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Monitor launches elective care productivity savings guide to senior and frontline staff

Monitor has set out a series of “practical” recommendations for clinicians, managers and frontline staff that could “significantly” help NHS productivity in elective care and cut the amount of time patients spend in hospitals.

Alongside the Royal College of Ophthalmologists and the British Orthopaedic Association, it detailed ways in which the elective teams could focus their efforts to “maximise” quality and efficient – from the point of first consultation to follow-up after operations.

Although financial research was based on elective ophthalmology and orthopaedic care pathways, the regulator said the techniques – intended to slash 13% to 20% of spending in these specialities – “can be applied to other elective care pathways” and “probably yield the same scale of productivity gains”.

Other areas set out to boost productivity include simplifying pathways used for patients at lower risk, as well as extending clinical roles to allow lower grade staff to take on “routine” tasks usually handled by consultants in outpatient or theatre departments.

The regulator also called on maximising theatre efficiency by better measuring, communicating and managing the amount of procedures per theatre session.

It argued that hospitals should implement “enhanced and rapid recovery practices” to reduce the length of stay, added to virtual follow-up assessments for patients without complications.

Dr David Bennett, its chief executive, said: “The financial challenge facing the NHS is growing and hospitals up and down the country are being asked to do more to make sure they live within their means. We are seeking to play our part by offering practical support to the clinicians, managers and frontline.

“This research identified some practical steps that could help hospitals improve clinical outcomes and reduce their elective care bills by as much as 20%, money that can be reinvested in improving care for patients.”

As well as recommendations, the regulator also provided four appendices focusing on operational opportunities, international case studies, examples of good practice within the state service and a financial analysis.

It builds on research showing “wide variation in performance” between providers at every stage of care, “specifically in staff costs, overhead costs and number of appointments”.

The recommendation report added: “From our standpoint, this variation is a cause for optimism as it indicates the scale of achievable productivity gains available to NHS providers now: if every NHS provider followed the good operational practices adopted by the highest performers at each stage of their elective ophthalmology and orthopaedic care pathways, they could save 13% to 20% of today’s spending on planned care in these two specialities.

“Moreover, the techniques which make processes more efficient in ophthalmology and orthopaedics can be applied to other elective care pathways and probably yield the same scale of productivity gains.

“Lastly, most of the techniques to increase productivity that the report describes, such as stratifying patients by risk and standardising postoperative care, will be well known to readers. But even today’s most efficient providers have not put all the critical techniques in place. There is an opportunity for all to improve.”

A spokesperson for the British Orthopaedic Association said the body was “pleased to have supported the development of this report”, and said all NHS bodies should “recognise extensive clinical engagement as critical to the success of any quality improvement initiative”.

The recommendations follow last week’s figures, released both by the regulator and the NHS Trust Development Authority, showing that NHS trusts and foundation trusts had accumulated an unprecedented funding hole of nearly £1bn during the first three months of 2015-16.

Monitor analysis found that this three-month deficit was worse than the entire full-year deficit for 2014-15.

Bennett stressed at the time at the NHS “simply can no longer afford operationally and financially to operate in the way it has been” and that it “must act now to deliver the substantial efficiency gains required to ensure patients get the services they need”.


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