NHS’s People Plan: Recognising the importance of work-life balance

Last week, the NHS released an interim People Plan. Following on from the NHS Long Term Plan released in January, the People Plan focuses on the health service’s vision for NHS employees and the immediate action needed to stave off a staffing and culture crisis.

There is a huge amount to be encouraged by in this report. It’s an honest, nuanced look at the challenges currently facing our health service. In recognising that the NHS needs to become an “inclusive and modern employer if we are to attract and retain the people we need”, the institution is taking a big step towards accelerating much-needed modernisation of how it supports its staff.

To see the People Plan acknowledge that “our people want to have more flexible careers and a better work/life balance” is music to my ears, as of course Patchwork’s core purpose is to create tools that help clinical staff achieve greater work-life balance. We enable them to use technology to retain their skills within our hospital wards, whilst also protecting NHS budgets.

As the wider world of work has rapidly evolved, the NHS has been stuck in a time-warp. As clinicians have seen friends and family benefit from an increase in flexible working, and the introduction of technologies to automate mundane tasks and make others easier, NHS teams have been battling decades-old systems and frustrations.

With increasing pressures and, in many cases, decreasing resources, it’s no surprise that sickness absence in the NHS is “2.3 percentage points higher than in the rest of the economy” and that we lose one in eleven staff permanently each year. Staff are doing their best, but as we know, many are reaching breaking point.

The ambition, therefore, to “make the NHS, already the largest employer in England, also the best” is laudable. Putting this at the top of the agenda is long overdue.

As a health tech provider, it’s not surprising that we also agree with the report’s assessment that technology will enable staff “to work to their full potential”. We are strong believers in the impact that carefully designed, empathetic technology can have on the NHS and its people. Money-saving and efficiency are core benefits, naturally, but the impact technology can have on well-being and workplace satisfaction is just as important.

As the report states: “we must put workforce planning at the centre of our overall planning processes”. Without its staff, the NHS wouldn’t exist. All stakeholders must therefore do everything in their power to ensure the ambitions of the People Plan are realised before it’s too late. We must protect, support and retain our clinicians to stem the tide of those leaving.

And, at Patchwork, we’re working hard to play a small part in this most vital of revolutions.

Walk in their shoes: why empathy is the key to unlocking true innovation in healthcare

If you haven’t experienced it, how would you know what it feels like? Dr Anas Nader, NHS doctor and co-founder of Patchwork Health explains why the digital revolution isn’t taking off in the NHS as it should. And offers a simple way to fix the issue

If you read the headlines, you’d be forgiven for thinking that healthtech is being heartily embraced across all levels of the NHS – swooping in to solve its woes. Indeed, the creation of NHSX and the digital mindset of the new Health Secretary have created a culture within the health service which is embracing technology like never before. Yet ask clinicians on the front line what they think of the latest gizmo or system and you’re more likely to get an eye roll rather than evangelism.

The reality is that a lot of the tech and innovation on offer today does stand to make a big impact on the NHS. Where it’s falling down is the approach to implementation. How new offerings are launched and incorporated into our existing system leaves a lot to be desired. Over-stretched clinicians are battling a wave of new initiatives that, in theory, are set to make their lives easier. In reality, they are adding to their daily burden.

Know your user

So how can we ensure clinicians and Trusts truly benefit from these innovations? The answer: empathy.

Whilst empathy might not sound like a natural bed-fellow to cutting edge tech, we must remember that context is everything. A product roll-out at Google HQ will never shakedown in the same way as introducing a new software system to a busy A&E department. The product itself, the way in which it’s introduced, how people are expected to use it; everything must be bespoke for the environment.

And that’s where empathy comes in. If you don’t understand the minutiae of how an NHS ward works, or sympathise with the complex challenges that come with being a clinician, how on earth are you going to create innovation that makes a difference?

We will continue to see new systems or products falling flat (with precious resources wasted along the way) unless we put empathy at the heart of the NHS’ digital strategy. The teams and start-ups behind any healthtech proposition must take the time to explore the unique challenges that come with working in our health service. They must work with frontline staff and truly listen to their needs and priorities. They must look to form partnerships and foster collaboration, rather than seeking to disrupt.

From my own experience when it comes to working within and with the NHS, the presence of empathy has strong bearing in long-term success. Our NHS staffing software, Patchwork, was conceived by following direct experience navigating flexible working within the NHS as junior doctors. And our original roll-out took the form of a public-private partnership with Chelsea and Westminster hospital; empathy with the end users was built into the DNA of the whole initiative.

Less disruption, more humility

In the fast-paced world of tech start-ups, it’s all too easy to lose touch with the realities of your users or customers. But by ‘living’ the problem we were trying to solve, then remaining as close to the ground as possible whilst we built a solution, we retained empathy with frontline staff and management teams. This means we’ve built a product that Trusts need and that NHS staff actually want to use.

While that might sound simplistic, health tech start-ups all too often fail to fully empathise with the institution they are ultimately looking to sell to. The NHS is unique, complex and multi-layered. Its structure is by no means perfect, but it handles a mind-boggling complexity of challenges 24 hours a day, every single day of the year. For the 1.5 million people who make that happen, there is barely a chance to catch their breath in the daily quest to keep the show on the road.

Healthtech start-ups who turn up with a Silicon Valley attitude or disruptive mindset often fail to make the lives of these clinicians easier, despite that being their intention. After decades of failed IT roll-outs and countless ‘innovation’ initiatives abandoned, there’s a deep (and understandable) sense of change fatigue on NHS wards. Those who don’t account for this, or take the time to engage with stakeholders at grassroots level, will flounder when it comes to adoption of their tech. And, when that happens, it’s ultimately Trust budgets and clinicians’ patience which suffer the most.

And that’s why empathy is the key to unlocking truly impactful innovation in the NHS. We must ensure those creating technology for our health service put clinicians, patients and Trusts at the centre of their priorities. Whilst jazzy technology might be eye-catching, the ultimate priority must be engaging the hearts and minds of those who’ll use it.

Why GPs leaving medicine is a symptom of an NHS-wide problem

Figures released by the BBC yesterday show the first sustained fall in GP numbers in the UK for 50 years. As our population increases and ages, the numbers of GPs is declining rapidly. The report makes for depressing reading.

That our NHS staff are under pressure is not news. Headlines about the strain clinicians are under are increasingly common. But what we’re now seeing are tangible statistics on just how many people are leaving the profession, and the impact this is having on patients.

Many of us will be familiar with how hard it can be to secure a GP appointment. They are a scarce commodity, with available slots often weeks away. A smaller number of GPs are having to cope with an increased amount of patients per head, alongside a marked rise in people living with chronic or complex conditions. Lack of access to primary care is pushing people towards overstretched A&E departments. As so the pressures increase across the whole NHS.

Increased Government funding for more primary care providers, including physios, pharmacists and other allied health professionals, is most welcomed. But the problem goes much deeper. And that means more revolutionary, more wholesale solutions are needed before the crisis escalates any further.

Junior doctors thinking about going into GP practice (or indeed any clinical setting) today are faced with relentless rotas, hugely pressurised shifts, and a lack of support from colleagues battling the same pressures.

In our all or nothing clinical culture, medics both new and established are opting for ‘nothing’.

We must start exploring ways to shift the culture within the NHS and change what working as a doctor in today’s health service looks like. We must of course invest in the training and recruitment needed to safely staff wards and GP practices, redressing the grim statistics that today’s report highlights, but we must also change what it means to practice medicine once you’re in post.

CCGs and Trusts must put the health, well-being and job satisfaction of their clinical staff at the very heart of their strategies, with central Government providing the funding needed to make structural changes to how we retain staff.

Then, technology must be championed to streamline these processes and take pressure off clinicians. New systems that dramatically reduce admin, minimise appointment no-shows, and more effectively triage patients will all help. As will educational programmes focusing on healthier lifestyles, those which promote a better understanding of pharmacists and physios, and the role of NHS 111.

There is no silver bullet to solving the NHS’ woes. But we must start with easing the burdens of our hard-working clinicians. Unless we do this, we cannot hope to continue to provide the level of care which patients expect and deserve.

NHS Workforce Statistics-why an increased headcount is both good news and cause for concern

This morning, the NHS released its latest workforce statistics. After last month’s quarterly figures revealed a dire state of affairs – with record numbers of clinical staff leaving citing poor work-life balance – teeth were gritted for more sombre statistics.

But this month’s analysis (relating to the workforce as of January 2019) show a slight upturn in overall staffing numbers. Across England, a 0.6% increase in overall staff was recorded – a total of 7,601 additional people.

This is, in many ways, encouraging. More NHS staff that ever are deciding to leave the profession, finding the pressures untenable. The response of Trusts and NHS England to the staffing crisis has shifted in recent months, with more concerted efforts being taken to recruit and retain clinicians. Hopefully, these latest figures are the beginning of a trend; the additional staff our health service so desperately needs, rather than a statistical blip or knee-jerk reaction to falling staff numbers amongst increased pressures.

Recent reports of hospitals laying on better support for clinicians feeling the pressure, such as yoga sessions, food and drink during night shifts, and mindfulness classes, are also welcome signs of a shift within the NHS when it comes to working culture. Because the more staff we can retain, the better care patients receive and the more money that can be diverted into infrastructure, training and patient care instead of emergency staffing.

Because whilst we must see an increase in clinical staff in order to handle the ever increasing NHS workload, long-term energy must be focused on retention, not gap filling.

We cannot hope to reverse the trend when it comes to retaining staff unless we fundamentally rethink how the NHS acts as an employer. The dichotomy of full time work versus locuming must be dismantled. Introducing accessible options for flexible working by empowering the hospital bank, reducing reliance on agencies, and reviewing our approach to training will all help create a healthier working environment for clinicians and recoup crucial resources currently flooding to agencies.

Every clinician is a vital contributor to the overall success of our health service. An upturn in overall numbers is therefore welcome, but fundamental changes to the foundations of how we recruit, train and retain our clinical staff cannot come soon enough.

Patchwork win big at the HSJ Partnership Awards

On the 20th March 2019, we were delighted to be awarded the prestigious HSJ Partnership Award in their “Medical Software, Systems and Technology” category. The award was for our work to digitally transform the medical staff bank at Chelsea and Westminster Hospital Foundation Trust (ChelWest). We were also chuffed to also receive a Highly Commended for the same project in the “Workforce Innovation” category.

The HSJ Partnership Awards showcase the most effective partnerships between the private and third sector and the NHS; collaborations that are making a substantial difference delivering value for money and improving patients’ lives through sector leading innovation and exceptional dedication to top quality service.

Creating meaningful, impactful and empathetic partnerships with NHS Trusts is at the heart of the Patchwork mission. Without such partnerships, we cannot hope to make an impact. That’s why we were so honoured to win these accolades.

It was a privilege to collect these awards alongside the team from Chelsea and Westminster Hospital, who were our first clinical partner when we started Patchwork. They have been pivotal in our journey as we’ve gone from having no more than an idea about how we could make a difference to building and rolling out a product which is saving vast amounts of money and changing lives across the NHS.

We cannot wait to build on our successes with ChelWest and the other seven Trusts we are collaborating with as we continue to build an approach to NHS staffing that truly works for everyone.

NHSX — An integrated approach to innovation across the NHS could unlock massive change

A new approach to healthcare innovation is upon us. With the launch of NHSX, a unit bringing together talent from the NHS, Government and industry, we could be set to usher in a new dawn of unity when it comes to rolling out new technology.

Anyone familiar with technology projects in the NHS will know that efficiency and integration don’t tend to be the words most commonly associated with the area. It’s not unusual for one Trust to discover that separate teams have been procuring different solutions to the same problem. The legacy of top-down roll-outs from private providers or consultants is not one of glory. And the announcement of yet another new system or bit of kit for clinicians to familiarise themselves with tends to produce eye rolls rather then applause.

Which is why the ambitions of NHSX are laudable. A coordinated approach to innovation throughout the health service should help bring forth much needed clarity for clinicians and Trusts alike. Pooling the expertise of frontline staff, entrepreneurs and Government should, in theory, make it easier to get the right solutions into the right hands as quickly as possible.

NHSX wants to make sure that Trusts “don’t have to reinvent the wheel each time” a new technology or service is sought. Instead, encouraging collective experience to dictate what makes an impact (and how it can be rolled out) will save vast amounts of time, energy and duplication.

This will help end the culture of small pilots that then struggle to achieve a foothold across the health service at large, as well as the multiple duplications of efforts (and associated costs) that can be found throughout the NHS. The ambitions of NHSX should help shift this culture and allow effective innovation to scale much faster.

At Patchwork, we strongly believe that there are some game-changing technology offerings already in existence that stand to make a wide-reaching and positive impact on our NHS. Creating a unit where all stakeholders can come together to push for collective, evidenced-based change will help get these innovations into the hands of people that will benefit them much faster than before.

We hope that this step forward will reduces the fragmentation we currently see across the system. Likewise, we hope that the brightest entrepreneurs will no longer be put off by the NHS’ notoriously difficult procurement process and instead invest their energies into creating solutions for this most important of institutions.

But, above all, we hope this marks a shift in what it means to introduce new solutions to our health service. With a more coordinated, cohesive and intelligent approach to rolling out new technology, we want to see change that truly supports those on the frontline and helps clinicians carry out their jobs more effectively. If we can end the era of frustration and eye-rolling on the ward when a new directive is sent from on-high, and instead replace it with confidence that this will be innovation that will work for them, we will be well on the way towards creating a truly digital, empowered NHS.

Topol Review Reaction: We must upskill NHS staff ready for the digital future, but we must also modernise what it means to work for the NHS

The long awaited Topol Review was published yesterday. The review, commissioned by the Secretary of State for Health last May, looks at how the NHS must upskill in order to be prepared for a digital future. California based Dr Eric Topol has duly delivered an insightful state of the union, looking at where the NHS must focus its energies to create a workforce ready to handle what the next generation of healthcare provision looks like.

Yet whilst alluding to the changing nature of work in its pages, the report skips over a critical problem facing the future of the NHS: how do we upskill and create a modern workforce if we cannot stem the tide of clinicians leaving the NHS altogether?

The NHS is in the midst of a staffing crisis. 2018 saw the number of junior doctors continuing on to specialist training following their foundation years drop below 50% for the first time, and it’s predicted that the NHS could be short of 350,000 staff by 2030. Whilst we heartily welcome any and all efforts to ensure our clinicians can thrive in a digitally-led health service, we must first address some of the fundamental challenges which are contributing to endemic staffing woes.

As the Topol review points out,

“the entry of millennials into the workforce has already resulted in changing expectations around work-life balance, flexible careers, rewards and incentives, relationships with employers and the use of technology.”

This is fundamental. We cannot expect the NHS to retain a workforce and foster development amongst it’s ranks if it can’t offer them the kind of employment they are looking for. Whilst their peers are flexing their hours, logging on from home, or enjoying the perks of co-working, millennial medics are being left frustrated by the strictures of life on the NHS payroll.

The report makes no mention of how the institution should look to address these structural issues. It does recognise that “the NHS needs to attract new talent and shape new career pathways”, but unless we can create a workforce that reflects modern day aspirations, the need to attract new talent will never diminish.

As the rest of the economy marches slowly towards a new reality of flexible, balanced working, the NHS has remained static. Indeed, in some respects it has gone backwards; just look at the increasingly proscriptive route for foundation training, or the hardline dichotomy between full-time and temporary work. The lack of flexibility in our system is driving modern medics away. Without this, the aforementioned new career pathways will fail to materialise.

The review points out that “within 20 years, 90% of all jobs in the NHS will require some element of digital skills. Staff will need to be able to navigate a data-rich healthcare environment.” For any other major sector in the UK, this statement might seem out of date. But the NHS is playing catch-up when it comes to modernising its organisational approach, despite the myriad advances and innovations happening in the wider healthcare sphere.

Pivoting the approach of an organisation the size of the NHS is a mammoth task. But one that we must invest all our energies into. We must think about the type of employer the NHS needs to be if it wants to retain clinicians, empower staff, and reduce its crippling agency spend.

A more flexible approach to training is needed, alongside new options for staff who want to work less hours, or perhaps split their time across different departments or employers. Reducing the admin burden associated with booking shifts or sourcing bank work can smooth the way, as well as helping Trusts move away from expensive locum agencies. And a new approach to rotas and annual leave regulations would reduce much of the frustration felt by doctors and nurses who simply want to book a holiday. Much of the tech which can enable this already exists; innovations which could introduce relatively simple structural changes that would make a massive difference to the overall reality of life in the NHS.

As we look to a creating a workforce fit for the digital future, we must not neglect the need to create an environment fit for a modern workforce.

Opinion: The NHS must become a flexible employer if it wants to retain its workforce

First published in HTN on the 5th of Februrary, 2019
By Dr Anas Nader, NHS doctor and Founder/CEO of 
Patchwork

We are seeing UK start-ups make huge strides when it comes to how patients are able to see their doctors. Technology-led solutions are increasing in popularity — from video-based consultations to remote tracking of conditions. But whilst the hype is currently focused on access, more attention should be paid to the desperate challenges facing NHS staffing.

The question going forward shouldn’t be, how can I see my doctor? But, will there be a doctor to see me at all?

The NHS’ staffing dilemmas are well documented. 2018 saw, for the first time, the number of junior doctors continuing on to specialist training following their foundation years drop below 50%. Whether taking a break, heading abroad or moving into locum work, this annual exodus is now staggeringly high.

And the recently released ten-year plan, which struck a hugely welcoming tone for a digitally-led future, attracted criticism over how it plans (or lack thereof) to approach some of the chronic issues at the heart of NHS staff shortages. The plan noted that a “significant uplift” in international recruitment would be needed to deliver on the plan’s laudable ambitions, but there was little in the way of detail about tackling the structural issues that have led us to this point.

There is a surfeit of people looking to train as NHS doctors and nurses — demand is not necessarily the issue. And additional efforts are being made to further boost the number of undergraduate and nursing places to keep numbers up. Instead, we are failing to retain those who qualify into NHS clinical roles.

Whilst the world of work has changed dramatically over recent years, the NHS approach and systems have remained largely static. Workplaces across the UK have become more flexible with hours, freelancing and remote working is on the rise, and portfolio careers are increasingly the norm. But the NHS, despite being Britain’s biggest employer, has failed to keep up with the times.

Indeed, the ten-year plan highlights the institution’s lack of flexibility and responsiveness “in the light of changing staff expectations for their working lives and careers” and states that many of those leaving their roles would remain if opportunities for development and more flexible working improved.

Our health service, but dint of scale and decades of gradual evolution, has created a rod for its own back when it comes to staffing. Hitherto unable to be the flexible, modern employer desired by its own staff, unsustainable solutions such as increasingly expensive reliance on agency locums and international staff have filled the void. This has created financial burdens for the system, whilst failing to tackle the root causes of staff churn. And the impact of this is something we can no longer ignore.

The health of our existing medical professionals is on the line. According to ONS figures, 430 health professionals took their own lives between 2011 and 2015. Two-thirds of doctors responding to the BMA’s 2018 survey said their stress levels in the workplace had increased over the previous twelve months. And figures released by the Royal College of General Practioners in December showed that a third of GPs said they wouldn’t be working in general practice in five years. Stress was cited as one of the most common reasons.

We are operating an unhealthy environment for clinical staff. We are all familiar with the macro and micro issues which have led us to this point — the strains and pressures of a system struggling to cope with demand. But NHS staffing and the happiness of our clinicians cannot continue to be the elephant in the room whilst we navigate our way towards a health service fit for 21st century challenges. The cracks in the system are too big to ignore.

NHS England and individual Trusts must be willing to challenge the status quo when it comes to what a career in the NHS looks like. We must focus energies on creating a modern workplace where modern clinicians want to stay and progress. Our junior doctor training should be less prescriptive. The route of General Practice shouldn’t be the only option for those seeking a semblance of work-life balance. Trusts shouldn’t have to rely on agency staff to fill rota gaps. And nor should doctors revert to locum work by default when they feel stretched to the limit by full-time practice.

As we put increasing amounts of energy into improving the way in which patients can access clinicians and track or share their health data, we mustn’t neglect the health and wellbeing of those whose job it is to protect ours. We have to focus on creating a sustainable, scalable working environment where clinicians are able to work and care for patients without burn-out, stress or low morale driving them away from the institution which has never needed them more.

Announcing partnership with BMJ

Press Release : 01 NOV 2018

Patchwork (formerly LocumTap) secures a strategic investment from BMJ to help healthcare employers better manage temporary staffing demands.

Healthcare knowledge provider BMJ has acquired a minority interest in health tech startup, Patchwork, to help hospitals better manage demand for NHS temporary staff (locums).

This follows an investment led by the Harvard Business School Alumni Angels earlier this year, bringing the total investment in Patchwork to £2 million.

Patchwork was founded in 2016 by ​Anas Nader and Jing Ouyang, two NHS doctors with a passion for technology and innovation.

Patchwork is a marketplace that connects healthcare employers directly with locum clinicians.

This enables instant shift bookings which increases staffing levels, improves patient safety and significantly reduces reliance on recruitment agencies.

Many NHS Trusts have used agency locums to help them manage peaks and troughs in demand, but some have now become overly reliant on agency locums for their staffing.

Figures* show that NHS spending on agency locums increased from £2.2 billion in 2009/10 to £3.7 billion in 2015/16, although recent progress has been made in cutting around £700 million from agency locums spending to around £3 billion in 2016/17.

The decision to invest in Patchwork is part of BMJ’s focus on achieving its vision of ‘A Healthier World’ by embracing innovative ideas, products, and new technologies.

Through the ​BMJ New Ventures​ initiative, BMJ ​works with healthcare startups and doctor entrepreneurs who share the company’s values to help ​solve problems and improve healthcare.

Commenting on the move, Anca Babor, BMJ’s Strategy Director, said:​​ “We are excited to be supporting the talented Patchwork team in their next stage of growth. Patchwork is an innovative digital solution which will make a great contribution to the future of the healthcare service through improved patient care and increased efficiencies for the NHS. Patchwork stood out with their comprehensive approach to this complex challenge.”

“This strategic partnership will strengthen our position in the medical careers space and enhance our digital offer. We look forward to similar future investments that will bring innovative ideas into BMJ.”

Dr Anas Nader, ​​CEO and Co-founder of Patchwork​​, added​​:​​ ​“We are delighted to be working in partnership with BMJ, a trusted brand with an excellent track record of supporting healthcare professionals throughout their career. With BMJ’s support, Patchwork will accelerate its positive impact on the NHS and its dedicated healthcare workers.”

[Ends]

Further information please contact: Patchwork Media Relations team: [email protected]

Notes for Editors **The Nuffield Trust: https://www.nuffieldtrust.org.uk/resource/the-nhs-workforce-in-numbers#5-what-are-the-financial-implications-of-these-shortfalls-

NHS England- https://www.england.nhs.uk/five-year-forward-view/next-steps-on-the-nhs-five-year-forward-view/funding-and-efficiency/

About Patchwork (formerly LocumTap): Patchwork is a tech company that connects healthcare workers directly with employers, saving the NHS millions in agency fees and improving the experience of flexible workers. https://patchwork.health

About BMJ: BMJ is a global healthcare knowledge provider with a vision of helping to create a healthier world. We share knowledge and expertise to improve experiences and outcomes worldwide. Explore our full list of products and resources at bmj.com/company.

Patchwork (formerly LocumTap) launches DHSC Flexible Staff Bank Pilots

Patchwork is delighted to announce the launch of our pilot for the Department of Health and Social Care (DHSC) Flexible Bank Programmein two our partner organisations — Chelsea & Westminster Trust and London North West University Healthcare Trust.

NHS staff at London North West Healthcare NHS Trust and Chelsea and Westminster NHS Foundation Trust will benefit from a greater freedom to choose which shifts they work, where they work them and quicker pay, as part of a revolutionary trial of new technology.

The trusts will use their pilot, funded by the Department of Health and Social Care, to roll out Patchwork across all departments. An initial trial of Patchwork has proved so popular that both substantive and agency medics have signed up to work flexibly in this way.

A spokesperson from London North West University Hospital NHS Trust said:

“London North West University Hospital NHS Trust is delighted to have been selected as one of the DHSC’s national bank flexible working pilots. Our staff banks are a valued and integral part of our workforce and we continue to invest in their development and growth. The use of the Patchwork Health app will improve the overall experience for staff joining and working with the Trust’s staff bank by making it simpler and easier to join, and enabling staff to better match the shifts they want to work around their availability, preferences and personal life.”

The pilots are also set to bring significant benefits to the hospitals involved — allowing them to significantly reduce their spend on agency staff by encouraging those who may otherwise leave and work for an agency to work as part of the bank instead. Flexible working initiatives are also proven to drive up staff engagement.

Following the conclusion of the trial, a comprehensive evaluation will be undertaken and the most successful elements of the apps will be rolled out across the whole NHS.

These trials are part of a raft of new measures designed to support staff in a modern NHS — including recent expansions in training places for doctors, nurses and midwives, a pay rise for all Agenda for Change staff and a review into how staff are supported to use new technology such as robotics and artificial intelligence.