The NHS needs to be more productive – or is it more efficient?

David Maguire writing at the King’s Fund – Stop reading this and get back to work – you need to be more productive. Or is it more efficient?




In the long-term plan, NHS England sets out a goal of achieving at least 1.1 per cent increases in productivity over each of the next five years. But there’s often confusion about the term ‘productivity’ and what it really means, with efficiency and productivity often used interchangeably despite meaning very different things. In the simplest terms, an increase in productivity is when a business makes more of a product (in the case of the NHS, it would be more “care”- doing more operations, for example) using the resources they have available. Efficiency, however, relates to the quality of the work being done – so producing the same, but at a lower cost to the NHS or with less waste.

NHS England and NHS Improvement have spent the past few years focusing on pushing the NHS to the limits of what can be efficiently achieved with the resources available. And it’ll use some of the additional £20.5bn in the funding settlement to get more of the same with the resources available, improving efficiencies in staffing, estates, equipment etc. But there’s a limit to what you can do with those resources, and that’s where productivity should come in.

If you look at the Office for National Statistics’ recent trend in public service healthcare productivity in England, 1.1 per cent per year doesn’t seem like an unrealistic target on the surface. Keep in mind this is productivity, and does not include the cost saving targets of around 4 per cent given to providers of hospital and other frontline services in recent years. The chart below shows that productivity increased by 2.1 per cent per year on average between 2010/11 and 2016/17. In fact, there was only one year of negative growth between 2002/03 and 2016/17.

Healthcare Productivity

Source: Office for National Statistics

The most significant gains since 2010/11 came from the extent of wage restraint in the NHS keeping input costs down. By keeping wage growth much lower than the increase in the number of people being cared for, the NHS was able to see big increases in the amount of care provided relative to the cost of each staff member or piece of equipment. With wage restraint ending and a big recruitment drive outlined in the long-term plan, how is this trend going to be maintained? If you look at the post-Francis Report period in Figure 1 (2012/13), you can see that the last significant NHS recruitment drive slowed productivity growth as labour costs rose at a faster rate.

For the next 2 years, the long-term plan outlines 10 priority areas for productivity growth. Most of these have already been enacted or announced – such as capping spending on agency staff, improving procurement, networking pathology and diagnostic services, improving value for money in prescription spending and reducing the number of clinically ineffective treatments. Future plans to increase productivity include a greater emphasis on using digital technology in community health services, a drive to reduce administrative costs and the publication of a 10-year national strategy to reduce patient harm.

The agency staff cap has provided significant savings to the NHS, with trusts spending more on bank than agency shifts, at least in nursing. In the future though we can expect to see the percentage of this saving fall as that form of staffing becomes less common. At the same time, absence due to stress and mental health issues has increased to record levels in recent years among nursing staff. How can we expect staff to work even harder in their time on shift?

The NHS has been working to reduce prescription costs and has produced huge savings over time through better use of generic drugs (though drug costs have been increasing in recent years, thanks to big increases in the cost of certain generic drugs). Similarly, waste in procurement and variation in prices paid for supplies could also open up significant savings, following on from NHS Improvement’s Model Hospital programme.

Less clear is the impact that technology will have on the productivity of the NHS. There are plans to digitise some services in the community across mental and physical health as well as primary care, but the evidence on the likely return on this investment is mixed. Individual schemes have shown cost-effectiveness, but the success of many digital technology schemes depends on a range of cultural factors, including the clinical model at work and engaging clinicians and other staff.

The thing is, of all the activities I’ve listed, in practice it’s likely only the digital technology schemes that would potentially increase productivity as opposed to efficiency. Despite referring to these changes as improvements for productivity and efficiency, most of the schemes outlined in the long-term plan focus on improving how the NHS provides more of the same care with the same workforce, rather than transforming the possibilities of what staff can do.

If the NHS continues to focus on the same schemes and improving efficiency it’ll see smaller and smaller returns until there’s little left to gain. As we and others have said, the funding settlement is only enough to maintain existing services at their current level, not provide enough additional funding to help transform how care is provided.

Productivity may have to wait, efficiency calls.



Tory conference police force admits sharing information on protesters with DWP

Disabled activists have demanded an inquiry after a police force that has patrolled four Conservative party conferences since 2010 admitted sharing information about protesters with the Department for Work and Pensions (DWP).




Greater Manchester Police (GMP) has now become the second police force to admit sharing information about people taking part in protests with DWP, following a similar admission by Lancashire police.

Policeman

But GMP has also admitted having a “sharing agreement” with DWP, even though the department explicitly stated two months ago that it had no such arrangements with any police force.

The admissions have followed claims reported by Disability News Service (DNS) that police forces have been targeting disabled protesters taking part in peaceful anti-fracking protests across England.

Lancashire police then admitted in December that it had shared both information and video footage of disabled anti-fracking protesters with DWP, in an apparent attempt to have their disability benefits removed.

Last month, DWP refused to say – in response to a DNS freedom of information request – which police forces had passed it information about claimants of disability benefits who have taken part in anti-fracking and anti-austerity protests.

But Greater Manchester Police has now told DNS that it passed DWP information – but not video footage – about protesters taking part in the anti-fracking protests at Barton Moss, Salford.

Those protests took place in 2013 and 2014, but the force also confirmed that it has shared information with DWP from protests not connected with fracking.

This raises concerns that it has passed information to DWP about disabled people who protested in Manchester about the government’s austerity-related social security reforms, particularly high-profile actions in 2015 and 2017.

In 2017, disabled activists from the Disabled People’s Direct Action Network (DAN) and Disabled People Against Cuts (DPAC) criticised “heavy-handed” police tactics at a direct action protest that blocked tram lines outside the conference.

The Tory party is due to return to Manchester in September for this year’s annual party conference.

Andy Greene, a member of DPAC’s national steering group, said: “Using the cover of suspected benefit fraud as a shroud for the targeting of disabled activists is outrageous.

“These are public services and should be deploying every resource they have to support disabled people to be active and engaged citizens.

“Yet, what we see is the use of those resources deployed against disabled people as if we are enemies of the state.

“Violence, the weaponisation of hunger, the ‘grave and systemic violations of disabled people’s human rights’ – this is what we are experiencing at the hands of the police, the DWP and other public services every day.”

He added: “There needs to be an inquiry into what’s gone on; and where wrong has been done, people have to be held to account.

“Who made the decisions within these services to share this information, when, how were these decisions justified?

“Disabled people need to be shown – not words – that they are safe to take part in protests, demonstrations, campaigning and activism without the threat of police violence or having their benefits and services taken away.

“The policing of disabled people by the very services designed to empower and enable us is a dangerous road to go down.”

Dennis Queen, who lives in Manchester and was arrested at the 2017 protest for public disorder but was later found not guilty, also backed calls for an inquiry.

She said she did not understand how the police could lawfully know who was claiming disability benefits.

She said: “In the same vein I don’t understand what business it is of the DWP if a person decides to attend a protest.

“As far as I am aware there are no questions in benefit claims about attending protests.

“There is no rule that claimants may not attend protests for us to be breaking. If there is then we ought to have a right to know about it.

“I can only assume this is being done to cause a chilling effect and make disabled people afraid to protest. As such, it’s an informal ban on protesting against disabled people.”

Three other police forces that have been involved in policing anti-fracking protests over the last six years – Sussex, Surrey and North Yorkshire – have told DNS that they have not passed on information about protesters to DWP.

A Greater Manchester Police spokesperson said in a statement: “As part of a sharing agreement, information about protestors has been passed to DWP but only in the event where concerns have been raised.

“During the course of our duties, whether this is at protests or not, if any concerns are identified, we are duty-bound to pass these onto the relevant partner agencies in any policing operation.

“No-one is deterred from taking part in protests or exercising their right to free speech.

“As with any operation, a strategy is put in place in order for us to facilitate peaceful protests with as little disruption to the local area as possible.

“The sharing of information is a useful tool for both us and our partners, helping us to build greater intelligence pictures, identify areas of concerns and work better with the communities we serve.”

A force spokesperson later added: “Information was passed to DWP in relation to the Barton Moss protests.”

She said that the raising of concerns that lead to information being passed to DWP are those “identified from intelligence gathering before all protests, reports made by the public and information passed on by police officers on the ground”.

The spokesperson also confirmed that information had been passed to DWP about both anti-fracking and non-fracking-related protests.

It is not yet clear which other protests have led to information being passed to DWP by Greater Manchester Police.

A DWP spokesperson said: “There is no formal arrangement in place between DWP and any police force for this or other similar scenarios.”

She had not said by noon today (Thursday) whether this meant her department was accusing Greater Manchester Police of lying about its “sharing agreement” with DWP.

She also refused to say if the minister for disabled people accepted that this exchange of information with GMP risked creating a more hostile environment for disabled people who receive benefits.

She also refused to say if Newton accepted that there would be grave concerns over the possible sharing of information with DWP by GMP from anti-austerity protests that were critical of DWP and its policies at Tory party conferences in Manchester.

Story source: John Pring at www.disabilitynewsservice.com