A productive conversation about productivity – what’s next for the NHS?

The NHS is facing unprecedented challenges. Increasing and unmanageable demand. The loss of experienced staff. Funding challenges. Patient complexity and acuity. Inadequate tech, infrastructure and estate. Low staff morale and less good will. The ongoing impact of Covid-19.    

These issues drive the productivity challenges that overwhelm the NHS every day - find out more in our NHS productivity puzzle article. The new Secretary of State for Health and Social Care has ordered a rapid assessment into the state of the NHS and its performance to diagnose the problem. Yet whilst this takes place Baringa believes that NHS organisations can take practical action now to begin to address productivity challenges.   

In our recent roundtable discussion with NHS leaders, we explored what could be done to address the NHS productivity puzzle.  We know that service modernisation, leveraging the power of data, digital and technology, and driving efficiencies through process improvement are key to improving productivity, but what else emerged from our discussion?

Themes from our discussion

Unlocking the power of people

Clinical and managerial staff in the NHS are not short of good ideas, but often it is difficult to turn these ideas into tangible actions and outputs. There is a need to move away from local competition and league tables to a culture where co-design, collaboration and people empowerment is central. This will better enable pockets of good practice from across systems to be shared, scaled and centred around the needs and experiences of end users, driving innovation, change and transformation forwards in a sustainable way.

Rebalancing service management and transformation activity

NHS funding has increased over the last decade, however our view is that this is not necessarily being allocated or spent in a way that enables or prioritises long-term transformation. For example, there is not enough upstream investment in transformation programmes and capital monies are often used to address short-term deficits as opposed to long-term gains. Linked to this, transformation activity can be seen as BAU, and as a result, there is very limited investment into dedicated resource with the sole purpose of driving improvement initiatives.  

Outcomes over outputs

For decades NHS performance has predominately been measured by activity, but our view is that this measure of productivity are outdated. Instead, we need to define what ‘value’ really means in the NHS, for our patients, our services, and our staff. Our view is that value represents improved patient outcomes, a reduction in health inequalities, the optimisation of funding to drive effective commissioning, and a happy and healthy workforce. Defining value will align leadership and enable the NHS to shift the dial towards leading with purpose, ultimately driving better outcomes for patients and wider society.

What should NHS organisations consider?

Whilst we wait for the outcomes of Lord Darzi’s investigation into NHS performance, we recommend that NHS organisations should consider: 

Establishing local productivity improvement networks to enable challenges to be addressed at a system level

Collaboration drives innovation and scales transformation at pace. Leeds Teaching Hospitals and the Yorkshire Ambulance Service are a great example of this. They accepted shared responsibility for poor ambulance performance and formed a partnership dedicated to addressing this. Together they achieved 99.9% of handovers within 1 hour, improving productivity and resulting in faster response times for the local population.

Clearly defining value to determine and measure meaningful improvement outcomes

Defining value and a common purpose are critical first steps to driving improvements in organisational performance. NHSE’s Central Commercial Function recently launched a strategic framework which defines and drives commercial value across the NHS, for example by better utilising the NHS’ scale in purchasing and quantifying the return on investment delivered to the frontline. The framework has already delivered value-driven improvement outcomes including developing a national approach to buying energy which is estimated to save between £60-£100 million a year over a three-year period.

Using benefits realisation to prioritise transformation portfolios

Benefits realisation should be a key driver in identifying and prioritising high impact areas and/or initiatives that offer the highest potential for improvement and value for money.  However, benefits are not always identified or tracked, which can lead to not prioritising the right initiatives, or in-flight programmes not delivering to their full potential. A London Trust recently shared an example of this happening in the implementation of an IT system where the benefits had not been robustly tracked.  This resulted in key functionality not being used as planned, limiting the value being delivered. The Trust is now working to unlock the system’s full capabilities and potential to not only maximise the return on investment, but to drive further improvements in patient care and productivity. 

Baringa will be holding further roundtable discussions to create the space for NHS leaders to share their experiences and contribute to developing outcome focused solutions.  We will also be publishing Baringa’s Matrix of Health Productivity, which provides a comprehensive framework for NHS leaders when assessing and driving productivity in local healthcare provision. 

Subscribe here if you would like to be a part of the roundtable discussions or get in contact with Ellie Wilkes if you would like to talk about improving productivity in your organisation.