Improving information quality and getting clinicians “on board” are crucial if the NHS is to improve its productivity, a management consultant has warned.

Speaking about the “productivity challenge” facing the health service, George Blair, managing consultant at Shared Solutions Consulting, said: “Our record on productivity hasn’t been good.”

He told delegates at the NHS Confederation annual conference in Liverpool that it was vital to understand what was holding it back.

He highlighted the lack of information he had seen at trusts as a major problem. Mr Blair said: “Working with trusts, I really feel for them because the information systems are so poor.”

In particular, he criticised the separate “silo” working of the clinical directorates in hospitals, which generated separate information streams.

“They’re in silos, they don’t come together,” he told delegates. “There ought to be an information team, not necessarily in the same room but there needs to be much better integration of information.”

Mr Blair also identified the importance of getting clinicians to “buy into” productivity.

He said: “The really crucial thing is there’s got to be something in it for consultants. Let’s not mess about. The people with power are the consultants.”

He suggested, as some trusts are already doing, that clinicians should be allowed to reinvest savings they made on achieving financial targets in “pet projects”, such as a new type of clinic or technology, as an incentive to be more productive.

Mr Blair also set out six questions that managers should ask about their services in order to help find productivity gains (see below).


How we save money:
Why do non emergency pathology
Do staff start times match patient numbers
How many A&E staff do you need at 3am
Mental health: how many teams do you need
Community teams: how to reduce car miles
What can you stop doing or do less often


In particular he noted the productivity gains on offer nationally from centralising pathology services for non emergencies, as they are in countries such as the US and Australia.

He said: “One of the strange things about Britain is that every hospital, virtually, has a pathology department with whole banks of machines, which are used for a bare minimum of time. There’s a huge amount of capacity with lots of staff.” 

Additionally Mr Blair explained how he thought the profiles of more productive and less productive trusts differed in his experience.

He said more productive trusts “can provide information, are welcoming and respond well to questions”. Meanwhile poorer ones are less able to do these things and more defensive, he said, with staff often appearing “browbeaten”.

But he added: “Every organisation has something they can teach the rest of the NHS.”   

South Tees Hospitals NHS Trust chief executive Simon Pleydell, who chaired the session, said there were many unanswered questions on NHS productivity.

He said: “I still wonder whether we know how to measure it and do we really understand how to engage our workforce in actually building true productivity gains.

“If you look at the health service on a macro level, actually it doesn’t appear that we’re getting more productive. We’ve put more money in but what are we getting for it.

“I think that’s a big challenge. For those of us involved in providing the services it just strikes me that this is the key challenge for us over the next strategic period,” he told delegates.