An easy answer to NHS productivity

Our Founder and CEO, Thomas Webb, reflects on the messages from this year’s NHS Confederation ICS Network conference and looks at how the NHS can be more productive despite the many challenges it faces right now.

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I recently attended the NHS Confederation ICS Network event. And it was a chastening experience.

It was incredibly well attended, with nearly every ICS represented, and with multiple Chairs, CEOs, Directors of Transformation/Strategy…you name it. The speakers were of the highest quality and a real highlight was Torsten Bell, Matthew Taylor and Stephanie Elsy in conversation about the cost of living crisis and wider political landscape.

The message from the summit was clear: There. Is. No. Money.

And there is no more money coming. But demand in increasing.

Whatever your political views, the facts are clear. Growth in this country has stalled. Productivity has also stalled. This is in combination with the cost of living crisis, which continues to take money out of both the public’s pockets and the government’s pockets (debt repayments are huge).

So there just isn’t the funding available for the NHS and social care to continue to do what they currently do to the same standards.

The only way out of this is for there to be an economic miracle and for growth in this country to pick back up again and tax revenues to rise. There are no clear ideas from either the Conservatives or Labour as to how the level of growth needed to properly fund health and social care will happen. Yes, Labour’s main narrative is an economic one, focusing on growth, but at the same time Rachel Reeves is ruling with an iron fist and has already put incredibly strict financial rules in place.

If Wes Streeting wants to invest more in the NHS, he is entirely dependent on the economic state of the UK. If we assume that an economic miracle isn’t on the way, then we have to face the facts that the NHS in its current state is financially unsustainable.

It will have to stop doing things that it currently does. It will have to make horrible decisions about which parts of society will suffer the most. Does it take money away from giving people dignity and care at the end of their lives to spend more on interventions in children, where the economic return on investment is greater?

So far, so depressing.

Of course, there are really considerable productivity gains to be made within the NHS. But this requires investment. Which isn’t coming. Not only because there is no money, but because HM Treasury look at the NHS as a financial black hole, asking for ever-more money and not achieving any better outcomes. So yes, some of this is of the NHS’s own making. Investing in ever-increasing staffing levels despite there being no evidence of that approach working, for example. There is a truly outstanding blog on this subject from one of our associates that I have done a poor job of summarising here. I urge anyone reading this to also read that, it’s brilliant.

So, is there nothing we can do? Not quite.

We would say this, given the market we work in, but there are genuine productivity gains to be found from making existing technologies in the NHS much more usable. This isn’t a huge national investment that will get a ‘computer says no’ result from HM Treasury. This is easily within the business-as-usual budgets of most trusts in the country.

It’s improved IT training quality. Simple. But effective.

KLAS data suggests that for every one hour you invest in training a clinician on electronic patient records (EPRs), you get back ONE HOUR PER WEEK in efficiency. Assuming a clinician costs maybe twice as much as an IT trainer, that’s around a 1:45 return on investment.

So, what does this mean in numbers? Well, we’ve calculated (very conservatively) that the NHS could release £1 billion a year in efficiencies just in time saved. Just from better IT training. This isn’t complex or complicated stuff. It doesn’t involve systemic working, cracking interoperability or unlocking patient flow. Just improve the quality of IT training.

Yeah, yeah, not cash releasing though, right? No, but given that poor EPR usability is one of the top contributors to clinician burn out (and the NHS could really do with retaining staff right now), there are huge savings available through reduced spend on bank and agency spend.

It’s a bit bonkers when you think about it. The IT systems that clinicians use are their primary tools, all day, every day. And we’re tying one hand behind their backs, not showing them how to use them properly. Why on earth not? It’s staring us in the face. Perhaps it’s just so close to us that we can’t see it.