Blog: Why you can't staff your way out of NHS demand

What decades on the frontline reveal about system-generated demand, avoidable work, and where meaningful change really starts.

Dr Simon Eccles has spent decades working in A&E as a senior doctor and serving on countless boards across London. He is also a thought leader on the best technology for the NHS, and he sat down with us to discuss ways the NHS can improve its use of Salesforce. With all his years of experience, he has seen winter pressures come and go, targets change, restructurings repeat, and countless workforce initiatives introduced with good intent. His view is not theoretical. It is lived.
When we asked Dr Eccles what he thought the biggest threat to healthcare was, his message was clear.

“You can’t people your way out of a problem.”

This is not a criticism of NHS staff. In fact, it is the opposite. According to Dr Eccles, the pressure clinicians feel today is not due to people not working hard enough. It is because the system they work in generates demand faster than any workforce plan can absorb.

“The NHS is full of people doing their best work in really difficult conditions. The problem is that the system keeps creating more work for them.”

For years, the default response to rising demand has been to add capacity. More staff. More shifts. More escalation. But Dr Eccles is blunt about where that approach breaks down.

“At some point, adding more people just means you have more people stuck in the same broken processes, with nothing changing and no technology that transforms things being added to the mix to rapidly transform things.”

From his perspective, with decades of experience in medicine, much of the pressure on contact centres does not originate there. It builds earlier, quietly, through fragmented access, poor communication, and delays that repeatedly return patients to the system.

“If people don’t know what’s happening, they chase. That’s not bad behaviour. It’s a rational response to uncertainty.”

This insight is backed up by the data. Millions of NHS interactions every year are driven by people simply trying to find out what is going on. Missed appointments due to lack of timely communication lead to triggered rebooking. Unclear referrals generate repeat calls. Delayed or hard-to-access results lead to more GP visits, more 111 calls, and more emergency attendances.

In one year alone, 8.4 million outpatient appointments were missed across the NHS, costing hundreds of millions and creating additional administrative burden and contact.

While the NHS 111 call centres handle over 20 million calls annually, with many callers seeking reassurance or updates rather than clinical intervention.

Dr Eccles has seen this pattern repeatedly.

“We talk about demand as if it’s something that just arrives at the door. In reality, a lot of it is created by how hard it is to navigate the system.”

This is where his experience across healthcare and national digital programmes gives weight to the argument. The NHS already knows a huge amount about its patients. The issue is not data collection. It is visibility and flow.

“The information often exists in paper records or multiple disjoined systems. We just don’t surface it in a way that helps patients or staff.”

The result is avoidable work landing on clinicians who should be focused on care.

• Doctors are answering questions that could have been resolved earlier.

• Nurses are chasing information across systems.

• Call handlers are fielding the same update requests all day.

Dr Eccles is clear that this is not solved by recruiting more people into those roles.

“You end up paying very skilled people to do work that shouldn’t exist in the first place.”

This is where lessons from other parts of the public sector become relevant. In policing, leaders faced the same breaking point. Call volumes rose. Staffing increased. Then plateaued. Eventually, they reached the same conclusion Dr Eccles describes.

You cannot scale by increasing headcount indefinitely to meet system-generated demand.
Instead, they invested in fixing the cause. By providing citizens with clear, proactive updates and a single point of self-service, police forces reduced repeat contact by more than half in some areas and avoided hiring dozens of additional staff. The work did not disappear. It simply stopped being necessary.
Dr Eccles sees the same opportunity in the NHS.

“If you take even a small percentage of unnecessary demand out of the system, you give clinicians breathing space. That’s where recovery starts for the amount of work reduced.”

This is why Infomentum’s focus on targeted digital change matters. Not large-scale transformation programmes that take years to land, but practical fixes to the points where demand is being created today. One booking line. One outpatient pathway. One discharge process.

The goal is not fewer people. It is fewer problems that require people to intervene.

From an A&E doctor who has seen the consequences of system failure up close, the message is clear. The NHS does not need more effort. It needs fewer avoidable obstacles.
Until those are removed, no amount of staffing will be sufficient.

Dr Simon Eccles often comes back to a simple test. “If you remove one step and a whole stream of work disappears, you’ve found the right place to begin.”

In his view, the NHS does not need to start with a complex transformation or clinical redesign. It needs to start with the work that only exists because the system is unclear.

“If the demand vanishes once people can see what’s happening, that’s avoidable demand,” he explains.

His advice is to look for queues that shrink when information is surfaced, calls that stop once updates are automated, and appointments that are attended once patients understand what is expected of them. Those areas are not just easier to fix. They are safer, faster, and more likely to build confidence in change. Once one of them improves, it becomes much easier to identify where the next fix should be.

Final thoughts

For leaders and clinicians who recognise this pattern, the question is not whether change is needed, but where it makes sense to begin.

Dr Eccles’s view is deliberately practical. Look for the work that disappears once people can see what is happening. Look for the calls that stop when updates are shared clearly, the queues that shrink when information flows, and the appointments that are kept when expectations are understood.

Identifying one of these areas and removing the need for that work can create immediate breathing space. And it's a a focused way to test change, build confidence, and concentrate effort where it makes the biggest difference.

So if you’re ready to consider where demand might be quietly created today, and where removing it could make a difference, we’re here to talk it through.