Consultant productivity falling as NHS financial crisis starts to bite

Almost half of the £2bn real terms increase in funding that the NHS received in 2015-16 went back into commissioning care from non-NHS organisations and to prop up the struggling social care system, whilst hospitals, amongst others services, found themselves struggling on limited resources, a new report by the Health Foundation has today revealed.

The report, A year of plenty? An analysis of NHS finances and consultant productivity, went on to state that a relatively small amount of the £2bn went towards NHS hospitals, mental health, community and ambulance trusts, whilst NHS providers’ operating income rose by just £0.8bn in real terms against their costs rising by a huge £2.4bn.

Increasingly, the Foundation found that planned care was being delivered by non-NHS providers to take pressure from hospitals struggling to meet rising demand in emergency wards.

There were also concerns raised about productivity targets set in the Five Year Forward view not being met, as staff were found to be ineffectively used and consultant productivity across 150 NHS acute hospitals fell by an average of 2.3% a year between 2009-10 and 2015-16.

Anita Charlesworth, director of Research and Economics at the Health Foundation, said: “Rising demand for emergency care meant that NHS providers haven’t had the capacity to deliver planned care and patients had to be diverted outside the NHS.

“NHS hospitals were left squeezed by sharply rising drug and staff costs with little additional funding. The result was big deficits that had to be covered by raids on investment budgets.”

Charlesworth also called on the NHS to urgently look at how to ensure additional funds reached NHS providers.

“The health service needs to plan better for emergency demand, fund emergency care fairly and make sure it gets the best possible price for care provided outside the NHS,” she argued. “Getting more NHS funding flowing to NHS hospitals is necessary but not sufficient to turn round the health service’s finances. The NHS has got to use the skills and talents of its workforce much better.”

The Health Foundation director went on to say that productivity was not falling due to staff not working hard but rather due to a system that was not designed to get the most from talented staff.

“Much better workforce planning is critical,” Charlesworth explained. “Increasing the number of consultants by a fifth without investing in nurses is a prime example of short-term cost-savings undermining the essential task of improving long-term productivity.

“With no obvious end to austerity there must be a decisive shift from short-term policy making.”

The news comes on the same day that the British Medical Association (BMA) sharply criticised NHS England for failing to get funds from the £40m resilience funds to struggling GP practices.

Industry response

Niall Dickson, the chief executive of NHS Confederation, said that the question of who provides the care was not the issue – but rather that the quality of and value for money of care stays at a high level.

“The last couple of years have been tough but even harder times lie ahead,” Dickson said. “The limited additional extra funding in recent years was supposed to bring the system back into balance and change the way services are organised – the reality is that there is still a long way to go on both fronts.   

“There is a real commitment in the system to transform the way services are run, but as this report shows all too clearly, attempting to do this while coping with unprecedented demand and the greatest period of austerity the NHS has ever experienced is going to be very difficult and change will take time.”

Dickson concluded by praising the great care that was still being delivered to millions every day despite the challenges the health service was facing. But he also issued a warning: “We need to be prepared for more difficult times – not only in hospitals, but in mental health and community services.

“If we are to succeed in radical reform we need honesty and support from politicians of all parties as difficult decisions are made.”

The BMA’s consultants committee chair, Keith Brent, also commented: “As the report makes clear, consultants are working incredibly hard but are often let down by a system which has been creaking at the seams and is now at breaking point.

“With demand on services at an all-time high and the NHS treating more patients year-on-year there is no question that consultants, along with other frontline staff, are working harder than ever.”

Brent went on to say that a statistical perspective should always be looked at cautiously, as consultants would always treat patients as individuals, not as “units to be processed in ever greater quantity”.

“This research highlights the shortage of doctors and nurses in some areas, and the need for an NHS with the right mix skill to deliver high quality care,” he stated. “Increasing the volume of activity is not the only way to improve efficiency, consultants also need the time and support to develop innovative ways of working that improve quality of care, as well as saving the NHS money”.

Royal College of Physicians president Professor Jane Dacre also said that the report should come as another warning for NHS England to act.

“Once again, we have another report which outlines that our consultant workforce is overstretched in an underfunded NHS,” she argued. “Where, each day, such circumstances hamper consultants ability to provide effective, timely and high-quality care to patients who often have complex, long-term diseases.   

But, according to Prof Dacre, the solution to the NHS’s problems go further than simply additional funding: “Money alone will not solve this issue; workforce planning is crucial.

“As noted by the Health Foundation, falling consultant productivity doesn’t mean consultants aren’t working hard, clearly, we know they are. If we are to improve productivity consultants need to be supported by strong teams encompassing nurses, management and support staff.”


Prof W Angus Wallace   28/03/2017 at 16:07

Your article implies that Consultant productivity has fallen despite many more Consultants being appointed. Unfortunately the team who explored this have not taken the changing face of surgical practice into account when producing this report. A number of changes have been taking place over the past few years - an increase in mandatory training, devolved Consultant time for appraisals and increasing NHS bureaucracy which removes the surgeon from the operating theatre. In addition the Supreme Court judgement on the Montgomery case - has meant that Consultants have to spend more time with their patient before surgery to ensure that the patient is appropriately consented for their operation. I do not believe the Consultants are working less hard, it is just that they are now being diverted to doing less productive activities which are now required of them. Consultants are working as hard or harder but the bureaucracy is making their role less enjoyable as well as less productive.

EW   31/03/2017 at 18:16

I think that part of the issue is that Consultants are now doing work that would have previously been done by trainees, due to lack of trainees / trainee timetabling. This also means trainee clinic lists no longer exist or are reduced in number - which would have counted under Consultant activity (lists supervised by the Consultant). This isn't a criticism of trainees - more a reflection of the impact of their numbers / rotas.

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