The hidden delays costing the NHS £1bn a year

“We have to get more out of the NHS for what we put in.” 

Thus spoke Wes Streeting in March this year. His words were a reference back to the NHS’ Ten-Year Health Plan, which is perhaps more focused on productivity than any other metric.

NHS trusts across the country have been tasked with reaching a productivity increase of 2% year-on-year. It has so far slightly overachieved this target, with an increase of 2.7% over the past year.

Unfortunately, the wider context for these figures is that productivity still hasn’t returned to pre-COVID levels, despite years of effort and billions in public funding. It is slow progress back to a level that it had reached almost half a decade ago.

What’s more, this inefficiency is systemic according to those on the inside. The NHS Staff Survey suggests that 44% of NHS workers don’t feel they have the equipment required to do their jobs, while studies from The King’s Fund have found that inadequate processes and unreliable technology are undermining practitioners.

In other words, it’s not a lack of investment or effort failing the NHS. It’s an institutional inability to enable healthcare workers to perform at their potential. The systems introduced to make this happen aren’t able to deliver on their promises or aren’t being leveraged in order to do so.

The NHS productivity gap

Thinking about what productivity means for the NHS, we come back to one measurement over and over again: time.

How long does it take to start work? To understand your tasks, to log into your workstation, to assess the information surrounding a patient? To log all of the data that these processes produce, and to feed it back into the trust in the right way?

These incremental delays can be just a few seconds, individually. But extrapolated across the health service as a whole, the data paints a bleak picture.

This year, Apogee made over 400 Freedom of Information requests to trusts across England, in an attempt to quantify these delays. The responses indicate that these delays account for approximately eight minutes of time per day, per staff member.

When you scale that across the health service, that’s the equivalent of thirty-five million patient hours per year. Cost-wise, that comes to over £1bn in lost productivity. 

We’re calling this the NHS productivity gap. It’s the difference between the technologies, processes, and systems introduced to the NHS, and the level at which they should empower the service to deliver.

The hidden cost of everyday delays

The productivity gap has three main focus areas.

The first is ‘start-of-shift friction’ — the time that practitioners lose just in getting themselves ready for the day. Between logging into devices, battling spotty connection, or simply waiting for inadequate hardware to power up, these issues are so common that time will vanish without the user even really being conscious of it. 

Beyond that, an incredible amount of time is lost to inefficient or inadequate data management. NHS trusts produce an incredible diversity and volume of data, with both digital and physical processes creating information in both realms. Protecting, organising, and rendering this data accessible to those who need it is a huge undertaking, and inevitably takes hours away from those who could otherwise deliver care.

Finally, there’s the bridging of the gap between practitioner and patient. Nearly thirty-eight million appointment communications were sent by post or hybrid mail, which is roughly a letter for one in two across the entire country. Consequentially, 14% of referrals are lost in “an NHS black hole”, according to Healthwatch England — inevitably meaning more delay between diagnosis and treatment.

All of these things exacerbate one another. If you can’t start work on time, you don’t know what data is or isn’t missing, or to understand a patient, and you can’t communicate with them effectively, then you don’t know what is required for a productive workday.

Why inefficiency often goes unseen

What’s more, many trusts aren’t able to even measure the time being lost to these challenges, let alone address it.

As NHS technology isn’t standardised across the board in many areas, most trusts have a unique technology stack in one way or another, whether that’s different providers or entirely different systems used to achieve similar ends. As a result, the capacity to measure performance differs too.

Many trusts that we contacted weren’t able to tell us how many pages has been digitised in Electronic Patient Record (EPR) systems over 2025. Some had no idea how many outbound patient communications had been sent by post. Some even failed to disclose how much time they’d lost to IT outages — not on the basis of FOI denial, but simply because they couldn’t tell.

As with any problem, you have to understand it before you devise a solution. The fact investment and new technologies being introduced to trusts doesn’t help resolve these issues is telling.

Time back, care forward

Many of the things we’ve spoken about in this article are mundane; the small details of the working day. But when analysed as a collective, they tell a very different story about the way the NHS works, and how we make it work.

The service is haemorrhaging time: at the start of the day, every time it needs to refer to patient information, and whenever it tries to contact those patients. The financial support for trusts, and the incredible work of its staff, are undermined by the NHS’ inability to recognise and combat its inefficiencies.

In this context, trusts need to re-evaluate themselves. They must build a greater understanding of where time is lost, and the processes or systems that are slowing practitioners down.

Once they’ve done so, they can prioritise the biggest challenges for them. That might be reducing the time lost in accessing and using technology; it might be reimagining processes that obscure the data practitioners need; it might be improving the communications flow between the trust and its patients.

Ultimately, all of these areas will need work. As they are so interconnected, work on one problem can cause more in another. But it is in these key areas that time needs to be recovered, perhaps more than anywhere else in the system.

The NHS is full of incredible people, and rightly held in great esteem by most Brits. It deserves to be unshackled. 

It is in the small details, rather than any great investment or grand political scheme, that this will happen. Time back; care forward.

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