Tackling waiting lists – why a rounded approach is needed

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Elective care waiting lists have remained persistently high in recent years, exacerbated further by the Covid-19 pandemic and recent industrial action.

But they cannot be tackled by increasing activity alone. A multi-pronged approach – which improves IT systems, seeks proactive assurance on digital infrastructures and focuses on upskilling the workforce in waitlist management – is required to effectively tackle the backlog.

Our Director of Consulting Services, Stephen Hall, makes this argument in our latest HSJ article, suggesting that bringing all these elements up to speed are crucial to stand a realistic chance of resolving the current size of elective care waiting lists.

“I recall managing waiting lists when I was a frontline manager in the NHS, and I did so effectively only with the support of multiple colleagues who had the expertise to share with me rather than formal training. There is, therefore, a real need for focussed training which is engaging and effective to support colleagues through this challenge,” Stephen writes.

He goes on to argue that inadequate IT systems and a lack of training for administrators compared to other staff groups are holding back the challenge of tackling the backlog, but that getting that these things right – alongside increased activity – can make all the difference.

You can read the full article here.

40 new hospitals – what’s the real story?

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Confused about the government’s 40 new hospitals programme? You’re not alone.

Ever since it was announced as a manifesto pledge by the Conservatives in December 2019, it’s been a clear lesson in semantics, misunderstanding and (some would say) smoke and mirrors.

How many of the 40 new hospitals are actually new? How many will be completed by 2030? How much will it actually cost? What about the further eight projects the government said would be funded nationally in 2021?

It’s all quite a lot to get your head around, with the only guarantee being more confusion.

Here, with the help of stats compiled and collated by the HSJ, we attempt to get to the bottom of it.

How do the numbers break down?

  • Of the 40 new hospitals, 7 are RAAC hospitals prioritised to be replaced by 2030. These are hospitals that can’t operate safely beyond 2030.
  • 10 smaller projects, mostly based in the South West, are still aiming to complete by 2030.
  • 12 large projects still aim to complete by 2030, but 8 large projects will be delayed beyond 2030.
  • 8 projects were already being built when the programme started, while 3 mental health facilities that were planned outside the programme are now being counted, apparently to help the government keep their 2030 pledge of 40 new hospitals.

What about the 8 extra hospitals?

In 2021, the New Hospitals Programme (NHP) was expanded when the government invited bids for another eight new hospitals to be funded nationally. Despite this, in May 2023, the government revealed that just five new schemes – all of them acute hospitals with unsafe roof plank structures, according to the HSJ – had been accepted onto the programme.

This came after 128 bids were submitted, meaning 123 were unsuccessful. Many trusts openly voiced their disappointment.

The five new schemes – Airedale General, Queen Elizabeth Hospital King’s Lynn, North West Anglia FT’s Hinchingbrooke Hospital, Mid Cheshire Hospitals FT’s Leighton Hospital, and Frimley Park – are all now being prioritised because they are RAAC hospitals that are deemed unsafe to operate beyond 2030.

How many are already complete?

According to a recently released government media fact sheet on the NHP, 2 schemes are already completed and 5 are under construction. By 2024, it says more than 20 will be underway.

The government says it remains committed to delivering all schemes announced as part of the NHP, which is expected to represent more than £20 billion of investment in new hospital infrastructure.

It also insists it is on track to deliver its manifesto commitment to build 40 new hospitals in England by 2030.

It says all three mental health schemes now being counted as part of the programme – Surrey and Borders NHS Foundation Trust, Derbyshire Healthcare NHS Foundation Trust and Mersey Care Foundation Trust – meet its definition of a new hospital, even though they were already underway before the pledge was made.

Will the target be met?

A report released last month by the National Audit Office (NAO) found that the government is likely to miss its target to build 40 new hospitals by 2030.

According to the spending watchdog, only 32 will be built in time. It said the project had been beset by delays while warning that ‘cost-cutting and inaccurate modelling of future demand could mean new hospitals are too small’.

The NAO claimed the government had used the definition of ‘new’ broadly, including refurbishment of existing buildings as well as completely new hospitals.

Of the 32 that will be built in time, 24 will be from the original new hospitals programme, the body said, along with the five that were added in May 2023, and three new mental health hospitals.

The further eight do not count towards the original definition of ‘new’ because they were already in motion when the commitment was made, the report added.

Are they really new?

The government currently describes its definition of a new hospital as: a major new clinical building on an existing site or a new wing of an existing hospital, or a major refurbishment and alteration of all but the building frame or main structure.

Some would certainly argue this stretches the definition of new. Back in August 2021, the Department of Health and Social Care (DHSC) distributed guidance to NHS trusts on ‘key media lines’ to use when responding to questions about the 40 new hospitals pledge, which defined a ‘new’ hospital in three ways: a whole new hospital on a new site or current NHS land, a major new clinical building on an existing site or a new wing of an existing hospital, or a major refurbishment and alteration of all but the building frame or main structure.

It’s interesting that, in its latest briefing note, ‘a whole new hospital or new site on current NHS land’ has disappeared from the definition.

In November 2021, the BBC emailed every NHS Trust involved in the programme, asking which of the three categories their project fitted into. Of the 34 trusts who responded, just 5 said they were building a whole new hospital. A further 12 said they were building new wings, 9 said they were rebuilding existing hospitals, and others couldn’t say which category they fell into.

Some would argue the wording doesn’t matter as long as hospitals are being improved and rebuilt, but others will bemoan the lack of transparency and clarity.

Others are concerned that the numbers simply don’t add up; they say £20 billion won’t be enough. And with only two hospitals currently constructed, others will question whether the 40 number can realistically be reached by 2030, and whether some of the facilities can even be counted as hospitals in the traditional sense.

There is also frustration from those in the mental health community, who argue mental health is badly under-represented when it comes to the programme. In total, there are only four new mental health schemes within the NHP, and three of these were underway before the manifesto pledge had even been made.

It’s certainly disappointing to see such a small number of mental health schemes being included, especially when the government says it is committed to putting mental health on an equal footing with physical health. What’s more, of the 128 bids for the eight new projects announced in 2021, a significant number were focused on mental health. But none were successful, calling into question the idea of parity between acute and mental health.

The government has said the programme will now become an ongoing, rolling one, allowing further funding bids in the future, but no set timelines have yet been provided for this.

A lot of confusion and uncertainty abounds when it comes to the 40 new hospitals pledge, and it takes a fair bit of brain power to try and work out exactly what is going on. That, if nothing else, is certainly not a great way of creating confidence in a programme.

Still confused by all this? You’re not alone!

NHS long-term workforce plan – what are the key enablers?

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The NHS’s long-awaited long-term workforce plan was finally released at the end of June, after many false dawns. But how can it be realised to achieve its full potential and really make a difference?

What was announced?

The long-term workforce plan covered a wide range of areas, but the most eye-catching announcements were:

  • A £2.4bn investment in training and apprenticeships over the next five years.
  • 130,000 fewer staff leaving the NHS over the next 15 years by improving culture, leadership and wellbeing, to help increase retention.
  • The NHS Plan could mean the health service has at least an extra 60,000 doctors, 170,000 more nurses and 71,000 more allied health professionals in place by 2036/37.
  • The number of medical school places will double by 2031 from 7,500 today to 15,000, while GP and adult nursing training places will also increase substantially by 2031.

How can the plan be a success?

Firstly, we should start off by saying that the plan is a welcome and much-needed piece of work, and we applaud its comprehensiveness. It’s also important to note that it’s not a silver bullet that will solve all of the NHS’s problems overnight – nothing can solve everything in one fell swoop in a complex system such as healthcare.

There’s also a need to acknowledge the length of time that the workforce plan will take to bear fruit. With this in mind, there is an absolute need to continue operational grip and delivery against targets. The foot needs to be kept on the pedal continuously, with regular monitoring and measuring being crucial to stay on track.

We believe there are five main areas of focus to ensure the service can meet its workforce ambitions.

  • Firstly, while the significant investment in training and apprenticeships is brilliant and welcome, it won’t on its own address the problem of recruitment and retention.
  • Secondly, while the focus on retention is welcome, the plan doesn’t really go into enough detail on how this will be achieved. Retention was only mentioned in vague terms in the plan despite its huge importance
  • Thirdly, despite the plan’s focus on retention and recruitment, there is not a clear enough strategy on how to retain staff and the close the current 1 in 10 vacancy rate in the NHS.
  • Fourthly, it was promising to see the plan mention an increase in investment in education, tech and physical infrastructure, but there will need to be more details about how this will be achieved in practice.
  • Lastly, as well as training, retention, closing the vacancy rate and investment in infrastructure, the fifth key enabler, as we see it, is improving productivity by 1.5%-2% – as without a productive workforce, positive change will be hard to come by.

It’s our opinion that the above five key enablers are needed to ensure the workforce plan is a success, and that all of the above regularly needs to be measured and monitored to achieve progress.

We must also take a moment to look at what was missing in the plan. For example, solutions to the problems in social care, which still requires a strong, robust review, otherwise the challenges in the NHS will merely continue. A flawed social care system means people stay in hospital longer than they need to, putting extra pressure on bed spaces. By contrast, a properly functioning system can help keep people well for longer and enable faster, safer discharges home, which would all reduce strain on the NHS and improve its capacity.

There wasn’t much on the pay and reward challenge, either. While it’s no surprise that it wasn’t mentioned in the plan – it’s something that ultimately sits in the hands of the government – it will need to be adequately resolved if recruitment and retention are to be true successes.

There is still an impasse with many health workers despite the recent pay offer made by government (in line with the recommendations made by the independent pay review bodies), and Rishi Sunak has said the only way these pay rewards will be made possible is by making more efficiency savings elsewhere in the NHS.

If you add that to the already expected productivity improvements, that is putting great pressure on a challenged system with no real clarity on how this is going to be achieved.

For recruitment and retention to be effective long-term, the current pay and reward challenges will need to be overcome.

Mental health parity and new challenges

While there were positive mentions of recruiting and training more mental health professionals, we’re not convinced that there was parity with physical health in the long-term workforce plan.

Lastly, there is a need to look at things more holistically and to understand how interconnected many aspects of society are. Amanda Pritchard, CEO of NHS England, appeared on Sunday with Laura Kuenssberg at the beginning of July, shortly after the workforce plan had been released, and made an interesting point that the NHS has to deal with the ills and challenges of society, which are now very different to 75 years ago.

Gambling, for example, is now 24/7 online and everywhere you look, from social media to the shirts of major football teams. Then there is vaping, whose harms may still remain somewhat of a mystery. There is a duty to try and address these issues that adversely affect people’s health, to once again reduce the strain on the NHS.

In summary, then, while we welcome the NHS’s long-term workforce plan, there are a number of essential steps to ensure it is successful and the need for a more rounded approach that factors in improved pay, social care, society’s changing challenges and a focus on retention.

The Future of Healthcare Survey: Through the Public Eye

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Many organisations are working to support and improve the NHS and social care system’s use of data, analytics and digital technology.

But what exactly does the public want to see?

Three years after the Covid-19 pandemic began, the NHS is under significant pressure and possibly facing its biggest challenges yet. Research by The Health Foundation shows deepening public concern about NHS services, with nearly two-thirds (63%) suggesting the general standard of care has worsened in the past 12 months and only a third (33%) of the public thinking the NHS is providing a good service nationally.

With just 10% of the UK believing ministers are tackling the NHS’s many problems in the right way (a record low), we wanted to initiate a debate about the future of the NHS – what people would like to see from the service and what kind of initiatives they would support.

We commissioned a survey of 1,000 UK adults (a nationally representative sample balanced on age, gender, social grade, education and region) to find out what British people would like the future of the healthcare industry to look like.

In our research on the public’s perception and what they see in the future of the NHS, we focused on three key areas:

  • What recent changes to the NHS have benefitted the public?
  • What would the public like to see the NHS implement to improve experience?
  • Which initiatives would the public support to help the backlog of NHS waiting lists?

Key points:

  • With the NHS facing immense pressure, the discourse surrounding the healthcare system’s future is becoming more pronounced. As political parties anticipate the upcoming general election, gaining insight into public opinion can play a vital role in shaping the future of the NHS and understanding what people want from healthcare.
  • This analysis delves into the public’s outlook and anticipations regarding NHS services, showcasing the discoveries from our research.
  • Our research was conducted in April 2023, where we surveyed 1,000 people aged 16 and older in the UK via YouGov Surveys.
  • The survey was carried out before Prime Minister Rishi Sunak announced his Primary Care Recovery Plan, where he promised to get rid of the 8am appointments rush, provide more GP appointments, provide better access to medical records via the NHS app and allow people to get the prescription medication directly from their pharmacy.
  • We found that people want a different, fresh approach to accessing NHS health services, including the option to book appointments online, more flexibility when booking appointments and the option to book double appointments for multiple concerns.
  • Respondents in Wales have found no benefit from recent initiatives (68%), suggesting they are either not reaching enough people or don’t add benefit.
  • With regards to NHS waiting lists, half of respondents (49%) are most likely to support an initiative that uses prioritisation systems to ensure that patients with the most urgent needs are seen first to help the NHS manage the backlog of patients waiting for care in hospitals.
  • Nearly half of respondents (47%) are experiencing extremely long waiting times in A&E and see this as one of the most important factors that should be tackled to improve the NHS experience, whereas 46% of respondents are more concerned about the availability of same-day appointments.

Over the coming months, we will continue to undertake work to explore the relationship between the NHS and the use of data analytics to play our part in improving healthcare in the UK for the generations to come.

Have recent changes to the NHS benefited the UK?

 Remarkably, half of respondents (50%) said that “none of the recent changes to the NHS has most benefited them”, with such changes including more over-the-phone appointments, data available to access through the NHS app, online pharmacies and booking appointments via online websites. Wales, in particular, found no benefit from recent initiatives (68%).

On the other hand, almost one in five (18%) Brits said booking via an online form rather than calling had benefited them, while 17% said that having more over-the-phone appointments has been beneficial to them.

Philip Purdy, Principal Consultant at Acumentice, said of the findings: “It’s interesting that the overwhelming response to the question of ‘what recent changes to the NHS have most benefited you?’ is none of the above. This suggests that the initiatives have not been widespread enough to capture people or didn’t benefit them.”

Stephen Hall, Acumentice’s Director of Consulting Services, agrees: “The responses to this first question tells us that patients want an updated approach to being able to access NHS health services, and possibly not having to attend every appointment face-to-face when a consultation over the phone will suffice in some instances.”

What would the UK like to see implemented to improve their NHS experience?

The biggest priority for the UK is A&E waiting times, with nearly half of respondents (47%) looking for shorter waiting times, followed by an increase in same-day appointment availability (46%) and more flexibility when booking future appointments over the phone (44%). The North East, in particular, would like to be able to book more in advance than just same-day appointments (68%).

Interestingly, more than one in four (27%) respondents would like to see the introduction of fines and consequences for cancelled or no-show appointments in a bid to improve the availability of bookings.

A further 16% of respondents wanted more virtual appointments and over-the-phone appointments, aligning with recent research suggesting that the majority of the UK are happy to get medical advice from a doctor via video link rather than in person.

Hall, who before joining Acumentice was the Executive Director for Performance and Planning across Kingston Hospital NHS Foundation Trust and Hounslow and Richmond Community Healthcare NHS Trust, advised: “Clinical triage is something that should already be happening. But, if not managed appropriately, it can lead to long waiting times for non-urgent cases.”

Purdy believes the responses are weighted towards faster and increased access to services and easier and more convenient booking of existing services rather than changes to services.

What initiatives would the UK support to help the NHS?

We asked survey respondents which of the following initiatives would you support to help the NHS manage the backlog of patients waiting for care in hospital:

  • Greater encouragement to seek treatment and care from primary care services such as general practitioners (GPs) and community pharmacies before being referred for hospital treatment.
  • Wider use of allied health professionals (e.g. physiotherapists, dieticians, occupational therapists) ahead of being referred to the hospital.
  • Use of prioritisation systems to ensure that patients with the most urgent needs are seen first.
  • Greater use of digital services such as self-care apps and remote monitoring tools.

Over half of respondents (51%) said they would support the ‘use of prioritisation systems to ensure that patients with the most urgent needs are seen first.

This would need to include greater use of data capture and digital transformation to make clear where the highest priority patients are. There is a lot of data in the NHS, but it’s not always used effectively, which has a detrimental effect on efficiency, waiting lists and outcomes. If this information could be more widely shared among key stakeholders, lines of communication and efficiency between departments would improve, leading to the right care being provided when needed.

On the other hand, nearly half of the respondents (49%) said they would back an initiative that would make “wider use of allied health professionals”, opening the debate to expand the 18-week Referral to Treatment standard (RTT) to non-consultant-led services.

A further 49% of respondents would support ‘Greater encouragement to seek treatment and care from primary care services such as general practitioners (GPs) and community pharmacies before being referred for hospital treatment’, and more than one in four (27%) would like to see greater use of digital services such as self-care apps and remote monitoring tools.

Conclusion

This research indicates that the UK believe that the current approach to improving the NHS, so far, has not been successful in reaching all people using the service. It’s apparent that, although much of the research points to a continued need for investment in digital innovation and the use of data to provide the healthcare that the public wants to see in the future, it also requires robust infrastructure around these initiatives to ensure there is a robust communication and patient involvement strategy.

Our survey suggests that there is scope for a serious debate regarding access to data and analytics to improve pathways and waiting times, as well as solid digital transformation support to ensure these programmes deliver the widespread benefits that they should.

Find out more about our recent work here, or stay up to date with our latest news on our blog.

NHS turns 75 – a national treasure that remains as vital as ever!

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It’s often hailed as the crowning glory of the post-war consensus. For many, it remains the national institution of which they are most proud. Healthcare, free at the point of use, for everyone – a wonderful concept admired around the world.

As the National Health Service reaches its 75th birthday, it’s an institution that continues to be held in high esteem and a source of national pride, despite the many challenges it faces.

Now is a time to celebrate the NHS and what it has achieved in the last three-quarters of a century, but also to look forward at how it can best thrive in the future – so it’s there for many generations to come.

Here, we briefly delve into its history and get a unique insight into what the NHS means to them from some of our team who have previously worked in the organisation itself for many years.

Free healthcare for all

The NHS was born on July 5 1948. It was a product of the post-war consensus, a time when – after World War II and Labour’s landslide general election victory in 1945 – the main political parties broadly agreed on policies to help the country recover from the devastation of war and the creation of a more comprehensive welfare state.

It was launched by the then Minister of Health in Clement Attlee’s post-war government, Aneurin Bevan, at the Park Hospital in Manchester, providing for the first time healthcare services that were free for all at the point of delivery.

Its early roots lay in the National Insurance Act 1911 and later the renowned Beveridge report, which spoke of a social insurance system ‘from cradle to grave’. The National Health Service Act was passed in 1946, bringing the NHS into being two years later.

A leaflet, titled The New National Health Service, was sent to every home in the country. “Everyone- rich or poor, man, woman or child– can use it or any part of it,” it said. A principle which still exists to this day.

‘Adding value back to society’

We are fortunate at Acumentice to have a number of ex NHS people in our ranks. In fact, our founder, Karina Malhotra, was previously a senior leader in the service.

Below, she – along with Stephen Hall (Director of Consulting Services), Philip Purdy (Principal Consultant) and Adam Ceney (Head of Analytics), who have many years of NHS experience between them – outline their favourite thing about the NHS, discuss the principle of free healthcare at the point of use and look ahead to where the institution might be 75 years from now.

What did you enjoy most about working in the NHS? 

Karina: Knowing that you were ultimately doing this to add value back to society – helping patients get the best experience and outcomes made it worth the hard work! I personally also enjoyed working in high-pressure situations with complex decision-making required. It was also very rewarding to work with great people from multiple disciplines.

Stephen: It was amazing to work with highly-skilled people, in challenging situations, trying their hardest to provide high-quality care to patients.

Philip: The NHS has a lot of everything – people, science and technology, big budgets and investments, a lot of activity, plus a lot of potential for positively affecting people’s lives. It’s something we can all relate to and understand.

Adam: I was part of the Quality Observatory function, creating ways to use data to identify variation in clinical pathways and the domains of quality, safety, and experience. I enjoyed being able to build an evidence base for staff to focus on, deliver and monitor change activities that improved patient care and experience.

What do you admire most about the NHS?

Stephen: Free world-class care at the point of delivery for the whole population.

Philip: Contrary to what we sometimes hear, the NHS compares favourably to other health systems in terms of efficiency, and it does this whilst spending less per head than many OECD countries including Germany, France and the Netherlands. It does all of this whilst delivering so much universally and free at the point of use.

Adam: Despite social and economic changes over the years, it still finds a way of delivering services that compare favourably to other countries and free at the point of use despite spending less per head of population than most health systems. Just look at how the NHS responded during Covid to see how valuable an institution it is.

Karina: I admire its resilience (even post-pandemic) – and it’s the staff that deliver that. And the fact that it continues to offer world-class healthcare free at the point of use.

Is the principle of free healthcare at the point of the use still compatible with the modern world? 

Philip: Absolutely. I think as a population we expect a lot more from healthcare than in previous decades and this has led to some difficult conversations about future funding, whether it is through universal taxation or top-up charges.

Adam: Yes, I’ll never get the argument that it isn’t. At times of medical need, people should not have to worry about how they will pay for it. This principle should always be the foundation for healthcare provision in the UK.

Karina: Yes, when it’s resourced appropriately. The UK still spends less on healthcare as a proportion of GDP compared to its European counterparts.

Stephen: Absolutely. However, it needs appropriate recurrent resourcing, and sophisticated demand and capacity modelling, bringing health and care data analysis together.

What needs to be done to ensure it’s still around in another 75 years’ time? 

Adam: It’d be helpful if politics and the revolving door of new visions and re-organisations was taken out of the NHS. They cause more problems than they solve. If it’s agreed as a nation that the NHS should exist, free at the point of delivery, then it should be designed and managed as such. This includes building a workforce and services that can meet and sustain demand. Part of this would be to stop viewing the NHS as the National Illness Service, only enacted when treatment is required, and focus on prevention, so we change our behaviours to take responsibilities for our health.

Karina: The NHS needs to be resourced properly, clear workforce planning should include appropriate renumeration;, better governance which takes more of a long-term view of improvement rather than only quick wins;, a real concerted focus on prevention and reducing health inequalities and looking at and addressing wider determinants of health (through better population health analysis) to make it true to its name – the National “Health” service.

Stephen: The right funding. Comprehensive short, medium and long-term workforce plans. More focus on population health management (PHM) and appropriate up-to-date equipment, e.g., specifically designed software to efficiently manage patient tracking lists. 

Philip: We must find a way of retaining and building the workforce so that it matches the demand for services – it’s the one thing that poses an existential risk to how the NHS runs, even above the money. If it cannot staff its services, then there will be an obligation to look to other systems and organisations who can.

–

The NHS certainly has much to be proud of over the last 75 years, but perhaps now faces its biggest set of challenges. It will require joined-up, long-term thinking (and more funding) to ensure it can keep up with rising demand and other obstacles. The recently announced long-term workforce plan is a start, but this – and other measures – need to be followed through in reality to make sure the NHS is still in fine fettle on its 150th anniversary.

From London to Manchester!

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June has certainly been a busy month for the Acumentice team, with not one but three key events.

Firstly, there was the HSJ Data & Analytics Forum on Wednesday 7 June at etc.venues in Fenchurch Street, where our Managing Director, Karina Malhotra, spoke as part of a panel discussion.

This was followed up the next day with the virtual Westminster Health Forum Conference, where our Principal Consultant, Philip Purdy, was one of several expert speakers.

Then, on June 14 and 15, Karina and our Director of Consulting Services, Stephen Hall, made their way to Manchester for the two-day NHS ConfedExpo.

Here, we provide a quick summary of the main takeaways from each.

HSJ Data & Analytics Forum

Attended by Karina, Stephen and Philip, this event had the goal of ‘unleashing the transformative potential of data to drive clinical and operational decision-making and enhance population health’. The three main themes were:

  • population health intelligence,
  • data governance,
  • and workforce.

The day was made up of keynote speakers, panel discussions, interactive discussion groups and networking opportunities.

Karina’s panel discussion, where she appeared alongside Joe Rafferty (CEO of Mersey Care NHS Trust) and Sarah Wilkins (Chief Digital Information Officer for North London Mental Health Partnership), revolved around turning analysis into action to overcome operational challenges.

Karina was particularly interested in talking about mental health waiting times, which don’t often make the headlines in the same way as acute waiting lists.

“Today I am here to talk about mental health waiting times, which I am personally very passionate about,” she said. “The number of people in contact with mental health services has grown by c40% since 2020 and now is approaching 2 million, but can we reliably say how long every one of these patients has been waiting? And if we can’t answer that, how do we go about improving things in a targeted way?”

She added: “Although data and analytics alone will never provide a silver bullet for reducing long waits – handled carefully, they can provide the foundation upon which to design interventions with a measurable impact.”

She pointed to Acumentice’s work in building a comprehensive pathway-based PTL/waiting list at Barnet Enfield and Haringey Mental Health NHS Trust as just one such example. “Where we are not just counting how long patients are waiting for activity (first or second contact, for example), but measuring waits to outcomes that are important to patients, such as their first assessment and first treatment.”

“It’s one of those foundational solutions upon which an organisation can build vast amounts of intelligence and gain real insight into its functioning, such as understanding existing demand and capacity gaps, tracing waiting times bottlenecks and ensuring appropriate prioritisation of patients.”

Elsewhere, Ming Tang, the interim Chief Data & Analytics Officer at NHS England, delivered an informative session on how to unleash the transformative power of data across the NHS – a challenge for the NHS where there is often a lack of interoperability between organisations. It was therefore positive to hear about the work by NHS England to create the environments and infrastructure to support local and national innovation and collaboration.

It was one of many excellent sessions on the day, with a highly engaged audience throughout.

Westminster Health Forum

Speaking of worthwhile and engaging events, this is always the case with the online Westminster Health Forum conferences.

The focus of this conference was on utilising data to drive health and social care developments, with sessions on patient records, data protection, public trust in data, workforce development, service improvement and policy priorities.

In his presentation, Philip – who was speaking as part of the session named ‘Next steps for developing services through use of patient data’ – zoned in on the importance of consistent recording, low friction technology to ensure it’s easy to gather and record data accurately, and checks and assurance to make sure important decisions in real-time are based on the best available data.

“In any conversation about next steps in utilising data, particularly when we start taking very impactful direct care decisions based on it, we need to make sure that the recording and quality process is at the forefront of our minds,” Philip said.

“Many of the data-led developments that we have heard about can be vulnerable to different forms of data challenges,” he added, citing the use of different information to prioritise patients as part of elective recovery as one. “This is fundamentally reliant on accurate and up-to-date waiting lists with a consistent methodology for measuring. This becomes particularly important as these efforts extend over multiple organisations.”

In the same session, there was an interesting presentation from John Bowers, Liverpool Supporting Families Programme Data and Information Manager at Liverpool City Council, where he highlighted the need for better communication and collaboration between medical and non-medical bodies to help tackle health problems and health inequalities at root – thus reducing the strain on the NHS.

NHS ConfedExpo

Most recently, Karina and Stephen headed up to Manchester for the two-day NHS ConfedExpo. A joint venture between NHS Confederation and NHS England, it is one of the most significant health and care conferences of the year, with over 140 sessions delivered through keynotes, theatre sessions, workshops, feature zones and focused discussions.

Featured topics included:

  • Sustaining the workforce and innovation in the NHS,
  • Sessions celebrating the NHS’s upcoming birthday, and
  • Talks on AI, data leadership, automation, health inequalities and digital transformation.

There were also thought-provoking opening remarks from Lord Victor Adebowale, chair of NHS Confederation, who talked about the need to have uncomfortable conversations, especially when it comes to workforce health inequalities and how local ethnic groups are represented in the leadership of their local health systems. Plenty of food for thought there.

What all three events showed was the undeniable challenges the NHS faces, but also the spirit of innovation and collaboration at play to make things better and create solutions to complex problems.

Our CSR roadmap – improving society and the environment

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Last year, we decided as a company to set out a CSR (Corporate Social Responsibility) strategy, as we believe that CSR and sustainability are just as important for SMEs as they are for larger organisations.

Since then, we have been working hard to create a roadmap that aligns with our values and vision and our goal to improve healthcare for all, tackling health inequalities wherever we find them.

Here, with the help of our CSR committee – Karina Malhotra (Managing Director), Lucy Mills (Head of Business Development & Operations), Fizza Hassan (Product Manager) and Abigail Smith (Business Analyst) – we explore our recent successes, our reasons behind putting a CSR plan in place and the growing importance of sustainability.

Acumentice recently became part of the Good Business Charter – can you talk us through this and what was needed to achieve it? 

Abigail: The Good Business Charter (GBC) exists for all companies, charities and public sector organisations across all industries and sectors. It encourages responsible business practices by getting member companies to adhere to 10 key components. As part of the certification process, we had to demonstrate that we were aligned with these 10 components, which includes a dedication to paying fair wages, employee wellbeing, environmental responsibility and employee representation.

At a time when people are caring more about who they work for, the GBC offers a straightforward accreditation which recognises organisations which prioritise and care for their employees, the environment, customers, and suppliers.

This is part of our wider CSR strategy – can you tell us a bit about CSR and why it’s so important? 

Karina: Exactly what CSR means will differ slightly in each company, but it’s essentially a business model implemented by companies to try to operate to improve their effect on society and the environment. Even though we are small, we care about improving our impact on a regular basis.

Typically, CSR can be broken down into 4 pillars: environmental, ethical, philanthropic, and economic.

For Acumentice, it’s important for us to have a CSR plan in place as it’s reflective of our core company values, which we are very passionate about.

Isn’t it just something that big corporate firms need to be concerned with? 

Karina: Traditionally, bigger corporates may have been more concerned with CSR due to their wider impact on society and the environment, but also because of better resources and capabilities to invest in CSR.

However, SME and startups will largely have the same reasons for wanting to engage. The current times indicate a shift in the attitude towards CSR, with more awareness, funding opportunities and government guidelines for a net zero roadmap. Therefore, there are now many more resources at hand for SMEs to implement an impactful CSR structure.

As an SME, we believe our journey to CSR is more personal. Our CSR journey is one we all feel connected to and understand the need for.

The question is: can a supply chain ever truly be ethical and sustainable? The answer to that may be disputed, but what is clear is the closer to we try to aim towards that, the higher the cost.

Therefore, you could argue we are more mindful, than bigger corporations, to what elements of the CSR plan we give our attention to. In part, this can be driven by the NHS (our clients’) demands, but also to ensure we really look at areas where we can add the most value back to the environment and society.

What does the CSR roadmap journey look like for Acumentice? And how did it all begin? 

Fizza: As the founder of Acumentice, Karina very much defined the path and values in the early days. In fact, she had already completed some research into getting accredited before the NHS had come out with their net zero supplier roadmap.

As the company grew, the people hired shared the same core value of social responsibility and thus a CSR committee was set up.

The committee decided it wanted to achieve an accreditation and, after reviewing a number of these, we concluded that the BCorp accreditation reflected the long-term growth and plans for Acumentice. As BCorp can be a long process and often has waiting periods from submission, we wanted to keep the ball rolling with other activity.

We first did a workshop with the whole team to understand which Sustainable Development Goals (SDGs, as defined by the United Nations) we align with. This was important as we wanted to centre our actions and plans around the SDGs that we were most passionate about. From those, we outlined four quick wins:

  1. Gaining GBC accreditation – we were already committed to working to improve within the 10 components of GBC.
  2. Finding a charity partner to work with.
  3. Communicating our journey and commitment to all stakeholders.
  4. Gaining ISO 14001 standard for environment.

Sustainability often comes under the remit of CSR – why is sustainability in the workplace increasingly important?

Abigail/Fizza/Lucy: Sustainability is becoming increasingly important for a plethora of reasons! One of which being that clients are actively looking for the right behaviours in the right places, such as net zero campaigns, working with charities and promoting a healthier lifestyle. Clients want to make sure that companies they work with believe in creating a better world for all of us.

People are becoming increasingly aware of the importance of protecting the workforce and environment. With that in mind, the value of promoting healthy lifestyles and protection of the environment promotes a happier workforce and higher retention rate.

The most important part of sustainability in the workplace, however, is not only about clients and staff retention, but it’s about doing the right thing – which has always been our guiding principle as a company. Companies are becoming more conscious of their impact and are understanding their power within their own communities, wanting to take the right corrective measures to ensure that we all have access to a sustainable society.

Net zero NHS – what are the plans and where are we now?

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In July 2022, the NHS became the world’s first health system to embed net zero into legislation, as part of the Health and Care Act 2022. This followed on from the NHS announcing in October 2020 its commitment to being the world’s first health service to reach carbon net zero.

The importance of reaching net zero – and its impact on the wider sustainability goals of addressing climate change for future generations – is widely accepted. We are also committed to this goal, with our own sustainability strategy having a keen focus on environmental protection.

But what are the NHS targets, how do they affect suppliers and how realistic and achievable are the ambitions? In this blog, we take a closer look.

The world’s first net zero national health service 

The ambition is certainly a commendable one and comes after the NHS established a net zero expert panel to review almost 600 pieces of evidence and conduct comprehensive analysis and modelling to understand when and how the NHS can realistically reach this target.

As the NHS itself acknowledges, identifying a route to net zero emissions for such a large, labyrinthine system brings with it several challenges. Despite this, it describes its targets as being ‘as ambitious as possible’ while also remaining realistic. It says these ambitions are backed by immediate action and ‘a commitment to continuous monitoring, evaluation and innovation’.

The institution has set two targets:

  • to reach net zero by 2040 for the emissions it can control directly (otherwise known as the NHS Carbon Footprint), with an ambition to reach an 80% reduction by 2028 to 2032;
  • and to reach net zero by 2045 for the emissions it can influence (the NHS Carbon Footprint Plus), with an ambition to reach an 80% reduction by 2036 to 2039.

This is part of the UK’s wider plans to reach net zero by 2050, by reducing its greenhouse gas emissions by 100% from 1990 levels.

What about suppliers?

It’s well known the NHS relies on a wide source of suppliers and it’s therefore no surprise they will have a major role to play to help the organisation meet its net zero targets.

A roadmap was approved by the NHS England Public Board in September 2021 to help suppliers align with the NHS’s net zero ambition between now and 2030. As a result, it’s already the case that all NHS procurements include a minimum 10% net zero and social value weighting, while for all contracts above £5 million per year, suppliers are required to publish a Carbon Reduction Plan for their UK Scope 1 and 2 emissions and a subset of scope 3 emissions as a minimum.

From April 2024, the NHS will extend the requirement for a Carbon Reduction Plan to cover all procurements, while from April 2027 all suppliers will be required to publicly report targets, emissions, and publish a Carbon Reduction Plan for global emissions aligned to the NHS net zero target, for all of their Scope 1, 2 and 3 emissions.

Further to this, from April 2028, there will be new requirements introduced overseeing the provision of carbon foot printing for individual products supplied to the NHS. And lastly, from 2030, suppliers will only be able to qualify for NHS contracts if they can demonstrate ‘their progress through published progress reports and continued carbon emissions reporting through the Evergreen sustainable supplier assessment’.

While the NHS strongly encourages all suppliers to prepare for the above milestones, it also recognises that not all suppliers are the same and that some will face more barriers than others in meeting the requirements.

It says support will be available for Small & Medium Enterprises (SMEs) and Voluntary, Community & Social Enterprises (VCSEs) at each stage of the roadmap, while a two-year grace period will be available for SMEs and VCSEs on key future milestones and requirements.

It’s fair to say that many suppliers are already on a journey towards sustainability – and if they aren’t already, the net zero plans will surely prompt a wave of suppliers to take stock of their emissions and their sustainability goals. At the same time, the above is a lot for suppliers – especially SMEs – to achieve, which is why it’s promising that support is available.

Where are we now?

At the beginning of the year, the BMA said more support was needed from UK governments to help the NHS reach its net zero targets.

While it acknowledged some good progress had been made in the NHS being less carbon-intensive and more sustainable, it also said this progress was in danger of stalling and called on governments across the UK to up their support for NHS organisations – who are one of the main contributors to public sector emissions – to help them ‘achieve sustainability goals’ and ‘keep up momentum in reducing their carbon footprint’.

At the same time, National Health Executive and E.ON Energy came together to hold a webinar offering a practical guide to achieving net zero, while others have talked of the need to fully electrify the NHS’s fleet of vehicles to lead the charge towards a greener future.

Meanwhile, a recent study found that single-use surgical items make up two-thirds of the carbon footprint of the five most common NHS operations, with researchers suggesting that better waste management and using reusable items where possible could aid in slashing emissions.

The research, which observed operations across three sites at University Hospitals Sussex NHS Foundation Trust, found that 68% of the carbon contributions came from single use, in particular plastic items such as gowns and drapes for patients and instrument tables.

Although exact data on how well the NHS is doing in meeting its net-zero targets is hard to come by, there are plenty of examples of net zero in action, and a cursory search on social media shows how many individuals and groups are dedicated to achieving it.

What’s more, as the largest employer in Britain and Europe, the NHS can set a great example for other major employers and industries and be a leader in the public sector. All action, however small, by employees, organisations and suppliers working in the NHS, can make a considerable difference to achieving the goal of net zero. Do you know how your organisation is working towards reducing its carbon emissions?

Unlocking the power of data: strategies to boost staff engagement with data

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In this blog, Adam Ceney, our Head of Analytics, explores the issues when it comes to staff engagement with data and the possible solutions to this.

There is no shortage of data that is collected, analysed, and distributed across the healthcare system, whether it is internally to manage services or in the form of centralised statutory data flows.  

With access to such large volumes of data, it is widely accepted that the provision and utilisation of this data is seen as a vital piece in the puzzle of facing down the challenges the NHS currently faces – whether that is elective care recovery, workforce or integrations.   

Yet, with all the teams of analysts, data scientists, developers, engineers and architects working out ways to make the data available and accessible, not to mention all the conferences, briefings and roundtables discussing this topic, staff engagement with data is still not where it could be according to our experience.  

There are several reasons we have found for staff being disengaged and seemingly disinterested in data across our engagements with healthcare organisations.  

See if you can spot any of these in your own organisation. 

  1. Data can be seen as complex and technical. There is often a lack of appreciation that staff members do not fully understand the significance and relevance of the data they have access to and, consequently, may not engage with it. 
  2. Data can often exist in a technical bubble with inadequate communication to wider groups of staff, meaning they may not fully grasp its importance or how it relates to their roles and responsibilities.
  3. Data can be of poor quality which can be due to inefficient processes and lack of ownership that often results in staff not having trust in the data they are receiving, which in turn causes engagement challenges when sharing data. 
  4. Staff perceive, rightly or wrongly, that data is only used to evaluate their performance or criticise their work. They may therefore be hesitant to engage with it as the fear of negative consequences can discourage active participation in data-related discussions. 
  5. Data presented to staff is not directly related to their job responsibilities or areas of expertise, so they may not see it as relevant to their work. When data is not aligned with their day-to-day tasks, employees may struggle to see how it impacts their job performance. 
  6. There is so much data that is being processed, analysed and pushed out to staff, which can lead them to be inundated with excessive amounts of data. They may feel overwhelmed, and you may hear staff describing their relationship with data as information overload. 
  7. Employees may not see the value of engaging with data, if an organisation lacks emphasis on using data to drive decision-making and leaders do not prioritise or role model data usage.
  8. Staff face a skills gap and feel they don’t have access to user-friendly tools to enable them to easily analyse and interpret data. This could discourage their engagement. 

 So, how many of the above are relevant to your organisation? If some are, then these strategies could help.  

Engaging with data – the solutions 

Provide training and support to enhance data literacy  

This can include data analysis techniques, data visualization tools and interpretation of data results. However, this training and support should not be a one-off ‘lunch and learn’, but an ongoing development path to help staff members develop confidence in working with data.  

Clearly communicate the importance, value and relevance of data   

Help them understand how data can drive informed decision-making, improve performance, and contribute to the overall success of the organisation.  

Present data in an accessible way   

This should meet the needs of the intended audience and highlight real-world examples of how data has been used successfully in the past in the organisation or sector. 

Encourage ownership 

Encourage staff to take ownership and accountability for data they have responsibility to collect, as well as involving them in the design and specification of data collection and its analysis and interpretation.  

Use data to make informed decisions  

Look to empower staff to use data to make informed decisions and hold them accountable for using data in their work in a transparent and open process. This can also foster a sense of ownership and motivation to engage with data. Lead by example too – this can be achieved through appropriate governance and structures/frameworks which set a bar for evidence gathering.  

Make data relevant 

Ensure that what is presented to staff is directly related to their roles and responsibilities. Achieve this by finding out their priority areas, what they need to do their roles effectively and what challenges they have in delivering. 

Avoid overwhelming employees  

Don’t burden staff with excessive data or complex reports. Do ensure data is presented in a concise, clear and meaningful manner. Use data visualisation techniques, such as charts or graphs, to make data more accessible and understandable and ensure staff are trained so they can fully realise the value of data.  

Build a positive culture 

A positive company culture should value data-driven decision-making. Encourage open discussions about data, create opportunities for employees to share insights or findings from data analysis, and recognise and reward employees for their data-related contributions.  

Provide access to user-friendly data analysis 

Ensure that staff members have access to user-friendly data analysis tools and technology platforms that enable them to easily work with data. Provide training on how to use these tools effectively and make them readily available for employees to access and utilise. 

Addressing these potential causes of lack of engagement in data from staff requires a holistic approach that includes effective communication, an engaged leadership, relevant and meaningful data, appropriate training and support, a positive organisational culture that values data-driven decision-making, and user-friendly technology tools. 

By implementing these strategies, organisations can foster a data-driven culture where employees are engaged with data and use it to drive decision-making and performance improvement.  

It may require ongoing efforts and continuous reinforcement to create a culture that embraces data and encourages staff engagement with it, but it will be worth the effort to improve patient care. 

Waiting time standard – why community-based mental health services need more help to meet it

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In this blog, our Principal Consultant, Philip Purdy, looks at why community-based mental health services need more assistance with meeting the proposed new waiting time standard.

Despite having gone under the radar compared to other new initiatives, a new waiting time standard for certain areas of mental health is set to be gradually phased in over the course of this year – although data recording and implementation issues means the new standards have not yet been introduced, with only an indicative timeline for their implementation. 

The 4-week (28 days) standard will mean that all mental health service groups – adults, older adults and children and young people – presenting to community-based mental health services should begin to receive care within four weeks from when they were first referred.  

But issues with the capture and recording of data makes it challenging, at present, to provide an accurate picture of the number of people who currently receive help within four weeks. This is why, to support systems in improving data quality and improve the flow of data relevant to the community waiting time standard, a phased approach to implementing the waiting time standard has been created, allowing more time for organisations to get used to the new systems. 

With the new approach, the clock starts when the first request for mental health services is received and stops when the person is in receipt of a clinical assessment, either a clinical or social intervention and a completed co-produced personalised care plan. 

Surprisingly, despite its obvious importance, the new waiting time standard wasn’t included in the NHS’s 2023/2024 priorities and operational planning guidance, suggesting that the challenges faced in recording and monitoring may be significant enough to prevent mandating this as a ‘must-do’ this year.  

Recent data featuring in the HSJ shows the extent of the challenge, with data assembled by NHS Benchmarking unveiling the first national picture of the number of patients currently being treated in four weeks. Its aggregated figures for 2021-22 revealed that 72% of adults and 67% of children waited more than four weeks for treatment. Importantly, this must be viewed alongside the caveat that metrics may be measured across providers with differing definitions. 

What’s the problem? 

Access waiting times are still a new concept for community-based mental health services. While it’s true that consultant-led mental health services have (technically) been subject to the 18 weeks RTT standard for a number of years, it’s also the case that this has not been widely integrated into how mental health organisations run their services. 

Consequently, and unsurprisingly, the infrastructure to collect and report on waiting times data, and utilise the intelligence provided by it, simply isn’t there at present. This means, in turn, that organisations are now involved in a game of catch-up to meet the conditions of the 4-week standard.  

What are the solutions? 

To allow mental health providers to monitor their performance against this new standard – and see how close or far away they are from making it a reality – a patient tracking list becomes worth its weight in gold. 

Here at Acumentice, we have been working closely with two mental health organisations to design and build a patient tracking list that enables these organisations to see in transparent detail how long their waiting times currently are. 

It’s important to note that this isn’t an easy process. It involves getting to grips with some complex pathways, interwoven between different teams and services. It also involves coming to terms with different sets of processes that have evolved in a way that don’t necessarily lend themselves well to easy oversight. 

During our work in this area, we have quickly concluded that these types of projects are as much about culture change as they are process change – developing capability in the process of management and oversight is as important as that in the technical field.  

A lesson from the past 

If we cast our minds back to the first decade of this millennium and the last time the NHS was introducing waiting time standards into new territory – namely cancer waits and RTT – we will remember the sea change in practice that was needed to make a success of those standards. 

This isn’t something that happens overnight, and this isn’t something that happens without the necessary support and assistance.  

It wouldn’t be a stretch to say that the NHS developed an entire industry to support the effective recording, management and reporting of waiting times with these previous initiatives. The new waiting time standard isn’t something that can easily be absorbed by organisations who are experiencing unprecedented demand for their services. 

This focus is going to become more high-profile as the year progresses, and we already know it’s going to be a difficult process and adjustment, but there are ways in which you can ready and prepare yourselves for it when it does come into play.  

It’s important to have the right systems and processes in place to enable you to meet the standard, and that’s something we can help with to ensure waiting times for mental health patients are adequately tackled and improved. Find out more here.