Simplyhealth uses AI to keep workers out of NHS waiting rooms

The health insurer is turning to agentic AI to scale its services, hoping to keep employees healthy and at their desks rather than waiting for NHS appointments

Simplyhealth has committed to tackling Britain's productivity crisis by addressing escalating corporate sick leave, which drains an estimated £150bn from the nation's economy each year due to the NHS's extensive treatment backlog.

The healthcare provider is embracing agentic AI to expand its operations, aiming to maintain workforce health and attendance rather than leaving staff waiting for NHS consultations, as reported by City AM.

"The average sick days per employee per year have spiked to 9.4, nearly two full working weeks", Simplyhealth chief customer officer Claudia Nicholls told City AM.

"If you think about it, that's nearly two whole working weeks... that's not good for productivity, and if you add that up, that's not good for the UK as a whole".

Simplyhealth delivers routine healthcare services including GP consultations, physiotherapy, mental health assistance, and diagnostic testing, addressing minor ailments before they develop into extended absences.

The firm maintains that healthcare coverage ought to be universally available, rather than remaining an executive privilege.

"It should be the working folk who have it... all of those key workers who help the economy run", Nicholls said.

AI as a productivity lever

To satisfy this expanding demand, Simplyhealth has streamlined substantial portions of its customer operations through a collaboration with technology giant Salesforce.

Customer service director Dan Eddie informed City AM that between 80 and 90 per cent of enquiries comprised standard administrative matters, which artificial intelligence now manages. "Two years ago, we could serve 25 members a day. Now we serve 50", stated Eddie.

"We're doing more than we've ever done, across more channels, with fewer people as we grow".

Claims automation now stands at 82 per cent, with reimbursements often reaching members' accounts on the same day.

Email response times have been reduced from 12 minutes to a mere 1.5 seconds when AI drafts the reply, significantly cutting operational costs.

While the deployment of AI has lessened human involvement in routine interactions, Nicholls confirmed that the company is comfortable with humans not being involved in some instances.

"In theory, with generative AI checking itself, you don't need a human", she added.

Job displacement

The adoption of AI has led to a 40 per cent reduction in customer service roles.

The remaining staff have seen a pay increase of 30 to 35 per cent, reflecting their upskilling to handle complex queries requiring empathy.

"The human side to healthcare for us is the single most important thing", claimed Nicholls.

However, this shift highlights the tension between efficiency gains and workforce displacement.

While some employees move into higher-value roles, others are effectively replaced by automation.

According to McKinsey, up to 30 per cent of tasks in the UK workforce could be automated by 2030, underlining a wider economic challenge.

Measuring impact

Simplyhealth has delivered impressive customer satisfaction levels, with 99 per cent of claims settled to customers' satisfaction and complaint numbers plummeting from 650 four years ago to merely 25.

Staff engagement metrics have also held firm at 8.3 out of 10, indicating that thoughtful change management has helped mitigate potential workforce challenges.

However, despite these enhancements, AI technologies may only partly tackle the productivity shortfall, as broader systemic issues such as prolonged NHS underfunding and widespread chronic illness also contribute to workplace absence.

"We see ourselves as a marketplace connecting supply and demand for healthcare", Nicholls said. "Technology plays a key part, but it won't replace the empathy and strength of our people".