Hospital finances and productivity: in a critical condition?

Charts and figures from the

research report

April 2015

2

Figure 1: Annual percentage change in operating income and cost in

2013/14 by type of trusts, real terms

2.5%

1.6%

2.1%

0.2%

1.6%

2.1%

1.2%1.4% 1.5%

-0.4%

3.8%

1.1%

Acute Ambulance Community Specialist All trusts

Operating costs Operating income

Source: Health Foundation analysis using trusts' financial accounts

Note: These figures exclude the operating costs and income of NHS Direct. In 2013/14, NHS Direct operating income was £78.9m

and operating costs were £109.5m, as reported in NHS Direct’s financial accounts

Mental health

3

Figure 2: Number of NHS trusts in deficit in 2012/13, 2013/14 and Q3 2014/15

28, 11%

221,

89%

2012/13

66, 27%

183,

73%

2013/14

132, 54%

114, 46%

Year to date (Q3,2014/15)

Number of trusts in deficit

Number of trusts in surplus

4

Figure 3: Variation in adjusted net surplus/deficit as a proportion of

operating costs across acute trusts, by type, 2012/13 to 2013/14, real terms

0.4%

-0.3% -0.2%

1.2%

1.8%

-1.2%

-1.6% -1.6%

0.5%

4.5%

Acute -

Small

Acute -

Medium

Acute -

Large

Acute -

Teaching

Acute -

Specialist

2012/13 2013/14

Note: Types of acute trusts have been grouped into small, medium, large and acute teaching trusts,

based on DH classification.

5

Figure 4: Adjusted financial performance of NHS providers in England in

2013/14

6

Figure 5: Total number and cost of temporary and permanent staff, 2012/13–

2013/14

£4.6bn, 10%

£42.0bn,

90%

2013/14Temporary

Permanent

£3.6bn, 8%

£42.4bn,

92%

2012/13Temporary

Permanent

Total cost

79,401, 8%

965,244,

92%

2012/13Temporary

Permanent

Total number of staff

91,963, 9%

987,024,

91%

2013/14Temporary

Permanent

7

Figure 6: Temporary staff costs as a percentage of total staff costs in England,

2013/14

8

Figure 7: Use of temporary staff by acute trust, 2013/14

0%

5%

10%

15%

20%

25%

30%

35%

Acute - teaching Acute - large Acute - medium Acute - small Acute - specialist

lower quarter 25th-50th percentile 50th-75th percentile

9

Figure 8: Skill mix of NHS trusts’ permanent and non-permanent staff,

2013/14

808

2,094

4,011

13,920

43,632

61,806

65,568

87,713

138,976

111

340

456

7

5,051

3,275

8,894

8,352

13,421

Social Care Staff

Other

Nursing, midwifery and

health visiting learners

Ambulance staff

Medical and dental

Scientific, therapeutic and

technical staff

Healthcare assistants and

other support staff

Administration and estates

Nursing, midwifery and

health visiting staff

Other Permanent

Note: Figures on staff number by skill are not available for foundation trusts and this figure therefore only

includes the 102 NHS trusts

10

Figure 9: Annual average real terms change in average earning per person from

2009/10 to 2013/14

-0.31%

-0.51%

-1.77%

Public sector NHS Private sector

Source: HSCIC NHS Staff Earnings Estimates to January 2014; Provisional statistics, ONS Annual Survey of Hours and Earnings

Note: Average earnings for NHS staff in England exclude earnings of staff employed under bank and agency contracts. Public and

private sector pay refers to average annual gross pay per person for all UK employees, while NHS pay refers to average earning per

employee of the English NHS

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Figure 10: Productivity, technical and allocative efficiency

Economy:

Buying inputs cheaplyProductivity:

Using inputs to produce outputsEffectiveness:

Producing the right outputs

Inputs (Staff, …) Outputs (FCEs, …) Outcomes (QALYs)

Technical efficiency Allocative efficiency

£ £ £

12

Figure 11: Change in hospital productivity from 2009/10 to 2013/14

0.94

0.96

0.98

1.00

1.02

1.04

1.06

1.08

1.10

1.12

2009/10 2010/11 2011/12 2012/13 2013/14

Output Input Productivity

13

Figure 12: Annual change in hospital productivity index from 2011/12 to

2013/14

0.41%

2.83%

-0.94% -0.95%

2010/11 2011/12 2012/13 2013/14

14

Figure 13: Average hospital productivity by region in England, 2013/14

15

Figure 14: Variation in productivity index of hospitals by size

1.03

0.99 0.99

Acute Small Acute Medium Acute Large

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Figure 15: Variation in productivity of hospitals from 2009/10 to 2013/14

0

0.2

0.4

0.6

0.8

1

1.2

1.4

2009/10 2010/11 2011/12 2012/13 2013/14

Interquartile range 10-90% range Mean

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Figure 16: Variation in productivity among acute trusts between 2009/10 and

2013/14

R² = 0.7223

-80%

-60%

-40%

-20%

0%

20%

40%

60%

-80% -60% -40% -20% 0% 20% 40%

2009/10

2013/14Trusts that were below average

in 2009/10 but above average

in 2013/14

Trusts that were above

average in 2009/10 and in

2013/14

Trusts that were above

average in 2009/10 but below

average in 2013/14

Trusts that were below

average in 2009/10 and

in 2013/14

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Figure 17: Variation in productivity among mental health trusts in 2012/13

and 2013/14

-60%

-40%

-20%

0%

20%

40%

60%

80%

-40% -20% 0% 20% 40% 60% 80%

2013/14

2012/13

Trusts that were below average

in 2012/13 and above average

in 2013/14

Trusts above average in

2012/13 and in 2013/14

Trusts above average in 2012/13

and below in 2013/14

Trusts below average in 2012/13

and in 2013/14

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Figure 18: Changes in NHS nurse numbers, 2012/13 and 2013/14

-0.2%

0.0%

0.8%

1.0%

2.0%

3.1%

Total number of nurses (HSCIC,

2015)

Nurses in acute, elderly and

general (HSCIC, 2015)

Nurses in hospitals in our

productivity analysis

2012/13 2013/14