Source · Select Committees · Public Accounts Committee
Recommendation 3
3
Accepted
Set out detailed plan for unprecedented NHS productivity gains, addressing staff retention.
Recommendation
NHSE displays a remarkable complacency about the realisation of future NHS productivity improvements, which, if achieved, would be unprecedented. According to official ONS measures, long-term productivity gains in the NHS averaged 0.6% a year over the period 1996–97 to 2018–19. But productivity subsequently fell and has yet to recover fully. The NHS has 19% more staff compared to before the pandemic but is only seeing 14% more patients. Workforce issues such as sickness and absence continue to impact productivity. NHSE is confident that the annual productivity gains that it has committed to of 2.0% by 2028–29 can be achieved because it contends the last two years have been affected by ongoing disruptions such as industrial action, and that further recovery is still possible, particularly through technology-enabled change. However, NHSE was unable to convince us that it has a detailed plan to achieve the promised productivity gains, and it does not yet fully measure and capture productivity in important areas, such as mental health and community services. recommendation NHSE should set out in detail which specific actions and initiatives it expects to contribute to the unprecedented increase in productivity it has committed to, and by how much. This should include specific measures to address poor staff retention and sickness rates, which contribute to low productivity.
Government Response Summary
The government agrees, detailing actions including training over 20,000 NHS managers and clinicians, supporting the National Retention Programme, deploying Electronic Patient Record systems and the NHS App, shifting care to community settings, and aiming to save £1bn by 2029 through biosimilar medicines uptake. Additionally, providers received 2025-26 productivity packs, and future plans will follow the Spending Review.
Government Response
Accepted
HM Government
Accepted
The government agrees with the Committee’s recommendation. pandemic. The most recent ONS publication of annual Public Sector Productivity shows: • NHS productivity continuing to recover in 2022-23, after the sharp rebound in productivity in 2021-22 following the Covid pandemic and the subsequent increase in demand – overall productivity improved by 1.9% between 2021-22 and 2022-23. • By the end of 2022/23, NHS productivity was 5.4% below the level it was in 2019-20, before the before sustained improvement as measured based on ONS methodology by NHS England over the last two years. • Consistent with the ONS methodology productivity has continued to improve and acute sector productivity is 2.7% higher in the year to December 2024. To support improving productivity further NHSE are focused on: • Increasing clinical and operational productivity –training more than 20,000 NHS managers and clinicians, and working with 25 Boards to build capacity and capability for improvement. The Enterprise Resource Planning (ERP) will make more efficient use of diagnostic and surgical capacity. Referrals will be optimised using A&G and clinical triage. • Maximising the value of our workforce – improving retention, reducing sickness-absence and reducing reliance on temporary staffing. The NHS has reduced spending on agency, from £3.5 billion in 2022-23 to a forecasted spend of £2.1 billion in 2024-25. Substantive staff retention has improved, supported by the National Retention Programme. In November 2024, the leaver rate was 6.8%, which is below the Long Term Workforce Plan target range. • Technology-enabled transformation – maximising the use of data and digital to improve the efficiency of services. Deploying Electronic Patient Record (EPR) systems and investment in the NHS App and other patient-facing services to free-up staff time. • Moving care to the right setting and improving prevention – realise savings by treating patients in less resource intensive settings and avoiding expensive hospital admissions. • Maximising the value of our spending – for example in medicines spending, driving uptake of best value biosimilar medicines with an ambition to save £1bn by 2029. For 2025-26, every provider has been sent a bespoke pack identifying productivity and efficiency opportunities. The plan for delivering productivity improvements from 2026-27 will be set out following Phase 2 of the Spending Review.