© Nuffield Trust20 April 2023

Productivity across the NHS

Anita Charlesworth

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While aggregate spend on workforce has increased, it now forms a smaller proportion of total expenditure

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This change in expenditure can be broken down into numbers of staff and expenditure per employee

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There are now fewer nurses per medical staff member, mainly due to an increase in the latter

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There has also been a far more rapid increase in Healthcare Assistants since 2007/08

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Productivity measure Measures of Output Measures of Input

Nuffield Trust

By acute provider

Cost weighted activity including acute and community service episodes and attendances

Labour cost

Office of National Statistics

Whole economy

Measures above plus:

Family health service consultations

GP prescribing

Quality weighting

Measures above plus:

Goods and service costs

Capital consumption

Our productivity measure for each trust was based on the Office of National Statistics’ whole economy index

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The ONS estimates that productivity has remained essentially unchanged over the last four years

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Better labour cost control in acute trusts leads to greater gains in productivity in our measure

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While productivity outliers have been brought towards the average, half of trusts are still in a range of 20%

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Statistically significant drivers of productivity

Tested but no effect found

Follow-ups per first outpatient appointment (-ve)

Better care, better value indicators other than first to follow-up ratio

Located in London (-ve) Index of multiple deprivation

Foundation trust status (+ve) Other geographic locations than London

Herfindahl–Hirschman index (i.e. competition between providers) (+ve)

Staff mix (proportion of employees who are medical or dental staff) (+ve)

Proportion of revenue from education, training and research (-ve)

Trust size (described as number of beds available overnight) (-ve)

Our econometric modelling was able to explain 35% of variation in productivity at a trust level

© Nuffield Trust20 April 2023

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