Cutting hospital staff won’t help productivity, says ICB chief

The leader of an integrated care board has dismissed a “narrative” that the NHS can become more productive by cutting hospital staff numbers.

West Yorkshire Integrated Care Board CEO Rob Webster said a whole “system response” was required to improve productivity. 

Mr Webster made his comments at HSJ’s Patient Safety Congress in Manchester after being asked what his message was to organisations facing increasing demands to cut spending and staffing numbers safely.

He said: “This narrative about ‘the NHS is not productive, there’s too many staff in hospitals, [and] therefore cut staff in hospitals, you’re more productive’, it’s not true.”

After the session on Monday, he told HSJ: “Just cutting staff in hospitals will not in itself make us more productive. There needs to be a system response that improves flow and has a strong focus on safety and quality.

“We also need a much more sophisticated plan for the future, with an eye on the medium term, where our hospitals are supported by all partners to be productive and where people themselves are much better supported in communities.”

NHS England’s patient safety director Aidan Fowler acknowledged during the session, however, that the service has “got to get better at working out what [the safe staffing] number is”.

He added: “One thing that is clear is we are, and there is a plan for, increasing workforce. We’re doing that for good reason, which is that demand is going up.”

But he did recognise that increasing staffing impacts the system, adding: “If you’re going to work in the current model, you have to accept you’re going to have to staff it properly and that’s a huge demand on the system.”

Over the past year or so NHSE has increasingly been asking systems and trusts to scrutinise workforce spend, sometimes pressing them to freeze non-clinical posts, and has told some areas their staffing levels are unaffordable. 

Last week, Lord Darzi criticised falling hospital productivity in his review of the NHS commissioned by the government.

He noted an “apparent paradox” with the number of appointments, operations and procedures not increasing at the same pace as the growth in hospital staff numbers.

Lord Darzi wrote in his review: “Growth in hospital staff numbers has increased sharply since the pandemic – rising 17 per cent between 2019 and 2023. There are 35 per cent more nurses working with adults and 75 per cent more with children than 15 years ago.

“The number of appointments, operations and procedures, however, has not increased at the same pace and so productivity has fallen.” His analysis showed the number of nurses per bed had also increased; and particularly highlighted midwivery, where he said the ratio of births per midwife has fallen sharply and was well below other nations. 

He added: “The key reason for this is that patients no longer flow through hospitals as they should. A desperate shortage of capital prevents hospitals being productive…

“Acute care providers will need to bring down waiting lists by radically improving their productivity. That means fixing flow through better operational management, capital investment in modern buildings and equipment, and re-engaging and empowering staff.”

He also pointed out that while “both hospital expenditure and hospital staffing numbers have grown faster than the other parts of the NHS”, workforce levels in other key out-of-hospital components have declined.

HSJ’s Patient Safety Congress in Manchester began yesterday and concludes today.