A division of labour: optimising hospital skill mix for output and quality

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Description/Abstract

The NHS must increase productivity by 6 percent per annum if it is to make projected efficiency savings of £21 billion by 2014. At the same time, it is expected to maintain or improve the quality of care. Given that staff costs are 60% of the current NHS budget, it is likely that both the number and composition of the 1.7 million strong workforce will need to be changed to meet these targets. We argue that not enough is known about the impact of altering the skill mix (e.g. by substituting registered nurses for healthcare assistants) on either hospital productivity or care quality to guide strategic decision making. Further, it is unclear whether output (represented by volumes of cases treated) and quality are necessary trade-offs when considering skill mix. We therefore conclude that further research on the optimal skill mix is required.