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.
… how speech recognition can enhance pathology and the wider patient journey
Pathology as a critical department on the path to diagnosis and treatment, has a vital role to play in simplifying and improving the patient journey – but with structured reporting, restrictive workflows, and legacy technology, unlocking mobility, efficiency and accuracy is a significant challenge.
Patient journeys across healthcare are, in some ways, unavoidably complex. Successful diagnosis and treatment require numerous departments to work together, sharing information and data, often under significant pressure and time constraints. Restrictive technology makes this task needlessly difficult for departments like pathology and, more importantly, it negatively impacts the patient experience and, ultimately, outcomes.
Like radiology, pathology must evolve to meet rising demand, considerable backlogs, and waiting lists that remain at record levels. Flexible, accurate speech recognition has the potential to deliver this evolution.
The challenges for pathology
The health of patients depends on a healthy, high-performing healthcare system. However, like radiology and many other departments, pathologists face considerable challenges in coping with the number of samples and analyses required to address NHS backlogs. These challenges are the main contributing factor to stress, burnout and poor work-life balance, more so than quantity of workload alone.
In August 2022, the number of people on NHS waiting lists reached 7 million. This landmark figure, in the height of summer, paints the picture of a difficult winter. For departments like pathology, it’s an issue that is perpetual.
In part, these difficulties are the product of high demand from patients and little to no transformation in how pathologists record and report on their work. Many departments are tied to deeply embedded, often antiquated workflows. With a need for structured reporting and a lot of complex detail, changing these workflows is seen as a significant risk.
At the same time, the pressure to change is immense. In 2015, the National Advisory Group on Health Information Technology in England found that pathology was key to diagnostic support outcomes and should be at the forefront of NHS digitisation. Since then, funding for AI and digital pathology services has been forthcoming and the NHS has begun to introduce new information standards for pathologist reporting.
However, transforming pathology and improving the patient journey also means rethinking how pathologists work day-to-day.
Investing in core clinical workflows and pathology efficiency
Unlike radiology, pathology is not traditionally an early adopter of new technology. Many pathologists find themselves using outdated, legacy systems every day as part of their routine. It’s in these ever-present, often limiting systems that Trusts can achieve the biggest return on investment.
Technology like voice-AI powered speech recognition allowing all too needed handsfree dictation now help to accelerate the pathology reporting workflow directly into the LIMS, enhancing and making them significantly easier for pathologists. Standalone or integrated into an EPR, EMR or LIMS, intuitive and contextual speech recognition gives pathologists a more efficient way to work, creating measurable time savings and improved reporting speed.
Ultimately, this influences the patient journey, waiting lists, and outcomes. Speech recognition enables a faster, more agile department, delivering a quick return on investment that empowers the radiologists and pathologists, to support the Trusts and patients alike.
At the same time, closer integration across pathology and radiology is a necessity. A study published in BMC Medicine identified this opportunity to bring diagnostic reporting systems together, improving clinical efficiency, research, innovation and, ultimately, patient care.
How Augnito is transforming pathology and patient care
Pathology is chronically underfunded and dependant on legacy technology, often unseen in depths of a hospital campus. Across complex workflows from macroscopic and microscopic analyses to final diagnosis, pathologists need best-in-class, hands-free technology to stay on top of rising workloads and play their important role in the patient journey.
Cloud-hosted
Augnito is a cloud-hosted, AI-powered speech recognition solution, that can now enable pathologists to create those structured reports using their voice to describe the biological make up and structure in precise detail. This provides seamless follow-on specialities with an easy, fast way to decipher the diagnostic next steps. Crucially, it’s the innovative and disruptive technology solution built in partnership with healthcare professionals, accounting for the reporting language specifics and complexity of every department across the patient journey.
Accuracy
Augnito delivers beyond 99% accuracy on any device, in any accent, with no need for voice profile training or a long onboarding process. The solution also includes a specific histopathology language modelling, capable of handling the complex detail and unique terms of pathology.
Mobility
It fits effortlessly into pathology workflows, any new technology especially when it needs to be completely mobile. Augnito is available on any device, anytime, anywhere, wherever and whenever it is needed.
Integration
Augnito includes a flexible API & SDK, “Augnito Voice Services”. This can be used to integrate the best-in-class medical speech recognition with the LIMS, enabling pathologists to work better, more accurately, more efficiently, and crucially within the existing workflow structure.
Flexibility
Finally, a cloud-hosted speech recognition like Augnito is available quickly with no complex changes to infrastructure. Departments can start using Augnito on any scale, especially where budgets are strained. By delivering measurable improvements to pathology workflows in days, not months, Augnito delivers a fast return on investment and soon pays for itself many times over.
Challenge Augnito – try it. Partner with Augnito
Try the Augnito App or request an evaluation version. Challenge it with the longest most complex medical terminology in a noisy environment and let us know what you think! Talk to us about reselling Augnito, or about its easy integration capabilities. Talk to the growing UK list of Augnito Partners to find out how their customers successfully transferred from legacy SR products to benefiting from this next-gen voice-AI driven speech recognition solution.
Technology has a vital role to play as the radiology profession continues to recover from the impact of the pandemic, workforce shortages, backlogs and changing ways of working. The cloud will be key in maximising productivity gains as radiologists and NHS Trusts look for more efficient ways of working.
For years, it’s been clear that radiology is a department in need of change. Long before the pandemic, the profession was notoriously understaffed, creating a steadily growing studies backlog, year after year. Meanwhile, it was becoming increasingly clear that legacy imaging systems, with their on-premise, hard to access data, would soon become untenable.
The events of 2020 changed life, work and healthcare on a global scale. Suddenly, the idea of radiologists working remotely, and in some cases from home, became a reality. Trends that were already in motion accelerated – and the backlogs grew even further out of control.
The spark of much needed modernisation was lit – and acceleration to digital transformation became a reality.
Modernising diagnostics throughout the NHS
In November 2021, the UK Government announced significant funding to modernise and digitise diagnostics. This was in addition to a Spending Review promise of £2.3 billion to transform diagnostic services across England.
The stated goal of this funding was clear: to increase efficiency by saving staff time, making data sharing easier, and speeding up patient treatment as a result.
In radiology specifically, this funding was pledged to be focused on sharing scans across settings, improving how scans are requested, and enabling radiologists to report on scans remotely.
How can these diverse targets be met in a way that helps government funding and taxpayer money go further? What kind of new technology can become the bedrock of transformation for radiology? Furthermore, how can this technology become a seamless part of the workflow, not just for radiologists, but also in how medical departments and disciplines interact?
Removing old processes and obstacles is only part of the answer. Using a solution that offers portability, connectivity and flexibility towards how radiologists now need to work in the post pandemic digital era provides a more holistic approach.
Improving the core workflow of radiologists
A key barrier to radiologist productivity is unwieldy and out of date software that makes reporting on images more obtuse and time consuming than it needs to be. Replacing such with an AI-driven speech recognition (SR) and voice transcription system is a powerful way to make day-to-day reporting more efficient, by:
- Enabling radiologists to easily dictate reports with extreme accurate results and little to no editing required
- Delivering an intuitive, easy to use interface for transcription
- Automating repetitive tasks through macros and auto-texts
As a simple replacement for manual transcription services, a voice-AI SR like Augnito creates considerable time savings for radiologists. As a result, they’re able to keep pace with a sizable workload – and reduce the backlogs created by the pandemic and working from home.
Taking speech recognition benefits everywhere
Crucially, Augnito was built in partnership with radiologists and around the clear, urgent need to make reporting more flexible, scalable and secure. The pandemic demonstrated that work from home was possible. But remote access is also a way for radiologists to work however and whenever they need to.
Augnito is a 100% cloud-hosted solution, available anywhere, bringing highly accurate speech recognition to smartphones, tablets and browser-based applications. With Augnito, radiologists can work securely from home – or anywhere else – while avoiding the need for complex and cumbersome locally installed applications, which often tie up IT resources.
At the same time, a cloud speech recognition solution helps Trusts use their funding effectively and achieve their digital transformation goals sooner and with greater ease. There’s no need for costly, complex changes to infrastructure, or ongoing maintenance and updates. A hosted solution is ready to use immediately, then backed by ongoing centralised management.
Speech recognition has helped radiologists work more efficiently for years. Now, cloud-hosted speech recognition empowers radiologists to work not just faster and more accurately, but with unlimited flexibility and peace of mind around security and compliance, including, GDPR and PID regulations. All while making change simple and risk-free for Trusts and healthcare providers, with a solution that can be securely provisioned in-line with a secure IT strategy.
Going beyond the radiology department
Radiologists themselves are at the core of how imaging and reporting is changing. But they also have an important role to play as part of a wider diagnostic process where information flows from GPs to radiologists and back again.
With this in mind, the connectivity and availability of radiology data is a fundamental requirement for digital transformation to be impactful – providing the holistic approach we touched on earlier.
Augnito can also be deeply integrated with other clinical and reporting technologies, using the Augnito API and SDK intergration tools.
Through integration, our industry leading SR engine can become an integral part of the entire healthcare clinical reporting path:
- Enabling GPs to report directly into their patient admin system in primary care
- Sending referral letters through to other specialised physicians/clinicians
- Working hand-in-hand with EMR/EPRs
- Returning patients and reports back to GPs and any follow-up community or mental health support
In many cases, we already have relationships with the leading providers to make Augnito integration faster and more straightforward. Similarly, we’ve built strong relationships across teleradiology, bolstering the ability to deliver SR to outsourced radiologists also helping to clear NHS backlogs.
In this way, Augnito isn’t just supporting radiologists individually – we are beginning to transform the entire field, as well as reaching out to the many other specialist professionals across healthcare.
A solution for every aspect of radiology reporting
Augnito is tailored to the challenges the profession is facing – and the big opportunities for change and improvement.
Accuracy is at the centre of what makes Augnito different. But it’s the quality of our solution and the sum of its many parts that makes it such a good fit for radiology’s continued transformation.
Augnito helps radiologists process their reporting more efficiently. It puts time savings in their hands, wherever they work – be it from hospitals or home. Augnito works out-of-the box with a range of intuitive apps and interfaces. It can also be deeply integrated with other clinical systems, extending the impact of its speech recognition benefits and empowering Trusts to save even more time and money. All from the same secure, cloud-based technology.