As part of the Health and Social Care portal, Open Forum Events are pleased to introduce the NHS Productivity: Delivering Better Value Care conference.
Despite the recent political manoeuvrings, it would appear that an increase in NHS funding is not high on the list of priorities. All the while that budgets are being squeezed the need for NHS services is on the increase. Performance figures confirm a relentless demand with the NHS treating more patients than ever before.
Keeping up with the demands is challenging, however, it is suggested that rethinking how to attain greater productivity and the way this is measured, may alleviate some of the pressures. Productivity is a simple comparison between the outputs produced by the NHS i.e. the amount and quality of care provided, with the inputs used to produce them i.e. staff, equipment, drugs clinical supplies etc. Improved productivity can be achieved through efficiency and cost measures or alternatively by getting better value from the existing budget.
In an effort to improve productivity several reports have been published. The Carter Review was published in February 2016 and analysed the productivity and efficiency in non-specialist acute hospitals. The report concluded that there was significant unwarranted variation in costs and practice which, if addressed, could save the NHS £5bn. Two further reports by the Nuffield Trust and Health Foundation focus on consultant productivity in NHS hospitals and indicate this has fallen over the last six years. Both reports stress the need to rethink existing strategies and the Health Foundation highlight poor workforce planning as the chief cause of falling consultant productivity.
Contrastingly and on a more positive note, figures from the Office of National Statistics (ONS) show that overall healthcare productivity grew in 2014, by 2.3% as outputs grew to 5.2% with a 2.8% increase in inputs. This is the fifth consecutive year of growth with productivity increased on average by 9% from 1997 to 2014.
The NHS Productivity: Delivering Better Value Care conference will provide a platform for invested stakeholders to discuss how addressing the productivity challenge can alleviate some of the financial pressure the NHS currently finds itself. The programme will examine how productivity can be improved in areas such as workforce planning and development, procurement, clinical practice and everyday processes by ‘doing something different’ to eliminate waste, improve efficiency and deliver greater value from the existing budget.
The demand for NHS services is at an all-time high and the continuing increase shows no sign of abating. Performance figures for April 2017 reveal that NHS 111 calls were up by 16% on the previous year; emergency admissions rose by 2.9%; diagnostics tests by 4.9% and consultant led treatment by 5.2%. The long-term trend is one of greater volumes of both urgent and emergency care and elective activity. The clinical workload in General Practice has risen significantly since 2007 and consultations have grown by more than 15% during the period 2010/11-2014/15. During this period funding, as a share of the overall NHS budget, fell from 8.3% to 7.9%. A clear example of having to do more with less. The demands on other areas of primary care, community care and mental health services continue to exasperate the NHS.
To enable the NHS to remain sustainable and meet the challenges it has had to embark on an ambitious programme of productivity improvement.
The annual budget for the NHS is over £100bn, half of which is spent on large hospitals as providers in the acute care sector and it was this area of the NHS that the Carter Review into operational productivity. The independent review ‘Operational productivity and performance in English NHS acute hospital: unwarranted variations’ concluded that there was significant unwarranted variation worth £5bn in terms of efficiency opportunity. The review makes numerous recommendations including: an increase in workforce productivity, saving a possible £280m per year and improved procurement processes, including greater transparency, which could save £700m per annum. In autumn 2016 NHS Improvement established the Operational Productivity Directorate to support the implementation of Carter’s recommendations.
The Getting it Right First Time (GIRFT) programme is a national initiative designed to improve clinical quality and efficiency through the use of data sets to support clinicians and managers to improve standards and increase productivity.
Away from the acute sector, the entirety of the NHS is striving to work more efficiently, deliver greater value and improve overall productivity, whilst continuing to deliver high quality care. To achieve this the NHS needs to seek to do things differently
The NHS Productivity: Delivering Better Value Care conference is an ideal platform to discuss how to improve overall productivity by developing efficiency measures and creating the circumstances where the existing budget yields increased value and the funding gap can be narrowed by being a more productive NHS.
With the NHS under sustained financial pressure, the need to adopt new approaches to service delivery has never been more pressing. Improving the level of productivity through efficiency measures and releasing extra value from the existing budget is now a requirement rather than an aspiration.
Chronic non-healing wounds represent a substantial and growing economic burden to healthcare systems. Although there are an overwhelming amount of treatment options available and a substantial volume of trial and observational evidence it is argued that consistent flaws within the evidence base make identification of optimal treatment impossible. The persistent uncertainty regarding the evidence base, a desire to implement evidence based practice (EBP) and acute financial pressures to reduce costs may have led to a sub-optimal situation in which possibly cost-effective, even cost-saving, solutions are ignored generating unnecessary costs and health-related quality of loss over time.
Recent developments in health economics have provided a means of more formally incorporating uncertainty into the standard economic evaluation framework via a comprehensive algorithm (Claxton et al 2016). It importantly identifies that presence of uncertainty per se is an insufficient cause to reject a technology and what is required is more nuanced approach which examines the consequences of incorrect decisions and the value and likelihood of further research. We apply this new framework to a new wound care technology, a topical haemoglobin spray, and explore what are the optimal decisions under varying conditions of uncertainty.
We find that under any reasonable characterisation of uncertainty the Claxton algorithm points to adoption or adoption with evidence development. In the event that future evidence cannot be reasonably generated the optimal decision would be adopt – the exact opposite of the current de facto position of non-adoption. We conservatively calculate the continued unnecessary costs of dressing changes alone to be in the region of £75m per annum to the NHS. We conclude by arguing that adoption of simple conservative decision heuristics which require technologies prove effectiveness beyond all doubt may be doing substantial and persistent harm to the NHS and its patients, particularly in the wound care area.
Evidence shows us that having engaged, healthy staff leads to increased productivity and an overall happier workforce. Staff costs account for 60p in every pound that hospitals spend. According to the Carter Review, improving staff productivity by five minutes every shift could save £280 million a year.
High value healthcare is not produced by NHS budgets and services alone. Value is created through coproduction and new approaches are needed to understand and capture this.
Research has claimed that approximately £74.5m worth of savings is being missed by NHS trusts due to the costs of patients missing appointments because of slow transport to hospitals. There is now an opportunity to use devolution in Greater Manchester to address this in a more joined-up manner.
GIRFT is a national programme, led by frontline clinicians, created to help improve the quality of medical and clinical care within the NHS by identifying and reducing unwarranted variations in service and practice.
According to the Carter review (2016), efficient workforce management could save NHS £2bn, which is by far the biggest cost burden for the British healthcare system. With a mobile-first approach, Quinyx helps to reduce workforce-related costs by automating labour intensive processes such as rostering, payroll, time punching, communication and forecasting. Quinyx CEO and Founder, Erik Fjellborg, will talk about how we have helped UK Healthcare providers such as Vocare with their workforce management and the importance of mobile use in the digital transformation of today with regards to the increasing number of millennials on the labour market. Vocare, a leading national specialist provider of urgent care services, will also join on stage to share their views on Workforce Management.
Digital Patient Workflow is a significantly different way of managing operational processes within a hospital, tracking every patient through a care traffic ‘control centre’. Using this approach can positively impact on Emergency, Elective, Outpatients, Diagnostics and Theatre performance. It is in over 900 hospitals in the US and is being piloted in 5 hospitals in England with a second wave to come.
The Carter Review emphasised the need to restructure the NHS procurement and supply chain delivery model to rationalise the procurement landscape, reduce spend and consolidate purchasing power.
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Construction of The Bridgewater Hall commenced on 22 March 1993, but the idea of a new concert hall for Manchester dates back to the reconstruction of the Free Trade Hall in the 1950s after wartime bomb damage. The Free Trade Hall was home to the city’s famous Hallé orchestra and also hosted rock and pop concerts. However, despite holding great public affection, the 1850s Free Trade Hall was ill-equipped to respond to the rising standards of service and acoustic excellence demanded by performers and audiences.