© Nuffield Trust 17 November 2015 Productivity across the NHS Anita Charlesworth

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

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

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

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

© Nuffield Trust Productivity measureMeasures of OutputMeasures 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

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

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

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

© Nuffield Trust 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

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