Developing publically owned solutions for our national treasure, the NHS

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E-rostering in the NHS

Challenges and solutions

This winter has seen the NHS placed under pressure in ways never witnessed in modern times. Staff have been pushed to their limits and ward managers have struggled to ensure adequate staffing levels as the pandemic took hold across the UK. As the number of patients in hospitals increased, with many deteriorating rapidly, clinicians have worked round the clock, for far longer hours than usual. The pressure has inevitably impacted on patient care, further adding to the burden on our NHS workers’ shoulders.

With effective e-rostering solutions in place, the burden on shift managers and staff could be reduced.

What is e-rostering?

E-rostering solutions have been around for some time. They allow clinicians to select shifts digitally, providing them with greater flexibility and more efficient work schedules. Specific skill sets can be matched to the right shifts when redeploying staff, using digital passports that are currently in pilot stage. A 2018 study by Newton Europe showed that caseload scheduling (one of the functions of e-rostering) could save each NHS clinician 34 minutes a week, which can add up to hundreds of hours per trust. By planning routes between healthcare settings or to patients’ homes for visits, clinical resources can be geographically matched so NHS staff can spend less time travelling and more time caring for patients.

In January, the Minister for Care Helen Whately announced ￡7.5million additional funding to support digital shift scheduling across the UK, as part of a ￡26million national fund to have all NHS clinical staff on e-rostering systems by 2021 – an ambition of the NHS Long Term Plan.

The problem with e-rostering

Effective rostering is crucial, now more than ever. It affects everyone working in the NHS and drastically impacts patient care if required staff are unavailable. Staffing is the main element of the NHS budget – we have to get it right.

Last year we worked with a small hospital Trust to see what issues they had with rostering. We looked at the solutions currently available and were surprised to find that e-rostering is remarkably underdeveloped, with data, patient files and staff allocation all handled locally. We should have a centralised rostering system for easier access, flexibility, safety and efficiency.

Our analysis found that existing systems are highly unintuitive, cumbersome and slow, failing to provide the level of flexibility to enable staff to quickly respond to changes. They also fail to empower staff to achieve a good work-life balance. Critically, data is held in silos meaning that patient acuity versus staff availability is manually calculated, increasing clinical safety risks and limiting the level of reporting available. Covid has highlighted the shortcomings of these existing siloed data systems. There was no holistic view of safe-staffing at either a local, regional or national level. Due to the nature of these systems, attempts to enable a rapid response to the pandemic failed.

Real-life examples of inefficiencies and cost

Specifically, for the Trust we worked with, inefficient tooling led to an estimated cost of ￡1.1million during the first wave of Covid, just to support staff redeployment. Across the whole country, this equates to roughly ￡279million. However, this figure could be even higher, as we worked with a small Trust.

This figure doesn’t take into account inefficiencies during normal operations or the extended effects of the ongoing pandemic which is causing an unprecedented increase in patient demand alongside a decrease in staff availability.

Between April and August 2020, as a result of Covid, 5,228 amendments were made to rosters affecting 775 individual members of staff at the Trust we worked with, costing it ￡2.169 million - more than half of this was related to increasing staff numbers to cope with demand. ￡549,000 was used for additional shifts for current staff to facilitate safer wards. A staggering amount of money for just one Trust in a period of only five months.

As we investigated, we found that a lack of integrated systems meant it was impossible to redeploy staff from less affected areas. Current software was found to be unfit for purpose in emergency planning, citing its complexity and inflexibility as the reason.

Shockingly, alongside our wider research of the systems available, we discovered through conversations with Trust teams that in recent months, existing suppliers have hiked their prices by 45%.

How can e-rostering be simplified?

Our aim is to simplify roster management, break it down to the bare bones: it should calculate patient need versus staff availability, understand these needs and then fill the gaps with the required staff.

Rostering impacts every aspect of the NHS – it’s a vital element of service delivery. We have worked with NHS Trusts, witnessing how they are all affected by this, especially the impacts on their finances and availability. As UK citizens, we are all directly affected by these issues. It matters to all of us that public funds are well spent.

We also want to make the best use of our existing projects with NHS organisations (like eREACT, the DITO project, and COVID co-assessment). These are hindered if staff are unavailable to help with research and development. Equally, it could be that these projects aren't viewed an appropriate use of their already highly-valuable time, or even, they aren't economically optimal in the current climate.

A browser-based rostering application suitable for all devices could be developed using open standards. This could provide health and care teams the opportunity to access a unified national view of patient acuity coupled with staffing data. It would enable the efficient and effective allocation, redistribution and ordering of staff resources across connected organisations.

As we have learnt with DITO and Open-eREACT we can persist or consume clinical information safely and efficiently using open standards. We can ensure the product is available to the customer in perpetuity and unencumbered under the custodianship of the Apperta Foundation. Furthermore, we can guarantee that the product is developed across all health and care settings and ensure clinical safety via rigorous testing.

An open e-rostering solution creates a technological asset for the benefit of the entire UK health and care sectors, under custodianship of the sector specialists who created it. Equally, it addresses every key customer issue in a single solution, such as:

• Staff management augmented with patient need
• Unencumbered and perpetual use of the software with no lock-in
• The ability to co-design and develop the application with the user to ensure that it is appropriate for the need
• All assets being held in custodianship to ensure strong governance and sustainability
• It is also designed to fit the federated, centralised nature of the NHS, being interoperable and iterable through an open approach.

This set of innovations uniquely enables the safe, secure and timely collection, management and sharing of critical resource data, alongside simple and intuitive interfaces to manage and allocate resources, even in emergencies.

Effective planning in unprecedented circumstances such as now is a hugely efficient use of the NHS tech spend.