Conclusions and recommendations
1. Between December 2004 and December 2006,
the Department and the NHS successfully transferred around 1.1
million staff on to a new simplified pay system.
This was a considerable achievement requiring a major job evaluation
process to assess each role within the NHS and to transfer staff
to new pay bands. The new pay system replaced previous complex
pay arrangements which prevented staff developing new roles and
obstructed the creation of modern team-working, focused on patient
care.
2. Agenda for Change has not yet brought about
service-wide changes in the ways in which staff work despite the
new pay system having been in place for nearly three years.
The Department should identify and promote good practice examples
of where Trusts have used Agenda for Change to make measurable
improvements in efficiency and patient care, for example, by staff
taking on new roles and working more flexibly. Trusts should also
identify a champion at board level to highlight such opportunities
and provide the necessary leadership to drive productivity improvements
from staff working differently.
3. In spite of the Knowledge and Skills Framework
having been re-launched twice, by autumn 2008 only 54% of staff
had received an annual knowledge and skills review.
Full implementation of the Framework is crucial to bringing about
improvements in patient care and efficiency. The Department and
Strategic Health Authorities should simplify the guidance and
processes that serve to support the Framework (in partnership
with the NHS trade unions), and highlight examples of what it
has achieved in Trusts where it has been implemented well. In
keeping with good management practice across the public and private
sector, all Trusts should ensure that every member of staff has
received a Knowledge and Skills Framework annual review by 1 April
2010.
4. The Department did not require Trusts to
measure productivity improvements and other benefits from Agenda
for Change. To motivate Trusts to deliver
change the Department needs to put in place a clear framework
of indicators to allow for comparison of performance between Trusts.
At a local level, when using Agenda for Change to reconfigure
roles and teams, Trusts should specify in advance the likely benefits,
and establish the means to assess (against baselines) whether
those benefits have been achieved.
5. No reliable figure is available for the
extent to which the £1.3 billion net savings promised by
Agenda for Change have been achieved.
The Department considers Agenda for Change to be an 'enabler'
and that its specific effects cannot be measured. When formulating
business cases for major reform programmes where cause and effect
may be difficult to measure, the Department should set realistic
targets, differentiating between aspirational objectives and those
where more practical measurement is possible.
6. Between 2001 and 2005 NHS productivity,
as measured by the Office for National Statistics, fell by 2.5%
a year on average, as growth in the amount of healthcare provided
failed to keep pace with the growth in NHS staffing and resources.
The Department and the NHS need to close this gap by having in
place clear and transparent measures of productivity to identify
areas where the pace of reform needs to be stepped up. Specifically:
- the Department should provide a clear framework
to enable Trusts to separate improvements in service quality which
are attributable to greater productivity from the impact of increases
in resources. The Department and Strategic Health Authorities
would then have the means to challenge Trusts on whether their
productivity improvement plans are sufficiently challenging and
sustainable, and
- the Department should, after discussions which
have lasted several years, set a timetable with the Office for
National Statistics to reach an agreed methodology for measuring
NHS productivity that fully reflects improvements in the quality
of healthcare.
7. Some £15 billion of NHS efficiency
improvements are planned over the next three years, but more clarity
is needed as to how these will be delivered.
The Department should set out how Agenda for Change will be used
to support the savings promised.
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