In order to maximise the efficiency of the provider sector, our survey suggests the following solutions and recommendations should be explored at national, regional and local levels.
- The forthcoming long-term plan offers an opportunity to identify realistic and deliverable improvements that can be made and chart a credible path to realising them. It should not assume that placing providers under ever greater financial pressure will automatically drive efficiency improvements at a rate faster than has been achieved in the past.
- Any new efficiency requirement should be based on realistic assumptions and collaboratively agreed with providers. This ask should take the starting position of the trust into account and be accompanied by co-produced realistic delivery plans at organisational, system and national levels.
- NHS staff at all levels should engage in the efficiency agenda, from joint ownership of efficiency across all board roles, to empowering frontline staff to make improvements to their own working practices.
- Distinctions should be drawn between cost reduction schemes, productivity improvements and system efficiencies, and the centre should share nationally compiled learning about where trusts could make savings under each of these different areas.
- There must be acceptance at a national level that some variation between organisations, and between local systems, is natural, explicable and justifiable. The national bodies and long-term plan should only describe variation as “unwarranted” where there is clear evidence that it can and should be removed, and there is a clear means of doing so.
- Accountability must shift away from single-year efficiency programmes and control totals to provide incentives for both commissioners and providers to prioritise more sustainable efficiency schemes with the potential to transform services and release greater productivity gains over a longer time period.
- Community and mental health trusts should have access to relevant benchmarking data of similar quality to the acute sector as soon as possible.
- Trusts and NHS Improvement should not rely on organisational reconfigurations like mergers or takeovers to make unsustainable services sustainable, and while new care models will result in more efficient ways of working and better quality of care for patients, the centre should be cautious about the extent to which they produce cash releasing savings
- To reduce the reporting burden on trusts, NHS Improvement should automate as many information collection processes as possible and put more effort and resource into supporting trusts to make improvements, even if this means reducing the size of its analytics function.
- NHS Improvement should consider identifying top performers on efficiency and introduce a structured programme for them to spread best practice through peer to peer support, along the lines of the Global Digital Exemplars.
- As poor facilities, particularly IT, are a source of frustration for trusts and a block on increased efficiency, it is vital that capital is made available to the frontline and that the DHSC clarifies the rules around access to capital as soon as possible.