Current NHS productivity measurement

The University of York’s Centre for Health Economics confidently announced that, despite the government making drastic cuts: “Hard working NHS staff are providing 16.5% more care per £ than they did 10 years before whilst national productivity has only grown by 6.7% over the same period

In particular, they claim that:

  • NHS outputs have continuously increased since they began measuring some 12 years before
  • 5.2 million more patients received planned or emergency hospital treatments over that period – an increase of 42%
  • Outpatient activity shot up by 131% with over 60 million more attendances

The ONS – Office for National Statistics – also joined in the applause with: “NHS England productivity grew by 3% over the last year which was more than treble the 0.8% achieved by the whole UK economy”

Apparently, the NHS has delivered over £6 billion of quality and cost improvements in the last year alone – action taken including:

  • Introducing a cost-per-hour cap on employing agency staff
  • Curbing prescription of medicines that have little or no benefit
  • Stopping routine commissioning of procedures where less invasive, safer treatments were available and just as effective

(Ed: £6bn is an impressive figure, if true, given total annual NHS spend is some £100bn – but, rather than stop there, ask how much more could have been saved)

Unsurprisingly, Simon Stevens, CEO of NHS England, has been quick to say the above findings are proof that: “Taxpayers’ investment in our NHS is money well spent”

Professor John Appleby, chief economist at the Nuffield Trust think tank adds his pennyworth, saying: “This certainly gives the lie to the idea that the health service is some form of backwater of inefficiency missing out on progress – it appears quite the opposite”

So, given this fanfare of good news, one has to ask why Prime Minister Theresa May rains on it all by requiring Simon: “To tackle waste, reduce bureaucracy and eliminate unacceptable variation within the NHS”

And how can the IEA – Institute of Economic Affairs – brand the NHS: “The most overrated and inefficient service in the world”

Both sides can’t be right

We suspect their opposite views depend on the base data they’re using – one might use some bits of the overall jig-saw, the other quite different bits

Whatever the reason, the NHS and associated think tanks seem to focus on patient volumes treated (outputs) and input resource costs – and less so on quality and service levels offered patients, especially the extra costs, wasted time and suffering many patients endure because of NHS system failings

For example, where’s measurement of the following:

  • Attendances (aka episodes) may indeed be going up but how many are repeat visits by the same patient for the same one health problem which was not dealt with right first time
  • How much of this failure demand is caused by the NHS themselves whilst patients are being treated for something else e.g. catching MRSA whilst an in-patient, or HIV/ hepatitis C when injected with infected blood
  • Waiting times are getting longer, forcing many patients to suffer longer as most cannot afford to ‘go private’ at great expense – how often does the same NHS doctor offer the treatment needed on a private basis and nigh immediately, even using NHS facilities

And, when patient queues lengthen, loud cries are always heard for ‘more funding for more input resources’ – last time, the beleagured Theresa immediately leapt in with an extra £20 bn (of our taxes), not least to garner votes at the next general election and outflank Corbyn

Nobody questions the body of senior health managers and experts who assume existing NHS methods are fine so it must be extra resources that are needed – ask front-line staff, however, and a different view emerges

It’s well-known that internal methods/ systems determine most (over 90% according to guru Dr Deming) of the productivity level of any organisation i.e. NOT employee numbers, engagement or incentivising them to work harder

Of course, the piecemeal action being taken, such as above, is most welcome – sadly, however, one never reads about any root-and-branch review of the whole NHS process, from GP gatekeepers through in-and-out patient services at hospitals and then on to social care services – nobody seems to quantify the waste and bottlenecks at each stage, nor identify ways to improve the entire patient flow

This is not to downplay the fact that the NHS has been a great success story – indeed, survey after survey show the vast majority of patients are more than satisfied with the service they receive despite managers having to cope with a constant diet of political reforms and ministerial micro-meddling – nor is it to deny that most staff work hard and long hours despite recent pay freezes and Brexit creating staff supply problems

But the rosy picture of the NHS painted by the University of York is misleading – their cherry-picking of what data does exist is not what hard-pressed tax-payers want to hear

Instead, a comprehensive ‘balanced scorecard’ of performance measures should be agreed by both NHS patients/ tax-payers and ministers/ managers which quantifies those KRAs – Key Result Areas – where the NHS is performing well or not, and where most scope for improvement lies

At present, big improvements that should be staring them in the face are going unseen


P.S. No sooner had we posted the above than Matt Hancock, UK Secretary of Health launched a new TPA – Tax Payers’ Alliance – report claiming the NHS could save £12.5bn in annual staff time, allowing staff ‘much more time to do the vital things they love’ – and a further £5.9bn in the social care sector

Their secret is increased use of automation – the use of technology to improve the methods and systems used by all NHS staff, help them address shortages and free professionals from repetitive tasks – technology which addresses the areas of biggest improvement potential that we outline above

Hancock explains: “Automation and innovation are changing the way we live our lives – they can transform the way we deliver public services for decades to come – it’s critical for all of us that we seize the opportunities of the future and ensure modern technology benefits staff, patients and our country as a whole”

“Big productivity gains are made when technology is embraced”

Dr Simon Wallace, Chief Clinical Officer at Nuance Communications adds that:

  • “The NHS must encourage a culture shift to ensure technology is properly used to boost efficiency, improve patient care and reduce stress and burnout seen across the healthcare profession”
  • “Technologies like cloud computing are enabling inter-operability, resulting in increased data sharing across Trusts and more complete patient records, whilst AI should reduce the burden of administration and support clinical decision-making”

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