Data Saves Lives: The Missing Chapter – Data and the NHS Workforce
In 2021, the Government published its draft data strategy, ‘Data Saves Lives: Reshaping health and social care with data’, which highlighted the power and impact that data had during the height of Covid-19 in shaping both the NHS’s and the public’s response to the global pandemic.
Beginning with a Ministerial Forward from the former Health Secretary, Matt Hancock, the strategy opens with a powerful statement:
“When facing the greatest public health emergency that this country has tackled for generations, one of the most impactful tools at our disposal was the power of data.”
The strategy is then split into seven ‘chapters’, covering a range of focus areas including the improvement of data available to health and care professionals, supporting decision makers with key data, and empowering researchers with essential data.
However, it seems that a vital chapter is missing. One which is key to the running of the NHS, and even more essential in the aftermath of the coronavirus pandemic. The use of data to support the NHS workforce, and the recovery of its people.
Chapter 8: Utilising data to improve workforce management, and support NHS staff
I propose adding a new chapter to the strategy – to encourage the implementation of effective people analytics to collect, analyse and use workforce data to improve HR and management, identify issues, and actively improve the working lives of NHS staff across an organisation.
Our vision is to make workforce data more accessible, easier to collate and understand, and more likely to lead to actions and positive change. In a time where our NHS staff have been left depleted and deflated by Covid-19, we want to see effective people analytics employed to help identify areas of concern within teams, engaging managers to make more informed workforce decisions, and supporting retention and recruitment efforts. Where this is deployed effectively, as we are seeing at trusts currently, people analytics decreases spend from temporary staffing and agencies, and leads to beneficial advantages for not only staff, but also patients.
An effective data programme – such as mii People Analytics – will work with key functions at an organisation to triangulate the various organisation datasets in use to easily obtain meaningful information relating to critical workforce issues. Whilst this step in itself is a huge leap in overcoming the ‘noise’ of data, an advanced people analytics programme will further support and advance workforce management efforts, enabling HR and workforce management to make meaningful decisions which benefit staff, and see problems or pain points before they occur.
An example of this has been seen during the first wave of Covid-19. The data obtained using mii People Analytics was able to pinpoint clusters of infection amongst staff, as well as identify those teams most at risk of staff burnout as a result of the pandemic, allowing for managers to take necessary actions to lessen the threat and increase overall workforce wellbeing.
With workforce data proving so essential in such a variety of ways, and across whole NHS organisations, it seems strange that the use of data for improving workforce management would be omitted from the data strategy. The overall benefits not only for bettering everyday workforce management, but also in extraordinary times such as those created by Covid-19, are substantial enough to create the anticipation of a next normal – where the improved and effective use of data and people analytics programmes are not just words in a strategy, but a readily available tool transforming HR and workforce teams.
Click here to read more about mii People Analytics, or please get in touch to discuss how it can transform your workforce management at info@liaisongroupold.com
David Jones-Stanley
Head of Workforce Advisory Services, Liaison Workforce
In this section
Tools to help tackle the NHS backlog
The number of people waiting for planned hospital treatment or investigations for a wide range of conditions in England has hit a record high of 5.7M. The list is growing at a rate of approximately 100,000 people per month according to data from NHS England, and the situation varies across specialities and geographical location.
The Health and Social Care Secretary, Sajid Javid, has warned that this is likely to get worse before it gets better, and that the number of people waiting could reach as many as 13M before figures start to fall.
Waiting lists were increasing before the pandemic but COVID-19 has certainly had a major impact. The reasons for this are multifactoral and include diversion of NHS resources to cope with COVID-19 and an increase in the number of people who didn’t or couldn’t access NHS treatment during the pandemic, now being referred to hospital. There are probably many more patients still to come forward.
Regardless of the drivers behind the growing waiting list, the problem must be addressed to ensure NHS patients get the treatment they need within a reasonable timeframe.
Managing elective recovery is a complex process after a serious health crisis with a very tired and reduced workforce.
There are several key challenges to reducing the waiting list for elective treatment (“elective recovery”), and in this article I will discuss how technology can support this objective.
1 Find out who still needs treatment
Validating whether those on the waiting lists still require treatment, or are still eligible, should be the first step for elective recovery. Some patients may have
decided to not have the procedure, have had it elsewhere, their condition may have worsened, or they may have developed co-morbidities. This might mean that another procedure, perhaps more complicated, will be required and that they should now be added to a different waiting list. Sadly, during the waiting period some patients may have died and will need removing from waiting lists.
Good data and integration is necessary to manage and keep the lists up to date. To validate those on waiting lists, patient engagement platforms can be used to send assessment forms to patients and find out their preferences for treatment and their current clinical condition.
The use of these platforms, combined with video consultations and follow-up calls will not only help with ensuring the right patients are on the right list, but may also go some way to reassure patients who feel anxious and frustrated that they have waited many weeks or months to hear when procedures might be scheduled. Patients don’t know who to call to ask and get irritated when, for example, their GP does not have the answers.
The use of online consultations also mean that clinicians can determine whether past investigations need repeating or if additional ones are required. Patient engagement platforms allow organisations to obtain consent, schedule appointments at an appropriate time and place and provide patients with helpful guidance about their treatment.
2 Sort and prioritse the list
Once the patients that do still require treatment have been identified, and are on the waiting list for the correct procedure, the next challenge is to prioritise them. A platform like Infinity is ideally suited to this and easy to use.
Infinity gives visibility of the detail of waiting lists, supporting prioritisation. Using dashboards, patients can be segmented by speciality, required procedure, geographical location, and time spent waiting, as well as priority status, referral status and more.
Relevant staff across the organisation have visibility through Infinity, so it is easy to analyse each list and manage the order in which procedures are performed.
3 Coordinate care
Once a patient enters the appropriate clinical pathway, the next challenge is to coordinate care as efficiently as possible.
Most hospital staff use paper lists and handwritten notes for day-to-day care coordination, which can be time-consuming and risks tasks being missed. If the NHS is to increase efficiency to achieve its aim of reducing the backlog, organisations need to move to digital systems that allow staff to see and share information in real-time, instead of logging onto multiple systems and using paper.
Infinity facilitates planning and coordination of care and procedures. Tasks for patients can be automatically or manually created based on standard patient pathways and assigned to appropriate teams. Tasks might range from preoperative assessments and investigations to clinical review and patient-initiated assessments and follow up. Automations can move patients to the next stage of the patient pathway based on the outcome or completion of a previous task.
Staff can update the status of tasks on Infinity in real-time, or tasks can be automatically updated via technical integrations with third party systems (e.g. the
EHR). This means it is clear where the patient is on the pathway, any delays can be identified quickly, and no task is missed or duplicated. Standardisation of tasks on a clinical pathway drives best practice so that the right people are doing the right things at the right time, in the right order. Time is saved chasing data from multiple systems and busy colleagues.
4 Monitor and act on further delays
Granular-level data collected by Infinity is useful not only for audit of clinical activity, but also to monitor demand, capacity and delays in real time to optimise services.
Managers and clinicians can see how many patients are at each stage of each pathway and understand where it may be possible to reallocate resources or offer
some patients treatment in an alternative location to reduce their waiting time.
Elective recovery is a pressing priority for the NHS and isn’t going to be successful without effort and investment. Although it might seem a daunting task, there are excellent digital tools available which, in collaboration, could help overcome the NHS’s waiting list problem. Infinity is one of them.
I, and the rest of the team at Infinity Health, are ready to help and can deploy our solution within a few weeks. If you’re interested in learning more, or would like to discuss your elective recovery challenges, please get in touch: hello@infinity.health
* https://www.bma.org.uk/advice-and-support/nhs-delivery-andworkforce/pressures/pressure-points-in-the-nhs
By Dr Jo Garland
Infinity Health
Balancing the challenge of Discharge to Assess in ICSs
Whilst many flavours of Discharge to Assess (D2A) models have been around throughout the NHS for many years, its acceleration to a ‘standard and funded’ model for safely discharging patients from hospital only became formalised in late 2020.
Whilst the use of D2A encourages health and social care partners to work collaboratively to assess a patient’s ongoing care needs, with the clear objective to help them to leave hospital for support either at home or at another suitable location, there are a number of challenges an ICS must balance to ensure that the pathway to effective D2A runs smoothly…
D2A capacity
As shown during the Covid-19 pandemic in 2020, D2A can make a significant difference to reducing capacity pressures for hospitals, by allowing beds to be freed up sooner.
However, it is often hard-pressed CHC teams who undertake D2A assessments alongside an existing workload of CHC assessments. It is known that these teams are often already battling backlogs caused by a host of different factors, from under-investment in qualified nurses, through to the after-effects of pandemic redeployment. What is obvious is that these teams are already under increasing pressure and now the imperative to get D2A assessments completed within a four-week timeframe has added to that pressure significantly.
For ICSs, this could lead to a number of unintended consequences. From a financial perspective, delays in meeting the 28-day requirement will prolong health funding of cases which may not qualify. Additionally, there appears to be a growth in higher cost and more complex packages of care around D2A which will tie up even more resource to audit over time.
From a quality perspective, many CCGs and ICSs will opt to incur additional costs by employing temporary or agency staff to help ease capacity pressures. But, from work we have done in various geographies across the country, we have seen a rise in variability of the quality of assessments.
And of course, there is always a patient and their family at the heart of this D2A process; looking for the right care and support for their loved one. Whatever the financial support, it is still crucial that patients are stepped down into the right setting for them, to aid their rehabilitation and care.
In all of these scenarios, where the pressure on CHC teams risks financial, quality, or patient experience, using a specialist CHC team such as Liaison Care, to ease backlogs and work alongside the CHC team in partnership is an option for ICS teams to consider.
Ensuring patient centred care, with collaborative system working
D2A works best when all parties involved are aligned to a common goal – ensuring patient-centred care. Working collaboratively towards this goal also benefits the teams and personnel involved, by sharing responsibility, risks and skills across the partners to find innovative and creative solutions that deliver safe, effective care and support.
To work well, this requires the involvement of many teams and providers, across both health and social care, but when managed effectively, it frees up beds, reduces length of stay and provides the potential capacity for hospitals to focus on driving down their huge treatment waiting lists.
And finally, understanding the place
Groundwork should be done to create a shared understanding of the place where the ICS sits. This may require consideration of local health and care providers, community provision, culture, accessibility, and funding arrangements.
Ensuring that D2A assessors have access to this knowledge will help to ensure that the correct decisions are made for patients. To overcome the challenge of keeping this knowledge up to date and ensuring it is made available to those who may need it, ICS leaders should look to make initial location data and reporting open to D2A teams to use.
That does suggest that drawing the system’s most experienced nurses into the D2A process is a wise move; and one which supports why CHC teams are so actively involved now.
Reaching a balance
As shown, achieving a balance for D2A will be a challenge for an ICS, albeit one with a considerable advantage. Where delivered effectively, the system can benefit from shorter hospital stays, more aligned community care, and better outcomes for patients. In those advantages, a strong argument for focusing on better use of Discharge to Assess can easily be found. There are just those ‘unintended consequences’ to manage out.
To speak to Liaison Care about options for partnered working to support CHC and D2A teams, please get in touch at info@liaisongroupold.com
Process successfully refined for Postponed VAT Accounting in EU Imports
The end of the Brexit transitional period on 31 December 2020 brought to an end previous VAT accounting practices relating to EU cross-border trade in goods.
Since 1 January 2021, imports from the EU have been treated in the same way as goods arriving from any other country. Import VAT, duty and procedures are complex, and those procedures are administered separately within HMRC and subject to different compliance requirements.
The transitional process has so far seen several stumbling blocks, particularly in relation to Postponed VAT Accounting (PVA). However, the process for this has now been refined and we have seen it work successfully for NHS bodies that undertake importing from the EU. We previously detailed the process of PVA, which you can find here.
In practise, there have been issues where clear instruction has not given to any intermediary being used to import goods on behalf of the NHS. The information requested varies between intermediaries and you should keep a written record of what is agreed and make sure this is communicated internally.
You will need to tell your intermediary how you want to account for import VAT so they can complete the customs declaration. This is very important as you cannot change how to account for import VAT on your customs declaration once it’s submitted.
One key element which has now helped the process is making sure the correct information is included on the declaration. For example, where using the CHIEF system to select to account for import VAT on your VAT Return using PVA you will need to enter ‘G’ as the method of payment in Box 47e along with the box 8 and 44 details.
It is essential that all departments in your organisation that are concerned with the import of goods are made aware of these new procedures, and this critical requirement to help move goods into the UK with minimal delays, whilst also ensuring that VAT is paid correctly.
You can find a full flow chart on the Government website to help guide you through the import process here. We have also summarised the key considerations specifically for NHS bodies which can act as a starting point for the process here:
The monthly postponed import VAT statement is divided into two parts and a summary of the contents of each page was published on the 24th September 2021: https://www.gov.uk/guidance/understanding-your-monthly-postponed-import-vat-statements
We regularly provide webinars to help guide you through VAT updates and changes, and you can find details of our upcoming sessions on our website.
If you have any concerns regarding these new procedures or would like more information, please contact your Liaison Financial VAT Advisor, or email us at info@liaisongroupold.com
Have you caught up with In Conversation With yet?
We work best when we work together. And with Liaison Workforce’s In Conversation With series, we aim to support collaborative working by sharing ideas and giving a platform to specialist insight to help advance the NHS.
So far throughout 2021, we have hosted a number of online conversations on a diverse range of topics, including:
- Remote working, with Dean Royles
- Growth and personal development, with Nicky Ingham
- The role of data and informaticians, with Patrick Mitchell
- Long-term thinking, with Peter Cheese
- A People Plan review, with Eve Russell
- System working and collaboration, with Darryn Allcorn
- Leadership, with Stephen Moir
Click here to catch up on any of these conversations, or to have your own, please get in touch at inconversationwith@liaisongroupold.com.
News & Views
A brief round-up of recent articles, guides and blog posts covering news and views on ICSs from healthcare experts…
- Andy Williams, Interim Chief Digital and Information Officer of Humber, Coast and Vale Health and Care Partnership, has published a new blog post asking whether an ICS Digital Strategy be greater than the sum of its parts. Read more.
- NHS Confederation’s latest report – Integration in action: tackling the elective backlog – contains early examples of how local systems are addressing the elective recovery challenge. Read more.
- The HSJ reports that five ICSs have missed a ‘key’ national target to improve NHS staff’s access to patient data. Read more.
- The HFMA’s briefing – The future financial sustainability of health and social care – considers whether the Health & Social Care Bill enables the change that the health and social care system needs, both in the short term as the country seeks to recover from the pandemic and in the longer term as the sector more fully addresses population health and wellbeing. Read more.