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NHS Productivity: It’s all in the (Job) Planning

Blog by Darren Kilroy, Medical Director – International, RLDatix

The 2024 Spring Budget might not have been the thing to put a spring in your step, and the politics of job planning are often those with of the small ‘p’ variety when it comes to cultural appetite for making the most of the process within an organisation. But like it, loathe it or indifferent to it, the announcements made concerning NHS productivity on 6th March have implications for the effective use of job planning in the field. It is untenable to walk past a comprehensive and rigorous approach to medical staff deployment if the expectations set out in the Budget are to be met by the NHS.

Some facts and figures now – but not many – and a little speculation. The additional £2.5 billion of day to day revenue funding announced in the Budget means that, in real terms, funding remains flat. And there are no changes in capital funding any time soon. The pressure effects of recent industrial action and the existing backlog will likely see some as-yet-unannounced in-year top up funding through 2024-5. We know how frustrating such an approach is for NHS providers. It doesn’t enable anyone to plan. It encourages the use of agency staff. Where we will see new money is for capital spending to boost NHS productivity. £3.4 billion of it. The definition of the latter remains a little unclear. This takes the shape of funding for “tech and digital” investment, the aspiration being, as set out in the Long Term Workforce Plan, a 2% per annum increase in NHS productivity. The service has never achieved that before. It’s never come close; this is a big ask.

£2.2 billion of the £3.4 is accounted for in this Budget. The additional £1.2 is yet to be sourced. Whether it is truly new money, or will be repurposed from capital budget elsewhere, is not clear. It’s for the next administration to resolve; we will have had a General Election by then. Of this funding, a significant chunk – £3 billion of the 3.4 – is tailored to better use of data, reducing administrative burdens on clinical staff, and replacing outdated IT. There is an expectation that ‘off framework’ agency use will cease, although this has been an expectation before and is caveated by the need to maintain emergency services as the priority. Maternity safety gets £35 million over three years.

The productivity metrics invoked to track and support the massive improvements needed to meet that 2% year-to-year gain will commence in the second half of the 2024-25 NHS year – taking us past the General Election. They will be held both at Trust and ICB level and from there fed centrally.

So where does this leave us in terms of medical workforce technology, particularly Job Planning? Simple. It leaves us absolutely obliged to ensure that all staff whose work patterns have a predictable basis – and that embraces the vast majority of Consultants, Specialty Doctors and very many Clinical Nurse Specialists and other autonomous practitioners – are in possession of an agreed, simple-to-administrate Job Plan. These Job Plans must be at the very least allied to operational outcomes relevant to the parent specialty, and ideally woven into Team Job Plans that demonstrate, at the tap of an icon, the available clinical resource at a given point in time to contribute to delivery of operational outcomes.

We know that certain pathways of care are extremely challenged in England. Ophthalmic surgery, cancer care, urology are just three. In these specialties especially, effective Job Planning is non-negotiable. It will be simply impossible for an organisation to even approach its productivity obligations without Job Plans. This is not discretionary activity. This is using the public purse properly.

There are well-rehearsed and very prevalent reasons why developing and sustaining a Job Plan process in Trusts falter. They are almost invariably rooted in problems with explaining the  ‘why’ to clinicians rather than the ‘how’, although the conflation between this is often confusing and it’s easy to understand why tenacity wanes in getting the process over the line year on year. But we are now firmly in the era of accountability for consequences – not financial ones, safety ones. People’s sight loss and their cancer survival are just two life-changing examples of where Job Planning, done right, will make a difference. The Spring Budget gives us a reason to re-engage with Job Plans. Productivity expectations give Trusts a reason to listen. Patients give us a reason to deliver.

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