A boost in efficiency is a boost for care

Source: NHE Sep/Oct 16

Jeremy Marlow, executive director of operational productivity at NHS Improvement (NHSI), explains how the regulator is supporting trusts to deliver quick wins and long-term efficiency savings.

With growing demands placed on the NHS each day, we cannot compromise on quality, but nor can we afford to deliver excellent services in anything but the most productive and efficient ways. There are encouraging signs from the first quarter figures for this financial year – 20% fewer NHS providers showed a deficit. My work with Lord Carter on his independent review into acute hospital productivity showed me that both international evidence and NHS experience confirm that high-quality patient care and value for money go hand in hand. We now need to go up a gear to help all providers improve their efficiencies and deliver better outcomes for patients. 

The NHS is rated as one of the most efficient healthcare systems in the world. Lord Carter and my team worked closely with 136 acute trusts on the review: all demonstrated some areas where they performed well. The question for our team was, how can we all understand what good looks like and, as importantly, how can we share that knowledge? 

Supporting consolidations through STPs 

NHSI has created the Operational Productivity directorate to do just this: support trusts on the ground to increase their productivity, from staff to services. The aim is to continuously improve patient outcomes and deliver no less than £5bn of efficiencies.  

Our ‘model hospital’ and prototype portal has a crucial role. The Carter Review outlined the concept of a model hospital: comparable data across all areas of the hospital is used to help identify what good looks like. All 136 acute trusts now access the prototype portal. From this national online information system, they can see how individual trusts compare to each other and identify areas where their own hospital needs to improve. So far, we have 1,400 users looking at data in five live hospital compartments with new users added every day. NHS staff – from clinical to clerical – have shown a huge appetite to be involved so they can understand where they need to improve and deliver change. 

We are also actively supporting trusts to identify quick wins and, specifically, to develop long-term business plans to consolidate their back-office and pathology services through the sustainability and transformation plan (STP) footprints. It was evident to me when I worked on the Carter Review that trusts could make significant potential savings by consolidating these services regionally. Indeed, Lord Carter’s Review of pathology services several years ago demonstrated this too. There’s a real opportunity to make rapid progress that would improve clinical services and save the NHS money now in the short and long term. 

Take the example of the Southwest Pathology Services in Somerset. Four years after Taunton and Somerset NHS FT and Yeovil District Hospital NHS FT merged, the two trusts recently announced the benefits from external investment in a new state-of-the-art laboratory. They report “massively improved turnaround times, while at the same time receiving an overall year-on-year reduction in the cost of their pathology service”.   

Working closely with the 44 STP leads and trusts, our teams at NHSI, made up of pathology and back-office specialists, are currently helping all STPs build their individual cases to consolidate these services and to then achieve their plans. We will continue to provide support once STPs start to put their plans into practice, particularly where commercial skills are required. And all the back-office and pathology data my team is collecting and analysing from each trust will help our experts develop the model hospital metrics for those areas. The support does not stop once a plan is written – trusts will be able to compare themselves continuously and share best practice through our portal and the regional support infrastructure that NHSI is building. 

Accelerating work and scaling up 

Now that the new directorate has been set up, we can start accelerating our work and scaling up. This autumn we are planning over 130 interactions with trusts to support their work across all areas, including visits and clinical specialty reviews through the ‘Getting it right first time’ programme. And with the new directorate embedded in NHSI, we will be expanding our scope to start investigating opportunities for improving productivity and efficiency in specialist acute hospitals, mental health and community care. We want NHSI’s Operational Productivity directorate to become a real resource for the whole NHS to use so the service can deliver the care patients want in the most efficient way possible. 

Since the demands on the NHS in England and on health systems around the world will continue to grow, we must continuously improve and adapt the way we operate to deliver better clinical outcomes and patient experience. Improving operational productivity is a vital means of doing this as it frees up our people and resources to meet the increasing demands without the need to make unsustainable calls on the nation’s public finances.

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