Support to expand community capacity including in social care

Improving patient flow will reduce the number of costly out of area placements, step down care to the least costly settings, create additional capacity for elective work, and have a positive impact on overall productivity growth.

Expanding community capacity is a key pillar of trusts’ clinical strategies. Increasing community capacity can also help manage demand on ambulance services. By improving acute hospital capacity and flow, fewer ambulance hours will be lost to handover delays.

Government must ensure local authorities have the financial and operational capacity to support social care.


Implementation of the long term workforce plan

Providers take seriously their responsibilities as employers and continually learn from each other to provide better working conditions and support for their staff. But much greater support at a national level is required. We welcomed NHS England’s recent publication of the NHS long term workforce plan as a good starting point for the national support needed. Government needs to ensure workforce pipelines help providers reduce reliance on agency staff and improve the wellbeing and retention of current staff. Investment in staff development and training will be key. Funding and regular iterative updates will also be crucial to the plan’s success, and to the sustainability of the NHS. As highlighted in the plan, "recovering productivity is categorically not about staff working harder" (NHS England, 2023j).


Resolution of industrial action

While it is currently difficult to quantify the impact of industrial action on productivity levels, we know for certain that strikes are disrupting trusts’ capacity to reduce the elective care backlog. The strikes are also having a financial impact due to the loss of elective income, additional reliance on agency spend, and the increasing use of BMA rate card payments for strike cover.

The government must work to resolve industrial action as soon as possible to ensure providers can meet national performance targets and mitigate against the financial risk caused by the strikes. The NHS cannot afford for industrial action to become business as usual, and we are clear that both unions and government must keep open dialogue until resolution is reached.


Digital investment to improve interoperability

Improving facilities and digital capabilities will better enable staff to focus on key operational and clinical tasks. Frontline digitisation via electronic patient records (EPRs) can transform services to improve outcomes, enhance productivity and contribute to broader social and economic development.

As NHS Providers’ Digital Boards programme has evidenced, EPRs can increase productivity by reducing the time spent by staff entering and searching for data, and help inform service transformation to improve population health management (NHS Providers, 2023c). However, limited headroom within operational capital envelopes is crowding out the availability of funding for vital digital investment. There also needs to be a recognition of the revenue needs for digital transformation.

"The next few years will need to be about delivering more for less and this will be reliant on digital technologies, collaboration and partnership and services designed to be effective and efficient." Acute trust


Capital investment to expand bed base and transform the estate

Expanding bed capacity

While the focus of this report is on improving productivity growth in the short term, the provider sector will require major additional capital investment to increase its overall general and acute bed capacity over the long term. The NHS bed base is significantly lower than equivalent OECD countries. The number of available beds across the UK fell by 5% while admissions rose by 5%, and The Health Foundation forecasts that up to 39,000 more beds will be needed by 2030 to deliver 2018/19 rates of care (Rachet-Jacquet & Rocks, 2022).

Government must ensure there are funded projections for bed capacity over the course of the next spending review, including general and acute beds, but also intermediate care, rehabilitation beds and step-down mental health support.


Expanding access to strategic capital investment beyond the New Hospital Programme

As we have emphasised in our recent report on NHS capital investment, giving trusts access to adequate strategic capital will deliver the transformation needed to improve patient flow and deliver integrated, high-quality care across the whole system. This requires full consideration of the needs across the acute, ambulance, mental health and community sectors.

There was overwhelming demand from trusts to join the New Hospital Programme (NHP). 128 applications from 100 trusts were received by government to access the final places on the scheme. Following the Secretary of State’s recent announcement confirming more than £20bn for trusts already on the programme, trust leaders now await further clarity about the government’s proposals for a rolling programme of additional capital investment for those trusts whose applications to join the scheme were not successful.


Investing in management

Investment in managers across the health service is vital to help improve productivity growth. As the IPPR has recently flagged, there has been a year-on-year decline in the number of managers and senior managers in the NHS between 2010-19. However, these staff are vital to help enable operational efficiencies, improve patient satisfaction, reduce the frontline administration burden on clinicians, and facilitate innovation. Indeed, the IPPR suggests the NHS is "one of the most undermanaged healthcare systems in the world" (Thomas et al, 2023).

In its recently published report on NHS productivity, the Institute for Government (IfG) argues that insufficient levels of management across the NHS have a significant disruptive impact on the service’s ability to improve productivity. For context, the NHS currently only spends 1.4% of its annual health budget on management and administration costs, which is less than half the OECD average (Freedman & Wolf, 2023).

The IfG’s report warns that simply increasing the quantity of managers across the NHS, without any other changes to the system, will not be sufficient to drive the required improvement in productivity levels (Freedman & Wolf, 2023). The NHS also needs to empower managers to make decisions that will drive improvements in productivity levels. To enable the NHS to deliver the greatest value for money, and to ensure it continues to deliver cash-releasing efficiency savings, will require a sustained commitment to investment in healthcare managers.