Yesterday, the King's Fund released a report on Agenda for Change, the new pay deal covering all NHS staff except doctors and some managers, which concluded 'there are few signs that it has delivered increased productivity'. Yet it cost the NHS an estimated £2.2bn and, in 2004/05 alone, came in at £220m over budget.

Earlier in the year the National Audit Office reached pretty much exactly the same conclusion regarding the new consultant contract. It wrote 'there is little evidence that ways of working have been changed…[and] few trusts have used job planning as a lever for improving participation or productivity'. Yet consultants' salaries have gone up by 28% since 2001/02 at a cost of £444m and, in 2004/05 alone, came in at £90m over budget.

In a similar vein a report to be released today by the DH containing the results of the GPs' Workload Survey, will reveal that GPs are now working on average 15% less hours than in 1992, despite being paid around 25% more. The GP contract also cost more than anticipated: £250m so in 2004/05.

But none of this should come as too much of a surprise, according to an online briefing released today by the think-tank Civitas, which argues that the findings are symptomatic of deep-seated inefficiencies in NHS staff planning, largely caused by 'pressures to meet an explosion of central direction that has forced a focus on targets and (later) financial pressures, thereby creating an upward-looking service with short-term goals, rather than one that is truly patient-centred and able to match supply and demand' (p.8).

In particular it argues that it is far too simplistic to lay the blame for the NHS' staffing failures 'at the feet of managers' (p.7).

While conceding that 'management in the NHS is far from perfect', and questioning the rapid overall increase in management (that has been over double the rate of clinical staff since 2000), the briefing's author, James Gubb, argues: 'it would be folly to rile managers without considering the system they are working in…in the NHS managers, administrators and staff as a whole have tended to increase in the wrong places and for the wrong reasons: to meet the latest government targets and objectives, rather than to add value to patient care' (p.7).

Faced with a cash-rich, but target driven environment, it was natural for NHS organisations to 'throw new staff into the task of meeting stringent government targets, rather than make real efficiency improvements' (p.4). Symptomatic of this:

• i. Little attention was paid to long-term costs when expanding the workforce. The number of people employed by the NHS now stands at 1.3 million - a staggering increase of nearly a third since 1999, and far in excess of projections in the NHS Plan (DH, 2000). This is most acute in the case of nurses, whose employment has increased by an astonishing 340% above that expected (p.3).
  
  But as boom turned to bust, the over-shooting of workforce growth targets has caused the current bizarre situation of 'job cuts at the same time as recruitment drives'. Employment in the NHS actually fell by c.9,000 between 2006 (Q1) and 2007 (Q1) according to the Office of National Statistics and of the c.9,000 nurses that qualified between May-September 2006, 31% were unemployed 6 months later (p.4).


• ii. Inadequate attention was paid to getting the best staff mix. Expansion has not always occurred in the right areas and 'demand significantly exceeds supply in some specialities'. This is most acute in midwifery, where staff increases have fallen far short of matching the 12.5% increase in the number of births since 2001 {stats}.
  
  The House of Commons Health Committee have also found evidence that 'the current trend of job reductions has ignored future service and workforce requirements', with, for example, the number of specialist breast cancer nursing posts frozen, in spite of recent demand for breast cancer services (p.5).


• iii. Little attention was paid to getting the best out of NHS staff. Significant pay increases were given to hospital doctors and GPs even before the new contracts were introduced for them, of 29% and 14% between 2001/02 and 2003/04.
  
  And, as was referred to earlier, the pay reforms - once they arrived - cost some £540m more than expected in 2004/05 alone, and have had questionable, if any, impact on productivity. 'It seems as though NHS organisations assumed that paying consultants and nurses more would cause them to become more efficient' (p.7).

***CORRECTION: In the original pdf, on p.7 the NHS Confederation was incorrectly attributed to acknowledging 'middle management is certainly bloated'. They have not written this and it should have been referenced to an article published on Reform's website by Karol Sikora: http://www.reform.co.uk/website/pressroom/articles.aspx?o=279 .***

'NHS Staff: too many, too fast' by James Gubb is available online here

For more information ring:
James Gubb: 020 7799 6677 (w); 0793 0243 570 (m)