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Productivity across the NHS


 Anita Charlesworth




05 December 2012               © Nuffield Trust
While aggregate spend on workforce has increased,
it now forms a smaller proportion of total expenditure
                                         50.0                                                                                             100%

                                         45.0                                                                                             90%




                                                                                                                                                  Proportion of total PCT operating expenditure on
 Real aggregate workforce spend (£bns)




                                         40.0                                                                                             80%

                                         35.0                                                                                             70%

                                                           56%       56%




                                                                                                                                                                    workforce (%)
                                         30.0    56%                           55%                                                        60%
                                                                                         52%       54%
                                                                                                             52%       51%       51%
                                         25.0                                                                                             50%

                                         20.0                                                                                             40%

                                         15.0                                                                                             30%

                                         10.0                                                                                             20%

                                          5.0                                                                                             10%

                                          0.0                                                                                             0%
                                                2003/04   2004/05   2005/06   2006/07   2007/08   2008/09   2009/10   2010/11   2011/12


                                                                                                                                                 © Nuffield Trust
This change in expenditure can be broken down into
numbers of staff and expenditure per employee
                                         50.0

                                         48.0
 Real aggregate workforce spend (£bns)




                                         46.0

                                         44.0

                                         42.0

                                         40.0

                                         38.0

                                         36.0

                                         34.0

                                         32.0

                                         30.0




                                                     © Nuffield Trust
There are now fewer nurses per medical staff
member, mainly due to an increase in the latter
                                                     6.0                                                                                                                   1.40
 Number of Nursing, Midwifery and Health Visiting
 Staff (inc Learners) per Medical and Dental Staff




                                                                                                                                                                                   Indexed number of medical/nursing staff (1.00 =
                                                                                                                                                                           1.20
                                                     5.0


                                                                                                                                                                           1.00
                                                     4.0

                                                                                                                                                                           0.80




                                                                                                                                                                                                     2003/04)
                      Member




                                                     3.0
                                                                                                                                                                           0.60

                                                     2.0
                                                                                                                                                                           0.40


                                                     1.0
                                                                                                                                                                           0.20


                                                     0.0                                                                                                                   0.00
                                                           2003/04       2004/05     2005/06    2006/07    2007/08      2008/09      2009/10       2010/11       2011/12

                                                                     Medical and Dental Staff       Nursing, Midwifery and Health Visiting Staff             National


                                                                                                                                                                                  © Nuffield Trust
There has also been a far more rapid increase in
Healthcare Assistants since 2007/08
                                                      4.0                                                                                                               1.60




                                                                                                                                                                                Indexed number of nursing/healthcare assistant staff
 Staff (inc Learners) per Healthcare Assistants and
 Number of Nursing, Midwifery and Health Visiting




                                                      3.5                                                                                                               1.40


                                                      3.0                                                                                                               1.20
             Other Support Staff Member




                                                      2.5                                                                                                               1.00




                                                                                                                                                                                                 (1.00 = 2003/04)
                                                      2.0                                                                                                               0.80


                                                      1.5                                                                                                               0.60


                                                      1.0                                                                                                               0.40


                                                      0.5                                                                                                               0.20


                                                      0.0                                                                                                               0.00
                                                              2003/04     2004/05      2005/06      2006/07   2007/08    2008/09     2009/10      2010/11     2011/12

                                                            Nursing, Midwifery and Health Visiting Staff      Healthcare Assistants and Other Support Staff        National


                                                                                                                                                                               © Nuffield Trust
Our productivity measure for each trust was based on the
Office of National Statistics’ whole economy index

Productivity measure   Measures of Output       Measures of Input
Nuffield Trust         Cost weighted activity   Labour cost
                       including acute and
By acute provider      community service
                       episodes and
                       attendances
Office of National     Measures above plus:     Measures above plus:
Statistics
                       Family health service    Goods and service
Whole economy          consultations            costs

                       GP prescribing           Capital consumption

                       Quality weighting
                                                                    © Nuffield Trust
The ONS estimates that productivity has remained
essentially unchanged over the last four years
                      1.20



                      1.10



                      1.00
 Productivity index




                      0.90



                      0.80



                      0.70



                      0.60
                          1995   1996   1997   1998   1999    2000   2001    2002    2003    2004     2005   2006   2007   2008    2009

                                                      Output index     Input index      Productivity index


                                                                                                                                  © Nuffield Trust
Better labour cost control in acute trusts leads to
greater gains in productivity in our measure
                      1.20



                      1.10



                      1.00
 Productivity index




                      0.90



                      0.80



                      0.70



                      0.60
                        2006/07   2007/08                 2008/09                   2009/10   2010/11

                                       Output index   Input index   Productivity index


                                                                                               © Nuffield Trust
While productivity outliers have been brought towards
the average, half of trusts are still in a range of 20%
                                      1.80

                                      1.60
 Productivity by Trust (NHST or FT)




                                      1.40

                                      1.20

                                      1.00

                                      0.80

                                      0.60

                                      0.40

                                      0.20

                                      0.00
                                        2006/07   2007/08             2008/09                   2009/10   2010/11

                                                  Min-Max   10%-90%      Lower-Upper Quartile    Mean


                                                                                                           © Nuffield Trust
Our econometric modelling was able to explain 35% of
variation in productivity at a trust level

Statistically significant drivers of          Tested but no effect found
productivity
Follow-ups per first outpatient appointment   Better care, better value indicators other
(-ve)                                         than first to follow-up ratio
Located in London (-ve)                       Index of multiple deprivation
Foundation trust status (+ve)                 Other geographic locations than London
Herfindahl–Hirschman index (i.e.
competition between providers) (+ve)
Staff mix (proportion of employees who are
medical or dental staff) (+ve)
Proportion of revenue from education,
training and research (-ve)
Trust size (described as number of beds
available overnight) (-ve)
                                                                                       © Nuffield Trust
www.nuffieldtrust.org.uk


        Sign-up for our newsletter
        www.nuffieldtrust.org.uk/newsletter


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        Twitter.com/NuffieldTrust




05 December 2012                              © Nuffield Trust

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Anita Charlesworth: Productivity across the NHS

  • 1. Productivity across the NHS Anita Charlesworth 05 December 2012 © Nuffield Trust
  • 2. While aggregate spend on workforce has increased, it now forms a smaller proportion of total expenditure 50.0 100% 45.0 90% Proportion of total PCT operating expenditure on Real aggregate workforce spend (£bns) 40.0 80% 35.0 70% 56% 56% workforce (%) 30.0 56% 55% 60% 52% 54% 52% 51% 51% 25.0 50% 20.0 40% 15.0 30% 10.0 20% 5.0 10% 0.0 0% 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 © Nuffield Trust
  • 3. This change in expenditure can be broken down into numbers of staff and expenditure per employee 50.0 48.0 Real aggregate workforce spend (£bns) 46.0 44.0 42.0 40.0 38.0 36.0 34.0 32.0 30.0 © Nuffield Trust
  • 4. There are now fewer nurses per medical staff member, mainly due to an increase in the latter 6.0 1.40 Number of Nursing, Midwifery and Health Visiting Staff (inc Learners) per Medical and Dental Staff Indexed number of medical/nursing staff (1.00 = 1.20 5.0 1.00 4.0 0.80 2003/04) Member 3.0 0.60 2.0 0.40 1.0 0.20 0.0 0.00 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 Medical and Dental Staff Nursing, Midwifery and Health Visiting Staff National © Nuffield Trust
  • 5. There has also been a far more rapid increase in Healthcare Assistants since 2007/08 4.0 1.60 Indexed number of nursing/healthcare assistant staff Staff (inc Learners) per Healthcare Assistants and Number of Nursing, Midwifery and Health Visiting 3.5 1.40 3.0 1.20 Other Support Staff Member 2.5 1.00 (1.00 = 2003/04) 2.0 0.80 1.5 0.60 1.0 0.40 0.5 0.20 0.0 0.00 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 Nursing, Midwifery and Health Visiting Staff Healthcare Assistants and Other Support Staff National © Nuffield Trust
  • 6. Our productivity measure for each trust was based on the Office of National Statistics’ whole economy index Productivity measure Measures of Output Measures of Input Nuffield Trust Cost weighted activity Labour cost including acute and By acute provider community service episodes and attendances Office of National Measures above plus: Measures above plus: Statistics Family health service Goods and service Whole economy consultations costs GP prescribing Capital consumption Quality weighting © Nuffield Trust
  • 7. The ONS estimates that productivity has remained essentially unchanged over the last four years 1.20 1.10 1.00 Productivity index 0.90 0.80 0.70 0.60 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Output index Input index Productivity index © Nuffield Trust
  • 8. Better labour cost control in acute trusts leads to greater gains in productivity in our measure 1.20 1.10 1.00 Productivity index 0.90 0.80 0.70 0.60 2006/07 2007/08 2008/09 2009/10 2010/11 Output index Input index Productivity index © Nuffield Trust
  • 9. While productivity outliers have been brought towards the average, half of trusts are still in a range of 20% 1.80 1.60 Productivity by Trust (NHST or FT) 1.40 1.20 1.00 0.80 0.60 0.40 0.20 0.00 2006/07 2007/08 2008/09 2009/10 2010/11 Min-Max 10%-90% Lower-Upper Quartile Mean © Nuffield Trust
  • 10. Our econometric modelling was able to explain 35% of variation in productivity at a trust level Statistically significant drivers of Tested but no effect found productivity Follow-ups per first outpatient appointment Better care, better value indicators other (-ve) than first to follow-up ratio Located in London (-ve) Index of multiple deprivation Foundation trust status (+ve) Other geographic locations than London Herfindahl–Hirschman index (i.e. competition between providers) (+ve) Staff mix (proportion of employees who are medical or dental staff) (+ve) Proportion of revenue from education, training and research (-ve) Trust size (described as number of beds available overnight) (-ve) © Nuffield Trust
  • 11. www.nuffieldtrust.org.uk Sign-up for our newsletter www.nuffieldtrust.org.uk/newsletter Follow us on Twitter: Twitter.com/NuffieldTrust 05 December 2012 © Nuffield Trust