Operational Productivity in NHS Providers


Dr Matthew Offord (Hendon) (Con): I beg to move,

That this House has considered operational productivity in NHS providers.

It is a pleasure to serve under your chairmanship, Mr Pritchard, and I welcome the Minister to his role. I believe this may be his first Westminster Hall debate, and I am greatly pleased that I am the Member who secured the debate.

The national health service featured heavily in the recent general election campaign. I recall speaking at several hustings and telling my constituents that I recognised that this Parliament would witness an increasing demand on NHS services. On occasion I was challenged on how the additional £8 billion highlighted by the Stevens review would be found. My response, then and now, is that the greatest efficiencies can be identified within current services without undermining patient care. Such a view is shared by Simon Stevens, but most interestingly it is a view shared by others, including my constituents Philip Braham and David Green, who established a medical recruitment company called Remedium Partners. I am pleased that both gentlemen are here today in the Public Gallery.

Having met Mr Braham and Mr Green before the election, I was eager to re-establish contact with them earlier this month to discuss their ideas about NHS efficiency in employment. It is possible that more cynical Members will say that this is more evidence of the Conservative party seeking to introduce greater private sector involvement in the NHS for others to make a profit, but that would be an incorrect assertion to make. In fact, I found our discussion focusing on opportunities to save the NHS more money and prevent its resources being plundered by unscrupulous individuals.

The publication of Lord Carter of Coles’ interim report, “Review of Operational Productivity in NHS providers”—the title of this debate—two days before our meeting could not have been more fortuitous. The report outlined four areas where Lord Carter believes greater efficiencies could be achieved to allow additional moneys to be spent on front-line care. One objective in seeking today’s debate was to air the issues and to place them on the public record. Lord Carter’s efficiencies within the NHS include saving £1 billion from improved hospital pharmacy and medicines optimisation, £1 billion from the NHS estate, £1 billion from improvements to procurement management, and £2 billion from improvements in workflow and encompassing workforce costs.

Workforce costs is the area that I intend to focus on in this debate, as I have discussed it directly with my constituents and because just a 1% increase in workforce productivity could achieve as much as £400 million of savings. This is a significant and important area of the
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work of the NHS. Lord Carter believes that the £2 billion figure would be achieved without making anyone redundant and without seeking to increase the responsibilities of staff, nor would it mean decreased levels of remuneration for future employees. What it does mean is a greater command of management control on non-productive time, which are the periods when staff emphasis is not on direct patient care—days and shifts of annual leave, sickness and training. It also includes better management of rosters, improved guidance on appropriate staffing levels and skill ranges for certain types of wards.

The NHS is one of the largest employers in this country, employing more than 1.3 million staff in more than 300 different types of roles. In the last year that figures were available, the cost to the NHS budget was £45.3 billion, the largest proportion of the £118 billion budget. The cost of nurses alone totals £19 billion, and with the increased number required for safer staffing and a third increase in the number of nurses leaving the profession in the past two years, the reliance on agency nurses will see this figure rising.

Mr Jim Cunningham (Coventry South) (Lab): When the hon. Gentleman talks about increasing the productivity of staff, can he itemise which staff he is referring to and say how much would actually be saved?

Dr Offord: We are talking about all the different staff. There are 300 different roles of employment in the NHS, so we are talking about everyone across the NHS, but I hope later in my speech to come to the specifics of clinicians and the use of agency staff for that sort of role.

John Stevenson (Carlisle) (Con): I congratulate my hon. Friend on securing this important debate. In my constituency in north Cumbria there is a hospital with a large number of agency staff, which has been a problem for some considerable time. I understand the need to employ agency staff, but does he agree that it would be far better to have staff employed directly by the hospital, as that would improve patient care and staff morale and also—to echo his point—improve the costs and productivity of that hospital?

Dr Offord: I certainly do agree with that point, and I hope to elaborate further on that. I also wish to touch on the use of bank nurses, or bank employees, who periodically work for parts of the NHS. I agree that for patient care it would be best to have full-time permanent staff who not only know the patients and the hospitals, but know the other employees they work with on a day-to-day basis.

Most worryingly, Lord Carter identified the fact that, in some of the 22 hospitals he surveyed, bank nurses are remunerated at a level that does not discourage them from remaining with, or moving to, agencies. I looked at the website of one of the trusts that took part in the review by Lord Carter and was surprised to see the range and number of bank employees—including, ironically, the position of the e-roster co-ordinator. I will not name that particular trust, as this debate is not a “name and shame” exercise, but I raise it to illustrate the point, because if such a role is vacant, what hope can there be to ensure that other clinical positions are staffed suitably?

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The e-roster co-ordinator is in the best position to monitor employment and identify irregularities in work patterns to prevent fraudulent practices. The majority of people who work for the NHS are honest, but there are a minority who seek to defraud its resources. I want to highlight the types of fraud that occur. Such fraud involves staff and professionals who claim money for services not provided or more money than they are entitled to, or who divert funds to themselves. It can also involve external organisations that provide false or misleading information, including invoices, to claim money they are not entitled to. Some of these frauds can be fairly low value, but they can often cost the NHS hundreds of thousands of pounds.

One example is Michael Botham, a hospital worker in Stoke-on-Trent who claimed nearly £20,000 for shifts he did not work. He applied for work via a recruitment agency, AMG Nursing and Care Services, in October 2007. He was then assigned as an unqualified healthcare worker to Bucknall hospital in Stoke-on-Trent, where he worked in the complex needs ward. Most worryingly, it took a ward manager to identify an overspend and to report their suspicions about Botham to the trust’s local counter-fraud specialist team. When the team analysed his timesheets, they revealed that he had submitted false claims for work from 1 January to 26 July 2009, complete with forged authorisation. In fact, he had worked only one shift during that period.

Botham also claimed payment for four shifts at Bradwell hospital, part of the same trust, in January 2009. Again, he had not worked those shifts and the authorising signatures were also false. In total, the trust overpaid £19,362 as a result of his false claims to the agency, which invoiced the trust in good faith on a weekly basis, but subsequently, to its credit, offered to pay back its fees of £3,956.50. This is a clear case of an individual deciding to defraud the NHS, but what is concerning is that the problem emerged only as a result of the scrutiny of another member of staff whose role was not to look for fraud.


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