The NHS stands to make huge efficiency savings from better productivity practices if it begins to focus on the underutilisation of its resources, argues Dr Angus MacDougall.

There has been much reported in the media of NHS staff being asked to sacrifice their annual leave in order to avoid the financial precipice that the NHS is currently teetering towards. This issue is compounded further by challenging winter months and problematic peak holiday seasons. 

This was an unprecedented and somewhat desperate move by the sector, which could suggest that the NHS is losing its way. With more and more trusts facing financial peril, there is a requirement as never before to find new ways to increase productivity and drive out costs.

“Improving utilisation would allow the NHS to make the £20bn ‘Nicholson challenge’ look like small beer”

However a common complaint across the NHS is that cost cutting and efficiencies are looked for in the wrong places. It is clear time is running out and that trusts need to focus in the right places and at the right level to release the financial pressures.

Focusing on cost savings from the macro level is like sailing a boat with a map but no rudder, while focusing at the micro level means that your small boat is no match for the strong tide you are trying to sail against. So at what level should trusts focus their cost saving activities?

I am going to make a bold prediction. At any one time in the NHS, a significant proportion of NHS resources, say theatre space, clinical rooms or MRI scanners, are not being used. This underutilisation could be as much as 20 per cent. Improving this would allow the NHS to smash the Nicholson challenge and make the required £20bn savings over three years look like small beer.

But why are these resources not being used? The answer is straightforward – poor organisation and lack of transparency at the level of staff and resources. Consultants are the main drivers of clinical activity in a hospital. Overall productivity in the trust is reduced when their work is not organised to maximise the use of the hospital’s resources.

Further to this, consultant activity will determine the activity of other worker groups such as nurses, junior doctors and allied health professionals. When information about consultant activity is not transparent and updated quickly the allocated staff and resources are wasted when they could have been deployed in other areas. So poor resource utilization results in a double hammer blow of reduced productivity and wasted costs.

What is required is advanced planning, with the production of clear rosters to give full oversight of which doctors are available at any given time. In the past, managing staff availability and scheduling treatment was often considered a time consuming task and a diversion from patient care. However, advances in technology have not only transformed these processes, they have also led to immense efficiency gains.

Modernisation is clearly the cornerstone of reform in this area. NHS trusts have to be realistic about what can be achieved with outdated technology and paper-based processes. If efficiency and cost reduction is the end goal, it’s time to equip staff with the means to achieve more with fewer resources.

With a move by some trusts to focus on organising their staff rosters specifically around the use of their resources, this approach will, I believe, drive much greater productivity gains.