Improving NHS productivity: kicking the growth habit

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The NHS has a growth habit: every year since its foundation in 1948 it has enjoyed average real-terms growth of 4 per cent, with even higher levels of growth over the past decade. The coalition government is still promising real-terms growth for the service, but in practice, economic circumstances mean this will be very small compared to past levels. So how should the NHS respond to this new no (or low) growth world?

This is exactly the question our new report Improving NHS productivity: More with the same not more of the same sets out to answer.

In contrast to other public services the NHS is not facing cuts to its budget so its challenge is not to cut services, but to simply deliver a little more to meet rising demand from the same resources. As the title of the report implies the NHS will not be able to deliver 'more with the same' if it does 'more of the same'. So what does it need to do differently? Currently it is a system designed for growth, focused on growth and solving its problems with cash-growth. Without this growth the focus needs to turn to scrutinising all NHS expenditure and activity.

Doing this reveals that the greatest potential to improve productivity and quality will come from focusing on clinical decision-making and reducing the large variations in clinical practice across the NHS. It is at the clinical front line where the bulk of NHS resources are committed on a daily basis by clinical teams prescribing, referring and admitting. And it is the unjustified variations in these practices that wastes NHS resources and can contribute to poor-quality care.

As decisions on resources are taken by these frontline clinical microsystems, it is with these teams that action to release resources has to start. Releasing this potential will require leaders and managers at all levels of the system to challenge doctors, nurses, and other health professionals to reduce variations in care and support them to improve productivity.


Fraser Kelly

medical and occupational health manager,
Consultant in remote and occupational Healthcare
Comment date
29 July 2010
you could start by challanging the NHS management mindset.
The idea that only generic home grown management is capapble of dealing with the challanges of the future is ludicruous.
ALl this does is re enforce the past approaches, and denies a huge contribution form outside the NHS trained manager system.
The world is full of splendid managers from heralthcare backgrounds in private,public and not for profit systems many of whom sucessfully drive excellence on limited budgets.
Fully agree that staff have to adapt,but if the leaders are denying new ideas form outside the system,then why should staff behave any differently?

Mary Stidston

Head of Workforce & OD,
Comment date
28 July 2010
Excellent timely report which needs lots of debate and exposure.

Staff and organisations ned help to see the challenge as one of engagement, redesign, redeployment and retraining rather than a threat of wholescale job losses.

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