How startups can cut NHS Trusts waiting lists

When the?National Health Service (NHS) in England opened its doors on 5th July 1948, it did so without enough doctors, dentists, nurses and midwives to attend to half a million waiting patients. To the frustration of many, the mismatch of supply and demand has persisted and grown ever since. In England, waiting times for regular hospital treatment hit record levels in August 2023 - around 7.75 million patients were waiting to begin treatment. The situation is likely to worsen in 2024 as a cost-of-living crisis puts pressure on people’s physical and mental health. It is all a far cry from the optimism of 75 years ago when the?NHS?opened its doors, providing health care for all, free at the point of use.?

Inadequate staffing and poor working conditions.

The big problem leaders of NHS Trusts are facing is staffing - despite the NHS being the country’s largest employer with 1.4m people on a headcount basis. Nearly 11,000 medical posts and 46,000 nursing posts are unfilled. EU?countries have an average of 3.7 doctors per 1,000 people. Britain has only 2.9.

Waiting times for hospital treatment in England hit record levels in August last year, which also showed emergency services were under acute pressure. About 7.75 million patients were waiting to begin treatment, up from 7.68mn in July. Meanwhile, the number of people waiting more than 12 hours for treatment after a decision has been taken to admit them to accident and emergency departments hit 33,107 in August, an increase of 15% from 28,859 the previous month.

Tackling staff shortages will not be easy. Despite the huge headcount, more workers are needed. One in every 11?NHS?posts in England is vacant; shortages are reported across almost every healthcare role. NHS?workers on regular contracts should know when they are working six weeks in advance. In practice, many do not. Medical workers frequently struggle to plan holidays, childcare and weddings - even their own. Trainee doctors have little control over where they live.

The UK’s armature prime minister’s key pledge of reducing the size of the waiting list by March 2024 is, like most of his other pledges, looking more like a pipe dream. Increased demand, record staff vacancies and industrial action all continue to hold back recovery efforts. Whilst NHS staff continue to work hard to reduce waiting lists, this is happening in extremely challenging circumstances — and that is before winter pressures hit.

Supply/Demand imbalances impair patient care.

Something else is happening to staffing in the NHS. Most NHS Trusts lack a rigorous approach to matching clinician supply to the demand for various health services. The resulting supply/demand imbalances impair patient care, demoralise clinicians and make service delivery inefficient. Consequently, they compromise a health system’s ability to deliver its service strategy - its goals for providing high-quality, accessible, cost-effective care.

Despite steady upward trends in the numbers of new doctors and nurses, vacancies continue to rise. As the pay-off for a gruelling decade of training and an intensely stressful job diminishes, it is not surprising that many medics look elsewhere. According to the latest figures, there are now an estimated 18,000 UK-trained doctors practising overseas. This is a 50% increase since 2008. In short, the NHS has developed a leak. And it’s not easy to mop up - so what can be done to plug the leak?

NHS: a laggard in using digital tools.

Technology should be used to plug the leak by matching demand with supply while achieving a flexible work culture, which gives doctors and nurses their work-life balance. On the same day the long-waited Workforce Plan was released by the government in June 2023, the Health and Social Care Select Committee in Parliament issued a report that calls the?NHS?a laggard in using digital tools. High-quality, sustainable healthcare depends on smart and intelligent digital platforms. However, many NHS Trusts are still unclear on where to focus investment, what technologies provide the greatest benefits for patients, staff and healthcare providers, and the return on investment.?For example, the NHS?could do more with artificial intelligence (AI) in staffing and diagnostics and with robotics in surgery. In the fast-changing world of staffing, one technology platform that has mastered the complexity of matching demand with supply using AI to plug the leak is Locum's Nest.

How NHS should select value-creating suppliers.

If the Fujitsu’s Horizon contract, the associated faulty procurement processes and two of its former executives, who held deep ties to the current UK governing party, hasn't taught us about the corrupt procurement practices within the public sector then nothing will.

The NHS spend a considerable amount of money (around ￡18bn on medicine and ￡6bn on consumables, including technologies) on large established suppliers every year. This principle may have worked in the past, but its validity in the 21st century is doubtful. Today, smart NHS Trusts select suppliers who are independent, small, agile, adaptable, and whose interests are aligned with Trusts’ objectives (see Figure 1).

Figure 1: Criteria for selecting suppliers in the 21st century.

In the 21st century, NHS Trusts must give up their obsession with high-cost large technology suppliers, which has proved counter-productive time and again. To get more from technology investments, NHS Trusts must understand the types of partnerships they need from their technology suppliers, decide which suppliers can offer those partnerships, and then act on building the right level of partnership. By avoiding value destroying behaviour, NHS Trusts and their selected suppliers can build a foundation of trust. These can be challenging for many Trusts because there are no traditional purchasing tricks that can do those things – only senior executives with forward looking mindset can make them happen.

How to select NHS staffing solution.

Most successful Trusts look for technology suppliers who understand their specific technology environment, offer ongoing independent advice, help them manage aggressive software upgrade cycles, and provide solutions for their most pressing business problems. They also need to select suppliers who can respond to sudden changes in markets – and the monolithic size and scale of large suppliers and their outdated practices are often prohibitive to achieve this objective. Agility is critical because, in the NHS, both demand and supply fluctuate rapidly. Here is an example of how Trust executives can analyse the staffing technology suppliers’ market and produce a competitive analysis chart that helps them better understand how suppliers in that market stack up against each other. The following chart (Figure 2) shows four types of staffing technology providers in markets where competition is high, and provider differentiation is distinct:

1. Leaders execute well against their current vision and are well positioned for tomorrow with a strong clinical presence of, say, more than 50 Trusts.

2. High Performers understand where the market is going or have a vision for changing market rules using bespoke and adaptable technology, but do not yet execute well.

3. Niche Players focus on a small segment or are unfocused, often use one-size-fits-all technology and do not out-innovate or outperform others.

4. Contenders execute well today or may dominate a large segment, but with weak clinical presence, they do not demonstrate an understanding of market direction.

????????????????? Figure 2: Competitive Analysis Chart of Staffing Solution Providers

NHS Trusts must not assume that the five-star supplier's selection model described earlier requires more technology, a room full of purchasing experts with all the external benchmarking information at their fingertips, and massive capital expenditure. Nothing could be further from the truth. Most Trusts have the infrastructure to develop the five-star supplier selection model. What they will need is to forfeit the favouritism of certain suppliers. Instead, a fresh attitude and new culture across the Trust is required to get their five-star suppliers selection model to deliver five-star performance.

What does all this mean?

I don’t expect us to clap for staffing technology platforms anytime soon. However, if we, as a country, care about empowering our frontline clinicians to do what they do best and relieving the unbearable stresses brought about in no small part by having to operate with antiquated infrastructure and technology, then we need to move the conversation beyond “more money and more doctors” to more data-driven, AI-enabled technology platforms that optimise the workforce and deliver high quality patient care, like Locum’s Next.

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About the author

Sukhendu Pal is an advisor to CEOs and Boards, of some of the world’s most valuable companies, as well as a lead mentor to Funding London’s 150+ portfolio of high-growth startups. He is neither an investor nor an advisor to any of staffing solution providers mentioned in this article.

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