By Dr Melinda Rees, CEO, Psyomics

Spend enough time in the NHS and you stop flinching at the word “productivity”.

You hear it in every strategy document, every board meeting, every government announcement.

And almost every time, it means the same thing: do more with less.

It’s the wrong framing.

After 25 years working in and around clinical services – from NHS leadership to service delivery in the independent sector to where I am building technology that works with NHS mental health services – I’d argue it’s part of why progress has been so hard to achieve and sustain.

Productivity in healthcare shouldn’t mean squeezing more out of an already over stretched workforce.

It should mean something more precise: delivering greater value per pound by protecting and deploying finite clinical expertise intelligently.

That distinction sounds subtle. In practice, it changes everything about how you approach the problem.

The demand side of this equation isn’t going to get easier.

Multi-morbidity is rising. Mental health need is growing. Cases are more complex, and patient expectations – rightly – are higher.

The assumption that we can recruit our way out of this is understandable but wrong.

Training pipelines take years. Financial resources are finite. Even in an optimistic scenario, workforce expansion alone doesn’t close the gap.

So, the real question isn’t how do we get more clinicians. It’s whether we’re deploying the ones we have with maximum precision.

And honestly, in most services, the answer is no.

• Clinical time – the most valuable finite resource in the system – is routinely lost to things that have nothing to do with clinical decision-making.
• Administration.
• Repetitive documentation.
• Poor workflow.
• Systems that don’t share information across boundaries.
• Inconsistent and variable clinical decision-making.
• Referrals that shouldn’t have reached a specialist clinic in the first place.
• Reactive care models that wait for deterioration rather than anticipating it.
• Gathering baseline information that could have been collected earlier, more consistently, and without the clinician in the room.

Meanwhile, the waiting list grows.

This isn’t a motivation problem or a workforce culture problem. It’s a system design problem.

And it’s solvable – meaningfully – if we’re willing to rethink how technology fits into the picture.

The challenge with digital implementation in the NHS has rarely been the technology itself – it’s been layering new tools onto processes that were already under strain.

A new system that digitises an inefficient workflow is still an inefficient workflow.

Real productivity gains come when technology is used to redesign how work actually happens – not just record it.

In practice, that means four things.

First, automating the tasks that don’t require clinical expertise – structured data capture, digital triage, standardised assessment pathways.

Every minute saved on documentation is a minute returned to care. At scale, those minutes add up fast.

Second, bringing patients into the process earlier.

When a patient contributes structured, meaningful information before their first appointment, the clinician and patient have a great head start.

Better routing, smarter questions, faster and safer decisions, quicker access to the right treatment.

Third, monitoring caseloads intelligently.

Utilising tools that flag deterioration or signal when a care plan needs to change, rather than waiting for a crisis to trigger a review.

Finally fourth, making sure every appointment actually advances care. That sounds obvious.

In practice, without recorded structured outcome data, it’s surprisingly hard to know.

None of this requires drastic AI transformation or futuristic promises.

Some of the biggest gains come from making simple workflow tasks consistent and seamless – the kind of unglamorous operational improvement that doesn’t make headlines but compounds quietly across thousands of patient interactions and increases productivity.

A 1-2 per cent productivity gain per clinician sounds modest.

At NHS scale, across millions of appointments, it isn’t. It’s the difference between a system grinding and one with genuine headroom to breathe.

It’s the difference between your close relative being able to get an appointment when they genuinely need one or languishing on a waiting list with little hope.

I think about this a lot through the lens of mental health services specifically, where I’ve spent most of my career and where Psyomics works.

Mental health has historically been underfunded and under-prioritised – something that disproportionately affects women, both as patients and as the clinicians and carers holding those services together.

The pressure to do more with less lands hardest here. And the argument that productivity means working harder is, in this context, particularly damaging.

Burnout in mental health services isn’t a footnote. It’s a crisis within a crisis.

The better argument – the one I’d like to see shape NHS policy – is that productivity means precision.

Precision in how we route patients. Precision in how we use structured data to reduce variation and improve decisions. Precision in how we protect clinical time for the work that only a skilled clinician can do and loves to do.

That’s not a technology story, exactly. It’s a system design story, in which technology plays an enabling role.

The NHS doesn’t need to do more with less.

The goal isn’t harder-working, exhausted clinicians – it’s smarter-working, compassionate enabled clinicians, and patients who are seen sooner.

Oestrogen helps protect premenopausal women from hypertension by relaxing and widening blood vessels, according to new research examining why women develop high blood pressure less often before menopause.

High blood pressure, also known as hypertension, affects more than a billion people worldwide and is a leading cause of heart disease and stroke.

Premenopausal women are less likely to develop the condition than men or postmenopausal women, but the biological reason has been unclear.

Researchers used a mathematical model of the cardiovascular and kidney systems to analyse how oestrogen influences blood pressure.

The analysis found that oestrogen’s strongest protective effect comes from vasodilation, the process by which blood vessels relax and widen, helping blood flow more easily and lowering pressure in the arteries.

Anita Layton, Canada 150 Research Chair Laureate in Mathematical Biology and Medicine and professor of applied mathematics, said: “Oestrogen is often thought of only in terms of reproductive health, but it plays a much broader role in how the body functions.

“It affects how blood vessels respond, how the kidneys regulate fluids and how different systems communicate with one another.

“What we found is that its impact on blood vessels is especially important for regulating blood pressure.”

The findings may also have implications for treating women after menopause, when oestrogen levels naturally decline.

The model predicted that angiotensin receptor blockers, a common class of blood pressure drugs, could be more effective than another widely used treatment group known as angiotensin converting enzyme inhibitors in treating women with hypertension, even after oestrogen levels decline after menopause.

Layton said her team has spent years developing a mathematical model of women’s kidneys and the cardiovascular system, designed to explore how different biological mechanisms affect blood pressure.

The model allows researchers to test individual effects separately and examine how each influences the body.

“We can turn on one effect, then another, and see exactly how each one affects the body,” Layton said.

She added: “For too long, women’s health, especially older women’s health, has been overlooked by medicine.

“Understanding how age and sex affect the body and, therefore, treatment, is an equity issue.”