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Why streamlining digital services is key to solving the NHS productivity puzzle

The burden of transformation shouldn’t lie with NHS staff – the private sector can help to improve operational processes and tackle patient backlogs.

By Julian Hunt and Matthew Rutter

The NHS cannot ignore the multitude of challenges it currently faces. From an ageing population with rising prevalence of preventable disease to growing waiting lists and staff shortages, to the unequal distribution of new digital technology across the country, our health service is facing the most difficult period in its history.

The pandemic had a detrimental impact on the delivery of healthcare services, lengthening existing backlogs in appointments, diagnostics, treatment and surgery. Productivity in the health sector has declined over recent years – the Office for National Statistics reported a 25.6 per cent fall in NHS England productivity in the 2021 financial year, compared to the previous one.

There is no easy fix to this problem. As the government and NHS collectively look at how they can create a health service fit for the future, the challenge will be in devising viable solutions while maintaining high quality care. The role that digital technology can play in helping to do this, by enabling healthcare staff to understand and meet patient needs and demand on services, is critical.

Indeed, the legacy of the pandemic was not purely negative, as digital technology gave patients a new level of autonomy in the transition to hybrid and remote services. It showed a rapid step-change in patients being more empowered to manage conditions in their own homes and fit healthcare needs flexibly around their lives. In coming years, “virtual wards” will contribute to this, as more patients get the care they need at home safely and conveniently, and hospital care can focus on those who need it the most.

However, the flipside is that many patients who did need face-to-face care were unable to access it during the pandemic. Chances for early intervention were missed, and many patients are now presenting with more acute, complex and serious problems. This ultimately hampers productivity – due to increased hospital admissions, and longer hospital stays, outpatient appointments and surgery times – and results in worse outcomes for patients.

To improve patient outcomes, we need to see a paradigm shift from a sickness service to a wellness service, from reactive to proactive care.

This shift will take time, and further modernising the NHS’s digital technology systems is at the heart of it. In many cases, NHS trusts are running on legacy technology – a survey by the British Medical Journal (BMJ) found that a staggering 71 per cent of NHS trusts still use some paper notes, while 4 per cent only use paper. Only a quarter of trusts use fully electronic records.

Given how technology is now fully integrated into our personal and professional lives, such as through hybrid working, we need to consider how digital solutions can better support the entire chain of patient care, from receptionists through to consultants. We also need to design and roll out digital solutions that allow patients to proactively access advice, guidance and treatment, in the most appropriate care settings.

At PwC, while we have a strong track record of advising clients in the health sector, our Managed Services teams have increasingly been stepping in to support implementation as well. The NHS has significant capacity constraints, so we can help to provide that capacity to transform services.

Often, we do this through assessing where operational processes can be streamlined, or where existing NHS technology can be used to its full potential, rather than requiring NHS trusts to invest in new, expensive systems. For example, we helped one large trust with four hospitals get on top of growing patient waiting lists and staff shortages caused by sickness. We streamlined the trust’s existing appointment booking and scheduling system, without requiring it to implement new technology. We also provided much-needed additional support capacity to maintain the booking service while the process was being improved.

By standardising the booking process across its hospitals, we helped to add 3,480 referrals, 2,211 outpatient bookings and 1,270 patient discharges in 12 weeks. We then looked at ways to transform the service to make it more efficient in future, such as by transitioning to a lower-cost booking provider, or by using an AI-powered chatbot.

We then handed the now improved and more efficient service back to the trust. NHS teams are facing a challenging and demanding work landscape – they don’t have the bandwidth to deliver systemic change themselves, so bringing in an external partner like PwC can help to introduce new processes and ways of working quickly.

It’s important to recognise that increasing productivity relies on improving the well-being of healthcare staff, who are experiencing high levels of burnout. At Ramsay Health Care UK, we deployed a delivery team to streamline the patient call system and boost patient bookings and revenue, but we also introduced incentives to help staff feel valued. We started weekly awards to incorporate positive feedback from patients, and recognise how many difficult situations staff had handled; we could see the morale building over time.

But improvements at a trust level aren’t enough – institutional reform is needed to drive change. We have two key recommendations that we believe could help to modernise the health service’s integration of digital technology. First, digital and technological experts should be appointed on to the NHS’s new integrated care boards, and the boards of NHS provider organisations. Second, more time, attention and funding need to go towards improving the digital maturity of organisations and their workforces.

According to the King’s Fund, only 6 per cent of the Department of Health and Social Care’s health spend goes towards capital investment, and of this, only 10 per cent (£1.2bn) goes towards IT and software. While the government’s focus is understandably on tackling the immediate NHS backlog, it is crucial it also looks more long-term at digital and physical infrastructure.

Removing the burden of transformation from NHS staff gives them the time back to focus on what they do best – helping patients and saving lives. Streamlining digital and administrative processes leads to reduced waiting lists, improved services and happier employees and patients. Health workers make a difference every day – so the more that we can collaborate with them to enable them to do that, the better.

This piece first appeared in a Spotlight Healthcare print report on 13 October 2023. Read it here.

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