Addressing NHS productivity could unlock billions to deliver neighbourhood NHS, says IPPR

By Integrated Care Journal

Restoring NHS productivity to pre-pandemic levels would have freed £19 billion more in 2023/24, enough to build a new health centre in almost every neighbourhood, according to a new report from IPPR.

Billions worth of extra care could be unlocked if NHS productivity problems and high staff turnover are addressed, according to a new paper from IPPR, From the frontline: Empowering staff to drive the NHS reform agenda.

Analysing the “twin crises” hitting NHS performance – low productivity and poor staff retention – the report establishes that in 2023/24, the NHS in England had a budget of £171 billion, but productivity was 11 per cent lower than before the pandemic, according to NHSE’s own estimates. If productivity had matched 2019/20 levels, the report finds, the NHS could have delivered an extra £19 billion worth of care – enough to build 900 new health centres, and almost enough to deliver the Labour Party’s manifesto promise of building a ‘Neighbourhood NHS’ in one year alone.

The new Labour government has now announced a major uplift to NHS spending in the 2024 autumn budget, taking the planned daily expenditure budget to £192 billion by 2025/26. Increasing productivity will be crucial to ensuring maximum benefit for patients. The NHS has a target to improve productivity growth to 2 per cent per year by 2029/30. Achieving this goal next year could deliver an additional £3.8 billion worth of care – enough to more than triple the numbers of MRI and CT scanners in the NHS.

“After years of mounting pressures, the NHS is facing two major challenges: high levels of frustration among staff, and low productivity which is taking a toll on patients.”

Dr Annie Williamson, IPPR research fellow and current NHS doctor

Exacerbating the issues around poor productivity, the report argues that the NHS is facing a parallel crisis of staff frustration and departure. It notes that between 2010 and 2023, the average annual NHS leaver rate was 11.2 per cent, meaning one in nine staff members left each year. This is compared to 2009/10, when the rate was 9.5 per cent, just over one in 11 staff.

If the leaver rate had been kept down at 9.5 per cent, IPPR estimates that an average of 12,000 NHS staff could have been retained each year since 2010. Holding the number of new entrants constant, this would equate to around 150,000 additional staff retained cumulatively.

IPPR argues that the two major crises facing the NHS – low productivity and poor staff retention – reinforce each other. High staff turnover increases costs and impacts care delivery, while inefficiencies, such as outdated equipment, deepen staff dissatisfaction and lower productivity levels.

Low autonomy for NHS workers is a key underlying issue, the report finds. Decision-making in the NHS often lacks information and insights from frontline staff, leading to the wrong priorities and missed improvements. Money may be spent on hiring locum doctors when staff feel new computers are what is needed, or on top-up winter crisis funding rather than community services to keep people well.

IPPR argues for a new approach to NHS reform. Unlocking staff insights and giving them a greater voice could lead to meaningful changes at every level, the report says.

IPPR calls for reforms to incorporate staff voices in clinical service design and national policymaking including:

Empowering frontline staff by establishing channels for service improvement led by Trust-level specialists, with protected time for all staff to participate
Setting up representative staff boards in each NHS trust to put forward ideas from the wider workforce and consult on all matters affecting staff wellbeing, with a duty on main NHS trust boards to consult them
Giving a staff voice in national workforce policy by reforming pay review bodies to include negotiation or embed a formal duty to consult with staff

Dr Annie Williamson added: “By addressing these issues [of low productivity and retention], we could unlock billions worth of better healthcare. More importantly, this would create a more efficient and sustainable health service, where staff voice is central to improving the quality of decisions throughout the NHS.”

Dr Parth Patel, Associate Director of Democracy and Politics, said: “We all know the NHS needs reform, but we keep getting distracted by the same red herring debates. The real issue is that we’re struggling to get the NHS firing on all cylinders again.

“Too many decisions are made at the top, while those on the front lines—who truly understand what’s needed—are left with little say. The status quo isn’t working. We need to empower NHS staff with a genuine voice and a real stake in the decisions that affect them. Only then can we unlock the NHS’s full potential again.”

The full report can be accessed here.

Operational management: The invisible backbone of NHS success

By Phil Bottle

Phil Bottle, Managing Director of NHS workforce planning specialists, SARD, discusses the unsung importance of operational management to the NHS, including how effective management can be the remedy for a system straining under the weight of misaligned capacity and demand.

Penny Dash’s recent comments cut straight to the heart of a critical issue within the NHS: the absence of robust operational management. Her observation that adding staff has not translated into the anticipated impact is a stark reminder that people alone, without the right systems and processes, cannot untangle inefficiencies or improve outcomes.

But what exactly is operational management in the NHS context? At its core, it’s about ensuring that the vast resources—people, time, and technology—are strategically aligned to deliver the best care for patients. It’s the art of transforming effort into efficiency, of turning plans into practical, measurable outcomes. It’s also about creating a culture of accountability, where teams understand their roles, adapt to challenges, and continuously seek improvement.

The cost of missing discipline

Operational management is not a glamorous term. It doesn’t grab headlines like breakthroughs in medical research or new funding announcements. Yet its absence is felt every day:

Empty outpatient clinics sitting next to overcrowded ones
Elective surgery lists under-utilised due to inflexible staffing
Temporary fixes taking precedence over sustainable solutions

These aren’t isolated problems; they’re symptoms of a system straining under the weight of misaligned capacity and demand. And they highlight the critical need for something often overlooked in healthcare: discipline.

“Dr Dash’s call for more ‘ops managers’ is a recognition that leadership matters.”

Operational discipline doesn’t mean rigid adherence to plans. It’s about creating the flexibility to respond dynamically to real-world challenges. It’s about having clear, standardised processes that still leave room for human ingenuity. It ensures the right people, in the right roles, supported by the right tools, are empowered to adapt and improve.

It is something clearly missing and sorely needed. Yet as unglamorous as this work may seem, these are the hard yards that need to be made for meaningful progress.

Unlocking potential through workforce planning

Workforce planning is one of the linchpins of effective operational management. Done well, it provides the foundation for aligning capacity with demand. It highlights inefficiencies and opportunities, offering clarity on how resources can best support service delivery.

However, traditional approaches to workforce planning often fall short. Data may be fragmented or inconsistent, job plans may fail to reflect actual service needs, and staff often feel excluded from decision-making. The result? A process that stalls and fails to deliver the needed impact.

What’s needed is a shift in focus:

From fragmentation to integration
Workforce data should tell a cohesive story, not present conflicting narratives. This requires shared frameworks, clear language, and accessible tools that translate data into actionable insights.
From top-down to collaborative
Operational management isn’t a one-person job. It’s a team effort that thrives on engagement at every level—from senior leaders to frontline staff. Collaboration fosters ownership, ensuring that changes are not only implemented but embraced.
From short-term fixes to long-term sustainability
Quick fixes may alleviate immediate pressures, but sustainable operational management looks ahead, anticipating future challenges and building resilience into systems and processes.

Leadership and accountability

Dr Dash’s call for more ‘ops managers’ is a recognition that leadership matters. But perhaps even more critical is focusing on the processes those leaders oversee. Operational management isn’t just about systems; it’s about the people who run them. Effective leaders don’t simply keep the cogs turning—they identify inefficiencies, question the status quo, and work collaboratively to drive meaningful change.

This may mean rethinking whether current processes are fit for purpose or innovating entirely new ways of working. For example, underutilised elective services or ‘dark hours’ in clinical spaces could be addressed by flexing traditional staffing models or introducing creative solutions such as cross-team task-sharing.

Equally, accountability plays a pivotal role. As Paul Corrigan pointed out, the NHS must create environments where success and failure are acknowledged and acted upon. However, accountability should not equate to punitive measures like league tables. Instead, it should foster collaboration between trusts, encouraging the sharing of best practices and lessons learned. Data is crucial here—not as a blunt instrument, but as a tool to illuminate areas of strength and opportunities for growth.

A moment of opportunity

The challenges are clear, but so too are the opportunities. Meeting today’s demand is as critical as planning for the future. Predictive analytics can help model upcoming needs and support proactive decision-making, but current demand models are just as vital. These tools allow teams to allocate resources efficiently, manage capacity in real time, and ensure patients receive timely care. Balancing immediate pressures with future-proofing is the operational challenge of our time—and one that must be tackled head-on.

Operational management is more than a behind-the-scenes function. When strengthened, it unlocks efficiency, empowers teams, and transforms patient care. The time to focus on “ops, ops, ops” isn’t years away; it’s now.

From innovation to application: How healthcare must adopt an AI approach to patient engagement

By James Neal

Healthcare systems can learn vital lessons from other sectors further along the AI implementation transition, writes James Neal, Chief Revenue Officer at EBO.

Artificial intelligence and machine learning are already mainstream tools in many sectors, helping to automate manual tasks, accelerate processes, and drive innovation. In healthcare, the adoption of this technology will make today’s practices seem outdated in just a few years.

However, as we scale up these innovations, we must look towards other sectors that are further along in their AI journeys to absorb lessons that are prime for application in the NHS.

Meeting patient expectations in healthcare

Across multiple industries, AI is revolutionising user experience, setting new standards that healthcare providers should aspire to meet. Patients, accustomed to seamless digital interactions in other areas of their lives, now expect the same from healthcare. They seek easy access to care, free from bureaucratic hurdles and inefficiencies.

“Embracing AI is not just a choice — it’s a critical step for the NHS.”

As IBM’s Senior Vice President, Paul Papas, has observed: “The last best experience that anyone has anywhere becomes the minimum expectation for the experiences they want everywhere.” This is particularly true in healthcare, where outdated systems can no longer meet modern demands. Lord Darzi’s review has highlighted that many NHS processes remain clunky and inefficient, causing frustration for both patients and staff.

The imperative to adopt advanced technologies is clear. In an era of rising demand and limited resources, embracing AI is not just a choice — it’s a critical step for the NHS to deliver sustainable care.

Taking a leaf out of the financial services playbook

The NHS can learn from the financial services sector’s focus on user experience, innovation, and its shift from one-way communication to interactive, user-centred dialogue. All of these are crucial to the financial sector due to high customer demands and volumes – which are also acutely present in healthcare.

Automating user journeys to dynamically interact with customers 24/7 – in any language, on any channel, at any time – ensures that accurate information can be accessed immediately and at the user’s own convenience.

With the ability to complete thousands of repetitive tasks and workflows simultaneously, AI automation reduces 60-80 per cent of repetitive inbound enquiries from public-facing teams. This saves staff precious time and increases capacity.

Take Exinity, for example. This trading and investing fintech is having great success using EBO’s AI automation technology to process over 80,000 conversations a month across five languages (English, Farsi, Russian, Chinese and Arabic) around the clock.

By adopting AI automation technology, Exinity aimed to automate 40 per cent of incoming requests within the first year, but impressively, surpassed this goal within just three months. Today, 50 per cent of all conversations are fully managed by AI, leading to greater efficiency, enhanced satisfaction, and reduced operational costs. This has also freed up service agents to focus on more value-driven tasks, further enriching the overall experience.

In the context of healthcare, the same technology is empowering patients to have more visibility and control over their healthcare journey, improving the patient experience while reducing the administrative burden on healthcare providers.

How a private hospital is showing the way

Saint James Hospital is setting a remarkable example of AI adoption within the private healthcare sector, significantly boosting productivity, enhancing patient experiences, and reducing staff workloads. With over a million appointments each year and a rapidly growing patient base, the hospital’s patient services teams were struggling to manage appointment bookings, especially during peak hours. The increasing communication bottlenecks led to inefficiencies in workforce coordination.

“The solutions now handles over 12,000 appointment bookings each month.”

Through EBO’s AI-powered Virtual Assistant (VA), the hospital has provided a two-way communication channel which is available on the hospital’s website and via Facebook Messenger. The tool is the first use of AI by the hospital, which integrates directly with its hospital management system and EPR. Today, the VA interacts with patients and service users via two-way automated human-like conversation, answering questions 24/7, and managing appointment bookings from start to finish. Patients can book, cancel or reschedule their appointments without the need for human intervention. Thanks to its AI context and sentiment awareness, the VA identifies customer’s emotions and adjusts the dialogue accordingly.

The results have been transformative. The solution now handles over 12,000 appointment bookings each month, with 93 per cent of interactions being completed end-to-end by the AI tool. At peak times, it absorbs 40 per cent of the call workload, allowing staff to focus on more complex tasks. Patient satisfaction has soared, with a 96 per cent approval rating—demonstrating how AI can dramatically improve both operational efficiency and patient experience.

Shifting from analogue to digital

Adopting AI automation isn’t just about appealing to the ‘modern’ patient and being there 24/7, on any device and available in any language. It’s about making experiences patient-centric, increasing patients’ access to healthcare and enabling patients to navigate their pathways easily and efficiently.

Shifting patient engagement from an impersonal one-sided interaction to a patient-friendly, conversational, and inclusive model promotes a more accessible and natural way for patients to interact with their healthcare provider. By automating repetitive administrative tasks and streamlining processes, AI automation technology makes patient journeys more convenient and engaging – enhancing choice and empowerment.

It’s not just about focusing on technology and moving from analogue to digital. Virtual Assistants are sophisticated enough to foster meaningful conversations and understand patient needs. Engaging patients through two-way conversations simplifies complex inaccessible processes into universally adaptable communication channels that cater to individual patient needs. It’s about using data to turn the currently reactive processes into proactive and predictive models by using the volumes of data captured to forecast scenarious and outcomes in real-time.

Nearly 20 NHS trusts and health boards across the UK are already using EBO’s solutions and are seeing exceptional results helping to reduce workload, increase efficiency, and improve patient satisfaction.

Time to work smarter, not harder

By adopting AI, we can create a more seamless and patient-centred experience. AI can help automate routine tasks, allowing patients to book appointments, access their health records, and manage their healthcare with ease. These innovations aren’t just about efficiency, they’re about making the NHS more accessible, responsive, and patient-centric.

It’s time to work smarter not harder to help the NHS reform and non-clinical AI innovations are going to be a key enabler. AI is the productivity tool the NHS is crying out for, and we have it in the palm of our hands. Now is the time to apply it.

Will NHS England’s medical consultant job planning improvement guide work?

By Phil Bottle

Phil Bottle, Managing Director of NHS workforce planning specialists, SARD, explains how a limited view of workforce data is preventing trusts from workforce planning effectively, and explores whether NHS England’s newly published job planning improvement guide will help solve the problem.

Let me start with a story. Back in 2010, when I was head of learning and development in the NHS, I’d watch our director of workforce in a blind panic every month as they pulled together a board report. The report was simple: who works for the trust, including substantive, part-time, honorary contracts, and temporary staffing costs. So why the panic? Because nobody knew the answers.

Month after month, they scrambled to piece it together. This wasn’t a capability issue — our director of workforce was an excellent leader, and adept in their role. The problem was systemic; nobody had the data, and more concerningly, nobody knew where to look.

This problem existed long before I joined the NHS, and unfortunately, it still exists today. So, when I saw NHS England’s new improvement plan, my initial reaction was, hopefully, a step forward. Workforce planning has been a constant struggle. But the real question is: does this improvement guide truly help solve the underlying issues?

The positives: A step in the right direction

I’ve been around the workforce planning block for almost two decades. I’ve seen countless attempts to kick-start meaningful change. The most notable difference with this guide? It ties job planning directly to patient value, something often overlooked. Too often, job planning has been about capacity without understanding how that capacity impacts patient outcomes. Finally, a patient-centric focus — this is progress.

The plan also discusses some important areas that need addressing; consistency, engagement, utilisation of data-driven insights, leadership focus, capability, process structure, and demand and performance metrics. These are key areas for improvement, and I support these measures.

The familiar oversight

However, here’s the big ‘but’ — this guide, like many before it, focuses too much on procedure, and not enough on resistance, lack of perceived value and inconsistent linkages to demand. These are the familiar hurdles that those doing the job know all too well lead to poor engagement, and the real root causes of 20+ years of subpar workforce planning.

“The data isn’t being utilised effectively, and everyones knows it.”

It’s like telling someone, “just try harder.” No amount of process improvements will solve the underlying barriers unless we address the core issues. As it stands, it feels more like a numbers game. Those who truly understand workforce planning and its relationship with patient safety outcomes and workforce wellbeing know it’s far more complex.

Workforce planning is not as straightforward as finding a round peg for a round hole. It’s more akin to a 1,000-piece puzzle — having the right people, with the right skills, in the right place, at the right time. Without this, a team’s, a department’s, or on a bigger scale, an organisation’s ability to deliver safe services and ensure staff wellbeing can resemble a shaky house of cards ready to tumble.

The root cause of poor job planning

A barrier to improving the consistency of job planning is cultural resistance. This is understandable to a certain degree, as job planning feels incredibly personal, even though it shouldn’t be. There’s a strong resistance to anything perceived as a threat to individual autonomy.

There is also an ambivalence towards the process due to the lack of perceived value. Why should anyone engage in this process if the data isn’t used for anything? The improvement guide talks about triangulating data with HR and Finance, but without demand modelling, it feels empty. The data isn’t being utilised effectively, and everyone knows it.

“Workforce planning… it’s failing because trusts don’t have the time and capacity to make it work.”

The inconsistent link to demand makes it feel like an afterthought. Demand should be at the core of job planning — ‘this is the demand on my service, and here’s the capacity to meet it’, not the other way around.

As a result, people don’t engage in job planning as it is seen as a process that doesn’t improve wellbeing, workloads, service objectives, or patient outcomes. The same applies to safe staffing, reducing backlogs, or achieving service goals.

The biggest issues: Time and capacity

Here’s the crux: workforce planning isn’t failing because of systems, leadership, or metrics. It’s failing because trusts don’t have the time and capacity to make it work. The process is complicated and labour-intensive, requiring significant hours from multiple people to be truly effective.

Until we address this fundamental issue — the lack of time and capacity — job planning, and therefore workforce planning, will continue to fall short.

Familiar solutions, same old problems

I’m not saying the challenges are easy to fix, but they are solvable. We need to think outside the box, beyond risk aversion, regulations, and procurement rules, and focus on what will add real, tangible value. Solutions that flatten the landscape by dealing with all the root problems holistically, rather than manage the hill. Solutions that tackle data analysis, engagement, expertise, tools, and training and provide tangible outcomes like better quality management information, not simply enabling more input methods.

This improvement guide offers procedural fixes, but it doesn’t tackle the deeper, systemic issues that have prevented job planning from being effective for so long. Real change will only happen when we address the root causes that are holding workforce planning back.

Data-driven, proactive prevention. Are we finally ready for population health management?

By Simon Swift

As we navigate the complexity of modern healthcare, it is clear that preventative, data-led approaches can help solve some of the NHS’ major challenges. But ‘are we finally ready for population health management?’ asks Health Navigator CEO, Simon Swift.

I am sure every generation of health and care leaders think they face unprecedented challenges. I don’t think it is an error to say the current NHS leadership feels this, and with some justification. Urgent and emergency care services are under immense pressure, planned care waiting lists remain very close to the 2023 high of 7.7 million, while persistent health inequalities threaten the foundations of the UK’s universal healthcare model.

We must ask ourselves a crucial question: what, if any, proven approaches are there to deliver better outcomes for patients while ensuring the long-term sustainability of our health systems?

I firmly believe that the answer lies in harnessing the power of data. This data-driven approach takes different shapes at different points across the system. For example, optimising system design and service scale and location at the macro level, while at the micro level, there are cumulative marginal gains to be made through ‘command centre’ type solutions to operational management, optimising efficiency and safety for people in A&E or waiting for planned care. These are impactful uses, but not sufficient.

Another use of data is to enable a shift from reactive to proactive care models. Logically it is attractive; we stop people becoming acutely unwell, which is good for them. If they don’t become acutely unwell, they don’t need urgent and emergency care, reducing demand at the front door. This (in the UK system) means we can allocate resources to focus on other things, and there is plenty to do. If we are going to be responsible custodians of health services, this transition is not just desirable; it’s imperative.

The case for change: A closer look at the crisis

Waiting times for emergency care have reached historic highs, which is a miserable experience for patients, an awful work environment for staff facing intolerable moral hazard and probably dangerous.¹ Bed occupancy rates in many hospitals mean managers are in constant firefighting mode, with waits backing up into A&E and elective cancellations routine, without a bed to admit a cold patient into.

Though this pressure on hospitals is universal, emergency department attendance rates are more than twice as high for those living in the most deprived areas compared to the least deprived, demonstrating the deep-rooted inequalities in our health system and society. The inverse care law is alive and well.

The COVID-19 pandemic has exacerbated these issues, creating a backlog of need that will take years to address. Moreover, an ageing population and the rising prevalence of chronic conditions are adding to the complexity of healthcare delivery. These challenges are not just statistics; they represent real people experiencing pain, anxiety, and diminished quality of life for many.

A data-driven approach to prevention

I believe we must use preventative, data-led, approaches to address these challenges, finally taking a step away from sole focus on the traditional reactive model. The evidence base is growing that the logically attractive proactive, preventative approach, leveraging the data at our disposal, actually works.

By harnessing this data (how this works is a sexy thing to some – advanced analytics and machine learning algorithms), we can identify patients at high-risk of unplanned care needs months in advance. This foresight allows us to intervene early, providing personalised support that empowers patients: precision population health management (PHM). The potential of this approach is enormous, offering a way to improve people’s health and so reduce pressure on acute services in the short-term and planned care in the longer term.

At HN, we’ve seen first-hand the transformative impact of this precision PHM approach. Our Proactive solution has demonstrated significant reductions in emergency admissions and A&E attendances.

Empowering patients and supporting healthcare systems

With advice from the Nuffield Trust and with the support of several NHS trusts, HN conducted a randomised controlled trial.² It meticulously tracked up to 2,000 patient outcomes across multiple trial sites. We demonstrated a 36 per cent reduction in A&E attendances for patients supported by health coaching, which is in line with other studies. This isn’t just about numbers; it’s about people avoiding traumatic emergency visits and receiving care in more appropriate, less stressful settings.

The benefits of proactive, data-driven care extend far beyond reducing hospital admissions. We saw improvements in mortality rates, Patient Reported Outcome Measures (PROM’s), patient activation, and quality of life.

These outcomes are transformative on multiple levels. For patients, it means taking control of their health, understanding their conditions better, and enjoying an improved quality of life. For healthcare systems, it translates into reduced pressure on acute services, better resource allocation, and improved overall efficiency.

This approach helps to address health inequalities. By identifying at-risk individuals early, regardless of their socioeconomic background, we can provide targeted interventions that prevent health issues from escalating. This is particularly crucial in areas of high deprivation, where health outcomes have traditionally lagged. For those close to this type of risk modelling it will be no surprise that deprivation (income and health) is a significant risk factor.

The role of technology

As we navigate the complexity of modern healthcare, it’s clear that innovation and technology will play a crucial role. However, it’s essential to understand that technology is not a panacea. The true power lies in how we apply these tools to reimagine healthcare delivery. Those who have worked in this arena for any length of time know that implementing a technology rarely delivers benefit alone, and is often problematic and unhelpful. Carefully designing the change in process, behaviour, decision making etc. that the technology enables is the key to delivering value.

While the potential of data-driven, proactive healthcare is material, we must acknowledge the challenges in implementing the approaches. Data privacy and security are serious concerns that need to be addressed rigorously. We must ensure that as we leverage patient data for better care, we do so in a way that respects individual privacy and complies with all relevant regulations. However, the current red tape-bound and bluntly obstructive approach to information governance in the NHS needs improving if we are to derive value at a meaningful scale and pace.

Looking to the future

The opportunities are tantalising. By embracing data-driven insights and personalised interventions, we can create a more proactive, efficient, and equitable healthcare system that actively helps people live healthier for longer. This approach not only addresses immediate pressures but also lays the foundation for a more sustainable future.

The change from sickness to health care will require collaboration across all sectors of health and care – from policymakers and healthcare providers to technology companies and, most importantly, patients themselves. We need to encourage innovation, where new ideas can be tested and scaled rapidly.

At HN, we’re committed to being at the forefront of this transformation. Our work in AI-guided clinical coaching is just the beginning. We envision a future where patients receive personalised, proactive care that keeps them healthy and out of the hospital.

References

¹ Jones S, Moulton C, Swift S, et al. Association between delays to patient admission from the emergency department and all-cause 30-day mortality. Emergency Medicine Journal 2022;39:168-173.

² Bull LM, Arendarczyk B, Reis S, et al. Impact on all-cause mortality of a case prediction and prevention intervention designed to reduce secondary care utilisation: findings from a randomised controlled trial
Emergency Medicine Journal 2024;41:51-59.

A People Powered NHS – A call to all health leaders

By Dr Allison Smith

Dr Allison E Smith, Director of Research & Insight at the Royal Voluntary Service discusses the key role that volunteers can play in delivering on core NHS goals.

The Prime Minister’s speech on 11th September 2024 pledged that this would be the ‘biggest reimagining of the NHS since its birth’. Hence, as we reflect on the plan for the future, we should challenge ourselves to think differently and work in ways which prioritise patient care and staff wellbeing. We should be bold and ambitious as the founders of NHS were in 1948.

In the original blueprint of the NHS, it was always intended to be a partnership between the state, the citizen and their communities. Public participation in the NHS e.g. via volunteering, informal carers and patient groups, has always played a vital role in the delivery of better health care. But in many ways, public involvement is a postcode lottery – a few areas do it really well, some do it (not well), and others have nothing. From the perspective of a volunteer-involving charity like Royal Voluntary Service – who have been supporting the NHS since before it was even founded – it is hard to get volunteering truly embedded in healthcare delivery. It still feels as if we are on the outside looking in or ‘pushing water uphill’. The purview of ‘integration’ appears largely limited to that of the NHS with social care.

With the public consultation on the 10-Year Health Plan, now is the time to rethink how the NHS – and wider healthcare system – works collaboratively with the public for the common good. System leaders need to stop putting up barriers to public participation and think ‘how can I build inclusive blended teams of staff and volunteers?’. Leaders should be embracing and nurturing the public interest and love for the NHS; 66 per cent of those signing up for the NHS and Care Volunteer Responders programme do so because they ‘want to support the NHS’.¹

The business case – in terms of the impact of volunteers on the NHS and wider healthcare system – we feel has been made.² The NHS and Care Volunteer Responders (NHSCVR) programme – first launched during the pandemic – has continuously proved its effectiveness, from driving system efficiencies to better patient care, workforce recruitment, and staff morale. For system leaders and frontline staff that embed NHSCVR within their local delivery there are big gains to be had.

For those unfamiliar with NHSCVR, this programme is a unique partnership between a charity (Royal Voluntary Service), a public service (NHSE) and a tech company (GoodSAM). It can match, via an App in real-time, requests for support from staff or patients with members of the public that can lend a hand. The programme is a key auxiliary service supporting the NHS and patients to expedite patient discharge, provide practical support to patients at home, deliver equipment for virtual wards, and provide support to ambulance crews waiting outside A&E. It is a free resource for local areas, is NHS approved, and can provide a critical safety net to mobilise volunteers at scale at times of high demand on the system.

In the past four years the programme has achieved significant scale; more than 2.6 million activities have been delivered in support of patients and the NHS, 221,000 individuals have been supported, and over 1 million members of the public responded. And while these numbers are indeed impressive, on the ground in local areas the programme delivers significant benefits for the system, staff, and patients – see table below.

The data also finds that those who volunteer report higher wellbeing. In a 2021 study by the London School of Economics, those that volunteered experienced statistically significant higher wellbeing compared to those who did not volunteer, and this wellbeing impact lasted for at least 3 months.⁶

This article is a call to all NHS system leaders; the breadth of impact – from this programme – plus others (see Helpforce) surely warrant the immediate integration of volunteers in NHS ‘BAU’, and centre stage in our reimagining of the NHS over the next 10 years.

Royal Voluntary Service will be attending the Integrated Care Delivery Forum in London on the 5th November.

For more information or to connect with a member of our team, please reach out to your Regional Relationship Manager. Contact details are available at nhscarevolunteerresponders.org.

References

¹ NHSCVR baseline survey, n=8481)

² See King’s Fund 2018 Views from the Frontline, Helpforce, 2020, Volunteer Innovators Programme

³ Programme data & Volunteer Annual Survey March, n=6302

⁴ Staff Annual Survey October 2024, n=345

⁵ Client/Patient Survey June/July 2024, n=687

⁶ https://blogs.lse.ac.uk/covid19/2021/06/02/happy-to-help-how-a-uk-micro-volunteering-programme-increased-peoples-wellbeing/

News, Population Health, Thought Leadership October 28, 2024

10-Year Health Plan must address cancer care failings identified by Darzi

By Gabriel Blaazer

From improving access to care and diagnosis to addressing treatment delays, Lord Darzi’s recent independent investigation highlights the complex web of challenges facing the NHS. In doing so, it also offers a series of starting points for the upcoming 10-Year Health Plan to address.

Cancer remains one of the leading causes of avoidable death in the UK, and despite improvements in survival rates over the past decades, the country still lags behind others in cancer care. Lord Darzi’s recent independent investigation into the NHS in England offers a comprehensive review of the current state of cancer treatment within the NHS and points to several factors that have contributed to its struggles. These include funding constraints, the aftermath of the Covid-19 pandemic, and systemic issues within healthcare management.

Using the failings identified by Lord Darzi as a basis, the upcoming 10-Year Health Plan for the NHS has the chance to radically transform cancer care provision in the NHS.

Rising cancer waits and slowing survival rate improvements

Cancer cases in England have steadily risen, increasing by approximately 1.7 per cent per year from 2001 to 2021. When adjusted for age, the rise is still significant at 0.6 per cent annually. This translates to around 96,000 more cases in 2019 than in 2001. Although survival rates for one-year, five-year, and ten-year intervals have improved, the rate of improvement slowed considerably in the 2010s.

The UK also continues to record substantially higher cancer mortality rates than its peers. International comparisons show the country falling behind not only European neighbours but also the Nordic countries and other English-speaking nations. While survival rates have inched upwards, “no progress whatsoever” was made in early-stage (stage I and II) cancer detection from 2013 to 2021. However, this has recently changed, with detection rates improving from 54 per cent in 2021 to 58 per cent by 2023, partly driven by the success of the targeted lung health check programme. This initiative has helped identify more than 4,000 cases of lung cancer, with over 76 per cent caught at stage I or II, significantly boosting early intervention efforts.

Nonetheless, challenges remain in treatment selection, particularly for brain cancer patients. While genomic testing, critical for tailoring treatments, is now more widespread, only five per cent of eligible brain cancer patients can access whole-genome sequencing. A recent Public Policy Projects (PPP) report has highlighted the inequalities in access to genomic sequencing. Moreover, turnaround times for genomic tests – only 60 per cent of which are processed on time – further hinder timely treatment for many patients.

Access delays and missed treatment targets

One of the key areas within the Darzi investigation is the NHS’ ongoing struggle to meet its cancer treatment targets. The 62-day target from referral to the first treatment has not been met since 2015, and as of May 2024, only 65.8 per cent of patients received treatment within this window. Similarly, over 30 per cent of patients now wait more than 31 days for radical radiotherapy, reflecting growing delays in critical care pathways. Given the importance of timely cancer treatment, the upcoming Plan must consider how to reduce delays in access to treatment.

While the number of cancers diagnosed through emergency presentations has decreased, with the percentage falling from nearly 25 per cent in 2006 to under 20 per cent in 2019, access to primary care services continues to be “uneven”. This affects the timeliness of cancer referrals, especially as the proportion of patients waiting more than a week for a GP appointment rose from 16 per cent in 2021 to 33 per cent per cent by 2024. Darzi notes that declining access to general healthcare services directly reduces the likelihood of timely cancer detection and treatment.

The drivers behind performance issues

Several factors have compounded the challenges facing the NHS’s cancer care system, as identified by Lord Darzi, which the 10-Year Health Plan must seek to address:

Austerity and capital starvation: Funding restrictions and limited capital investments over the past decade have led to under-resourced healthcare infrastructure, making it difficult to accommodate growing patient demand. The underinvestment in estates and facilities is also preventing the NHS from making full use of diagnostic advancements; in many cases, hospitals may be able to purchase new state-of-the-art diagnostic and imaging equipment, but not have a suitable site in which to use it. PPP has explored this topic in detail in a previous report.
Covid-19 pandemic: The pandemic severely disrupted healthcare services, creating a backlog of cases and delaying non-Covid-related care, including cancer treatments. Although efforts have been made to prioritise long-waiting patients, the effects of the pandemic still ripple through the healthcare system, contributing to worsened performance.
Lack of patient voice and staff engagement: The investigation highlights that the perspectives of both patients and healthcare staff have often been overlooked in decision-making processes, resulting in management structures that are out of touch with the realities on the ground. A more engaged and responsive system would likely yield better outcomes. The need for coproduction was reiterated at PPP’s recent Cancer Care Conference, and is increasingly being recognised in Cancer Alliances’ health inequalities strategies.
Management structures and systems: The report also points to inefficiencies within the NHS’ management structures. These systems are often seen as bureaucratic, which slows down decision-making and the rollout of new treatments. Disparities in the adoption of new systemic anti-cancer therapies highlight these inefficiencies, as some regions wait over a year for access to drugs approved by NICE, while others see the same drugs introduced within a month. This inequality in access to drugs is a key driver of the postcode lottery that is seen in cancer care.

The importance of early diagnosis and screening

A clear priority identified by Lord Darzi is the need for more effective early diagnosis strategies. Cancers detected at stages I and II are much more treatable, and early intervention is strongly associated with better survival outcomes, as well as substantially lower treatment costs. Darzi notes, however, that progress in this area had been stagnant until recent years, with no gains between 2013 and 2021. The improvements seen in early-stage detection from 2021 to 2023 offer hope, but Darzi cautions that further efforts are needed.

The 10-Year Health Plan must also seek to address the UK’s lack of CT and MRI scanners relative to other comparative companies – a major inhibitor of greater diagnostic capacity in the NHS.

Screening participation rates have also declined, with breast and cervical cancer screening coverage falling since 2010. Yet there are signs of promise. For example, the bowel cancer screening programme has been highly successful and provides a model that could be replicated for other types of cancer.

However, hopes for improved early diagnosis cannot rely solely on the establishment of national screening programmes. Poor levels of health literacy, particularly among underserved communities, must also be addressed to ensure that people know which signs and symptoms to be aware of, and to seek treatment if necessary.

More sophisticated treatments but growing delays

The development of more sophisticated treatments is a key area of progress, but the availability of these treatments is often constrained by capacity issues. While the NHS is a world leader in incorporating genomic testing as part of routine cancer care, delays in processing these tests and long waiting times for treatments like radiotherapy undermine their potential impact and can lead to poorer outcomes.

As Darzi points out, “turnaround times are poor… [which] can delay the start of treatment,” especially when coupled with the system’s failure to meet its 62-day target for referral to treatment. In a healthcare system already stretched by rising demand and workforce shortages, delays in treatment can make the difference between life and death for many cancer patients.

Addressing the challenges ahead

Lord Darzi’s investigation underscores the critical need for systemic reforms within the NHS to address the growing cancer burden. From improving access to care and speeding up diagnosis to addressing treatment delays, the report highlights the complex web of challenges facing the NHS. In doing so, it also offers a series of starting points for the upcoming 10-Year Health Plan to address.

While recent advancements in genomic testing and early detection programmes offer hope, the NHS must tackle its systemic inefficiencies, funding shortfalls, and management issues if it is to close the gap with its international counterparts and improve outcomes for cancer patients.

For more information about PPP’s Cancer Care Programme, or to request further discussions, please contact: Rachel Millar, Programme Lead for Cancer Care: rachel.millar@publicpolicyprojects.com

Dr Chris Rice, Director of Partnerships for Cancer Care and Life Sciences: chris.rice@publicpolicyprojects.com

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How EDI can support NHS staff by creating a psychologically safe environment

By Dr Melissa Carr

In the face of increasing pressures, equality, diversity and inclusion offers NHS managers a pathway to foster supportive, inclusive environments that allow healthcare workers to thrive and patients to receive better care, writes Dr Melissa Carr for ICJ.

An ageing population with complex needs. Long waiting lists and over-stretched services. Disengaged and demotivated staff. The recent Darzi report highlighted in grim detail the challenges facing the NHS.

With healthcare workers on the front line under huge pressure, it’s unsurprising to see high rates of burnout, stress and staff turnover.

With the Long Term Workforce Plan predicting a potential shortfall of between 260,000 and 360,000 NHS staff by 2036/37, retaining an engaged workforce is an organisational priority.

One crucial solution lies in the training and development of NHS managers who are equipped to lead teams within this challenging environment.

By using Equality, Diversity and Inclusion (EDI) practices, managers can create psychologically safe environments where team members can ask questions, raise concerns, admit mistakes and suggest improvements without fear of negative consequences.

How a culture of psychological safety can improve outcomes for staff and patients

Think back to a time when you worked in a team where finger-pointing and blame was the default. How would you have felt about reporting a mistake? Or suggesting a better way to do something?

Creating a safe workplace where colleagues can raise issues and share best practice is essential within any healthcare setting. As previous failings of care, and the inquiries that followed them show, toxic cultures can silence legitimate concerns.

EDI practices enhance and enable psychological safety in teams. The NHS equality, diversity and improvement plan highlights the importance of managers that can model inclusive leadership behaviours, guard against workplace bullying and discrimination, and create channels through which staff can speak up and highlight problems.

What research into psychological safety tells us about failure

More than 20 years of research has found that organisations with higher levels of psychological safety, often achieved through the implementation of EDI practices, consistently achieve better outcomes.

They don’t just protect staff from discrimination, stress and burnout. They can also have a transformative effect on how teams function.

Professor Amy Edmonson, who pioneered the idea of team psychological safety in the 1990s, discovered something interesting during her early research. Edmonson examined the relationship between error making and teamwork in hospitals but, rather than showing that more effective teams made fewer mistakes, the results found the opposite. Teams who reported better teamwork apparently experienced more errors.

A dive into the data explained why. It established that more effective teams reported more mistakes because they talked openly about them. It can feel challenging to hold your failures up to the light, but it’s the most effective way to troubleshoot systematic errors and drive positive change.

As a practical guide to improving patient safety culture published by the NHS in 2023 confirmed, team environments that allow for ‘intelligent failures’ which lead to reflection and improvement usually achieve the best patient safety outcomes. Psychological safety provides the environment in which this can work effectively.

As Amy Edmonson says: “Psychological safety is not about being nice. It’s about giving candid feedback, openly admitting mistakes, and learning from each other.”¹

How integrated care systems can support safer workplaces

Within a culture of robust psychological safety and leaders trained in EDI processes, teams can openly challenge the status quo and flag fixable mistakes. Importantly, they are also empowered to suggest innovations that can improve the systems they work within.

One of the key functions of integrated care systems (ICSs) is to identify pockets of best practice across services and provide a platform where they can be widely shared. The repository of case studies on the NHS England website is a treasure trove of success stories – from social prescribing initiatives to fast-tracking cancer diagnoses by using AI.

ICS leaders must continue to create open channels for feedback. These help to foster team collaboration and trust, encouraging a no-blame culture, and shared aims and ambitions.

In a culture of collaboration rather than competition, this focus on knowledge-sharing encourages learning and improvement at all levels.

Using EDI practices to ensure psychological safety

Individual managers can make a big difference to their immediate teams but change on a larger scale can’t happen without clear organisational frameworks.

Equality, diversity and inclusion practices go hand in hand with psychologically safe workspaces. They provide the safety nets and support networks which allow people of all ages, ethnicities, sexualities and genders to share their lived experiences and raise concerns. They also work to erase the bullying and discrimination that makes workplaces fundamentally unsafe and silence the voices of staff.

In an organisation as multi-layered, complex and hierarchical as the NHS, inclusivity must be prized as highly as productivity. This means that everyone is given a platform to speak up, no matter their discipline, experience level or pay grade.

EDI frameworks aren’t a silver bullet for the complex issues facing the NHS. But they can tackle the significant problem of staff disengagement and enable a culture where diversity of thought is prized.

Empowering managers to lead teams

Psychologically safe workplace are as important to staff wellbeing as they are to patient safety. When employees feel valued, supported and – crucially – listened to, they experience lower levels of stress and burnout.

At Henley, we recognise that inspiring leaders can make a huge difference. That’s why we’ve partnered with NHS England to launch the first cohort for NHS colleagues pursuing careers in EDI.

Professionals at the beginning of their leadership journey, with no more than three years of experience within a management role, will learn the skills to create positive, inclusive and transparent working environments for their teams.

Dr Melissa Carr, Director of EDI at Henley’s World of Work Institute

NHS-backed study shows 73% reduction in GP waiting times using AI triage system

By Integrated Care Journal

An independent, NHS-funded evaluation has validated the transformative impact of an AI-powered Smart Triage system on primary care delivery in England.

The Groves Medical Centre, a leading family GP practice in Surrey and South West London, has achieved unprecedented improvements to patient access, practice capacity and sustainable staff working patterns after implementing Smart Triage.

Smart Triage, an AI-powered autonomous patient triaging system developed by health technology company Rapid Health, was implemented at The Groves Medical Centre in October 2023. The system has transformed patient access, enabling equitable and safe care based on clinical need rather than on a first-come-first-served basis.

An independent real-world evaluation, funded by Health Innovation Kent Surrey Sussex – one of 15 health innovation networks across England – and conducted by Unity Insights, has measured the impact of autonomous patient triage between October 2023 and February 2024. The evaluation assessed the system’s acceptability, implementation, effectiveness, and impact on health inequalities.

Key findings of the evaluation include:

Patient waiting times reduced by 73 per cent, from 11 to 3 days, for pre-bookable appointments
The practice had 47 per cent fewer phone calls at peak hours, with a 58 per cent reduction in the maximum number of calls, all but eliminating the “8am rush”
Same-day appointment requests fell from over 62 per cent to 19 per cent, significantly expanding the capacity for pre-bookable appointments
70 per cent fewer patients needed a repeat appointment, having received the right care on their first visit
85 per cent of appointments booked via the new system were delivered face-to-face, a 60 per cent increase compared to the pre-implementation period
Only 18 per cent of all patient requests were initiated over the phone after the system was implemented versus 88 per cent prior to it being implemented
91 per cent of appointments were automatically allocated without staff or clinical intervention

These changes have culminated in a better overall experience for patients at The Groves Medical Centre. GPs now spend 15 minutes with patients, rather than 10 – a 50 per cent increase. Additionally, the practice has achieved an 8 per cent increase in the number of appointments delivered per working day without hiring additional staff. Patients now have a wider selection of appointment slots to choose from, with an average of 61 slots available per patient appointment request. This has resulted in a 14 per cent reduction in patient no-shows, despite the practice already maintaining low DNA (did not attend) rates.

In contrast to traditional online consultation and triage tools that only collect information, Smart Triage fully automates the patient navigation process from the initial contact with their GP practice. Whether requesting care online, by phone, or in person, patients are guided through a series of questions based on their concerns. The system then assesses their symptoms and directs the patient to the most suitable care, even enabling immediate self-booking into the right appointments. This streamlined process empowers patients to access care at their convenience while relieving the practice from direct involvement in each request. This is the first time a study has proven an autonomous clinical system is safe and effective in doing this process end to end.

Dr Andrea Fensom, GP Partner at Groves Medical Centre, remarked: “Smart Triage has completely changed how we work. It has not only optimised our resources but increased patient access. Feedback shows that patients find it easy to use our online tool and it’s convenient for them, giving them multiple options for appointments where safe to do so and booking them with the most appropriate clinician for their problem. We are all very proud of these results.”

Jake Kennerson, Group Manager at Groves Medical Centre, added, “The positive outcomes we’ve seen in such a short period are a testament to the effectiveness of this innovative system. There’s been a significant decrease in the number of patients requiring same-day appointments and wait times have been drastically reduced. All of this change was achieved during the peak winter months and without any additional staff. If others were to adopt a similar approach, it could lead to transformative results for patients and the NHS as a whole”.

Carmelo Insalaco, CEO of Rapid Health, expressed his pride in the system’s success: “We’re really proud to see the extraordinary impact of autonomous patient triage at The Groves Medical Centre. These results reflect what we consistently observe with our customers across the country – the remarkable potential for Smart Triage to dramatically enhance patient access and choice, while solving the persistent challenges of lengthy waiting lists and disruptive morning bottlenecks. We look forward to further collaboration and expansion across the wider NHS to benefit more patients and healthcare providers”.

By implementing the software, GP practices and Primary Care Networks (PCNs) can improve patient access, reduce workload, unlock capacity and manage patient demand more effectively. With better access for patients online, call volumes are reduced and peaks in demand can be smoothed out, eventually eliminating the ‘8am rush’. This ultimately enhances and automates the Modern General Practice Access Model which was introduced by NHS England last year.

Greater Manchester lauded for approach to population health

By Integrated Care Journal

A new report from the King’s Fund had praised Greater Manchester’s progress on improving population health, emphasising the importance of addressing the wider determinants of health.

The King’s Fund has praised Greater Manchester for its work improving key measures of health and health inequalities. The influential national charity has called Greater Manchester “the poster child for devolution” in England and has recognised the time, effort and resources put in place helping people to live good lives, improve wellbeing and prevent illness.

The new report, published this week, shows how health is influenced by wider determinants such as high‑quality and secure housing, a good job and a healthy environment. It highlights the vital link between health, and the communities we live in as well as the value in aligning strategies to ensure improvement of both the economic and health status of the population.

Since 2015, Greater Manchester has had a wide-ranging devolution deal with Government on health which has led to improvements in life expectancy and other measures (see here for information). Greater Manchester’s model was integral to the creation of statutory integrated care systems in 2022 with improving outcomes in population health and health care a key aim.

The King’s Fund report reiterates the importance of population health being a core goal of integrated care systems and the value in different government departments below the national level working more closely together, including at mayoral level. It underpins Greater Manchester’s ‘live well model’ that aims to transform the relationship between work and health.

While this new publication recognises the financial challenges that the NHS and other public sector organisations face, it makes the case for continuing with a population health approach and the strong evidence that improvements in health can have for the economy at large.

Andy Burnham, Mayor of Greater Manchester and NHS Greater Manchester Integrated Care Partnership co-chair, said: “Greater Manchester’s health devolution journey has a simple but fundamental principle at its heart: that more local decision-making can deliver better outcomes for people.

“This report from the King’s Fund sets out clearly the wider social factors that impact people’s health and wellbeing, but also the power of devolution to draw the connections between those issues and tackle them systematically.

“That is the strength of our devolved approach, and the mission of the new Live Well service that we want to pioneer here in our city-region. There are still challenges and pressures that we face. But we’ve made progress already, including on healthy life expectancy, and by bringing together partners and joining up the support offer for residents – whether that’s health and social prescribing, housing advice, or employment support – we can deliver better, more efficient public services, and improve people’s life chances.”

Jane Pilkington, Director of Population Health for NHS Greater Manchester Integrated Care said: “The King’s Fund spotlighting Greater Manchester as leading the way in population health is pivotal to re-emphasise the important role the NHS plays in improving the health and wellbeing of residents, by focusing on preventing ill-health in the first instance rather than just treating sickness, as well as relentlessly working to reduce health inequalities.

In Greater Manchester we need to continue to work together with communities and the voluntary sector, local government, and the NHS to help create a place where everyone can live a good life, growing up, getting on and growing old in a greener, fairer more prosperous city-region – focusing on improving both the health and economic circumstances of our residents.”