The NHS is facing the biggest battle in its nearly 75-year history. Staff vacancies have hit a record high of 133,000, a figure that represents 10% of its total workforce. Data from NHS Digital shows that 15,000 nurses resigned from the health service in the year to March 2022, with 4,000 citing work-life balance as their reason for leaving. It’s not just nurses quitting. In England last year, 3,229 doctors resigned from the NHS, with 341 citing burnout.
Patients are suffering as demand for NHS services outstrips supply. The number of people waiting for treatment stands at 7.21 million. Three million of those patients have been waiting over 18 weeks and 379,245 have been waiting over a year. This isn’t a new issue, either. Staffing issues meant there were 4.4 million people on waiting lists in early 2020, before Covid arrived in the UK and resulted in the cancellation of 2.4 million operations.
Patients are turning to private healthcare to jump the queue. More than 250,000 people paid for private treatment last year – 29% more than in 2019 – and that figure excludes those who already have private insurance. This has relieved some of the NHS’s backlog but worsened its recruitment problem. The NHS and private sector both recruit from the same pool of talent, meaning there is fierce competition to attract and retain the best staff. In March, it was reported that private healthcare companies were offering NHS doctors bonuses of up to £5,000 to recruit colleagues for commercial healthcare providers.
Healthcare staff who work in the private sector are typically paid significantly more than NHS workers. Between August and October last year, private pay increased by an average of 6.9%. In contrast, public pay rose by an average of just 2.7% at a time when inflation is at 10%. The NHS also can’t compete with more manageable workloads and better work-life balance offered by private healthcare providers. So, what can it do to improve the employee experience, win the war for talent and give patients a world-class service?
Cloud-based software giant Salesforce built several digital tools for the NHS to tackle the Covid-19 crisis. Now, the company believes it can help the world’s fifth-largest employer to modernise and boost its recruitment by transforming how it collects and harnesses data. “We want to develop state-of-the-art digital communications for the NHS,” says Salesforce’s chief health officer, Simon Eccles, who was previously chief clinical information officer at the NHS. “That includes communicating with patients about their clinical journey and with staff about their working environment, conditions, pay and job applications.”
Salesforce’s customer relationship management (CRM) software has transformed the way businesses across every industry communicate with their customers and staff by collecting and analysing data to create streamlined, personalised and automated processes that save time and money and generate income. Eccles believes an NHS-specific CRM could optimise its recruitment. The UK government wants to recruit 50,000 more nurses by 2024/25 and rapidly increase the pace of recruitment across all roles and professions – but its current system isn’t working. “We need to make it much easier for people to apply for roles in the NHS,” says Eccles. “The NHS needs a tool that can automate the process as much as possible and remember if you’ve applied for another NHS role previously. At the moment, there are too many steps and communication is poor during the application process, which is hampering recruitment.”
Bureaucracy is also a hindrance for staff once they’ve been hired. Doctors and nurses who are embarking on their first roles in the NHS are often on rotation, meaning they change departments or hospitals on a frequent basis. “There is a huge slew of paperwork for doctors and nurses to complete,” Eccles explains. “If they get this wrong, they face not being paid correctly or having their annual leave recorded properly. The last thing a doctor or nurse needs after a 12-hour shift is to spend hours on the phone querying a mistake with their pay.”
Salesforce believes the solution could be a personalised dashboard with a simple interface that records the individual records of every employee. This would include qualifications, career records and references to reduce paperwork and ensure staff can apply for new roles at speed. The same dashboard would also give staff visibility of their weekly and monthly rota. Displays would be individual to each employee, making it easier for management to optimise workforce planning. “We can build simple tools to ensure clinical safety in the workplace,” says Eccles. “These would make it easy to view staff availability and plot the right mix of staff with the right mix of skills each shift – we don’t do that at present.”
The NHS needs to get much better at understanding an individuals’ communication preferences
During the pandemic, Eccles says the NHS underwent “between five and 10 years’ worth of digital transformation” to implement remote working solutions for staff and to enable patients to access consultations online. But it still lags behind businesses in other sectors, which have a granular understanding of how to communicate with different types of customers thanks to their use of data-rich CRM tools. “The NHS needs to get much better at understanding an individuals’ communication preferences,” says Eccles. “But digital communication isn’t the answer to everything – roughly 20% of the UK population doesn’t own a smartphone – so we need to work out what different demographics want at different stages of the patient journey.”
Preferences could include simple options such as receiving appointment invitations or confirmation via phone, letter, email, text message or via an app. Automated translation tools could also provide clearer communication with patients with limited English language skills. Salesforce’s CRM software would enable the NHS to store people’s preferences in one place and communicate appointments via patients’ preferred methods automatically, rather than offering millions of people a blanket solution that doesn’t fit their needs.
Understanding and recording patients’ preferred mode of treatment is also key to optimising patient care. In London, the majority of new sexual health infections are now diagnosed online. Remote solutions are also the preferred option for early mental health support, where people often feel more comfortable discussing issues from home. Offering a mix of in-person and remote solutions is another opportunity to enhance NHS services. Virtual fracture clinics offer a convenient alternative for patients who have attended hospital with a bone, joint or muscle injury and struggle to attend follow-up appointments around work or childcare.
At the same time, the NHS must also upgrade its traditional communication methods. “Ringing up an NHS switchboard to change the time of an appointment, find out test results or even contact another department as a member of staff can be a long process,” says Eccles. Salesforce works closely with businesses to deliver CRM solutions that underpin call centres. By helping to reduce the number of people who need to pick up the phone, minimise call times for those that do and improve the number of times people find out the answers they need when calling, patient satisfaction can be significantly improved.
The NHS has much work to do to improve employee and patient engagement and provide a level of service that can compete with the private sector and attract and retain the best staff in the long term. But CRM software provides an opportunity to transform the NHS into a modern and personalised service. One capable of delivering world-class health interventions that boost the population’s health, save lives and secure the future of public healthcare.
Lessons from New Zealand’s digital healthcare revolution
New Zealand’s healthcare system has used cloud CRM software to transform the way it manages the health of its population at scale
Weeks before the first cases of Covid-19 arrived on the shores of New Zealand in February 2020, the country’s healthcare system began a rapid digital transformation that has boosted citizen engagement and productivity, and generated cost savings. Its investment in digital solutions could now provide a template for the modernisation of the NHS.
New Zealand’s Ministry of Health initially developed a bowel screening system on the Salesforce CRM platform as part of its National Bowel Screening Programme. It enabled patients to sign up to receive a test in the post using an online portal built on Experience Cloud, where they entered their personal details and relevant health history.
This data, along with their test results, was then stored on an individual profile on an online community portal called Service Cloud. This portal enabled the ministry to follow up on cases, share results, and invite patients in for additional screening services like a colonoscopy via a simple app.
This workflow provided a template for the country’s Covid-19 contact tracing system, which was built on the same platform. The first version went live in just 10 days and provided the government, healthcare staff and patients with the tools to communicate and keep the spread of the virus under control, while ensuring data security. “We worked with our regional partners, co-designing a system that not only met the changing needs of frontline staff, but also included the type of security controls that are required of a national programme that is dealing with personal data,” said Michael Dreyer, group manager, national digital services, Ministry of Health.
The results were staggering. In August 2020, the New England Journal of Medicine (along with numerous other publications) highlighted New Zealand as the premier example of how to eliminate Covid-19 transmission after the country reached a zero case count while the rest of the world was wrestling with wave after wave of cases. The system that was put in place put the patient and provider at the centre, moving the needle in vaccine uptake and proving that when citizens have a degree of control and involvement participation goes up.
The success provided the evidence and incentive to modernise the rest of New Zealand’s healthcare system. “The pandemic created heightened expectations amongst citizens and staff of what healthcare should look like, because there was now an app for Covid symptoms and later vaccinations,” says Louise Ashbrook, vice-president of public sector health at Salesforce. “People involved in managing the outbreak wanted streamlined workflows, and patients expected personalised, engaging experiences.”
Since then, additional programmes have been built on Salesforce to manage the health of New Zealand’s population. These include the Aotearoa Immunisations Register, a Communicable Disease Management Platform, a system to manage adverse effects of medicines, and a system for managing health sector agreements and payments.
This personalised approach could now be adopted by the NHS. “The needs of people living in London, which is well served in terms of healthcare services, are very different to people living in rural areas,” Ashbrook explains. “We need data to build a picture of what those needs are, so we can communicate with patients and deliver services more effectively. This could mean booking appointments via an app rather than letters, or offering virtual care rather than hospital appointments.”
Doctors could also be relieved of unnecessary paperwork if patient data is collected once and stored in a singular system to avoid patients being asked for the same information, which eats into appointment slots. NHS backlogs may be slashed with the help of CRM software. Almost a million women in the UK missed mammogram appointments because of the pandemic, but keeping a register of those who are available to come in at short notice and take up unused slots could accelerate this clear-up.
This vision of a modernised NHS could soon become a reality. “We’re really keen to show the healthcare sector what’s possible and the timeframes,” says Ashbrook. “A lot of the software systems that the NHS may need have already been pre-built, so we’re able to configure them for the needs of the NHS and get them live really quickly.” If they can, then NHS staff and patients can look forward to a healthier future.
Find out more at salesforce.com/uk/public-health
