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  • 26th May 2023

What might NHS Trusts and other healthcare providers do next?

The final part of our series on how the role of behavioural insights in reducing backlog in the UK's National Health Service


This week, we have shared our thoughts on how behavioural insights might be applied to the elective care backlog, tackling current demand as efficiently as possible, and reducing future short and long term demand.

Today, we’re wrapping up with some final recommendations for NHS Trusts and other healthcare providers, and inviting you to get in touch.

Behavioural science interventions are low cost and quick-to-implement ways cut NHS backlog

There is now a large body of evidence which finds that interventions informed by behavioural science have been successful at improving healthcare delivery. A recent US meta-analysis of behavioural interventions applied across a range of policy areas (including health) found that the average impact of a behavioural intervention is 8%.

This impact size is not huge (although can be increased by combining interventions) – behavioural science will not resolve the backlog entirely. However, given the extent of the backlog, we suggest that every opportunity should be taken to help reduce it, and behavioural science interventions provide a low cost and quick-to-implement way of doing so. 

Some of the suggestions made above require developing and testing interventions in new clinical contexts (eg interventions to change more complex processes such as optimising complex pathways, or to reduce unnecessary referrals, appointments, and investigations) and therefore would take slightly longer to implement at scale. However, for the reasons provided above, these suggestions are still worth pursuing.

The majority of the suggestions above can be actioned and start delivering results now. BIT recommends prioritising these actions as follows:

1. Scale past interventions with proven impact

Where interventions have already been proven to work, the immediate priority should be to scale them up. The most promising examples include:

  • Introduction or updating of reminder text messages to reduce missed appointments
  • Updating letters to increase breast cancer screening
  • Updating text messages to increase cervical cancer screening

A behavioural insights approach could also be used to share insights about what has worked, facilitate uptake of good practice and encourage scaling of successful interventions across trusts.

2. Adapt past interventions with proven impact to optimise them for use in the local/clinical context in question

Some past interventions have been beneficial and would just need tailoring to the local or clinical context. Evaluation of the adapted interventions in the new context would then be important. For example:

  • Using timely prompts to spread demand
  • Providing information to improve patient self-care and management
  • Text messages to support patients while they wait (and potentially also improve clinical outcomes)

3. Increase uptake of safe, tested, and approved innovation 

Behavioural and graphical tools have been seen to encourage uptake of innovation in healthcare professionals in an online environment. These tools could be tested in the real world, and applied to encouraging uptake of health technology, such as tools which can help a clinician decide when to refer or when patient follow-up is required. 

NHS England’s plan for tackling the elective backlog also recommends “using every pound carefully”. While the above recommendations have the potential to deliver both efficiency and cost savings, behavioural insights could also deliver cost savings in other aspects of NHS functioning.

For example, in a trial conducted with the Health Foundation using BIT’s online experimentation platform Predictiv, BIT found that behaviourally-informed changes to an NHS procurement platform reduced the chance of overspend by 94% compared to the existing platform. If these changes have the same impact in the real world, BIT calculated they would save the NHS £15 million for every £1 billion spent on procurement.

Finally, it is worth noting that the suggestions made in this series of blogs relate to reducing demand placed on the NHS: tackling current demand as efficiently as possible, and reducing future avoidable demand in the short and longer-term.

However, demand goes hand in hand with two other things: supply and need. NHS England’s plans to increase health service capacity will provide support on the supply side, but it would also be interesting to explore the question of need.

For example, while waiting for care, some patients’ symptoms may have resolved or they may have sought treatment privately. Carefully reviewing who still needs treatment in the backlog might also be a quick way to cut waiting lists and ensure that only those who need care are offered appointments. 

The Behavioural Insights Team provides organisations with support applying behavioural insights to their local challenges. In the past, support provided by BIT has ranged from light-touch advisory support to leading full-scale randomised controlled trials. If you would like to discuss anything in this series of blogs in more detail or if you would like to explore how BIT might be able to support you to apply behavioural insights to start reducing your healthcare backlog, please get in touch: alix.brazier@bi.team.

We look forward to hearing from you!

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