For HTN by Darren Atkins, Chief Technology Officer (Artificial Intelligence and Automation), East Suffolk and North Essex NHS Foundation Trust (ESNEFT)
As the NHS continues to struggle under the weight of increasing demand, reduced budgets and crippling skills shortages, senior stakeholders continue to search for innovative ways to create efficiencies whilst also driving enhanced patient care. For many years now, there has been a strong focus on digitisation as a way to achieve more with less across the national health service. However, whilst there have been some good examples where technology has succeeded in streamlining processes and improving patient care, much of the narrative around IT in the NHS to date has been of wasted opportunities and wasted money.
However, I strongly believe that the emergence of AI and Intelligent Automation is set to change all of that over the next five years. Huge advances in these technologies means that they now offer NHS Trusts, and the NHS itself at a national level, a golden opportunity to transform services, drive improvements in care and ensure a more stable and sustainable future. Indeed, The Institute of Public Policy Research (IPPR) estimates that automation could save the NHS £12.5bn per year.
Intelligent Automation is the present, not the future
Unfortunately, within much of the NHS there is still a feeling that AI and automation is ‘futuristic’, something that will make a difference in ten or twenty years. This is largely driven by media reports which focus on the truly remarkable prototypes of robots and AI being used in frontline clinical care. Without doubt, this is genuinely awe-inspiring, but it also takes the focus away from the real benefits that Intelligent Automation could and should be delivering to NHS Trusts and their staff today.
In a nutshell, Intelligent Automation (where AI is integrated alongside Robotic Process Automation technology) can deliver cost savings, improved access, enhanced patient care and free up capacity for over-stretched frontline staff. It smashes the established ‘Iron Triangle’ in healthcare, where access and effectiveness can only be improved through increased spending. And unlike other industries, where there are (often misplaced) fears that AI will lead to mass job displacement, in health and social care, Intelligent Automation will only ever complement human skills and talents, by reducing the burden of repetitive and administrative tasks and freeing up of staff to spend more time on direct clinical care with patients.
Intelligent Automation in action
At ESNEFT, we’ve embarked on a groundbreaking Intelligent Automation programme over the past year, working with Thoughtonomy, to streamline a number of processes to free up time for our staff to focus on delivering excellent patient care, rather than on repetitive administrative tasks. And already we’ve seen how this technology can deliver game-changing results.
For instance, we’ve deployed digital labor to streamline GP referral processes. Every week our Trust receives up to 2,000 requests for consultations with clinicians through the National GP e-referrals process. Previously, disparate documents and patient data were downloaded manually from several systems before being recompiled into a new file, uploaded and sent to a consultant for review. It was a repetitive, time-consuming and morale-sapping task for our medical secretaries, and it took them away from looking after our patients.
By automating much of this process, the Trust saw almost immediate results in terms of operational and financial efficiencies. Within the first three months, more than 500 hours of medical secretaries’ time was redirected to direct patient contact; referral processing time was cut from 25 minutes to five minutes (and was carried out 24/7); and cost savings of £220,000 were achieved. The feedback from medical secretaries has been overhwlemingly positive.
Similarly, another automation is aimed at reducing the rate of missed appointments (DNA – Did not Attend) at Colchester Hospital (part of ESNEFT). This is important to eliminate the time and financial costs of missed appointments, but also to ensure more patients can be seen by clinical staff each week and improve patient care altogether.
Virtual workers are now being used to cancel appointments automatically in the hospital’s patient records system – all outpatients are sent a text in advance of their appointment which gives them the option to cancel simply by responding with a quick text message. The virtual worker is notified of any cancellation request by the Trust’s text reminder service and can then search for the patient and appointment – just like a human would – and notify the relevant clinic at Colchester Hospital. The free appointment can then immediately be reallocated to another patient.
In its first eight weeks, the DNA automation programme prevented 1,356 appointments from being missed, meaning Colchester hospital saved £216,960 from being wasted through missed appointments in that period alone, with projected savings for the first year of £1.5 million.
Just as importantly, this has freed up vital outpatient capacity for the booking team to actively manage so patients are now being seen more quickly by clinical staff, meaning better patient care, an instant improvement in clinical utilisation and reduced waiting times. The service is having a significant impact on the ESNEFT Patient Tracking list (PTL) performance and the Trust’s DNA rate.
Scaling across the NHS
The results are impressive at a Trust-level but when you begin to consider the potential impact of such programmes across the NHS as a whole, the numbers start to become eye watering. Take these DNA appointments.
Almost eight million hospital appointments were missed, or ‘Did Not Attend’ (DNA), in 2017/18, according to NHS England. That does not include appointments cancelled in advance by either the hospital or the patient. With each hospital outpatient appointment costing the NHS approximately £120, that equates to almost £1 billion worth of appointments which were missed in 12 months.
When you consider that this is just one single process in an NHS that comprises thousands of such processes, you begin to get a sense of the size of the opportunity that Intelligent Automation presents. With this in mind, we’re now working to establish a free NHS marketplace that will allow Trusts to collaborate together and repurpose automation work that has already been done. This will speed up the time of delivery for Trusts and reduce the overall deployment costs across the NHS.
Getting started with Intelligent Automation
From the conversations I’ve had with leaders within other NHS Trusts, there seems to be uncertainty about how to start off on the automation journey.
From my experience, there are three things to keep in mind:
- Start small and scale-up
The best way to get up and running with Intelligent Automation is to start with the easy wins. That means selecting a small number of processes that can easily be automated and focusing on those. This allows all stakeholders to learn and develop their skills and it also enables the automation team to prove value from the outset. Once the Trust has successfully automated its first processes and demonstrated time savings, efficiencies and enhanced patient care, it is then ready to scale up. - Build the right team
So much of the success we’ve had at ESNEFT has come about because we’ve put together a team with the right skills, ambition and commitment. We’ve recruited people into the team based on their mindset and vision, rather than their experience, and then provided them with the learning and support to upskill. This has been critical in shaping a team that is united in its determination to deliver results and make a real difference to the Trust, our frontline staff and our patients. - Establish a culture of automation
It’s easy to get focus solely on the technology when it comes to automation but it’s important to remember that success depends in large part on the willingness of operational staff to embrace automation and recognise the benefits it can deliver, not just to the Trust but to them as individuals – easing the burden of administrative tasks and freeing them up to focus on what they are best at – namely, delivering excellent patient care. By focusing on this, frontline staff will embrace change and become vociferous supporters of automation, identifying further processes for automation.
