Sectors
Get In Touch
Four classical musicians performing a string quartet in a nineteenth-century rehearsal room, illustrating Baumol’s cost disease and the limits of NHS productivity. NHS productivity and patient pathways

Anita

There’s a report coming out this week…  

Understanding NHS productivity and patient pathways is crucial for efficient healthcare delivery.

This report will highlight key insights into NHS productivity and patient pathways.

Improving NHS productivity and patient pathways is essential for better patient care.

… from Anita Charlesworth and friends at the Health Foundation. It’s embargoed so I can only tell you it’s about productivity, and …

… particularly focusing on NHS productivity and patient pathways.

Niall Dickson and I have done a podcast with Anita…

This post will focus on NHS productivity and patient pathways to explore their impact.

We must discuss NHS productivity and patient pathways in detail.

Case studies on NHS productivity and patient pathways can provide valuable lessons.

… watch this space.  

The future of NHS productivity and patient pathways looks promising with new strategies.

The Health Foundation are the John Lewis of think tanks, elegant and aspirational…

NHS Productivity and Patient Pathways: A Critical Examination

… I sometimes think we need a B&Q approach? Nevertheless the report is a cuppa-builder’s read, and…  

… reminds me of a sadly overlooked Dutch computer scientist who died over twenty years ago, whose work has something very useful to tell us about productivity.

Improving NHS productivity and patient pathways can lead to significant healthcare savings.

Edsger Dijkstra. 

Stay with me!

Dijkstra devised an algorithm for finding the shortest route through a network.

Think GPS in yer car; lots of possible roads between here and where you want to be. Each road has a ‘cost’ attached to it… distance, time, difficulty. Dijkstra’s algorithm works out the least-cost route from A to B.

OK, forget roads… think NHS.

Symptoms… GP… bloods… referral… outpatient… scan… another outpatient appointment… diagnosis… treatment… rehabilitation… home.

That’s a network.  Every connection and interface has a cost… not just money;

  • Time. 
  • Delay. 
  • Travel. 
  • Anxiety. 
  • Duplication. 
  • Risk. 
  • Error.
  • Staff-hours. 
  • Lost days at work.

NHSE requires a 2% productivity improvement, every year, for three years… 

… calculated by dividing Activity Growth by Spend Growth. If a trust increases the care it delivers by 5%, while its costs only rise by 2%, the index goes up.

Feedback from staff can enhance NHS productivity and patient pathways.

Technology plays a key role in NHS productivity and patient pathways improvement.

Research shows that NHS productivity and patient pathways are interlinked.

Last year there was a 2.7% productivity increase, but…

The ONS, says it was 1%.

Wot’s true? Dunno… but I do know…

… the wider economy productivity’s been growing at x̄ 1.1%. So, tell the nay-sayers to £^&%-off.

and…

… there’s something else… William Baumol …

… he pointed out what became known as the cost disease.

Some work lends itself to productivity improvement…

… a factory that once needed a hundred people can use robots and need ten, but…

… a string quartet playing Beethoven still needs four musicians and broadly the same amount of time it needed two hundred years ago, and…

… their wages and costs keep pace with today’s wider economy…

… we pay more for what we got two hundred years ago!

Healthcare has a lot of Beethoven in it.

There are a lot of things we do for patients that will always take the same amount of time today, as it did when Florence did it.

Examining a frightened patient, explaining a cancer diagnosis, helping someone out of bed after surgery, feeding a confused elderly person, delivering a baby…

… there comes a point when doing it faster isn’t productivity and it’s not feasable.

It’s a risk… which is where Dijkstra meets Baumol…

… are we looking for productivity in the right place?

We measure theatres. Beds. Clinics. Staff. Scanners. Appointments… every stop on the patient’s journey.

Dijkstra would ask a different question. Is this the shortest journey?

Why does a patient;

wait to see a GP,

wait for a hospital appointment,

wait to see a consultant,

wait for a scan and then

wait to see the consultant again?

Could the route be…

GP→diagnostic→specialist→treatment?

One junction disappears.

An elderly person who falls;

Home… ambulance… A&E… assessment… admission… ward… discharge team… home.

Could the route be…

Home→urgent community response→

assessment→treatment→home?

The productivity gain isn’t necessarily making any one person work harder…

… it comes from removing interfaces and miles from the journey.

You can have an exquisitely productive diagnostic centre and still people queuing and after, waiting months to be diagnosed and treated.

You can have efficient hospitals, efficient GP practices and efficient community services and still have an inefficient NHS.

Optimising the parts doesn’t necessarily optimise the whole.

Understanding the nuances of NHS productivity and patient pathways is vital.

NHSE recognises the problem. Its planning framework says conventional productivity measures based on things such as unit costs, activity and workforce can actually penalise organisations for shifting care into more appropriate settings, and…

… says it’s developing measures that better recognise prevention and the left-shift.

Productivity shouldn’t principally mean… how many patients did we process?

Productivity should mean… how quickly and safely did we get someone from needing help to being helped?

AI and better data add huge interest…

… if we knew capacity, we could calculate waiting times, diagnostic availability and clinical need in real time, and the best route through healthcare for each patient?

Not necessarily the nearest hospital.

Not necessarily the traditional pathway, but…

The best route.

Baumol tells us there are limits to musicians playing and nurses caring.

Dijkstra tells us we can make the journey much shorter.

Ultimately, the goal is to maximise NHS productivity and patient pathways.

Maybe the NHS has spent too long measuring the efficiency of the stops.

It’s time we measured the journey.  

Let’s ask Anita.

News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.

Discover more from The Training Network

Subscribe to get the latest posts sent to your email.

Previous Posts

Unfinished concrete bridge ending abruptly above a valley while a high-speed train races along a separate track towards the distant horizon. AI transformation in the NHS

Horizon

AI has arrived before the NHS is ready. Regulation, infrastructure, accountability and digital foundations remain unfinished, leaving healthcare racing to complete yesterday’s modernisation while tomorrow’s transformation accelerates beyond it.

Read More »
Overhead view of a senior management meeting room after a meeting, with a long table covered in briefing papers, notebooks, laptops, water glasses and coffee cups. Empty chairs surround the table while two officials leave the room in the background. NHS England abolition feasibility

Responsibilities

Abolishing NHS England was supposed to simplify management and save billions. Instead, workforce, legal and financial complications raise an awkward question: who decided this enormous reorganisation was actually feasible?

Read More »
NHS finance staff working on spreadsheets in a hospital office beside a busy clinical ward. NHS pension contribution £5.4bn saving

Spreadsheet

Britain may be run less by ministers than Treasury spreadsheets. NHS pension assumptions could release £5.4bn, raising a bigger question: will the NHS benefit, or will Treasury take it back?

Read More »
Staff outside Quarry House in Leeds, the NHS’s northern headquarters. NHS devolution and regional power

Power

Moving NHS managers and ministers from London to Leeds is not devolution. Real reform means transferring power, budgets and authority to regions, not simply relocating command-and-control bureaucracy further north again.

Read More »
Busy NHS community health centre waiting area with patients seated while nurses and clinical staff move between reception and consulting rooms. NHS Neighbourhood Health

Plug

Neighbourhood Health is the NHS’s eighth attempt to shift care from hospitals into communities. Without proven targets, extra capacity, workforce and double-running money, history looks likely to repeat itself again.

Read More »
Female GP prepares for the working day in a GP consultation room, with a computer, examination couch and blood sample tubes visible. NHS prostate cancer PSA testing policy

Newspaper

A quiet change to NHS prostate cancer testing shifts power from informed patients towards GP judgement, raising serious questions about transparency, inequality, evidence, cost and the future of PSA testing.

Read More »
A working mother sits in her parked car outside a UK care home, overcome with emotion after visiting her mother with dementia while balancing work and family responsibilities. Andy Burnham social care reform

Answers

Andy Burnham’s social care reforms promise fairness for families, but funding alone cannot solve workforce shortages, capacity constraints or NHS integration. After seventeen years, voters deserve detailed answers, not aspirations.

Read More »
Modern NHS regional health authority headquarters with staff entering the main reception, illustrating regional NHS leadership and healthcare system management. NHS missing middle

The Missing Middle

Roy Lilley argues the NHS needs to restore a powerful regional tier, creating a functional middle between Whitehall and local providers to improve planning, accountability, delivery and long-term resilience.

Read More »