1 Introduction
1.1 Background
The Scottish Government published Better Health, Better Care in December 2007. This set out an Action Plan for NHSScotland over the 5-year period to 2012. The delivery of more effective, efficient and productive services is a key and integral component of the Action Plan and of the Scottish Government Efficiency Programme.
Better Health, Better Care recommended the establishment of a national steering group to bring greater coherence to work already ongoing related to efficiency and productivity and to integrate and coordinate efficiency and productivity activities across NHSScotland. The NHS Efficiency and Productivity Steering Group ( EPSG)was established in April 2008, and aims to assist NHS Boards identify improvements, share good practice and deliver efficiency savings in order to ensure optimal deployment of resources to the delivery of front line patient care.
The Efficiency and Productivity Programme is a key and integral component of NHSScotland's overall quality improvement strategy. Efficiency is one of the six internationally recognised dimensions of healthcare quality. It sits alongside effective, equitable, safe, timely and patient centred ( diagram 1). The NHS Efficiency and Productivity Programme is about supporting sustainable continuous improvement that will enable NHSScotland to work better together todeliver quality, consistency and value. Delivering quality and value is central to the provision of a patient-centred NHS and is fundamental in terms of meeting patient aspirations of 21st Century Healthcare Services. Ensuring effective and efficient utilisation of resources is good management practice. The Efficiency and Productivity Programme recognises that achieving and sustaining efficiency and productivity gains is one of the most fundamental challenges facing NHSScotland and therefore aims to support the service to realise tangible efficiencies, particularly cash releasing, for reinvestment in front line clinical services by promoting the efficiency dimension of quality, improving consistency of care and embedding an efficiency ethos at all levels from individuals, to teams, to hospitals to NHS Boards and within all quality improvement work.
Diagram 1
In terms of definition, both efficiency and productivity are about the relationship between the resources we put in and the outputs and outcomes that flow from those resources. Being productive is not necessarily about working harder, but about enabling staff to work smarter, spending more time where it matters for them and for patients, improving the quality and value of direct patient care. It is ultimately about making best use of all resources available for the provision of services and minimising duplication and waste in the system.
In practice, efficiency and productivity can be defined in several ways:
- Delivering the same quantity and quality of service from less resource
- Delivering a greater quantity of service of the same quality from the same resource
- Delivering the same quantity but a better quality of service from the same resource.
1.2 Context
The NHS in Scotland has benefited from substantial financial investment over the previous decade. Overall expenditure on health has increased by 40% in real terms between 2001/02 and 2006/07, rising from £6.1 billion in 2001/02 to £10.2 billion in 2007/08. On 14 November 2007, Scottish Ministers announced the outcome of the Scottish Spending Review which confirmed a further increase in NHS resources over the period to 2011 and a target to deliver 2% cash-releasing efficiencies annually. This will deliver a £1.6 billion saving within the Scottish Government Efficiency Programme with a savings target for health of £215.2 million per annum, equating to £646 million over the three year period 2008/09 to 2010/11. Additionally, the UK Budget in April 2009 announced a further £5 billion efficiency drive across the UK public sector, which will require further efficiencies from Scottish public services, in addition to those identified on the 2007 spending review.
This delivery plan sets out the first phase of the programme proposed by the NHS Efficiency and Productivity Steering Group. The programme will set out a second phase of activity once the impact of the 2009 budget is understood.
In December 2007, Audit Scotland published the Overview of Scotland's Health and NHS Performance in 2006/07. In relation to productivity and efficiency, this report concluded that performance against key targets, including waiting times, is improving but further work is needed in some areas. The report also suggested that investment in the NHS does not appear to be matched by increases in traditional consultant-led activity, and that productivity remains difficult to measure. Audit Scotland also identified a need to develop the current NHS performance management system to be able to report on productivity, cost and quality together. The report noted that this should fit with wider work on developing outcome measures.
Over a number of years, many initiatives and programmes have set out to measure and improve efficiency and productivity. There is recognition that current levels of performance in NHSScotland continue to demonstrate continuous improvement, however, there remain significant levels of variation across a range of measures and indicators and a sense that traditional datasets have not kept pace with clinical innovation and service developments. Understanding the key characteristics of high-performing services and developing a delivery framework that supports improved performance and greater consistency across a range of efficiency and productivity indicators is a key deliverable of the NHS Efficiency and Productivity Programme.