Productivity is not a dirty word: Lord Carter’s report on NHS resources

Lord Carter’s report on workers’ productivity in the NHS could offer opportunities for physiotherapy staff, says Gill Hitchcock.


Do you long for the chance to improve patient services? 

There could be scope to do so, depending on how the government and trusts implement the recommendations arising from Lord Carter’s lengthy inquiry into productivity and the use of resources in England’s NHS.
The Labour peer, ordered by health secretary Jeremy Hunt to undertake the review, says he ‘knows’ that allied health professionals (AHPs) often ‘hold the key’ to unlocking inefficiencies in care pathways. The problem is, their skills and expertise are not always optimised.
His solution is to set up a national team – a ‘workforce efficiency improvement collaborative’ – to identify and solve issues that prevent trusts from making the best use of their AHPs.
Just some of the areas that need looking into are skill mix and competencies; how the relationship between specialist and generalist AHPs affects productivity; as well as the contribution that support staff can make to optimising the role of AHPs. 

Significant contribution

Lord Carter also says that access to AHP services should be examined by the team. Although they are not traditionally part of the ward skill mix, AHPs do make a significant contribution to admission and discharge processes. How trusts use this resource, however, varies and so the benefits are often not fully realised.  
Steve Tolan, the CSP’s head of practice, says: ‘Obviously if the NHS is more productive and efficient this would contribute to the sustainability of the services as a whole. And we know that AHPs have a role in increasing patients’ resilience, reversing dependence and expediting care.
‘Examples include helping people to transfer home, keeping people out of hospital and, in some circumstances, avoiding more expensive treatments.’ 
Overall England’s NHS spends £33.9 billion a year on staffing. AHPs, together with other professional, scientific and technical staff, represent the third largest staff group in the NHS. The spending on this group totals nearly £4 billion.
The review suggests that an improvement of just one per cent in staff productivity will save the NHS £280 million a year. This equates to hospitals using new working methods that would save every member of staff five minutes on an eight-hour shift.
Tackling delays in discharging patients who are well enough to leave hospital would save the NHS £900 million. The inquiry found that about 8,500 people remain in hospital every day because of a lack of social care.
Every trust that Lord Carter spoke to recognises the efficiency opportunities and quality improvements open to them, if they could only change the way their clinical services were delivered. 

Contributing to productivity 

The reason these are ‘rarely realised’ is down to the time and effort needed to present and explain the benefits to local partners and communities.
‘It’s so important that members are aware of this term “productivity”, says Mr Tolan. ‘It is a non-clinical word, but it doesn’t mean it is a dirty word. Physios should be thinking about the contributions they can make to productivity, and help to ensure that any changes are in the interests of patients, not targets that risk undermining quality.’
Health secretary Jeremy Hunt has urged all trusts to implement the recommendations ‘immediately’. Another positive sign is that the implementation will be led by NHS Institute for Innovation and Improvement, with Lord Carter on board as a non-executive director from April. 

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Gill Hitchcock

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