Much like the entire healthcare system, mental health services in the NHS and wider community are facing unprecedented pressure. Rising demand, increased awareness, and stretched budgets make diagnosing and treating mental health conditions a considerable challenge.
It’s an urgent issue that affects everyone. Last year, mental health patients in Accident & Emergency departments waited more than 5.4 million hours. Vulnerable groups like pregnant women aren’t receiving the care they need—not because of a lack of funding, but because of overwhelmed workforces and chronic understaffing. And those people who do receive treatment are significantly less likely to be satisfied with their experience than those with physical conditions.
Technology like AI and speech recognition has the potential to raise standards of mental health care. For example, recent studies show how speech recognition could be used to detect the signs of depression. However, despite recent advances in AI and natural language processing, there’s just no substitute for the distinct, empathetic role of a mental health professional (MHP).
Mental health specialists routinely go above and beyond to capture the often lengthy context around a patient’s condition. It’s a significant drain on already exhausted medical professionals and Allied Health Professionals (AHPs), not just during the day, but out of hours and during valuable home time. It’s here that technology can be most impactful, not replacing professionals, but enabling them to work more flexibly and focus on what matters most: their patients and their personal time.
A flashpoint for mental health care
The COVID-19 pandemic impacted mental health for the worse, with numerous sacrifices made to combat the virus and widespread uncertainty. Society as a whole saw a groundswell in dormant or entirely new mental health conditions. Mental health professionals were faced with even more work—only completed thanks to their commitment/passion for their work, and a great deal of time and effort.
This mental health crisis led to what former Health and Social Care Secretary Sajid Javid described as ‘a decade of change in just two years.’ This quote from a Mental Health Summit speech reflects both the rapid increase in mental health conditions—but also a rapid shift in priorities for the government.
Unfortunately, two years of rapid change can’t undo the damage of decades of underfunding. In January 2023, the UK government pledged £150 million to support urgent mental health care, but health and care providers are already dealing with chronic understaffing. Data from Mind shows that, as far back as 2013, four in ten mental health trusts had staffing levels below benchmarks. More recent reports from the British Medical Association show that the mental health workforce has had little growth in the decade since.
While more investment in mental health provision is welcome, it must be targeted appropriately—and applied consistently. Building highly qualified capacity takes time. Improving the mental health landscape will be a long, arduous process. Those patients suffering with mental health conditions can’t wait for Trusts to find, hire, and grow their resources and human expertise.
Investing in mental health professionals (MHPs)
Investment in patient-facing services will always be vital to transformation, but there’s also a significant opportunity to invest in the capacity that’s already there. This starts with understanding and supporting the overworked mental health teams on the frontlines of the patient experience.
Reported by the CQC, 45% of patients aren’t always given enough time to discuss their needs. This reflects a department under pressure—and that’s pressure that the right technology can alleviate.
The work of mental health professionals is notoriously complex. The role is wide and varied. And professionals need to be multiskilled in providing advice and counselling, behavioural management, and developing strategies for patients to manage their thoughts and emotions. Amid these considerable demands, unwieldy software and slow reporting processes negatively affect quality of care. This is a particularly big challenge in mental health, where collaboration across practitioners is so vital. In an effort to accurately capture the insights a colleague will need, it’s all too easy to overlook the needs of patients themselves.
How Augnito empowers mental health trusts
Developed in close partnership with medical professionals, Augnito delivers integrated, flexible speech recognition—and a more efficient, agile way of working. Mental health teams can switch to using Augnito’s designated mental health vocabulary, capturing all the vital clinical data naturally, descriptively, quickly, and accurately. This frees up time to focus on patients, not admin. More importantly, it reduces reporting that encroaches on home life—often the case at the end of the day when the MHP is finished.
Crucially, Augnito was built for the fast-moving, collaborative nature of healthcare. Patient notes can be captured on any device—Windows, MacOS, smartphone, or tablet—or directly in an existing clinical system. And a focus on security means information can be safely stored, fed into other systems, or securely shared with other teams across healthcare and social care as necessary.
Available in the cloud on a simple subscription basis, Augnito offers:
- Beyond 99% accuracy
- Support for any accent out-of-the-box
- No need for time-consuming voice training
- Faster reporting with average 5% efficiency gains
AI-powered speech recognition like Augnito won’t transform mental health provision itself. But it can transform how MHP’s work every day, enabling them to care for patients with more eye contact, more time to talk and listen, applying more attention to every step along the care journey to improved mental health.
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With the NHS under immense pressure, bed stocks are infamously limited. However, this pressure shows no signs of slowing – and the number of beds across the NHS shows no sign of growing in a way that’s substantially impactful. What other approaches can we take to address this major challenge and, crucially, how can technology help?
From healthcare professionals to the general public, most of us are intimately familiar with the continued lack of beds in our healthcare system. Even pre-pandemic, few health experts felt we were well equipped with beds and ample resources. Now, the BMA continue to stress the severity of this problem: data from December 2022 reports occupancy rates consistently exceeding safe levels and call capacity a ‘critical limiting factor’ for the NHS.
Beyond those early adopter areas like radiology and pathology, speech recognition technology has the potential to reduce costs across entire Trusts – potentially freeing up resources to invest in new ways to grow capacity and bring occupancy down to reasonable levels.
The impact of DTOC on bed capacity
Recently, in our previous blog post, we wrote about the significant challenge of Delayed Transfers of Care (DTOCs) – those periods when a patient is ready to be discharged from an acute care bed but remains in the bed regardless. Typical bottlenecks and obstacles to discharge/transfer include:
- Awaiting completion of assessment, including incomplete documentation
- Awaiting care packages
- Awaiting nursing home placement
- Awaiting community equipment and adaptations
- Awaiting further non-acute NHS care
- Awaiting care packages in own home
- Disputes and legal challenges
Across all these areas, faster documentation and reporting time can help keep people moving along the patient journey. If not, DTOC dramatically worsens the problem of poor bed stocks and low capacity.
Every day a patient stays in an acute care bed unnecessarily, beds remain unavailable to those who need them. While this is obviously a barrier to delivering timely, effective treatment and care, it also creates unnecessary cost.
The costs of a widespread bed shortage
Bed shortages, driven by needlessly extended hospital stays and DTOCs, lead to significant costs to the NHS. This is a wasted expense that does nothing to improve patient journeys, experiences, and outcomes.
In February 2020, DTOC metrics reported by the GSS show on average 5370 people were delayed per day. The actual cost of these delays is significant by any measure. According to Age UK, in 2019, the cost of a DTOC bed per day was £346. whereas Department of Health figures from 2017 put the cost at £400 per day. Even if we assume the NHS’ own £350/day cost was accurate in February 2020, this means that month’s cost for 155,700 days was over a staggering £54 million.
An effective, accurate speech recognition technology like Augnito can reduce this cost and deliver a considerable saving by enabling clinicians and healthcare professionals to work and report more efficiently, removing some of the above mentioned common obstacles to prompt discharge or transfer. And the cost of adopting Augnito is significantly less than the cost of adding and maintaining more beds.
Repurposing even just 5% of February 2020’s estimated DTOC cost into Augnito licences could empower tens of thousands of clinicians to work more efficiently, reduce reporting time, and focus their energy on patients. Even a seemingly small 1% efficiency gain could dramatically improve both staff workloads and, more importantly, patient journeys overall.
Addressing the consistent fall in NHS beds
Over the past three decades, the total number of NHS hospital beds in England has more than halved. In part, this reflects changes to the ways patients are treated and is a trend we can see reflected in other advanced healthcare systems. For example, an increase in day surgery and long-term policies to move patients into care in the community have partly driven this ongoing reduction in capacity.
Of course, we all know that demand hasn’t followed this proposed downward trajectory. While the number of beds may have decreased, the number of patients treated has continued to rise sharply. Today, the UK has fewer acute beds relative to its population than most other European countries.
Worse, the longer-term outlook is bleak. The Health Foundation’s REAL Centre analysed bed stocks against best-case demand and found a significant gap. According to the report, 35% more beds will be required by 2030 – even if NHS initiatives to reduce hospital stay durations succeed. Apply the estimated DTOC rates we’ve shown above and the cost skyrockets.
The impact of speech recognition on efficiency and cost
As the NHS has consistently found for more than three decades, expanding bed stocks isn’t a simple task. Capacity is a complex issue and, as demand continues to surge, occupancy rates of 99% and above aren’t likely to improve without significant change.
It’s not that technology like Augnito AI powered speech recognition can solve the DTOC challenge overnight. It’s that incremental improvements to the way healthcare professionals work, collaborate, and share information creates consistent improvements over time. Eliminating the slow reporting and typing into cumbersome, often outdated systems saves time, reduces costs, and enables budgets to be repurposed into wider, systemic changes.
Augnito is already used widely across healthcare, helping those in diagnostic and reporting roles capture clinical data quickly, securely, accurately, and more cost-effectively. Crucially, Augnito’s flexible licensing means it’s available to Trusts for a fraction of the cost of adding capacity or keeping patients in beds for longer than they need them.
For Trusts, this creates time and money savings with a compound effect. The ease of implementing Augnito across multiple individuals, departments and parts of the patient journey means even small efficiency gains for healthcare professionals create a significant, meaningful saving overall. The facts speak for themselves: the cost of a single extra bed per day is close to if not 10 times more than the cost of a single Augnito licence for a month.
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In a climate of continued and yet unprecedented pressure on the NHS, Delayed Transfer of Care (DTOC) is not just another step in the patient journey. It’s a crucial step on the path to positive care outcomes. Since 2014/15 the number and rate of delayed transfers has been consistently rising.
Today, nine years on, delayed transfers of care (DTOCs) contribute to intensifying backlogs, rising costs, and more distress for patients. Can technology built to make healthcare more efficient influence both the extent of DTOC incidents and Trusts’ ability to deal with them?
Shiraz Austin, Managing Director at Scribetech (UK) Ltd – UK distributor for Augnito solutions – takes a deep dive into this topic.
Over the past few years, the number of available beds within the NHS has continued to decline.
In December 2022, the average daily number of beds was just 136,508. This reflects a ratio of 2.4 beds per 1000 people in the UK population – significantly lower than countries like Austria (7.1 beds/1000 people) and Germany (7.8 beds/1000 people).
There are a range of systemic, complex issues that contribute to the UK’s lack of NHS beds. Initiatives like the Urgent and Emergency Care Plan promise to improve this situation, but this is a slow, ongoing process. The results may only be seen years into the future, leaving Trusts, CCGs and healthcare providers to instead pay attention to a metric that’s more meaningful in the short-term: Delayed Transfers of Care, or DTOCs.
The scale of the DTOC problem
DTOC describes patients who are clinically ready to be transferred or discharged from acute or non-acute care, but continue to occupy a bed. This can result in needlessly long hospital stays for individual patients, as well as delays for other patients who are waiting for a bed.
While Delayed Transfers of Care should be minimised through effective discharge planning and joint working between NHS and social services to ensure safe, person-centred transfers, unfortunately, for the past two decades, this planning process hasn’t been as effective as it could be.
We might assume that the NHS carries the majority share of responsibility for delays, however, social care carries its fair share too. The overall pattern of DTOCs is not uniform between the two organisations responsible for the delay. Percentage increases for patients delayed, per day over a 10-year period, have fluctuated between these organisations’ systems, showing patients either awaiting a social care package in their own home, or awaiting further non-acute NHS care as being the main reasons for the DTOC.
In 2017 the NHS DTOC goal was just 3.5%. The gap between this goal and reality is significant.
If we look at data between August 2010 and 2017, NHS delays increased 25%, while social care delays were up 130%. By December 2018, the number had decreased by over one third to 4,155 patients delayed on average per day. Since then, data for February 2020 shows that the number increased again by 29%, to an average of 5,370 patients delayed per day.
What does this mean in terms of days and cost? In February 2020, there were 155,700 delayed days across the NHS. While NHS England paused reporting DTOC data as the COVID-19 pandemic intensified, a common-sense approach tells us the number of delayed days is likely to have worsened over the past three years.
For patients, DTOC severely impacts the quality of care being delivered and creates difficult, often distressing patient journeys. For the NHS, DTOC creates added staff pressures, workload burdens and a significant, unnecessary cost.
The financial impact of DTOCs
Findings published by the Government Statistics Service (GSS) for February 2020 show the average number of people delayed per day that month in England was 5370. While some sources like Age UK estimated the NHS excess bed day rate at £346 in 2019, the Department of Health report average costs in 2017 of around £400 depending on treatment. Multiply the delays per day by the day rate and we have an estimated cost of DTOC of £2,148,000 per day for February 2020 alone.
Yearly figures seem to have stopped being used past 2016, when a report by the National Audit Office (NAO) showed delays in discharging older patients from hospital when they no longer need care was costing the NHS £820 million per year.
The complexities of calculating excess bed day rates and recorded bed stays have been compounded by treatment tariffs and care cost models that do nothing to reduce the financial burden that DTOCs clearly carry. They reflect a direct cost in the £millions to the NHS – for maintaining patients in beds when they are ready to be discharged, or transferred, to home care or social care. And let’s not discount the financial ripple effect that DTOC has throughout the whole healthcare process that is even more difficult to track: poor bed availability, high occupancy and growing waiting lists. All resulting in patients entering the NHS system later, when their conditions may be more acute and, ultimately, more costly to treat.
Throughout the COVID-19 pandemic, the UK Government looked to help tackle this issue through funding designed to financially assist discharges to social care. However, with this funding planned to end after March 2023, the NHS will need to look at new ways to maximise limited budgets.
How speech recognition can support DTOC improvement
Technology like clinical speech recognition (SR) has the capacity to increase productivity and streamline the creation of medical documentation for healthcare professionals, easing the burden of growing admin workloads with faster, more flexible and mobile ways of working. We believe it can also influence key metrics such as DTOCs – as well as create savings for NHS budgets.
Reducing internal delays to discharge or transfer
In part, DTOC is affected by internal delays – the technical and logistical barriers to getting patients discharged swiftly and effectively. The administration involved in discharging or transferring patients must be efficient and accurate if they are to be discharged on time.
Developed in partnership with medical professionals, Augnito delivers cloud-based, AI-powered speech recognition on any device or operating system. Augnito empowers clinicians to capture live clinical patient data easily and wherever they need to, with extreme accuracy and none of the delays of manual transcription or digital dictation.
Patient notes, referrals, follow-up letters and care package instructions can be ‘spoken’ directly into an electronic patient record (EPR), simplifying the patient discharge or transfer process. This not only saves valuable time and money for the NHS and social care system, but also helps reduce the patient journey and, ultimately, improve care outcomes.
Reducing external factors on DTOCs
Efforts to tackle the DTOC problem will need a whole system-wide approach addressing the consistent lack of capacity across all parts of the system.
As outlined earlier in this document, DTOCs are not exclusively an NHS problem. The data referenced in ‘The scale of the DTOC problem’ highlights that in many cases, patients are unable to be discharged due to a lack of onward care, including from space in care homes to funding for home care services. Many of these challenges are the result of a health and social care system that continues to be under significant pressure, as well as a longstanding lack of investment in important provisions like community nursing.
It’s in the DTOC that the impact of clinical SR technology, like Augnito, has the potential to be most transformative. Switching to Augnito and using streamlined, automated clinical workflows can create an efficiency gain of around 5% per day. This time saving has a very real financial impact. It can provide a reduction in document turnaround time, patient referral record keeping, and clinical documentation inaccuracies/errors – as part of the discharge process and the patient onward care journey. This could save the NHS hundreds of thousands of pounds per month.
Currently, these productivity bottlenecks are a wasted administrative cost, not influencing or improving the patient experience. Transforming efficiency is significantly more cost-effective than trying to grow bed stocks. With a new, more seamless way of working, savings can be focused on what matters most: replacing the soon to cease March 2023 Government funding, and reinvesting in patient care by improving healthcare provisions outside the hospital environment, raising the standards of community care, and ensuring every patient can be discharged effectively and at the right time for a better outcome.
In our next blog, we’ll discuss in more depth how the financial implications of DTOC extend across the whole of the health and social care system and how savings could be repurposed for medical efficiency gains and an improved continuum of care.
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– when they matter most
With growing waiting lists, strict government targets, and increased demand, everyone involved in diagnostics is under pressure to work faster. But efficiency and speed are also vital to improving the most important thing of all: patient outcomes.
In November 2022, NHS England announced a landmark move to speed up cancer diagnosis or all-clear for patients. For the first time, GPs across the country can access fast-track testing, with direct orders of CT scans, ultrasounds, and brain MRIs. Crucially, the availability of these tests extends to those patients whose symptoms fall outside the NICE guideline threshold for urgent referrals.
For patients, this reflects a continued effort from the NHS to accelerate pathways through the diagnosis to treatment. However, for already overloaded diagnostic teams, radiologists and pathologists, it heightens the need to transform – and accelerate – ways of working.
Early diagnosis creates better patient outcomes
According to Cancer Research UK, 4 in 10 cancer cases are diagnosed through an urgent suspected cancer referral. This creates a significant gap between the most urgent referrals and those patients with concerning symptoms who would experience a longer wait for screening.
Easier access to tests across the NHS is an important step towards better outcomes. But this also moves the potential bottleneck in diagnosis and treatment to radiologists and pathologists, now facing unprecedented demand.
More than ever, healthcare professionals need faster ways to report – without compromising accuracy and precision.
How speech recognition delivers speed, accuracy and quality
As an intuitive, natural way to create reports and transcribe information, speech recognition (SR) has the potential to dramatically accelerate how pathologists report. Compared to typing, speech is as much as five times faster.
At the same time, these speed and efficiency gains are only as meaningful as they are accurate. Increasingly, AI and machine learning mean SR can deliver accuracy beyond 99%, in any accent, with a language model developed for clinical terminology.
As a result, diagnostic teams can keep pace with the rest of the NHS as it continues its transformation to faster, more efficient and secure ways of working and delivering care.
How Augnito fast-tracks pathology workflows
The NHS is understandably focused on new ways to make frontline care and patient journeys faster. But these journeys are all interwoven – and ultimately limited – by the speed with which the departments involved in diagnosis can work.
Augnito was developed in partnership with healthcare professionals to make workflows faster and more flexible, while preserving accuracy and quality. With standalone applications or integrated into existing clinical systems, Augnito delivers the accuracy that patient outcomes depend on.
However, Augnito also empowers pathologists and radiologists to improve the way they work day-to-day. Creating reports is as easy as speaking, sharing information can be highly automated and secure, and our suite of platforms means professionals can report from anywhere.
It’s more than an alternative way to create the same reports. It’s a way to rethink how diagnosis works and dramatically improve patient care with a measurable impact on productivity and efficiency.
Finally, Augnito makes workflow transformation more available and accessible with a flexible, cost-effective approach to implementation and management. As a cloud-hosted technology, Augnito doesn’t require changes to infrastructure and IT. It’s easy to switch on and start using on any scale, with data security, compliance and management taken care of by our expert team.
Try a faster way of working
Augnito is already impacting the patient journey through our growing list of UK customers and partners. Request an evaluation version or try the Augnito app to see how you can start to benefit from faster reporting, efficient diagnostics and securely impacting the patient journey for a better continuum of care.