimisation 2.0’, that goes beyond simply purchasing new software. Instead, it focuses on redesigning tired admin processes around the new possibilities that digital technology and AI offer.
Building a health service that enables clinicians to focus on care and gives patients more agency cannot be left as an empty electoral promise. Lord Darzi’s review is a vital step – discovery is the first step to the path to change – but it must be reflected in policy and implemented sooner rather than later. Tens of thousands of clinicians are counting on it.
By Ryan Reed, Head of Public Sector and Digital Transformation Expert, SPS
