How would clinicians use time freed up by technology?

Health Foundation – May 2024

Key points

• The idea that technology can free up ‘time to care’ for NHS staff, allowing the health service to increase volumes of clinical activity, has become a major focus of health policy, informing the NHS Long Term Workforce Plan and the NHS productivity plan announced in the 2024 Spring Budget. This analysis from the Health Foundation explores how freed-up time might be used, drawing on a survey of clinical staff, expert interviews and a rapid evidence review.  
• If potentially time-saving technologies are to generate productivity benefits, then the time freed up has to be used effectively. This is often assumed but by no means guaranteed. The evidence review estimated that less than 1% of the literature on the impact of technology on staff time in health care actually considers how freed-up time is repurposed. Given this significant evidence gap, more research is needed. 
• Our analysis cautions against the assumption that time freed up by technology will automatically translate into the equivalent amount of time being used for patient care. When we asked clinical staff how they would likely use freed-up time, survey respondents allocated only 27% of that time to patient care or direct clinical activity. It is important that policymakers, system leaders and those involved in workforce planning use realistic assumptions when it comes to modelling how freed-up time may be used. 
• This figure, however, should not be taken as a general rule or upper limit on the use of freed-up time for patient care. Explicit planning is required to ensure the effective repurposing of time, and this should be done with staff and wider stakeholders. So good change management is critical to deriving the benefits from time-saving technologies. 
• Our survey respondents and expert interviewees suggested that, in addition to potentially increasing care volumes, freed-up time could be used in a range of ways, from enhancing the quality of patient consultations to having more time to think and undertake wider professional activities like training, research and quality improvement. These activities can also benefit productivity – for example, through boosting care quality, enhancing knowledge and skills, streamlining service delivery and supporting staff wellbeing and retention. A broad view of how freed-up time can contribute to improved NHS productivity is therefore crucial. 
• There is an important opportunity here for NHS leaders and employers to create a compelling ‘offer’ for staff, one making it clear that – in addition to increasing care volumes – a proportion of freed-up time could be used for activities, such as training or research, that would not only benefit productivity but make a crucial contribution to improving job quality.

Further information – How would clinicians use time freed up by technology?

Listen to Mums: Ending the Postcode Lottery on Perinatal Care – APPG on Birth Trauma

A report by The All-Party Parliamentary Group on Birth Trauma – May 2024

The inquiry received more than 1,300 submissions from people who had experienced traumatic
birth, as well as nearly 100 submissions from maternity professionals. It also held seven evidence
sessions, in which it heard testimony from both parents and experts, including maternity
professionals and academics.

The picture to emerge was of a maternity system where poor care is all-too-frequently tolerated as
normal, and women are treated as an inconvenience. We have made a set of recommendations that
aim to address these problems and work towards a maternity system that is woman-centred and
where poor care is the exception rather than the rule.

Read the report – Listen to Mums: Ending the Postcode Lottery on Perinatal Care

Guidance on improving access to maternity care for women affected by charging – RCOG

RCOG – May 2024

Maternity Action has prepared this guidance with the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists to assist NHS Trusts to improve access to maternity care for women affected by NHS charging.  

This group of women are at increased risk of poor maternal health outcomes and NICE guidance states that additional measures should be taken to promote access. There is much that can be done to improve current practice within NHS Trusts, working within the current legal framework.

This guidance has been prepared to assist NHS Trusts to minimise the negative impacts of NHS charging on migrant women’s access to maternity care.

This guidance covers all aspects of policy and practice within NHS Trusts, including overseas visitor teams and finance departments.

It is intended to support changes in organisational policies and practice.

This guidance relates to England only, as regulations and guidance differ in Scotland, Wales and Northern Ireland.

Read the Guidance – Guidance on improving access to maternity care for women affected by charging

CQC downgrades overall rating of Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust following inspection

CQC – 28th March 2024

CQC carried out unannounced focused inspections of urgent and emergency care services, medical wards, surgical wards, diagnostic imaging and maternity services at Bassetlaw District General Hospital and Doncaster Royal Infirmary. At Montagu Hospital, inspectors looked at urgent and emergency care services, medical wards and diagnostic imaging. Inspectors also looked at diagnostic imaging at Retford Hospital. These inspections took place due to concerns received about the quality of care being provided.

Read the report – Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust

National Lung Cancer Audit (NLCA) State of the Nation report

HQIP – 10th April 2024

The National Lung Cancer Audit (NLCA), which is part of the National Cancer Audit Collaborating Centre (NatCan), has published a new report on the care received by patients diagnosed with lung cancer in England and Wales during 2022. It found that curative treatment rates for patients with early-stage lung cancer have been maintained (at 78% in England; 76% in Wales), despite the growth in demand due to an increase in early-stage presentations. More specifically, the proportion of patients diagnosed with stage I/II lung cancer has increased; in England, the proportion rose to 33.8% in 2022 compared to 30.5% in 2021 and 30.2% in 2019.

However, the report also states that several areas of care require significant improvement. Unlike most treatment metrics, the proportion of patients who had a lung resection has still not returned to pre-pandemic levels, although more patients had surgery in 2022 than 2021. Bed capacity issues may have been a contributing factor to this indicator not yet returning to 2019 levels and, as such, a call is made for providers to ensure that they have capacity to meet both current and future demand.

Other findings include:

• Time from diagnosis to treatment has worsened (in England, the median time was 41 days)
• Performance could be improved in relation to patients with stage IIIA non-small cell lung cancer (NSCLC) and good performance status being offered curative intent treatment, as well as for patients with advanced disease and good performance status receiving systemic anti-cancer therapy
• A third of patients are still being diagnosed after presenting via the emergency route, and there is marked geographical variation in these rates.

This report goes on to state that data completeness also requires improvement, particularly ‘smoking status’, and ‘seen by lung cancer CNS’ in the English Rapid Cancer Registration Dataset. It also underlines the importance of NHS trusts using the ‘route to diagnosis’ data item to record patients diagnosed after screening by the targeted Lung Health Check (TLHC) programme, saying: “Good quality data on the route to diagnosis is essential for the impact of screening on outcomes to be evaluated.”

Read the report – National Lung Cancer Audit (NLCA) State of the Nation report

The 2024 local elections: pre-election period considerations for NHS trusts and foundation trusts

NHS Providers

This briefing sets out considerations for NHS foundation trusts and trusts in the period of time known as the pre-election period leading up to the local authority and Greater London Authority elections on 2 May. It highlights the practical implications around providers’ activities, including in relation to integrated care systems (ICSs), and with regard to communication during the pre-election period. It also covers the requirements on central and local government, the civil service and arm’s length bodies during the pre-election period to maintain political impartiality in carrying out their public duties and ensuring that public resources are not used for the purposes of political parties or campaign groups.

Read the report – The 2024 local elections: pre-election period considerations for NHS trusts and foundation trusts

Supporting patients with meals and snack times while in hospital

The Patients Association – March 2024

Through The Patients Association’s project work with NHS England, patients and carers have identified several areas where NHS resources supporting meal and snack times in hospital could be strengthened or improved through minor amendments. Participants in a focus group said that NHS England’s existing written resources for patients and staff were clear and helpful, but felt that some changes and additional information on the online portal, where the resources are accessed, could make them even better.

Further information – Supporting patients with meals and snack times while in hospital

Parliamentary and Health Service Ombudsman Scrutiny 2022–23

Public Administration and Constitutional Affairs Committee – February 2024

The report sees the cross-party Committee issue a renewed call for legislative reform to the PHSO’s structure and operations. In its 2022 report the Committee called for the Government to prioritise Ombudsman reform and introduce a Bill before the end of the current Parliament. The Government responded by stating it ‘is not convinced that fundamental reform is a priority at the current time, nor that legislation is the answer to many of the identified issues’.

The Committee acknowledges the work the PHSO has done to attempt to clear the backlog of cases created by Covid-19 and welcomes the fact that the PHSO has met its 7-day target for making initial decision on cases. However, the report expresses continued concern that the PHSO has missed its target on cases decided following further consideration.

As the PHSO has failed to meet some of its own performance targets on taking decisions, PACAC asks for the PHSO to ‘provide details of the methodology it uses for deciding its targets for how quickly it should resolve cases subject to further consideration and outline any steps it will take to review that methodology to arrive at more realistic targets to be used in the future’.

In its report PACAC reiterates its concerns around PHSO’s continuation of its temporary measure, introduced to address the Covid backlog, of demarcating some cases as below the ‘severity of injustice’, meaning that these cases are not subject to detailed investigation.

The report discusses the quality of PHSO casework, noting that while it has received praise for its handling of cases, it has also received evidence of inadequate case working, including in particular poor experiences for disabled and elderly people. PACAC asks the PHSO to set out the steps it will take to address these concerns.

The report welcomes the increase in the number of cases resolved by mediation and is supportive of the PHSO’s ambition to broaden the range of cases resolved by mediation in 2023-24. Noting that this ambition will require addressing the potential barriers arising from the culture within the relevant bodies, PACAC says the Government should outline how it is working with NHS England and other stakeholders to promote a culture and training that is supportive of mediation among NHS staff and those working in government departments.

Download the Full Report

Reinforced autoclaved aerated concrete (RAAC) in hospitals: management information

Department of Health and Social Care

This page gives information on hospital sites in England that are confirmed to contain reinforced autoclaved aerated concrete (RAAC).

All hospital sites with confirmed RAAC are in NHS England’s ongoing national RAAC programme. This programme is backed with significant additional funding of £698 million from 2021 to 2025 for trusts to put in place necessary remediation and failsafe measures.

The information on the spreadsheet includes:

• site location
• NHS trust
• RAAC status

As of 29 February 2024, there are 54 hospital sites with confirmed RAAC in the rolling national programme, which has been in place since 2021. Since May 2023, 31 sites have been identified, following updated monitoring guidance from the Institution of Structural Engineers (IStructE). Sites join the programme regardless of the extent to which RAAC is present on the estate or whether it is in clinical or non-clinical space.

Four sites have entirely eradicated previously confirmed instances of RAAC. Seven hospitals that are most affected by RAAC are also part of the New Hospital Programme for full replacement by 2030.

Where possible RAAC is identified, visual inspections and structural surveys take place to verify its presence and level of risk. Once the presence of RAAC is confirmed, trusts join the national RAAC programme. This programme supports mitigation, remediation and wider planning to maintain safety.

Keeping hospital capacity open while carefully monitoring and mitigating RAAC until it can be removed is fully in line with current evidence and recommendations from IStructE.

Hospitals with RAAC in England

Our Workforce Disability Equality Standard (WDES): Annual Report 2023 – CQC

CQC – 23rd January 2024

Our Workforce Disability Equality Standard (WDES) report for 2023 uses 10 specific measures or ‘indicators’. They enable us to compare the experiences of disabled and non-disabled colleagues. We do this so we can develop how we ensure equitable outcomes for all colleagues.

Read the Report – Our Workforce Disability Equality Standard (WDES): Annual Report 2023 – CQC