Public Sector Productivity

Lord Patel Excerpts

Wednesday 9th October 2024 Lords Chamber

[Lord Patel (CB)]

My Lords, if the noble Baroness, Lady Neville-Rolfe, is looking for any answers that I might have about how to increase productivity in the NHS, she might be a bit disappointed. However, I will give my views.

NHS productivity has long been a focus of politicians and policymakers. Any debate about challenges facing the NHS ends up with a discussion about productivity—mostly about how to increase it. Several recent reports from official organisations and think tanks demonstrate the wide interest in the subject. I will refer to one or two of them, particularly one detailed report from the King’s Fund

In my view there are four key issues when looking at productivity in the NHS. The first is how productivity in the healthcare sector has changed over time. Secondly, what has driven the recent fall in productivity? The third is the limitations of official productivity data. Fourthly, and lastly, is productivity going to increase and what needs to be done for it to do so?

Looking at how productivity has changed, the ONS data shows that over the past few decades NHS productivity increased faster than that of other public sector services, such as education and social care, and even the wider economy. However, in 2021, health sector productivity fell by 23%. In 2021-22, it had a slight recovery but was still down 7% from pre-pandemic levels. The recent NHS England data, which focuses mostly on the acute sector, shows that it is still down by 11% compared to pre-pandemic.

A number of different factors have driven this recent fall. Investment has already been mentioned—capital investment in buildings and technology, as well as outdated equipment and buildings not fit for purpose. There is a low ratio of managers with the competency to manage the flow of patients to administrators, who end up increasing bureaucracy and waste. NHS staff sickness has led to experienced staff leaving the service and new staff replacing them—and we have had a considerable increase in staffing. Less experienced staff are not fully trained, hence the process slows down. Industrial action and more sick patients with multi- morbidity, requiring more complex care, requires greater resources. Compared to my day, today’s complex cancer surgeries, for instance, could take as long as 10 to 14 hours per patient. That requires a lot of resources.

There are limitations to official data. Not all data is captured on the new way of delivering care, particularly in the community. Different organisations use different metrics. Data is collected for the acute sector but not for community settings, which skews the numbers. There needs to be consensus on what data should be collected to measure productivity across the whole healthcare sector.

Is productivity going to increase? There are several initiatives, including the financial package of £3.4 billion announced in the last spring Budget, to build capacity in technology. The NHS productivity plan aims to save £35 billion by 2029, with yearly increases in productivity of 1.9% to 2.2%, and one hopes that that will happen. However, without addressing the capital funding backlog of £11.9 billion for more investment in social care, to improve patient care and to provide better support for hard-pressed staff, none of this will happen. It will be challenging to increase productivity to that level. Post-Covid, for reasons that are not obvious, productivity continues to decline. For example, out-patient appointments per consultant are down 7%, and surgical activity is down 12%, as has been identified in the Darzi report.

It is right that politicians focus on the productivity of the health sector but, as experience has shown, there needs to be some realism about how easily and quickly it can be achieved. We need also to recognise that, in healthcare, quality matters more than quantity. We need high-quality care delivered with the resources available and not more quantity, as some may think. I look forward to the Minister’s answers.