Call for evidence outcome

Reducing bureaucracy in the health and social care system: background and questions

Updated 24 November 2020

Applies to England

Background

A lot of what we define as ‘bureaucracy’ is an essential part of any effective health and social care system. For instance, the recording, reporting and collection of information allows us to constantly improve the services and support we offer to our citizens. Regulations, coupled with assurance and accountability measures, have an important place in maintaining safe, high standards of care.

However, not all of this is efficient or effective. Previous government reviews have found that some bureaucracy has left health and social care staff, and local leaders, feeling over-burdened, disempowered and unable to deliver innovation and improvements on the ground.

Onerous clearance processes, duplicative information requests, unclear accountability structures ‒ all of these factors, and more, can generate excessive bureaucracy which takes our people away from their essential role of caring for citizens.

Why we’re doing this

Our ongoing response to coronavirus (COVID-19) has revealed where temporary changes to rules and regulations could be beneficial in the longer term as the health and care system has clearly demonstrated its ability to streamline processes to get the job done.

The Department of Health and Social Care (DHSC), together with its health and social care partners, is now reviewing how it can embed the positive changes that have occurred in recent months, as well as building on previous and current work to reduce bureaucracy and encourage innovation.

We’re already making progress. For instance:

• we consulted on reform of professional regulations in 2019
• DHSC is working with the British Medical Association and the Royal College of General Practitioners to review the levels and sources of bureaucracy in general practice
• NHS England and Improvement are restarting the Releasing Time To Care programme launched in the Interim People Plan

Who this is for

The views of the health and care workforce are critically important to this work. So, we’re now inviting all those currently working in health or social care, or those who have recently left, to share their insights and experiences of overly burdensome or dysfunctional bureaucracy in the health and social care system. This includes clinical and non-clinical roles.

This call for evidence is open to those who work in England only.

What we’ll do with the evidence

The responses to this call for evidence will be used alongside other sources such as meetings, interviews, research reports and academic literature, to:

• build an up-to-date picture of the most common bureaucratic burdens experienced by those providing care directly, as well as managerial and administrative staff in the NHS, public health and social care sectors
• inform action by government and relevant arm’s length bodies to change processes, rules and regulations, including through planned reform of professional regulation, where we have the existing powers to do so in the short-medium term

Maintaining safe and high-quality standards of care, as well as giving staff and patients the ability to speak up about poor care or safety issues, is paramount. This call for evidence will therefore not take forward submissions which would have a detrimental impact on patient care and safety.

Deadline for responses

The closing date for responses is 13 September 2020.

Questions

Answer the survey

About you

To evaluate responses fully, we need to ensure we reach a wide number of people from diverse backgrounds and experiences.

The following set of questions will help us better understand who is responding to this consultation and in what capacity.

1) What is your ethnicity? Choose one option that best describes your ethnic group or background

• white
• mixed/multiple ethnic groups
• Asian/British Asian
• black/African/Caribbean/black British
• other ethnic group

2) How would you describe your gender?

• male (including transgender men)
• female (including transgender women)
• prefer not to say
• other (please specify)

3) How long have you worked in the NHS, healthcare or social care sectors?

• 1 to 10 years
• 11 to 20 years
• 21 to 30 years
• over 30 years

4) Which of the following best describes your field? Please select one.

• administration
• adult social worker
• allied health professional
• ambulance service team
• care worker or personal assistant
• clinical manager
• clinical support staff, including healthcare assistant
• dental team
• doctor
• estates and facilities manager
• general manager
• health informatics
• healthcare sciences
• HR manager
• medical associate professional
• nursing or midwifery
• operational manager
• pharmacy
• psychological professions
• public health, including health visitor and occupational nurse
• other, please specify

5) Which of the following best describes where you work for the majority of your time?

• community care service
• home care service
• hospice
• hospital ‒ on wards
• hospital ‒ office based
• GP surgery
• residential care home
• school
• other community service
• other NHS or healthcare provider
• other social care
• other (please specify)

6) Please select from the list below the region covered by your current or most recent workplace. Please select all that apply.

• national coverage
• London
• south-east England
• south-west England
• north-west England
• north-east England
• West Midlands
• East Midlands
• east of England
• Yorkshire and the Humber
• other, please specify

7) We may wish to undertake a number of follow up conversations with participants to discuss their responses in more detail. Is this something you would be interested in taking part in?

In agreeing to take part, we would only contact you in relation to this work and would not share your details more widely.

• Yes, happy for DHSC or an external research contracted appointed by DHSC to re-contact me for a follow up conversation about this research.

• No, would not like to participate in further conversations at this time.

[For those who are happy for DHSC to contact them:]

8) Thank you for agreeing to a potential further discussion, please could you provide your contact details in the text box.

Your experience of bureaucracy

For the following questions, please consider up to 3 examples of where you’re currently experiencing, or have recently experienced, unnecessary bureaucracy which you would like to change or remove.

Your example can cover something you’re asked to do or something you ask others to do.

By ‘unnecessary bureaucracy’ we mean tasks or processes which you think are duplicative or require a large amount of work but which appear to add little value.

This could include, for instance, having to fill in a very similar online form for multiple providers on different digital interfaces. It could also include a process or behaviour which hinders you from trying out new, innovative ways of working which would could have a positive impact on patient safety, quality of care or patient experience. For instance, burdensome clearance processes across numerous teams or organisations.

We would like you to focus on examples that have a significant impact on your day-to-day job in terms of time or cost.

You can give up to 3 examples of unnecessary bureaucracy.

1) Thinking about a particular example, which of the following best describes the unnecessary bureaucracy? Please select the most relevant option for example 1.

• ad hoc request
• data request from another organisations or central government
• inspection
• interagency transfer of information
• performance management of clinical staff (including yourself)
• patient or client record management
• performance assessment or review
• planning
• recurring or routine report
• other, please specify
• don’t know/can’t say

2) Which of the below best describes why you feel this is an example of unnecessary bureaucracy? Please select all that apply.

• it takes unnecessary time away from patient care
• it takes too much effort or too much time, for example through poor technology
• it duplicates existing requests from my own organisation or other external organisations
• it takes too long to receive approval or validation
• it’s asked too many times (the volume is unnecessary)
• it seemingly does not add value or result in visible action
• I don’t know how the information is used
• the request changes format regularly
• it does not allow me to try new or different ways of working
• don’t know/can’t say
• other, please specify

3) Please provide more detail about your example, including a brief description of what the task or process entails and its intended purpose.

4) Still thinking about your example, to the best of your knowledge, which organisation is responsible for generating the bureaucracy? Please select all that apply.

• Department of Health and Social Care
• Care Quality Commission
• Clinical Commissioning Group
• Healthcare Safety Investigation Branch
• Health Education England, central
• Health Education England, regional
• NHS Digital
• NHS England and NHS Improvement, regional
• NHS England, central
• NHS Improvement, central
• NHS Resolution
• local authority
• my employer
• professional regulators
• Public Health England
• Skills for Care
• other organisation (please specify)
• don’t know
• not applicable

5) If you could, what would you change about the task or process in your example to ensure it adds value to your work or is made more efficient? This could include getting rid of it; if so, please give your assessment of the impact on patient care, safety or experience, if any.

• align timeframes for requests across different organisations
• increase data sharing across organisations
• reduce clearance processes
• digitise the task or process
• make the task or process less frequent
• transfer task or process to another organisation
• get rid of it completely
• other (please specify)

If you think this would have an impact on patient care, safety or experience, please note it below.

6) Would you like to give another example?

• Yes
• No

7) Do you have any other reflections on reducing unnecessary bureaucracy that have not already been covered by this survey?