In May 2024, we surveyed trust chief executives and finance directors to gather their views on various finance-related topics, including NHS productivity. We received responses from 114 trusts, representing over half (55%) of the provider sector (209 trusts) across all regions and trust types in England.

Key findings

1. The three factors that respondents said presented the biggest challenges to increasing productivity were: delayed discharges and disruptions to patient flow (48%); lack of revenue funding growth compared to rising demand (38%); and increased patient acuity and complexity (37%).
2. The top three initiatives that respondents were most likely to say have had a major impact on increasing productivity growth within their organisation in 2023/24 were: reducing agency spend (55%); workforce initiatives focused on staff retention or changing skill mix (53%); implementing new models of care and pathway improvements (e.g. virtual wards) (50%).
3. Trust leaders have mixed views on the deliverability of the national target of achieving 1.9% annual productivity growth from 2025/26 to 2029/30. Several trusts noted that the target was challenging, but achievable. Other trusts highlighted that substantially improving productivity levels would only be possible with targeted investment in tackling the enablers of productivity growth, including investment in capital and digital technologies.
4. Over half (57%) of respondents said that estate related issues were severely (9%) or significantly (48%) impacting their ability to deliver improved productivity levels.
5. 53% of respondents said it would be difficult (35%) or extremely difficult (18%) for their system to live within the agency spend limits for 2024/25 as set out by NHS England in the operational planning guidance.   
6. 85% of respondents strongly disagreed (39%) or disagreed (46%) that their trust had sufficient resources to tackle health inequalities.
7. No trusts agreed or strongly agreed with the statement ‘your trust has sufficient funding to invest in prevention and help manage future demand growth’; 94% of respondents disagreed (34%) or strongly disagreed (60%) with this statement.