Automated triage and “bedside robots” are among technological innovations that could help address staffing shortages and free up nurses to spend more time with patients, according to a major review of health and social care.
In the final report from his independent review of health and care, commissioned by the Institute for Public Policy Research (IPPR) a decade after his seminal report for government, High Quality Care for All, Lord Ara Darzi sets out a bold vision for the future of services in England, including moving to free nursing and personal care at home and radical changes to the way services are structured.
Ensuring services are properly staffed is one of the key priorities in his 10-point reform plan amid “overwhelming” evidence that staffing shortages harm the quality of care.
However, the report also emphasises the need to make the most of new technology and artificial intelligence to fill gaps in staffing and boost efficiency.
“Given the scale of productivity savings required in health and care – and the shortage of frontline staff – automation presents a significant opportunity to improve both the efficiency and the quality of care in the NHS,” says the report.
Moving to “full automation” could reduce the burden of admin tasks “while freeing up time for clinical decision making and caring”, it suggests.
“It is possible to envisage a future of digital first triage of patients in fully automated assessment suites,” says the report. “For inpatients, ‘bedside robots’ may become a reality, assisting patients with meals, transportation and mobilisation.”
If the NHS truly realised the potential for automation this could lead to productivity gains of £12.5 billion per year, according to an analysis carried out as part of the review.
It could free up 29% of nurses’ and health visitors’ time - valued at £2.6 billion per year – and 11% of midwives’ time worth £80 million a year.
“Increased automation could free up 29% of registered nurses’ time worth nearly £400 million each year”
Meanwhile making the most of technology in social care would generate productivity gains worth a total of £6 billion annually, according to the analysis. Increased automation could free up 29% of registered nurses’ time worth nearly £400 million each year.
While technology would for the most part complement staff roles rather than replace them, the report suggests workers in jobs that are affected by automation should have the “right to be retrained and redeployed”.
When it came to ensuring there are enough key staff, Lord Darzi says the NHS should aim to be self-sufficient in the education and training of doctors, nurses and allied health professionals by 2030.
“Health and care providers should have the ability to recruit easily from abroad”
In the meantime health and care providers should have the ability to recruit easily from abroad backed by immigration policy that is “favourable to health and care staff”.
The government recently announced nurses and doctors would be excluded from a cap on the number of people who can be employed via the Tier 2 visa route.
Lord Darzi says senior care workers should also be exempt and added to the shortage occupation list.
In the event that the UK’s Brexit deal does not include EU free movement, he argues the government should agree an extended transition period to allow free movement of health workers for six years and free movement of social care workers for three years.
Meanwhile British citizenship should be offered to all EU citizens currently working in the NHS.
In order to boost recruitment and retention of nurses and other staff long-term, the review recommends NHS pay should stay in line with private sector wages.
The report also calls for a “bolder and more systematic approach” to addressing staffing shortages caused by “a failure to train and recruit enough people into the sector”.
“There have been some attempts to address this, with the creation of new roles such as physician associates and nurse associates, as well as policy pledges to increase the number of nurses and GPs in training,” said the report.
“The scale and breadth of the staffing gaps in the service needs a bolder and more systematic response”
“However, while these policies are welcome, they are only part of the solution. The scale and breadth of the staffing gaps in the service needs a bolder and more systematic response.”
It flags up what is described as a “growing consensus” that Health Education England (HEE) “does not have the ability or firepower to co-ordinate workforce planning efforts”.
Instead HEE should be merged into a new single body called NHS Headquarters that would also incorporate what is currently NHS England, NHS Improvement, Health Education England, and the core functions of Public Health England.
Under this new structure HEE would also be given a role in planning for social care too.
Work to tackle staffing shortages will “require significant investment in traditional roles such as doctors and nurses” but should also embrace new ways of working such as the nurse associate role.
”We must seize the opportunity of apprenticeships”
“There should be a focus on investing in the workforce outside of the acute sector which has been neglected in recent years. And we must seize the opportunity of apprenticeships,” says the report.
“Boosting the number of apprenticeships could both widen access to high quality careers in the NHS, and ensure the NHS has the skills it needs for the future.”
To help ensure this happens, Lord Darzi suggests changes to the apprenticeship levy that would allow trusts to boost pay for nursing apprentices.
“Going forward, apprenticeship levy funds raised within the NHS should be ring-fenced for the sector, with unspent levy funds available to re-invest in training in the NHS,” says the report.
“NHS trusts should be given flexibility to use levy funds to pay in a proportion of apprentice wage costs in key shortage areas, such as nursing, in order to boost apprenticeship recruitment. An apprenticeship pay rate – equivalent to at least the living wage – should be collectively agreed and included in agenda for change payscales.”
One of the biggest changes outlined in the review report is a move towards universal, free personal and nursing care for adults in England – along the same lines as the Scottish system – initially funded by increases in national insurance.
“GPs should be offered the chance of becoming NHS employees”
The review report also suggests all GPs should be offered the chance of becoming NHS employees for their core clinical services with additional funding to pay for practice nurses, clinical and admin support.
Meanwhile general practice, mental health and community services should have the option of joining together to form “integrated care trusts for all out-of-hospital care” with the benefit of “shifting power and funding away from the acute sector”.
The NHS Confederation, which represents organisations across the healthcare sector, said Lord Darzi was right to demand real change, especially when it came to social care.
“We are at a watershed moment for health and social care and it is important the next steps are the right ones,” said chief executive Niall Dickson.
“Lord Darzi is right to identify significant action is absolutely essential for social care. Similarly, we agree that systems need to be simplified, locally led and patient centred with care shifted away from hospitals and into the community.
“In particular there needs to be more investment in primary care. The new long-term funding deal announced by the Prime Minister simply will not work if we carry on doing the same things in the same ways.”