We have written before about the problems of measuring NHS productivity usefully – you can’t
– or that of an individual hospital – you also can’t
– but you can measure the availability, utilisation and efficiency of usage of major NHS INPUTS
such as surgeries, operating theatres, MRI scanners etc
You can also measure:
- OUTPUTS, such as numbers of patients seen, number of operations conducted
- OUTCOMES, such as the effectiveness of treatments, patients’ ratings of services received
and waiting times, ranging from numbers exceeding 4 hours at A&E, say,
(a statistic some claim to be ‘gamed’) to those waiting months if not years for important operations.
You can also measure the costs of the NHS, overall and by provider.
Comparing such different measures of NHS inputs with their outputs and outcomes
would paint a broad picture of the ‘Value for Money’ tax-payers get for their money
– employing just one overall measure, purporting to represent NHS productivity,
prompts no specific action anywhere and merely aggregates good performers with bad,
good systems with bad, thus hiding where any action is truly needed.
Nevertheless, we are told that overall NHS performance has been steadily getting worse
over the last decade and more, and not because of Covid, recent strikes by nurses, doctors and consultants,
or the ageing of the population (surely an NHS success story)
– nor the possibility of demand increasing for an increase in the range of services offered.
The main culprit is always the lack of sufficient money for more and more inputs
– especially more pay and more capital investment:
- Staff are said to be overworked and suffer all-time low morale – hence, many are leaving
and proving difficult to replace
- Capital investment is said to be urgently needed for new hospitals, replacing antiquated
IT systems and introducing new technology.
The consequence is a downward performance spiral.
But the underlying assumption is that current assets and systems employed work well
i.e. they could not be significantly bettered so, to achieve the improvements needed,
major new investment is vital, not just for more staff but more new technology.
Sadly, the NHS has become an endless game of political football
– whichever party is in power claims: “The NHS is safe with us” and then proves it
by pouring more billions of our money into it, but to what effect?
For example, who knows how well current major assets are used
– how wasteful, how inefficient are they? Why did past enormous investments not do the trick?
The following extracts help explain – they’re from an article/ advertorial, especially for
‘The NHS’s productivity conundrum – why tech investment alone won’t solve the problem’
By 
Karina Malhotra and published in the HSJ– Health Service Journal
Investing in NHS tech must prioritise effective training and address wider productivity challenges to avoid repeating past mistakes and ensure sustainable improvement.
Jeremy Hunt’s budget last month included a big focus on investment to improve productivity in the NHS.
While the £3.4bn set aside for modernising IT systems and digital transformation is welcomed, it is not enough on its own to get productivity back to pre-pandemic levels. Even with this funding boost, the £3.4bn will be spread across three years and won’t arrive until 2024-25.
The idea behind improving antiquated IT systems, and increasing patients’ access to care through greater use of the NHS app and other digital innovations is a sound one, but we must be clear there are challenges in place that need to be resolved to ensure the money achieves its goal of improving the NHS in the long-term.
Investing in tech, but what about those using it?
The NHS still relies heavily on people to function effectively. You could have the most fantastic, ground-breaking tech in the world, but that’s of little use if the people on the ground don’t know how to implement it or aren’t supported or trained to do so.
This has been the reality in the past. When I was a senior leader in the NHS, I saw new tech introduced that wasn’t implemented correctly. There wasn’t staff buy-in. There weren’t training programmes to help staff get to grips with the tech that was supposed to save them time.
Tech on its own doesn’t solve the NHS’s productivity problem. Tech that people know how to use – through effective, accessible learning and development – and tech that is implemented well can make a real difference. Astonishingly, though, managers in the NHS who generally lead these projects don’t currently get the digital transformation training that they need to implement new tech successfully. This is surely a massive flaw in any plan to boost productivity.
There is certainly a desire from staff for more training. In the NHS Staff Survey 2023, 45% of staff said the opportunities aren’t there for them to develop their career in their organisation, while 40% said they are unable to access the right learning and development opportunities when they need to. Unsurprisingly, as a result, there is a stark downward trend in motivation whilst (at the same time) a rising trend in staff turnover. The costs of these fundamental problems impacting overall staff wellbeing is estimated to be in the region of £12bn.
Tech shouldn’t be viewed as a magic cure-all or a direct replacement, but as an asset to staff to make their lives easier. It also needs to be implemented for a purpose, with an intended outcome that is measured and tracked
Tackling wider productivity challenges
In addition to getting the tech, training, and implementation right, there are other factors to consider, too. They include staff wellbeing, motivation, health and pay. After all, if you don’t have a happy, healthy and motivated workforce, any attempts to improve output are likely to fail. What’s more, a happy, healthy and motivated workforce is far more likely to fully embrace digital transformation, rather than seeing it as a time-consuming distraction.
Buy-in is crucial.
Tech shouldn’t be viewed as a magic cure-all or a direct replacement, but as an asset to staff to make their lives easier. It also needs to be implemented for a purpose, with an intended outcome that is measured and tracked. In other words, a new IT system or tech innovation shouldn’t be a mission in itself – it should come with a clear goal of improving patient care and other defined benefits, which makes staff more likely to engage with it.
Once they are engaged, it all comes down to how the new tech is delivered and implemented, which leads us back to training.