The need for efficiency savings is nothing new for the NHS – it is in our DNA. But to overcome the current funding pressures, workforce challenges, rising service demand and ongoing care backlogs, we need to consider bold moves which accelerate productivity, eliminate cost and improve effectiveness.
Radical rather than incremental improvements are needed to attract and retain the right people, maintain high levels of service quality and patient safety, and deliver the standard of experience we have all come to expect as consumers in a digital age.
This does not come easy, but by drawing on growing examples of effective corporate services – driven by sharing resources, introducing automation and AI – healthcare organisations and systems could leap ahead in their journey to deliver even more for even less.
Driving productivity through shared services
With most ICBs forecasting a deficit this financial year (2024/25) as early as July, cost reduction is top of the agenda but needs to be significant and sustainable.
According to research by Deloitte, there are major efficiency and quality gains to be had by pooling resources and developing global (end-to-end) shared services within organisations, across ICSs and even beyond system boundaries. A global shared services ‘central office’ model brings corporate services functions together not simply to save money but to act as an engine of productivity to deliver:
- Economies of scale, with greater efficiencies available as the size of the delivery patch increases
- A wider set of skills and capabilities, providing workforce resilience, enhanced inhouse expertise and reduced reliance on external expertise
- Systems and processes that are developed once and deployed regionally or nationally
- Seamless end-to-end services which eliminate duplication, while improving accuracy and speed.
Although the most significant gains are to be had when this is done on a large scale, there are still benefits for individual organisations to centralise the skills, processes and capabilities that employees and patients rely on most heavily.
Potential barriers include lack of resource, poorly integrated systems and processes, workforce resistance and differing priorities both within and across organisations. Though significant, these barriers also apply to most systemwide initiatives. Tackling these requires us to clearly demonstrate and articulate the potential benefits, measure and share incremental success, and support our people through change. Doing so strategically rather than piecemeal has the potential to enable multiple collaborative initiatives and encourage a step change in how we work.
Working smarter with automation
Some organisations are already seeing tangible efficiency gains using robotic process automation (RPA) and working collaboratively with others to maximise impact. Leeds Teaching Hospitals NHS Trust is using RPA across multiple departments to complete repetitive tasks, freeing up staff to focus on activities that require human input, or removing vacancies where a digital helping hand is sufficient. Examples include waiting list validation, appointment booking and cancellation, referral management and finance tasks. Since implementing its first RPA process in September 2020, the Trust now has 97 live processes running, generating cost avoidance and efficiencies worth approximately £1.3million. By working in partnership with the West Yorkshire Association of Acute Trusts, neighbouring trusts are sharing learning, and code, to avoid duplication and enable new processes to be developed more quickly.
Streamlining corporate services with generative AI
Generative AI takes automation a step further, using chatbots to handle queries which are trained using organisational assets. At Arden & GEM, for example, we have used large language model (LLM) technology to develop an inhouse HR AI assistant trained using our policies and procedures. This answers common queries from colleagues on everything from what they should do if weather prevents them from getting to work, through to how to handle a negative work environment. As the bot draws only from our own policies, we can feel confident that the information is accurate, and can self-correct when made aware of omissions or errors. As an inhouse model, input queries are not used to train the model, avoiding some of the concerns often raised about open access models such as ChatGPT.
With the appropriate input, this type of generative AI could be developed to manage routine HR, finance, IT and other corporate service enquiries efficiently across multiple organisations, eliminating duplication, improving customer experience and reducing cost.
Where to start
Understanding where change can have the biggest impact is a crucial first step in your productivity and efficiency journey. Rather than approaching the challenge by function, taking a strategic view of where you are now and what you want to achieve across your organisation, system or region provides the initial building blocks for more centralised working.
With improved productivity and better integration across healthcare organisations in mind, Arden & GEM has combined quality and efficiency best practice with sector knowledge to develop a maturity matrix to guide our productivity programme. This approach considers people, processes and technology in benchmarking our performance and digital maturity to provide a roadmap for change based on robust self-assessment.
As well as identifying quick wins within the organisation, the outputs highlight:
- the art of the possible through effective digitalisation and collaboration
- true root causes of poor quality and/or inefficiencies
- the tools and skills needed to successfully implement local improvement programmes.
Operational realities dictate that we must manage immediate financial pressures and meet current patient needs which can make strategic innovation feel beyond reach. But those same realities show that change is not optional. By sharing our inefficiencies and quality issues as well as our strengths and skills, how quickly could we plug the gaps and design shared solutions that deliver better experiences and outcomes for patients?
Jason Bloomfield, Chief Operating Officer, NHS Arden and GEM CSU and Chair of Software Skills, One NHS Finance Innovation Forum
