NHS Tayside Assurance and Advisory Group: staging report of findings and recommendations

5. Benchmarking

In this section, we set out some initial benchmarking analysis in relation to workforce and prescribing; those areas highlighted earlier in this report as consistently overspending compared to budget.

5.1 Key Points

• NHS Tayside employs more staff, both clinical and non-clinical, than its proportional share of the national total. This is consistent across most of the staff groups.

• Benchmarking analysis of NHS Tayside's workforce compared with the rest of NHS Scotland indicates significant challenge around the sustainability of existing service models in Tayside.

• The size and scale of the gap between NHS Tayside's share of NRAC funding and its operating costs relative to peer Boards highlights the need for a comprehensive review of the models of care within both hospital and community settings.

• NHS Tayside and its associated HSCPs prescribed 2.7% more items per weighted patient than average in Scotland and the cost per item prescribed was also 6.5% higher than average.

5.2 Overview

Using published data from National Services Scotland's Information Services Division ( ISD), NHS Tayside have undertaken a benchmarking exercise comparing their operating costs for 2015/16 against the Scottish national average and with the three other comparable teaching boards in Scotland ( NHS Greater Glasgow and Clyde, NHS Grampian and NHS Lothian). This review has highlighted opportunities which could result from improved efficiencies, tackling variation and redesign of service models.

It should be noted, however, that benchmarking information is not definitive evidence in itself and is best considered as an indicator of issues which may benefit from closer scrutiny or more detailed exploration of the underlying causes of variation.

5.3 Workforce

NHS Tayside's total pay costs in 2016/17 were £530.2m, an increase of 1.7% on the previous year (£521.2m in 2015/16). Supplementary staffing costs, which encompass overtime as well as the costs of bank and agency staff, were £20.9m (an increase of 1.3% from 2015/16). These supplementary costs represented around 4% of total pay costs in both years.

In terms of workforce ^[29] , NHS Tayside's total staff complement is high - representing 9.30% of the NHS Scotland total - compared with its NRAC target share of 7.85%. This finding is consistent across most staff groups, clinical and non-clinical, hospital and community based.

Information collected by ISD, and publicly available on their website, provides alternative comparisons for financial year 2015/16. These compare NHS Tayside's 'Adjusted Population share' (equivalent to its actual NRAC funding share) of 7.64% to its share of the total NHS Scotland staffing costs for various staffing groups.

Although the comparison base is slightly different, the finding is consistent - NHS Tayside is spending proportionately more than would be expected across every staffing group.

• Medical and Dental hospital staff costs - NHS Tayside accounted for 8.99% of the Scottish total compared with their actual 7.64% Adjusted Population share; this represents a 17% difference.

• Hospital nursing staff costs - follow a similar pattern to medical staffing with NHS Tayside's share of the total Scottish spend at 9%; 18% above its Adjusted Population share.

• Allied Health Professionals and Other Hospital Staff - the NHS Tayside share of the overall NHS Scotland workforce in 2015/16 was 8.5% and 9.3% respectively.

• Community Staff costs - NHS Tayside's spending was equivalent to 8.6% of the Scottish total.

5.4 Operating costs

A comparative analysis of costs of service provision across the four teaching boards, taking account of staffing costs but also the costs of drugs, equipment and overheads provides a further perspective on the costs of the models of care implemented within Tayside relative to peers.

Hospital inpatient costs

Total hospital inpatient costs for 2015/16, both the cost per case and the cost per Inpatient week, were both considerably higher in NHS Tayside than in the other three teaching boards.

• At £4,013 per case, Tayside's costs were 39% above the Health Board with the lowest cost per case, and 4% above the Health Board with the second highest cost per case.

• In relation to cost per inpatient week, NHS Tayside's cost of £4,677 per week was 19% above the lowest, and 14% above the Health Board with the second highest cost per week.

This position is evident across the costs per case and costs per day for acute surgical inpatients and acute medical inpatients as well as the cost per week for general psychiatry inpatients.

Analysis by expenditure type

Breaking these overall costs down into some of their constituent parts, ISD figures show that NHS Tayside is spending above its Adjusted Population share of 7.64% on its management and administration costs (9.6%), its energy costs (9.7%) and its laboratory costs (11.61%).

Theatre running costs per hour, at £1,651 per hour, was also between 15% and 55% higher than comparative peer Boards.

Whilst it is not uncommon for the largest teaching boards to be spending above their Adjusted Population share, due to the regional and tertiary services which these health boards provide, no other board is so consistently above its share as NHS Tayside. The other teaching boards are also all delivering within their overall allocated budgets.

5.5 Prescribing

NHS Tayside and its associated HSCPs prescribed 2.7% more items per weighted patient than average in Scotland (17,128 compared with the average of 16,673). The cost per item prescribed was also 6.5% higher than average (£11.4 compared with the average of £10.7 per item).

The combination of prescribing more items per patient, and prescribing more expensive items, means that the total prescribing cost per weighted patient within NHS Tayside was 9.4% higher than average in 2016/17.

This position has persisted since 2015/16, with items prescribed per patient and cost per item prescribed increasing at a faster rate than average in Scotland. Achieving prescribing costs in line with the national average could achieve savings of £12.4m.

NHS Tayside has undertaken significant work in addressing prescribing activities and costs and has used the metric cost per treated patient. Costs in many areas appear to be higher because more patients are treated. This is discussed further in Appendix 2.

Whilst some of this variation will be explained by specific local requirements, as indicated in section 3.7, further work is required to understand the underlying reasons for the variations in NHS Tayside's prescribing costs.