Effective leadership and staff engagement will be “critical” if hospitals are to achieve the lion’s share of the £20bn NHS savings goal by 2015, a new Nuffield Trust study has found.

The research also suggested government plans for major NHS reform may, in the short term, be an “enemy” of the service’s quality, innovation, productivity and prevention savings drive.

The study included a review of UK and international literature on improving hospital efficiency, and a survey of senior executives and clinicians at hospitals that have overcome financial problems without harming patient care.

One of the “strongest findings of this study is that good leadership and good general and clinical management are crucial for making productivity gains”, authors Jeremy Hurst and Sally Williams said. Given this finding, they continued, it is “surely a worry” that the planned NHS reform “risks distracting managers from the efficiency agenda”.

“In the long term the hope must be that the reorganisation is a friend to QIPP, but in the short term it looks like an enemy,” they wrote.

Can NHS Hospitals Do More With Less? found good leadership, staff engagement, and certain management practices appeared to be linked with high productivity. Cooperation between managers and clinicians was “particularly important”. It cited US research suggesting effective nurse management, and employing degree-qualified nurses, seemed “to protect quality of care when there are reductions in nurse/patient ratios”.

More broadly, it found large gaps in evidence on the impact of savings programmes on care quality, stating that the “measurement of quality in the literature on hospital efficiency is invariably missing or incomplete”.

Despite this, they found evidence suggesting that there were “considerable efficiency gains yet to be made by the NHS in England”.

Nuffield Trust head of policy Judith Smith said: “It is very difficult to justify cuts if inefficiencies in areas such as rates of day case surgery, length of stay, and the purchasing of hospital supplies remain untackled.”

Based on the findings of the report the Nuffield Trust called for:

  • Clinical commissioning groups to establish clear goals with local providers in respect of day surgery rates and length of stay.
  • The NHS Commissioning Board to strongly encourage CCGs to make the most of new technologies and NICE guidelines, particularly those around optimal practice, ‘do not do’ recommendations and cost savings technologies.
  • Senior managers and clinicians to “test the benefits of a higher ratio of qualified and senior staff” with smaller numbers overall, rather than opting for vacancy freezes when savings have to be made in staff costs.
  • Hospital boards to proceed cautiously when considering mergers, which “do not automatically lead to efficiency savings unless beds and services are closed” and can create “diseconomies of scale” when forming organisations of more than 600 beds.