The reality of the world: anticipating failures to achieve success


Emil is a former British Army officer who now specialises in change and transformation in complex environments, including the NHS. He is currently Head of Transformational Programmes and Projects at NHS Shared Business Services.

I recently walked into my local high street bookshop. I counted dozens of books telling me how to succeed at project delivery. There was no shortage of people offering their tips for success. I couldn’t find any books about how to avoid failure.

This is odd but not surprising. From childhood, we’re conditioned to be uncomfortable with the thought of things going wrong. No-one likes making mistakes. Our education system is built on telling us ‘how to do things’, and punishes us for getting things wrong. The world is filled with motivational speakers talking about the sunny uplands. Can you think of a single modern motivational speaker who talks about avoiding the dark abyss?

Emil Bernal, Head of Transformational Programmes and Projects, NHS Shared Business Services

Programmes and projects are no different. We start with optimism and marvel at the promise of a brighter tomorrow. And, for sure, optimism is needed to motivate a team to take on challenging goal. But excessive optimism in our ability to shape and influence the future has led to spectacular failures.

Things can and do go wrong. The NHS has the dubious honour of hosting one of the most expensive failures – the world’s largest civil IT programme, the £12.4 billion National Programme for IT.

In their book, “How big things get done”, Bent Flyvbjerg and Dan Gardner researched the outcomes of over 16,000 projects in 136 countries. Their data shows that 92 per cent of projects overrun on time, cost or both. And cost overruns can be dramatic.

The average cost over-run for every Olympic Games since 1960 is 157 per cent. NASA’s James Webb Space Telescope was 450 per cent over budget. Scotland’s Parliament building was 978 per cent over budget.

The private sector doesn’t do any better. In 2000, Kmart launched two IT projects. Costs exploded, contributing to the company going bankrupt in 2002. Even families get it wrong: you only have to watch Grand Designs to see people’s home renovations go over budget and run late.

We need to learn what went well with previous projects. And we need to understand what went wrong – “how not to” repeat the same mistakes. So, when wide-ranging reports are published – like Patricia Hewitt’s recent review of Integrated Care Systems – I start, as many people do, by thinking “how are we going to get this done”? The next thought is perhaps less common. How do we avoid things going wrong?

Here, then, are five ways to stop things going wrong:

1. Go to the cinema. Or, rather, think about projects in the same way as the film industry: get the balance right between planning and delivery. There’s often a push to start “doing something”. This misses the point that planning is doing something. The film industry understands this, and gives film producers time to plan. During planning, costs are relatively low while film producers explore ideas, produce storyboards, and redraft scripts. Costs explode when production starts and Hollywood stars and crews are working. The work that producers put in upfront means that filming follows a well thought-through plan and avoids costly delays.

2. Find experience and expertise. Very few projects are genuinely unique. There will always be something that makes a project different from others. But, in many ways, your project will be “another one of those”. People who worked on “one of those” will have valuable experience and expertise. Find those people.

3. Listen to that experience. Having found your experts, listen to them even if – especially if – it’s something you don’t want to hear. Listen when they tell you that the project will cost more than the figure you have in mind. Listen when they tell you the project is likely to be more complex and take longer that you ideally wanted. Listen when they tell you about the issues and risks you’re likely to face. It’s better to be told a painful truth early, rather than push ahead in comfortable ignorance.

4. Ask four questions. There is a cultural tendency to shy away from disagreement. So, be explicit and ask for alternative views. As we start to form an outline solution to a problem, I’ll often ask four interrelated questions: what’s good about our solution that we should keep? What needs to be changed? What’s not needed? And – probably the hardest question to answer – what’s missing?

5. Get hindsight in advance. Lessons learnt – or after-action reviews – are standard practice. Flipping this on its head is a useful way of identifying where things could wrong. This approach was popularised by psychologist Gary Klein and Nobel laureate Daniel Kahneman and is often called a ‘pre-mortem’. It’s simple but powerful. Get the team to imagine that their project has already failed. What caused the failure? Work backwards to figure out the causes. Run through a few scenarios. The time spent visualising different outcomes will bring to life the future for the team. And, after the pre-mortem session, make sure that you re-energise the team’s belief in the project.

By taking these steps, you can give yourself the best chances for success. But even the best planning won’t stop issues from cropping up. A supplier lets you down. A team member falls ill. A pandemic. A ship getting stuck in the Suez canal. You’ll have to be ready to manage issues and find practical solutions. But, by getting the planning right, the window of time when risks can come crashing into your world will be smaller – like the film industry which spends time in planning so that the costly production phase can zip along from start to finish.

Learning from your mistakes is called experience. Learning from other people’s mistakes is called wisdom. I wonder how long it will be before I start to see the shelves of my local bookshop filling up with stories about things that went wrong and how to avoid making the same mistakes?


Featured, News, Workforce

Poor work/life balance driving NHS exodus


As vacancies hit record levels, doctors and nurses want more flexible work arrangements to carry on working in healthcare, study from Deloitte finds.

Poor work-life balance is a key driver of job dissatisfaction for healthcare workers, and improvements are within the power of employers, according to new research from Deloitte’s Centre for Health Solutions.

The findings come from the report, Time to Change: Sustaining the UK’s clinical workforce, which looked at the experience and resilience of front-line clinicians, based on a survey of 1,286 UK public healthcare workers. The study examines how attitudes within the profession have changed since 2017, when a similar piece of research was conducted, and includes input from doctors, nurses and other clinical staff working in primary, community and secondary care.

Having a ‘sense of fulfilment/making a difference’ (42 per cent) and a good ‘work-life balance’ (41 per cent) are the top two drivers of job satisfaction for healthcare workers, the study found. By contrast, pay (60 per cent) and having a poor work-life balance (42 per cent) were found be the two main drivers of job dissatisfaction within the professions.

The high ranking of work-life balance for job satisfaction and dissatisfaction is in stark contrast to five years ago, when work-life balance was the fifth-biggest driver of job satisfaction, according to Deloitte’s 2017 study.

When asked how their feelings on job satisfaction and dissatisfaction has affected career intentions, the most common response, among 53 per cent of all respondents and 59 per cent of doctors, was to reduce hours and move to part-time working in healthcare. In addition, 40 per cent of clinicians overall, including 35 per cent of doctors and half of nurses and midwives had considered leaving the profession and changing career.

The study follows a slew of unwelcome news in recent days, including (now-confirmed) speculation that the government’s long-awaited NHS workforce plan (due to be published Tuesday 30th May) is to be delayed as it is considered too costly and the admission from the Health Secretary, Steve Barclay, that the 40 new hospitals will now not be built by 2030 – in contravention of the Conservative government’s flagship pledge.

Additionally, NHS vacancies remain at record levels as the health service continues to struggle to attract and retain staff. One-fifth of all nursing posts in England are estimated as vacant, and NHS trusts fear that the situation will not change until the government sets out a fully-costed workforce plan.

Karen Taylor, Director and Head of Research at Deloitte Centre for Health Solutions, said: “The problem has worsened over the past few years and our findings mirror recent staff surveys from the industry. There is a clear need to address the physical and mental health needs of staff if employers are to build a resilient workforce.

“Many solutions are in the hands of local health organisations to address and several have implemented effective solutions, just not at the scale needed.”

Sara Siegel, Partner and UK and Global Head of Health at Deloitte, said: “The most vital asset in healthcare is its workforce. Our study shows that the availability, accessibility and quality of care available to patients depend on having the right professionals, with the right skills, in the right place, at the right time.

“Healthcare leaders have a real opportunity to make a long-lasting impact in this crucial area. Those that have adopted new ways of working and technologies, have already realised the benefits to empower their workers. Not only will this help patients, but it will have a positive impact on job satisfaction that supports individuals to build rewarding, long-term careers in healthcare.”

Implications for physical and mental health

The study also revealed that 87 per cent of clinicians had experienced an increase in their workloads since March 2020, including 90 per cent of nurses and midwives and 84 per cent of doctors, with serious mental health and wellbeing implications for those staff affected; 46 per cent of clinical staff reported experiencing a negative impact on their physical health, including 50 per cent of hospital doctors and 45 per cent of hospital nurses. The study also found 57 per cent disclose a negative impact on their mental health, including 58 per cent of hospital doctors and 59 per cent of hospital nurses.

This contrasts with the 2017 study, in which 30 per cent of hospital doctors and 32 per cent of hospital nurses said that their workload had a negative effect on their physical health; and 23 per cent of hospital doctors and 33 per cent of hospital nurses said that it affected their mental health.

Digitisation will help – eventually

Numerous policy documents and reports, including the NHS Long Term plan, have identified the importance of adopting technology across healthcare. Deloitte’s study therefore asked healthcare workers which technologies they think are helping to improve the quality of patient care. The top five technologies included Electronic Health Records (EHR) (87 per cent), e-prescribing (78 per cent), patient apps (73 per cent), at-home diagnostics (70 per cent) and remote consultations (70 per cent).

Adoption remains low, however, and only 64 per cent of clinicians said they are using EHRs, while fewer than half of respondents have adopted e-prescribing (46 per cent), patient apps (33 per cent), at-home diagnostics (22 per cent) and remote consultations (39 per cent). Likewise, automation of human resource and occupational development services is lagging behind other industries and the study points out the crucial need to modernise these areas.

Dr Karen Kirkham, partner and Chief Medical Officer at Deloitte added: “While healthcare workers know that technology-enabled care models, systems and processes can improve outcomes and safety for patients, simplify tasks and reduce the significant administrative burden for clinicians, adoption remains fragmented.

“Healthcare leaders need to modernise and unlock better ways of working that improve the employee – and employer – experience. More efficient HR and people policies that focus on equality, diversity and inclusion, investing in leadership and professional development, and accelerating the digitalisation of healthcare infrastructure, will go a long way towards developing new ways of working that release time to care.”

Featured, News, Workforce

NHS must seize upon growth in physiotherapist numbers


Growth in the physiotherapy workforce should be the solution to the workforce crises in the NHS community rehabilitation services.

The physiotherapy workforce is ripe for expansion, which is good news for the public, policy makers and service providers. But this good news is not resulting in a high-quality rehabilitation service for all with a well-resourced physiotherapy workforce.

Many people do not know what good quality rehabilitation should look like, and there exists a growing unmet population need, combined with historic understaffing of community services, particularly of rehabilitation services.

At present, nearly a third of people in England has a long-term health condition. People with long-term conditions are being pushed into the most expensive and overburdened parts of health and care because they are not being supported in the community to manage their conditions effectively.

The needs of people with long-term physical conditions account for half of all GP consultations, 70 per cent of bed days in hospital and 70 per cent of total health and social care spending, while more than 60 per cent of patients admitted to hospital as an emergency have one or more long-term conditions.

Lack of access to high quality rehabilitation services

Narrowing the gap in healthy life expectancy will only happen with better access to quality community and primary care services for people with long-term conditions and for these services to be integrated around their needs.

NHS community rehabilitation services have been developed in a piecemeal way, often siloed by medical condition, with varying criteria for access. Furthermore, poor access to rehabilitation is particularly concentrated in areas of deprivation and among marginalised groups, resulting in more demand for GP appointments, increased A&E attendance and admissions.

Delivery plans for NHS policies have been also undermined by the lack of calculations on the additional staff capacity needed. For example, policies on urgent community response and discharge to assess have been implemented at the expense of rehabilitation, because they are delivered by the same group of staff. This has meant the policies have failed to reduce emergency admissions or the harm from delayed discharge.

However, for the last five years, additional roles in primary care have improved access to expert advice and diagnosis within primary care.

The value of Musculoskeletal first contact physiotherapist roles

An example of this is the establishment of the role of the Musculoskeletal first contact physiotherapist (MSK FCPs). MSK FCPs are improving patient outcomes, reducing demands on GPs, cutting medicine prescribing and reducing unnecessary onward referrals and tests.

The initial target provided in the Interim People Plan 2019 was stated as 5000 MSK FCPs, but currently there are only 1376 posts covering many GP surgeries and population sizes several times more than originally modelled. Due to these issues, GPs report that they don’t feel the impact of MSK FCPs, and issues of MSK FCPs retention are emerging.

This dynamic undermines implementation and has slowed down the evolution of the MSK FCP role which would support integration with community services.

How can we expand the physiotherapy workforce?

Community rehabilitation services are experiencing difficulties with recruitment and retention, but even greater issues are a lack of established posts and gaps in provision. 15 per cent of physiotherapy staff are leaving the NHS each year and almost half of them are leaving within the first five years of qualifying.

Many are moving to the private sector, but some newly qualified physiotherapists are seeking positions in low-skilled roles in the commercial sector citing less stress, flexible working hours and better pay. There is also the worrying issue of support workers retiring; a 2019 CSP survey of support workers shows that approximately 24 per cent of the current physiotherapy support worker workforce are over 55 years of age.

To compound this, a recent CSP staffing survey, showed that 93 per cent of physiotherapy managers reported that there were insufficient staffing numbers to meet patient needs and 39 per cent of physiotherapy staff reported that this was something they were very concerned about. CSP members also reported having less time to spend with patients, longer waiting times and a lack of available time to improve services, while issues around staff retention and an inability to fill vacant posts were also highlighted by members as contributing factors to insufficient staffing levels.

In the UK, there are currently nine registered physiotherapists for every 10,000 people compared to Denmark, where there are 26.8 physiotherapists for every 10,000 people and Norway, where there are 25.3 physiotherapists for every 10,000 people.

What are the solutions?

Over the years, the NHS has not grasped that, if done well, an increase in physiotherapy provision can help to meet patient needs and reduce pressures on the most overstretched parts of the system.

Insufficient staffing levels are contributing to recruitment and retention problems, which has led to a vicious cycle of high workloads and too few staff.

Change can happen but this requires increased staffing as well as doing more to attract and retain the physiotherapy workforce. The growth in the numbers of registered physiotherapists is increasing, but a sustainable and long-term workforce solution is urgently needed.

The NHSE Long Term Plan must support integrated workforce planning, with targets across primary and community sectors based not on the status quo but on Government and system policy objectives to improve provision to meet population need.

Support workers also have a vital role to play – they need expanding in number and should be upskilled through Rehab Assistant Practitioner apprenticeships to take on greater responsibility, making it possible to safely expand the support worker workforce as a proportion of the workforce overall.

As well as addressing under-staffing, community services also need more strategic leadership, consistency of provision and visibility within the NHS. The lack of leadership in community services is worrying; where Trusts have Chief AHPs at a senior level, community service leadership is strengthened, improving visibility. As well as ensuring this is the case within all Trusts, there need to be more clinical therapy roles within the community working at an advanced practice or consultant level to drive up consistency in standards, lead integration across pathways and partnership working with primary care.

The good news is that the number of registered physiotherapists is growing, alongside a supply of students. Now is the time for the NHS to utilise this rise in numbers. Doing so will go a great way towards tackling the current workforce crisis in NHS community rehabilitation services.

The Chartered Society of Physiotherapy will be joining ICJ and Public Policy Projects at the Integrated Care Delivery Forum in Manchester, this Thursday 25th May. The event is free to attend for relevant healthcare professionals, so come and say hello!

Featured, News

Mental health transparency is on the rise, says new report


More than 1 in 4 people (29 per cent) now feel comfortable enough to openly disclose to their employer if they need time off due to poor mental health.

A new survey of 8,000 UK adults conducted by Nuffield Health has highlighted an increase in mental health transparency in the workplace. Nuffield Health’s 2023 Healthier Nation Index finds that while workers are more likely to discuss mental health concerns with their employers, there are indications that stigma around mental health is still prevalent across workplaces.

In this year’s survey, 35 per cent of UK employees said they called in sick due to poor mental health but gave another reason. While this is a significant percentage, it is lower than the findings from Nuffield Health’s 2022 report, with the percentage previously being 39 per cent.

This is especially significant given that Nuffield Health’s 2023 Healthier Nation Index, also revealed that more than 1 in 4 people (29 per cent) now feel comfortable enough to disclose to their employer if they need time off due to poor mental health*. These latest findings suggest a positive shift in how employees are communicating with their workplaces about their emotional wellbeing.

Whilst this still indicates that stigma remains a barrier for people talking about their Mental Health at work, it is a promising sign that people are beginning to speak out when they need more rest, emotional support, and time away from their desks. The findings have been released to coincide with this year’s Mental Health Awareness Week, which focuses on anxiety. Employees are being urged to ‘#Find5’ to tackle anxiety this Mental Health Awareness Week.

Lisa Gunn, Mental Health Prevention Lead at Nuffield Health commented: “We are passionate about building a healthier nation and know that challenging work environments and stress can have a huge knock-on effect on both our physical and mental wellbeing.

“As well as the day-to-day worries that come with our personal and working lives, employees have also had to deal with the impact of a global pandemic and now the ongoing cost-of-living crisis. All these stressors combined can significantly affect the mental health of employees, so it’s more important than ever that businesses find ways to create open, transparent, and connected workplace environments.

“When people feel supported and able to reach out to their employer, this can have a positive impact on their mental health alone and help them better address feelings of worry and anxiety.

“That’s why we are calling on other UK workplaces to #Find5 minutes to look after their bodies and minds. Just spending five extra minutes on personal wellbeing a day can significantly boost mental and physical health.”

Below, Lisa offers advice on how employers can play their part in creating a connected and transparent workplace, which prioritises both physical and mental wellbeing:

1. Notice when anxiety takes over

In the past year, 48 per cent said their work had negatively impacted their physical/mental health, so it’s imperative that companies are equipped to recognise signs of mental distress, like anxiety, in others.

The symptoms of anxiety can be seen in various ways. Physical signs include heart palpitations, shortness of breath, headaches, tiredness, and dizziness. You might notice heightened emotions in the workplace such as irritability or tearfulness.

Employees experiencing anxiety may find it hard to maintain a healthy work-life balance. They may cancel annual leave last-minute – claiming they have too much on, to take holiday – work from home late at night or insist on coming into work when unwell.

However, spending too much time at work is counter-productive, as it can result in us overlooking our physical and mental health. According to this year’s findings, 59 per cent of Nuffield Health respondents said they were also less productive at work* when their mental health was poor.

Just five minutes of conversation from employers reaching out to employees presenting with signs of anxiety or distress can have a positive impact. This could be as simple as asking ‘Are you OK?’ or offering more regular meetings to catch up on how they’re feeling about their workloads.

2. Keep talking

It is encouraging that more employees feel comfortable sharing with their employers when they are having problems with their mental health. However, 18 per cent of us will still go to work one or two times a year when our mental health is poor, and 19 per cent will go to work more than ten times a year when experiencing poor mental health.

It’s good for managers to try and understand why individuals come to work despite experiencing reduced mental wellbeing. The more we know about the actions of our teams, the more support we can put in place to help them and reduce behaviours like presenteeism.

Aim to spend at least five minutes with employees each week, practising ‘active listening’ – a skill that requires a genuine understanding and reflection of what’s being said and providing a considered response, especially for those experiencing symptoms of stress and anxiety.

Active listening means listening attentively to what’s being said and showing understanding by paraphrasing and asking open questions to demonstrate your understanding.

Employers may also consider offering Emotional Literacy Training to staff – equipping them with the skills needed to recognise signs of distress in others and themselves and the confidence to approach them. This way they can nurture a workforce capable of recognising and tackling signs of anxiety in both themselves and others.

3. #Find5

Our 2023 study revealed 38 per cent of people in the last 12 months have dedicated no time to supporting their own mental health, which includes everyday self-care, activities like meditation or speaking to a medical professional.

This Mental Health Awareness Week, Nuffield Health is extending its ‘#Find5’ campaign to encourage individuals to ‘find 5 with 5’ – spending five extra minutes a day focusing on their physical and mental wellbeing for body and mind.

In the same way, employers can play a huge role in creating an environment where employees feel a sense of connection and belonging by promoting campaigns which foster connectivity, team building and reduce stress.

Our study shows individuals are becoming more aware of the benefits of exercise on overall wellbeing, with 27 per cent saying that exercise lifts their mood and helps them feel less anxious or depressed.

Encouraging employees to #find5 throughout the working day could also be as simple as promoting regular exercise in morning meetings or creating ideas to be distributed around the office or over email.

In just five minutes, managers can also arrange, or raise awareness of, physical health screenings available in the office to uncover any underlying issues among employees.

4. Be open about formal support

While meaningful social interaction plays a key role in reducing feelings of anxiety, professional support can also be invaluable. This may include Cognitive Behavioural Therapy (CBT) and Employee Assistance Programmes (EAPs) that offer direct and confidential access to a mental health expert.

Offering these services can help employees to understand and address feelings of anxiety using techniques such as challenging negative thoughts.

It only takes five minutes to signpost employees towards the support on offer, along with guidance and encouragement on how to access the help available. This may be via email to employees, an office huddle or a virtual ‘wellbeing hub’.

We want mental health transparency to keep increasing beyond the 4 per cent we have seen within the past year and openly communicating the options available shows employees that conversations about mental health are both welcomed and expected.

5. Allow individuals to pick what’s best for them

Finally, it’s important to remember that no single intervention works for everyone. The key to supporting the workforce is flexibility.

Employers should be flexible with letting staff choose five minutes of self-care each day, whether it’s simply stretching at their desk, going for a brisk five-minute walk between meetings or finding five minutes to do a short, guided meditation or breathing exercises.

Similarly, employers need to be flexible in how their teams choose to communicate with them. Encourage individuals to use a communication style that works best for them – whether it’s an in-person meeting or a phone call – this will make it easier for people to come forward and share their experiences.

More flexibility means workplaces can cater to the individual and allow everyone to thrive and overcome feelings of anxiety.

Acute Care, Featured, News

Trusts driving progress on patient flow through collaboration and innovation


New report from NHS Providers features practical approaches taken by trusts and partners to improve patient flow and quality of care.

NHS trusts are driving significant improvements to patient flow through in the face of significant system pressures, a new report by NHS Providers has found. Providers Deliver: Patient flow presents a series of case studies where trusts across the acute, community, mental health and ambulance sectors have developed effective approaches to improve patient flow in the face of unparalleled system pressures, including unprecedented workforce shortages, rises in poor health and in complex conditions, and a lack of funding.

These types of approaches will be central to plans to recover core performance standards across the whole health and care system. The report sets out the wider context behind obstacles to patient flow that cause delays, and argues that work to address them requires a joined-up approach based on close partnerships between different types of providers.

Key themes that have emerged from the case studies include:

  • Admission avoidance – delivering more out of hospital procedures and walk-in (ambulatory) care to reduce unnecessary admissions, freeing up hospital capacity for those who need it.
  • Care at home – virtual wards, remote monitoring of patients and developing the mental health and community care workforce.
  • Working to improve health as well as treating illness.
  • Collaborative working with other providers.
  • Leadership that protects and promotes the autonomy of clinical staff.

The report includes a contribution from NHS England’s national director of urgent and emergency care and deputy chief operating officer, Sarah-Jane Marsh, who wrote: “It will take strong partnerships between acute, community and mental health providers, primary care, social care and the voluntary sector, to ensure a system that provides more, and better, care in people’s homes; gets ambulances to people more quickly when they need them, sees people faster when they go to hospital and helps people safely leave hospital having received the care they need.”

In a foreword for the report, the Chief Executive of NHS Providers, Sir Julian Hartley, said: “All too often attention is drawn exclusively to headline waiting times in urgent and emergency care, but we know the drivers of long waits and delays are extremely complex with no one, single solution.

“The case studies in this report show how trusts are working collaboratively to prevent avoidable admissions, manage demand more effectively, build additional capacity sustainably, use technology to deliver more care outside of a hospital setting and deliver real improvements in the health of the populations they serve.

“In the most challenging of circumstances trusts have shown great resilience and innovation. As the NHS works towards sustainable recovery from the pandemic and to reduce waiting times for core services, it is clear a preventative, whole-system approach will be key and that trusts are well positioned to deliver.”

The future of occupational therapy and the impact of technology


Leading occupational therapist, Alicia Ridout, discusses her award-winning work and explores the central role of technology in the future of occupational therapy.

Alicia Ridout, a leading occupational therapist, has recently won the Royal College of Occupational Therapists (RCOT) Tunstall Award for Technology Innovation for her work on the pioneering COG-OT – the Clinical Onboarding Guide for occupational therapists, which she and her team have used to continue their discovery work and to progress the project.

Here, she discusses the importance of technology in occupational therapy and why programmes such as COG-OT are essential for health professional development.

The importance of occupational therapy in wider healthcare

Occupational therapy is essential to the health and care sector and as a sector, we need to ensure that robust systems are put in place to keep up to date with digital competencies and boost confidence to use technology safely, in day-to-day practice. This will help the sector to continue supporting the efforts of the wider health and care landscape to digitise services effectively and improve access for people who need it.

Alicia Ridout, independent occupational therapist and creator of the COG-OT app

Occupational therapy is about working alongside people and their families, helping them achieve their personal goals and essential practical skills, using a holistic approach that respects their strengths and assets. This includes physical, sensory, mental health or communication needs. We see people in a wide range of contexts, people who are experiencing a wide variety of challenges, often for very different reasons.

Occupational therapists’ roles are unique in that we provide services to all age groups, across service boundaries. When it comes to supporting the wider care sector workforce in enabling people to safely access digital tools and services, the sector has always been actively focused on seeking out new technology. COG-OT provides a quick and easy means to access evidence and build competency driven technology skills.

The role of technology in occupational therapy

According to a recent study by RCOT, occupational therapists are facing pressures due to increased demand and vacancies within the industry. This potentially risks leaving people needing assessments, with little or no intervention.

There is a huge opportunity for technology to support people accessing services and occupational therapists, particularly when it comes to prioritising their requirements and influencing technology procurements. Using digital solutions offers the chance to reduce variation in workflows and processes, and also facilitate best clinical practice, streamline access to the right technology, at the right time, and ensure the end user’s experience is high quality.

We launched COG-OT as a web app in 2020, as a proof-of-concept approach to supporting practice development, funded by the Elizabeth Casson Trust. To date, we have won further funding from the Trust to evaluate the tool, as well as funding as part of the RCOT awards twice, in 2021 and 2023, which is crucial for the continued development of this vital resource for occupational therapists.

Why COG-OT has made a difference to the profession

COG-OT supports the profession with guide question sets to stimulate their reasoning about the needs of their service users. It can provide areas of focus and exploration when assessing people who have been referred to their service. This is hugely beneficial to less experienced digital practitioners, as it can help to navigate to the correct technology solution for an individual’s needs and ensure effort invested in the onboarding process is effective. The tool can help therapists by instilling confidence and a consistent but personalised approach to the deployment of technology.

Since the pandemic, digital practice has become increasingly prominent and this is no different in occupational therapy. Digitisation offers its own challenges, but by implementing tools such as COG-OT we are aiming to equip professionals with the digital clinical risk management tools they need for effective practice.

Why investment in technology needs to be prioritised, and how ICSs can support the occupational therapy community

ICSs provide a voice for Allied Health Professions (AHP) via Councils, driving improvement programmes and getting research into practice. The COG-OT team have been working with colleagues in an ICS to surface digital requirements across systems of care and we aim to share this insight widely. Digital confidence is one of many challenges facing AHPs at present, and the wider workforce.

However, as a next step, the sector needs to ensure consistent access to digital solutions, both to support workflows and also speed access to the right technology for users of services and their families. This will ensure that no matter the patient pathway, occupational therapists have easy access to recommended platforms that are of high quality, adhere to regulatory requirements and support clinically driven and collaboratively defined solutions for people in need.

Occupational therapists need to clearly articulate their requirements in this respect. They play a key role in personalised care and ensuring a holistic approach to safe digital deployment at every stage in the care journey – from hospital to community or intermediate care and at home. Digital use at home is different to a hospital environment, and we need to ensure holistic clinical risk assessments are completed.

By integrating safe and high-quality technology into our daily practice, working together with service users and their families and with other health and care professionals, we can pave the way for solutions that really make a difference.

For more information about COG-OT, please contact:

For more information about Tunstall, please visit:

News, Primary Care

GPs urged to join rapidly growing digital registration service


More than 240,000 online patient registrations have been completed through new national online service designed to make registering patients quicker and easier.

More than 900 GP practices – around one in seven nationally (14 per cent) – have already enrolled for the digital Register with a GP surgery service, which is managed by NHS England. The service, which enables patients or carers to go online to find and register with a local GP practice, is now available via the NHS App, with more than 240,000 new registrations processed.

GP practices process around 6 million registrations a year, with many still using paper forms, which prospective patients often have to collect themselves. Feedback from the 2020/21 GP Bureaucracy Review identified GP registration as a high volume and difficult task for practices and patients and the new service has been designed to simplify the process for both service users and practices.

The new online service has been trialed at GP surgeries across the country and has been shown to save practice staff up to 15 minutes per registration, by helping to reduce paperwork and administration time. The service, available to all practices, has been rigorously tested with users and a wide variety of patient groups, including charities who support homeless people and asylum seekers.

Patients can access the service using individual practice websites and the NHS website’s Find a GP service (which is also available through the NHS App), with the service automatically checking they live in the catchment area of a given practice.

The patient’s information is then automatically emailed to GP practices in a structured format aligned to their IT systems, helping reduce the time it takes staff to process registrations. The service is fully integrated with NHS login, which enables people to use one login to access several health and care services, verifying their identity. It also matches patients to their NHS numbers, with a 90 per cent first time match rate, further cutting administration for practices.

The service is fully compatible with translator services, ensuring accessibility for patients and a new-look paper form is still available for those who wish to use it.

Stephen Koch, NHS England’s Executive Director of Platforms, said: “This service reduces the administrative burden for general practice as well as making GP registration even more accessible to the public, offering patients more choice, convenience and consistency.

“We’re pleased to see a growing number of GP practices are coming on board, helping them save time and money. By recently integrating the service with the NHS App, we hope even more GP practices will take advantage of this new digital tool.”

Dr Shanker Vijay, Digital First Clinical Lead for London and a practising GP, already uses the service and assists other practices to introduce it. He said: “We live in a ‘one-click’ culture and we recognise that many busy people want online solutions.

“Vulnerable patients and those with physical access needs don’t need to visit the GP surgery to register, and people can access the service at any time, including outside of working hours to fit around their other responsibilities.”

There are also plans to make the service compatible with a number of Robotic Process Automation (RPA) solutions, which use bots to enable registration information to be automatically added into GP clinical systems at the touch of a button, as an optional extra. Full clinical system integration is also planned for next year.

More information on Register with a GP surgery is available here. Practices interested in offering the service can self-enrol or contact the dedicated support team, or attend the upcoming webinar on June 14, 2023 by registering here.

News, Primary Care

English pharmacies to offer prescriptions for seven conditions under GP access plans


Patients to receive quicker, more convenient access to NHS care from high street pharmacies, in a major expansion of services under new plans to improve access to primary care.

Patients who need prescription medication will be able to get it directly from a pharmacy, without a GP appointment, in plans announced by the government today. Published as part of the government and NHS England’s primary care plan, the policy forms part of the government’s efforts to free up 15 million GP appointments in England over the next two years.

The reform means that, by next winter, people suffering from seven common conditions, including earache, sore throat, or urinary tract infections, will be able to access medication directly from a pharmacy, with the government investing £645 million over two years to expand community pharmacy services.

Almost half a million women will also no longer need to speak to a practice nurse or GP to access oral contraception and will instead be able to access it directly from their local pharmacy. There are also plans to more than double the number of people able to access blood pressure checks in their local pharmacy to 2.5 million, up from the 900,000 carried out last year.

Ending the 8am ‘rush’ for appointments is a key part of the plan. This will be supported by investment in better phone technology for GP teams enabling them to manage multiple calls and redirect them to other specialists, such as pharmacists and mental health practitioners, if more suitable. During trials, this has increased patients’ ability to get through to their practice by almost a third.

Extra training will also be provided to staff answering calls at GP practices, so that people who need to see their family doctor are prioritised while those who would be better seen by other staff such as physiotherapists or mental health specialists are able to bypass their GP.

Prime Minister, Rishi Sunak, said of the plans: “I know how frustrating it is to be stuck on hold to your GP practice when you or a family member desperately need an appointment for a common illness. We will end the 8am rush and expand the services offered by pharmacies, meaning patients can get their medication quickly and easily.

“This will relieve pressure on our hard-working GPs by freeing up 15 million appointments, and end the all-too stressful wait on the end of the phone for patients.”

In another significant step, up to half a million people a year will be able to self-refer for key services, including physiotherapy, hearing tests, and podiatry, without seeing their GP first.

The plan also commits to further reducing bureaucracy for general practice and building on the work of the Academy of Medical Royal Colleges. Local health systems are being tasked with making fit notes available via text and email to patients, to avoid unnecessary return trips to their GP.

In the run up to the NHS’ 75th birthday on 5 July, the new plan aims to support primary care services to continue to adapt and innovate to meet patients’ needs, with nine in ten people able to access their GP records, including test results, on the NHS App within the next year.

Demand for access to GPs is steadliy increasing, with the number of people over 70, who are five times more likely to need a GP appointment than teenagers, growing by a third since 2010. GP teams are already treating record numbers, with half a million more appointments delivered every week compared to pre-pandemic.

The NHS Chief Executive, Amanda Pritchard, said: “The care and support people receive from their local GP is rightly highly valued by patients and so it is essential that we make it as easy as possible for people to get the help they need.

“GPs and their teams are working incredibly hard to deal with unprecedented demand for appointments. But with an ageing population, we know we need to further expand and transform the way we provide care for our local communities and make these services fit for the future.

“This blueprint will help us to free up millions of appointments for those who need them most, as well as supporting staff so that they can do less admin and spend more time with patients.

Health and Social Care Secretary, Steve Barclay, said: “This plan will make it easier for people to get GP appointments.

“By upgrading to digital telephone systems and the latest online tools, by transferring some treatment services to our incredibly capable community pharmacies and by cutting unnecessary paperwork we can free up GPs time and let them focus on delivering the care patients need.”

Responding to the announcement of the GP Access Recovery Plan, Nuffield Trust Chief Executive, Nigel Edwards, said: “These are practical measures which should make getting treatment easier and more convenient for patients. Enabling pharmacists to provide more care to patients and take some pressure off general practice is long overdue.

“However, it will need to be implemented carefully. The number of community pharmacies has actually been shrinking as their workload has risen. We will need to check there is genuinely new funding and serious support so that patients aren’t just shuffled between two overloaded parts of the NHS. If not many pharmacists are actually able to take this up, it could become confusing for the public, and the new digital systems which the plan intends will help allocate patients to different services won’t have enough options.”

Number of repeat prescriptions ordered via NHS App up 92% in last year


2.4 million repeat prescriptions were requested through the NHS App in April and more than 500,000 repeat prescriptions are now booked through the app every week.

New figures released by NHS England show that since the NHS App’s launch in December 2018, more than 42 million repeat prescriptions have been ordered through the app. In April 2023 alone, the NHS App enabled 2.4 million repeat prescriptions to be ordered, compared with 1.7 million in April 2022 and 393,000 in April 2021.

The latest figures represent a 92 per cent year-on-year increase in repeat prescriptions ordered via the app from 13 million in 2021/22 to 25 million in 2022/23. The increase comes ahead of the NHS’s milestone 75th birthday on 5 July, when the achievements and innovations of the NHS and its staff will be celebrated.

Patients across England were reminded of the benefits of using the NHS App to order repeat prescriptions, ahead of the upcoming bank holidays in May.

Chief Pharmaceutical Officer for England David Webb said “we are reminding people of the excellent benefits of the NHS App,” particularly in the context of May’s long bank holiday weekends limiting access to GPs.

Webb continued: “Patients can order repeat prescriptions through the app at a time and date convenient to them and access community pharmacy information about local healthcare advice and services available during the bank holidays.

“The NHS has always innovated and adapted to meet the needs of each generation and as we approach the NHS 75th birthday, the NHS App is yet another fantastic example of how we are doing this.

“The app offers a digital front door for interacting with the NHS with a host of new features launched in the last year– empowering patients to access services from the comfort of their homes. As ever, if you need care during the bank holiday weekend, come forward – using 999 in life threatening emergencies and NHS 111 online for other health concerns.”

Some of the features available on the NHS App enable patients to view their GP health record, nominate their preferred pharmacy, find local NHS services and get health advice via 111 online.

New and innovative features continue to be rolled out to help patients access convenient and high-quality care when and where they need it. Patients in many parts of the country are now able to view and manage their hospital appointments on the app, and many GP practices are now sending NHS App notifications to patients with appointment reminders and other messages relating to their care.

Health and Social Care Secretary Steve Barclay said: “Technology is transforming the way we deliver healthcare for patients, and I’m determined that the NHS App plays a vital role in this.

“Repeat prescription orders through the app have increased by 92 per cent in the last year – including 2.4 million in last month alone. This is freeing up valuable time for clinicians and helping people access services easily and conveniently from the comfort of their own homes.

“A host of new innovative features have also been rolled out– from viewing GP records to finding local health services – offering a digital front door to the NHS.”

The NHS App has now recorded more than 32 million sign-ups (as of April 2023).

More than 28 million of these have fully verified their identity through NHS login, which means they can now access a variety of digital healthcare services quickly and securely through the NHS App.

News, Social Care

Dire state of social care sector undermined pandemic response, study finds


Structural weaknesses, unaddressed by successive governments, left social care struggling to provide the service and protection that people needed during the initial waves of Covid-19.

Lack of visibility of the sector, unclear accountability, insecure funding and poor workforce pay and conditions impacted the sector’s ability to implement protective measures in a timely way, according to a new report published by the Nuffield Trust.

The report is the result of a two-year joint study between the Nuffield Trust and the London School of Economics, and looks at issues which emerged with the Covid-19 response in the social care sector in England. Focusing on the initial four months of the pandemic response (February-May 2020), it found that the fragmented nature of the system and a shortage of civil servants working on social care contributed to confusion over who was responsible for decisions and implementation in the Covid response, which, for example, undermined the effective distribution of PPE and testing for care staff.

The study also concluded that successive governments failed to respond to concerns surrounding pandemic-preparedness identified by multiple cross-government planning exercises. Amid a poor understanding of the sector and its capabilities within government, many smaller care providers were unable to effectively accommodate infection control measures and adhere to the slew of ever-changing guidance and regulation, with disastrous consequences for the nearly 20,000 care home residents who died in England and Wales in spring 2020.

Natasha Curry, Deputy Director of Policy at the Nuffield Trust, commented: “What happened to social care at the start of the pandemic represents the consequences of letting one of our most important public services languish in constant crisis for years. Those early months exposed an array of weaknesses within social care that impacted the shape, speed and effectiveness of the response. Many of these difficult challenges could have been eased had warnings been heeded. Governments of all hues have failed to make social care and those who need it a priority.”

Drawing on interviews with sector experts, workshops with social care stakeholders (including people who use care), policy documents, and literature, the report identified areas that could put social care on a more resilient footing in the future.

The report found:

  • The government, NHS England and Public Health England missed opportunities to prepare the sector for a pandemic, or other crises, in the years immediately before Covid-19. They excluded social care from pandemic-planning exercises such as Exercise Alice. After exercises that did include the sector, such as Operation Cygnus, action was not taken to address the problems that were identified. Once infections took hold in England, the government did not sufficiently apply pre-existing knowledge of infection spread in care settings.
  • There had been no dedicated director general for social care in the Department of Health and Social Care (DHSC) since 2016. No adult social care representatives sat on the Scientific Advisory Group for Emergencies (SAGE) in the opening weeks of the pandemic. This meant social care leaders felt largely invisible, despite the critical role of the sector.
  • The wider Covid-19 response, which was perceived to be hospital-focused at the outset, caused many issues for social care staff because the structure of the workforce and what their jobs involved were not well understood. For example, a lack of access to Covid testing and sick pay had far-reaching consequences for staff when self-isolation policies were in place, especially for those on zero hours contracts.
  • The long-term tendency of governments to allocate funding to social care in the form of sporadic injections of cash limited the scope for strategic investment and had implications for how robust the sector, and its infrastructure, were when entering the pandemic. Many providers of care, which are often small businesses, entered the pandemic with little or no cash reserves.
  • During the pandemic, the succession of emergency funding pots offered to social care initially took a long time to reach the front line, and their short-term nature prevented strategic planning. While seen as a lifeline for care providers, extensions to the funding were frequently announced with only weeks, days or in one case hours before the end of the scheme and did not allow those on the front line to spend it to meet the needs they could see.
  • There was a lack of data and information about who uses and provides adult social care services and how to communicate with them. Covid-19 has accelerated efforts to collect data, and this is helping to lay the foundations of a robust source of standard data.
  • The government did not adequately consider the fragile state and the complexity of the adult social care infrastructure, in particular residential care buildings and equipment. Small organisations, that make up much of the sector, lacked the back office capacity to interpret continually updated guidance and outdated care home buildings struggled to isolate or group together infected residents and to accommodate wider infection control measures.

There has been some positive progress in learning from these problems, with the Department of Health and Social Care (DHSC) bolstering its social care capacity and expertise and the signaling of it as a priority area with the appointment not only of a specific director general but also a chief social care nurse.

Following the first four months of the Covid-19 response, progress was made to plan for ongoing outbreaks in the short to medium term, for instance with the establishment of the social care taskforce in June 2020 and the decision to continue to provide PPE purchased centrally. The smoother subsequent rollout of vaccinations in social care settings pointed to improved collaboration between the government and social care partners, and the prioritisation of carers in the vaccination rollout was widely regarded as a positive step forward.

Adelina Comas-Herrera, report co-author from the Care Policy and Evaluation Centre at the London School of Economics and Political Science, said: “The pandemic has had a tragic impact on people who use social care and those who provide care, unpaid and paid. This has been a shared experience internationally but the evidence suggests that some countries were able to cope better than others. Our research shows that social care in England needs a system-wide reform to be able to respond not just to emergencies, but to the implications of longevity and competition for workforce with other sectors.”

Care Minister, Helen Whately, said: “During the pandemic [the government] supported social care with £2.9bn in specific Covid funding, sent out more than 230m Covid tests to care homes and prioritised social care for Covid vaccinations. We are committed to learning lessons from the pandemic and are investing up to £7.5bn over the next two years to put social care on a stronger financial footing, help reduce waiting lists and alleviate workforce pressures.”

The full report can be accessed here.