Swipe Right?

The Christie Hospital in Manchester, England is trialing an app intended to streamline its temporary staffing requirements in a modern, flexible and cost-effective manner. If successful, it could be rolled out more widely across the National Health Service (NHS) in England and Wales.

The app, Circular Wave, consists of a real-time platform for direct engagement between health care staff and NHS organizations in the area. As explained by the makers of the app in a recent interview, "[a] doctor using Circular Wave receives a notification about a job and can say yes or no. It is very streamlined - like Tinder they can swipe to accept or reject to job. The hospital can then book them."

The app has appeared at a time when the government is facing mounting pressure to address NHS costs and efficiencies, including those associated with recruiting temporary healthcare staff. A government report published in June 2015 sets out a blueprint for how implementation of efficiency and productivity changes could save the NHS £5 billion each year by 2020. The app, which acts as a "digital handshake," is intended to disrupt and exclude the middleman markets of agencies. So-called "rip-off agencies," which deliver healthcare staff who are engaged contractually on a temporary basis, are increasingly being scrutinized in light of tight controls over NHS spending and efficiency drives imposed during 2015. Following a consultation conducted by Monitor (the NHS regulator established under the Health and Social Care Act 2012) and NHS Trust Development Authority (TDA), bodies which have since merged and rebranded as "NHS Improvement," the government introduced rules in November 2015 to cap the hourly rates that NHS organizations pay for agency workers.

However, Circular Wave argues that the government's hourly rates cap is not in itself enough to halt the NHS's escalating staffing spend. According to the two founders of the company, the government's caps (i) negatively interfere in a free market economy, (ii) ignore the fact that most agency workers have permanent jobs and use the income from agency jobs to "top up" their permanent NHS salaries, meaning that it may be difficult to find staff to fill the temporary shifts now that the rates for doing so have become less lucrative, and (iii) incorporate a "break glass" mechanism (allowing NHS hospitals to exceed the per-hour capped rates on "exceptional safety grounds" which is likely to become the norm rather than the exception.

Rather than charge a commission like agencies do, Circular Wave propose to charge NHS organizations a monthly fee for use of the app, priced on a sliding scale up to a maximum of £10,000 per month. If Circular Wave's initiative is adopted more widely within the NHS, it will be interesting to observe how these monthly fees correlate to (presumably lower) spending on agency fees, in the context of overall NHS spending. Compared to commission-based spending, the "monthly fee" approach may also prove more transparent, thereby facilitating monitoring and efficient planning of NHS expenditure on temporary staff.

Looking beyond pure financials, the app represents a welcome initiative to incorporate modern technology within the NHS, an organization not typically hailed for showcasing technology-savvy systems. Earlier this month, the government announced that it would be investing £4bn in NHS information technology. In this context, apps like Circular Wave—which appear to provide easier communication methods for filling NHS shifts more quickly—may be just what the government is looking for.