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NHS productivity across trusts
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
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