Source · Select Committees · Public Accounts Committee
Recommendation 15
15
Accepted
Complex patient needs, longer hospital stays, and staff sickness impede NHS productivity recovery.
Conclusion
We asked witnesses why NHS productivity continues to be lower than before the pandemic. NHSE told us the NHS currently has 19% more staff compared to before the pandemic but is only seeing 14% more patients. It named several factors as contributing to the ongoing difference.24 NHSE highlighted that the population is getting older with more complex and acute health needs, meaning length of stay in hospitals are becoming longer, and increased post-pandemic infection control which limits efficiency. NHSE also noted the impact on productivity of workforce sickness levels which, while reduced significantly from a recent peak, still remained higher than pre- pandemic.25 They pointed to examples where progress had been made such as reducing the use of temporary agency staff and better use of generic 21 Q 29 22 Q 32 23 C&AG’s Report, paras 3.11, 3.15 and 4.26 24 Q 12 25 Qq 8, 49 11 pharmaceuticals. But the rise in average lengths of stay in hospitals, in part due to the lack of availability of social care and community health services, was a factor in preventing a return to earlier levels of productivity.26
Government Response Summary
The government states that the NHS is working to recover lost productivity, with recent data showing improvement and ongoing efforts focused on clinical productivity, workforce retention, technology, care setting optimization, and maximizing spending value; bespoke packs identifying opportunities have been sent to providers.
Government Response
Accepted
HM Government
Accepted
3.2 The NHS is working hard to recover lost productivity caused by the Covid-19 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. 3.3 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. 3.4 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.