2 Measuring the benefits from Agenda
for Change
6. In its 2002 business case to the Treasury, the
Department predicted that new ways of working introduced as a
result of Agenda for Change would bring about productivity savings
of between 1.1% and 1.5% a year. This improvement in productivity
was to form part of £1.3 billion savings in the first five
years of the pay reform, along with savings from reductions in
equal pay claims, reduced use of agency staff and more controllable
pay costs.
7. At the time of the Comptroller and Auditor General's
Report, the Department was unable to produce evidence to show
whether the productivity improvements or other savings had been
achieved.[12] The Department
viewed Agenda for Change as an 'enabler' contributing to the wider
improvements in patient care (for example, reduced waiting times
and reduced length of stays in hospital). It argued that measuring
efficiency savings in aggregate from a range of initiatives, including
Agenda for Change, was more appropriate than introducing potentially
bureaucratic measures to assess the cause and effect of each initiative.[13]
Taking a global view of savings in this way, however, creates
the risk that the Department and Trusts fail to identify the relative
contribution of different initiatives. Having this information
would allow them to encourage those which are successful and bring
an end to those which are not.[14]
8. Despite the claim that the effect of Agenda for
Change is not measurable, the Department has since estimated cumulative
savings from Agenda for Change of between £1.1 billion and
£2.2 billion.[15]
These savings are calculated using a series of assumptions of
how Agenda for Change has contributed to wider improvements in
the NHS through the development of new roles or using the Knowledge
and Skills Framework. For example, Dartford and Gravesham NHS
Trust has improved its stroke service by using the Framework to
strengthen staff competencies for dealing with patients who had
a stroke. The Department has then calculated savings on the assumption
that the new roles and ways of working have been implemented across
the NHS. There is, however, no evidence that Agenda for Change
has led to systemic changes to the way that NHS staff are working.[16]
Other assumptions made within the savings calculation are also
not fully supported by evidence; for example, the assumption that
Agenda for Change has contributed to reductions in staff sickness.
9. The Department does not have an agreed methodology
for measuring productivity and does not consider that the present
measure of productivity used by the Office of National Statistics
takes sufficient account of improvements in the quality of care.[17]
The Office for National Statistics data show, however, that NHS
productivity was stable between 1995 and 2001 and then fell by
2.5% a year on average between 2001 and 2005. During the latter
period the amount of healthcare provided by the NHS expanded substantially
but the resources used by the NHS grew at an even faster rate.
For several years, the Department and the Office for National
Statistics have been attempting to develop a better measure which
accurately reflects quality. An agreed measure would allow for
NHS productivity to be assessed from year to year and help the
Department understand and manage the impact of its policies on
the efficiency and effectiveness of the NHS.[18]
10. The Department did not establish a baseline against
which to measure progress against the 10 success criteria set
for Agenda for Change in order to assess its contribution to improvements
in the way they deliver their services.[19]
With no means of measuring the benefits of Agenda for Change and
no requirement for them to do so, Trusts' attention moved to other
initiatives and challenges once staff had transferred to their
new pay bands in 2006. In addition, the Department does not have
an active benefits realisation plan for Agenda for Change despite
an expectation that the programme will deliver further savings.[20]
12 Qq 3-4 Back
13
Qq 5, 24 Back
14
C&AG's Report, para 25 Back
15
Q 109, note 1 Back
16
C&AG's Report, paras 3.3-3.4 Back
17
Qq 37-39 Back
18
Committee of Public Accounts, Forty-first Report of Session 2007-08,
NHS Pay Modernisation: New contracts for General Practice services
in England, HC 463 Back
19
Qq 62-69 Back
20
Q 41 Back
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