Healthcare delivery
The challenges of the NHS productivity goal
Kate Woodhead RGN DMS discusses the productivity challenges facing the NHS, as it faces strike action, a decline in goodwill, staff burnout and a mounting backlog. The problem is far from simple and will need to be addressed by tackling multiple factors.
Great strides have been taken across English Trusts to tackle the backlog of care for urgent and emergency care, cancer tests, long waits, and many types of diagnostic services to meet patient’s needs and to recover from COVID-19. They have introduced a range of initiatives designed to improve staff morale such as more facilities for staff health and wellbeing, alongside processes to help discharge patients faster and adaptations to buildings to treat more patients. However, some of the significant barriers
to continuation of the progress are being felt by the recent industrial action which has been dragging on in different professional groups over the last eight months. This has served to increase costs due to having to staff the gaps with agency and locum staff, in dealing with the huge number of cancelled outpatient appointments, surgical operations or many other urgent procedures.1 Apart from the days lost to industrial action, excellent progress is being made to cut waiting lists, although they are still growing and sit around the seven million mark. The productivity
challenge is that Trusts need to be able to see more patients, undertake more procedures and all this while protecting quality and safety. It is reported that, even after adjusting for absence and staff sickness, the NHS at present has 11% more nurses, 16% more junior doctors and 11% more consultants than before the pandemic began and yet, despite this, some Trusts are having great difficulty in delivering more admissions.2
Productivity and efficiency All the measures used to identify progress in productivity and efficiency essentially look at the inputs, which are staff, facilities, and equipment, against growth in outputs produced, which include treatments delivered for patients and the quality of care provided. Recent data from 2019 and 2021 are pointless comparators as they do not take into account the slowing down of work to accommodate COVID-19 productivity, which limited surgery to urgent and emergencies only, and pleas to the public to stay home and not to ‘bother’ the health service. The NHS is currently tasked with ‘improving
productivity back towards pre-pandemic levels’, eliminate waste by delivering an annual efficiency target of 2.2% and reduce unwarranted variation.3
More than half of all
Trusts expect that, by the end of the financial year 2024/2025, they will have returned to pre- pandemic levels. There are a number of significant barriers, as Trust leaders report to NHS Providers4
; the
top three constraints are staff exhaustion and burnout, followed by increased patient acuity, followed by delayed discharges and disruptions to patient flow.
Staff exhaustion and burnout The most concerning challenge is the continued exhaustion and burnout reported by staff, together with low morale.4
All the measures
relating to burnout have remained persistently high. Almost half of all ambulance staff reported feeling burnout due to their work. Relentless operational pressures also have a huge impact on the willingness of staff to go the extra mile – for example, they are less likely to sign up for additional shifts or to work on after their work time has finished, unpaid. This latter action has been a feature of NHS work for many years, and many say that the NHS would collapse without the goodwill. In addition, to the recorded increases in staff
there remains a very large vacancy rate. It is so dynamic with so many leavers, it is difficult to get an accurate figure. Most media outlets concur that there were 112,000 vacancies in July 2023.5 Sickness and absence, mostly due to mental health and psychological strain on staff, is higher in 2022 than in previous years at a reported 5.6%, which is equivalent to a loss of 75,000 staff to illness.6 This all adds to the low morale and concern for individual staff. In addition, we know that record numbers of experienced staff are leaving the service or retiring early, which leaves supervision and learning for those more inexperienced and junior, very much under covered. Professions that are particularly short
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www.clinicalservicesjournal.com I September 2023
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