United Kingdom


  • Industry: Government & Public Sector
  • Type: Business and industry issue
  • Date: 21/08/2012

Motivated staff are the NHS's best medicine 

A version of this article originally appeared in the Guardian


Twenty years of working in the health service has taught me that technocratic reforms alone are not enough to improve efficiency and care.

People are the NHS's most important asset. As the £20bn efficiency drive bites further and pay is constrained, posts are lost and pensions are reduced, staff face a difficult period. Some in the profession may be tempted to see employees as a cost to be reduced, but the NHS workforce is to be treasured.


In a forthcoming report on healthcare across the globe, KPMG estimates that in developed countries, health systems may be facing a workforce shortage of between 22% and 29% by 2022, as populations age, patient demand increases and the health workforce shrinks because of people leaving their jobs. I've heard people say "cost walks on two legs", but this is a short-term and damaging view. It is more accurate to suggest that value walks on two legs, and with this in mind the report will showcase five approaches that successful organisations have adopted to create a seemingly paradoxical synergy, one where staff productivity improves while work attractiveness and professional motivation blossoms. The point is a simple one. If we are to resolve our impending workforce crisis, we need to take a longer-term, strategic view about how to increase workforce productivity.


Successful organisations that work with their trade unions and professional bodies take a strategic view of their collective position. Anybody who has managed a healthcare provider will tell you that the most important differences to the quality and cost of patient care result from the design of the clinical care process, the degree of innovation in the business model and the motivation of staff. While legislators and policy-makers often focus on laudable but technocratic reforms – such as new payment systems, organisational arrangements and better regulation – these can only ever have a limited impact on how people care for others in times of ill-health.


Our research has found that successful healthcare organisations have a strategic and long-term focus on patient value; consciously empower healthcare professionals and give them greater autonomy; systematically apply leading-edge business and care process redesign methods; improve clinical and management information so it is routinely used in day to day activities; and have unambiguous staff performance management and accountability frameworks.


These global truisms are well illustrated, for example, by Buurtzorg, an aged care provider in the Netherlands. It placed more power in the hands of well trained nurses, encouraged the use of the latest techniques, and let them organise care and place the patient at the centre of their efforts. It dramatically reduced its total hours of care yet improved clinical effectiveness and morale.


I have spent 20 years working for the NHS and as a hospital chief executive signed the first Trades Union Congress partnership agreement with unions. I know patient value is created by dedicated staff caring for patients. I also know staff can feel frustrated by things that get in the way. We should give them the tools and trust to do an even better job.


Mark Britnell

Mark Britnell

KPMG Global Chair, Healthcare


020 7694 2014mark.britnell@kpmg.co.uk


Mark Britnell is Chairman of KPMG’s Global Health Practice. Mark joined KPMG in 2009 following 20 years of distinguished service in the NHS.

Mark worked at operational, strategic and policy levels during his varied career in the NHS. In 2000 Mark was appointed Chief Executive of University Hospital Birmingham FT where he signed the UK’s second largest new hospitals PFI deal. In 2006, Mark became Chief Executive of South Central Strategic Health Authority before joining the Department of Health as the first Director General for Commissioning & System Management .

Mark helped to produce the NHS Plan and advised on Foundation Trust policy. Mark also worked alongside Lord Darzi to produce the Next Stage Review and now works internationally with public and private sector organisations. In the past fifteen months, Mark has visited 32 countries to support healthcare clients around the world. 

Mark has the following qualifications and fellowships:
BA (Hons); DSci (Hon); DUni (Hon), Senior Associate, Kings Fund; Senior Fellow in Health Service Management at the University of Birmingham.


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