Practical value in the NHS

The King’s Fund has previously highlighted the fact that addressing waste and variability in clinical work can create better value in the NHS. But what does value mean to people working in the NHS – and how it is being applied in practice? | The King’s Fund Blog

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‘Value’ sounds like a familiar concept but it can mean different things to different people. One definition of value in the health and care sector is ‘health outcomes per dollar spent’, so attempts to increase value can look at either improving quality or reducing cost.

In early July we held a roundtable discussion with health service providers to better understand their approach to value improvement – initial research for a new project intended to understand the practical barriers and challenges that frontline clinical, operational and managerial leaders have encountered in pursuing better value health care. Experts who attended – including a chairman, chief executive, chief nurse, deputy chief operating officer, change leader, and representatives of national bodies – agreed that the emphasis should be on patient care. Clinicians are more likely to engage in a programme that revolves around the quality of services, and better care is typically less wasteful, so as one participant put it, ‘if you focus on quality, money will fall out’ [spending will reduce]. Consultants will often drive through successful programmes with change management teams, but we also discussed the role of junior doctors, nurses and therapists, who frequently witness low-value care and understand how to fix it. We know that substantial changes in practice can be delivered as we have seen, for example, in generic prescribing, reduced length of stay and the move towards day case surgery.

Read the full blog post here

Investigation into NHS continuing healthcare funding

National Audit Office

National Audit Office has published findings of investigation into NHS continuing healthcare.

NHS continuing healthcare (CHC) is a package of care provided outside of hospital that is arranged and funded solely by the NHS for individuals who have significant ongoing health care needs.  Funding for ongoing health care is a complex and highly sensitive area, which can affect some of the most vulnerable people in society and those that care for them. The number of people assessed as eligible for CHC funding has been growing by an average of 6.4% a year over the last four years.  In 2015-16, almost 160,000 people received, or were assessed as eligible for, CHC funding in the year, at a cost of £3.1 billion.

NHS financial temperature check: finance directors’ views on financial challenges facing the NHS in England

Healthcare Financial Management Association (HFMA)

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This is the seventh in the HFMA’s series of briefings setting out finance directors’ views on the financial issues facing the NHS in England. The briefing draws on the responses of 73 finance directors of trusts and foundation trusts and chief finance officers of 100 CCGs. The NHS financial temperature check provides a national picture of finance directors’ views of the financial outlook and the challenges NHS finance staff are facing.

Sustainability and transformation plans: how serious are the proposals? A critical review

London South Bank University, School of Health and Social Care, May 2017

This report argues that in order to deliver a better future for the NHS, all 44 STPs would need to be given legislative powers and support necessary to achieve effective collaboration, plus some much-needed clarification on their role. It also recommends that STP leaders need to plan ahead based on the reality of their current situation, identify changes that are evidence-based, develop workforce plans that match their ambitions, and focus on reducing demand before removing resources from the acute sector. Alongside the main report, 44 sub-reports are available, each critically reviewing the plans for each STP locality.

Towards affordable healthcare: Why effective innovation is key

This major new report, supported by EY has found that whilst the UK is well placed to innovate to improve health outcomes and reduce costs, the UK is often not doing enough with the tools at its disposal | ILC

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Image source: ILC

With the NHS committed to achieving efficiency savings of £22 billion through productivity gains of 2 to 3% between 2015 – 2020-202, ‘Towards affordable healthcare: Why effective innovation is key’ explores how health care innovations currently employed at home and abroad could increase productivity and reduce costs.

The report showcases seven outstanding global and UK-based innovations with a strong evidence base of demonstrable success, and calculates the savings that could be achieved by implementing them across the UK. Home grown innovations include:

  • The UK’s Memory First Project, an integrated dementia service run by a consortium of GPs across Staffordshire. Savings if working methods applied nationally: up to £38 million between 2019 – 2030.
  • Manchester Royal Infirmary’s programme of providing the training and equipment to perform home dialysis. Savings if programmed applied nationally: up to £5.6 billion between 2014 – 2030.

The report concludes however the UK is often not doing enough with the tools at its disposal to implement such innovations. Social care is underfunded and fragmented, which has consequences also for NHS costs, and funding mechanisms within the health system can often discourage innovation; there continues to be a slow uptake in the UK of new drugs and treatments, with adoption speed varying across the country.

Leeds Teaching Hospitals reducing agency spend case study

This case study shares the experience of Leeds Teaching Hospital NHS Trust on how they reduced levels of medical agency spending | NHS Employers

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The Leeds Teaching Hospitals NHS Trust has reduced its medical agency spend by introducing a central deployment service and making effective use of e-rostering to deliver a consistent and professional approach to the deployment of junior doctors.

This case study details the work the trust has carried out, from the medical workforce team working with medical managers, consultants and junior doctors to standardisation of processes. Read up on the steps they took towards improvement and the successes that have been achieved.

Download the full case study here

How healthcare is funded

Kings Fund, March 2017

The NHS is experiencing the longest and most severe slowdown in funding in its history. This has raised questions about the sustainability of its funding model. This article explains the main models used to finance health care: taxation, private health insurance and social health insurance. It outlines how each model works in its purest form, while recognising that most countries typically pay for health care using a combination of methods.