Why workforce efficiency gains stall and what it takes to unlock them  

Following my session at the HFMA Northwest Branch Annual Conference, I’ve been reflecting on one of the most consistent themes I see when working with NHS organisations:  

We are not short of insight; we are short of conversion.  

Across the NHS, opportunities for workforce efficiency and productivity are being identified every day.  
The data exists.  
The variation is visible.  
The potential impact is significant.  

And yet, in many cases, those opportunities never fully translate into sustained operational change.  

A £320m opportunity hiding in plain sight  

In my session, I shared findings from RLDatix Workforce Efficiency Assessments conducted across 50 NHS Trusts.  

What stands out is the scale and consistency of the opportunity:  

• £7m+ average productivity opportunity per Trust  

• £320m total identified opportunity across the cohort  

• Clear, repeatable patterns of variation in workforce deployment  

This isn’t about isolated inefficiencies; it’s systemic. Across organisations, similar opportunities emerge time and again when workforce data is benchmarked and analysed consistently.  

The opportunity is real.  
And it’s measurable.  

So why does progress stall?  

One of the biggest misconceptions is that organisations struggle because they lack visibility.  

That’s rarely the issue.  

In most cases, the challenge lies in what happens after the insight is identified.  

Too often, opportunities get stuck:  

• At the reporting stage, where variation is acknowledged but not actioned  

• In review cycles, where findings are discussed but not operationalised  

• Between teams, where ownership is unclear  

• Outside of day-to-day workflows, where change isn’t embedded  

In other words, the gap isn’t in identifying opportunity; it’s in converting that opportunity into sustained change.  

But beneath these structural barriers sits something more subtle.  

The workforce stories organisations tell themselves  

Every organisation has workforce stories.  

• “Our vacancies are driving agency spend.”  

• “Weekends are just harder.”  

• “Our sickness is under control.”  

• “Our bank simply can’t fill demand.”  

These aren’t unreasonable assumptions. Most are built on years of operational experience and reinforced by management information that appears to confirm them.  

But having worked with more than 50 organisations and analysed workforce data across thousands of rostered units, one pattern is remarkably consistent:  

The stories are often only part of the truth.  

And when assumptions become accepted truths, they can unintentionally limit where organisations look for improvement.  

Looking beyond the obvious  

The organisations making the most progress aren’t necessarily those with the fewest challenges.  

They’re the ones willing to ask a different question:  

“What if the story we’re telling ourselves isn’t the whole story?”  

That shift in thinking often uncovers opportunities hiding in plain sight.  

What the data often reveals instead  

“Vacancies are driving our bank and agency spend”  

This is one of the most common assumptions and on the surface, it often appears correct.  

In one organisation, temporary staffing reports showed nearly 16,000 hours requested to cover vacancies.  

But when this was compared with the actual vacancy position, the numbers didn’t align:  

• Temporary staffing demand equated to 100+ WTE.  

• Actual vacancies were closer to 37 WTE.  

The gap wasn’t due to unexplained vacancies.  

It was hidden unavailability:  

• Annual leave  

• Sickness  

• Training  

• Maternity leave  

Planned workforce models assumed around 22% unavailability.  
The reality was closer to 30%.  

The implication is significant.  

Recruitment still matters, but improving how availability is understood and managed represents a far more immediate opportunity.  

The question shifts from “How many vacancies do we have?”  
to “How much of our workforce is actually available to deliver care?”  

“Weekends are just harder”  

Almost every organisation accepts higher temporary staffing usage at weekends as inevitable.  

And the data does show increased demand, particularly on Sundays.  

But the deeper question is: why?  

In many organisations, that increased demand isn’t unpredictable.  
It follows consistent, repeatable patterns.  

Which leads to a different conversation:  

• If demand is predictable, why is it managed reactively?  

• Should elements of that demand be built into baseline workforce planning?  

At the same time, many assume bank fill is stronger at weekends due to enhanced pay.  

In reality, staff engagement is often more consistent across the week than expected, particularly when technology is used to proactively match shifts to available workers.  

The issue isn’t simply weekend pressure — it’s whether predictable demand is being planned for effectively.  

“We understand our sickness”  

Every organisation tracks sickness. Many have well-developed wellbeing strategies.  

But averages can be misleading.  

In one case, overall sickness sat at around 5%, appearing well controlled.  

However, within the clinical areas driving the highest temporary staffing demand, sickness exceeded 8%.  

In another organisation, a major programme targeted musculoskeletal absence, yet data showed mental health-related absence was the largest contributor to operational pressure.  

The interventions weren’t wrong.  
They just weren’t focused on where they could have the greatest impact.  

Organisational averages support reporting, but they rarely tell the full operational story.  

“Our bank can’t fill demand”  

Supply constraints are real, but supply isn’t always the limiting factor.  

In one organisation, bank fill rates stalled at around 79%.  

The assumption: insufficient bank workers.  

But the operational reality was different.  

Shifts were typically released with less than five days’ notice, despite demand being visible weeks in advance through the roster.  

Earlier visibility creates flexibility.  
It enables planning.  
It reduces last-minute escalation.  

The constraint wasn’t just supply; it was timing and access to opportunity.  

From insight to execution: closing the gap  

These examples highlight a consistent pattern:  

The barrier isn’t identifying an opportunity.  
It challenges assumptions and embeds change into how decisions are made every day.  

Benchmarking alone is not enough.  

Yes, it makes variation visible.  
Yes, it highlights where action is needed.  

But visibility does not equal impact.  

To unlock the £320m opportunity we’ve identified, organisations need to focus on three critical shifts:  

1. Embed insight into operational workflows  

Insights must move beyond reports and into the tools, processes and decisions that shape daily workforce deployment.  

2. Create clear ownership for change  

Opportunities need accountable ownership not just at board level, but within operational teams who can drive and sustain improvement.  

3. Enable continuous, not one-off, optimisation  

Workforce efficiency is not a one-time exercise. It requires ongoing visibility, tracking and adjustment as demand evolves.  

What this means for the NHS  

The findings from these 50 Trusts point to a significant system-wide opportunity.  

But more importantly, they highlight a critical truth:  

The NHS does not need more insight;  it needs better enablement to act on it.  

Closing the gap between insight and execution is where the real value lies.  

Looking ahead  

At RLDatix, we’re continuing to evolve how we support organisations to move from insight to action, not just identifying opportunities but helping teams operationalise and sustain them.  

This is the thinking behind our RLD Intelligence capability, connecting workforce insight directly with decision-making and delivery.  

Because if the opportunity is already visible, the next step is making it real.