The problem the NHS faces or one of them at least(!) is the fact that it is what management guru's call 'people rich'.
It needs people. It is the opposite of most industries, able to deskill work by sharing the workplace with robotics or technologies. Componentise work; break it up into chunks, reducing the skills needed to complete the tasks.
The car industry produces much better cars using fewer people and lots of technology.
At the margins the NHS can reduce staffing by back-office amalgamations, robotics in pharmacy and pathology. We can make staff more effective with the clever use of new kit-n-caboodle but we still need people.
About 70% of a typical hospital's costs are tied up in people.
It is because no one has yet produced a robot that can wash yer granny's bottom; we need kind caring people to do it... and lots of them. There are more and more bottoms that need a wash.
We haven't yet got a conveyor belt where robots can fix your hip or an android take your temperature.
Improvements in staff productivity, closing the income-expenditure gap... a huge task. Right now the biggest lever we have to 'improve' productivity is the suppression of wages. Pay restraint.
No one working at the sharp end of the NHS has had anything like a better pay deal since 2010. It amazes me the trades unions have been so docile. Pay inflation is the lowest it has been since 1975.
A more ambitious approach to productivity might be more sophisticated models of care. Complex and difficult to deliver without endless consultation and a complete rework of the tariff and incentive structure.
The productivity challenge is very serious. Since 1995/6 to 2010/11 (Page 15) the average annual increase in NHS productivity has been about 0.4%.
Between 2012 and 2015 the pressure was on and it improved with a huge jump to 3% average. Don't celebrate to much; it was mostly achieved by pay restraint, better pharma-procurement, redundancies, lower than forecast inflation and tightening the tariff - the amount the NHS pays for treatments.
It is worth noting, 60% of the gains came from secondary care. Now you know why Trusts are running out of money!
To get anywhere near the present productivity challenge the NHS will have to deliver a close on 5% improvement, year on year.
There are some things that we can do: the NHS has 3 square miles of land it isn't using; an estimated �2.9bn could be saved from best practice facility and estate management; reserves for legal claims run into billions and there is a huge amount to come out of back-office costs.
But... we are missing a trick. As we are so heavily dependent on people, shouldn't we make more of people as our premium asset? Shouldn't we think very carefully before training budgets are cut?
I'm not talking staff training as in recruiting new people. I'm talking staff development. The Five Year Forward view says this:
"HEE will work with employers, employees and commissioners to identify the education and training needs of our current workforce, equipping them with the skills and flexibilities to deliver the new models of care, including the development of transitional roles. This will require a greater investment in training for existing staff..."
By way of contrast, in their report 'False Economy' the Council of Deans highlight cuts to Continuing Professional Development funding for Nursing, Midwifery and the Allied Health Professions.
There is a simple question; given the dependency we have on people to deliver care, shouldn't we care more about training and developing them to deliver the care?
As knowledge increases, so productivity increases. As training increases, so skills increase.
On-going education improves, confidence, competence, a greater willingness to make a better job of the job and reduces the cost of care.
Helping people to do a better job creates good relationships between management and employees.
Education improves quality, reduces errors and guess what...
... helps make the NHS more productive.
