NHS efficiency map

The Healthcare Financial Management Association and NHS improvement have updated the NHS efficiency map.


This map promotes best practice in identifying, delivering and monitoring cost improvement programmes in the NHS.


It contains links to a range of tools and guidance to help NHS organisations improve their efficiency and includes sections on enablers for efficiency, provider efficiency and system efficiency.


UK hospital patient discharge: the patient perspective

Wright, S. et al. European Journal of Hospital Pharmacy. Published Online: 13 January 2017

B0007092 Hospital appointment
Image source: Alex Williamson – Wellcome Images // CC BY-NC-ND 4.0

Objectives: Hospital discharge is a complex process that can result in errors and delays for patients, particularly around the supply of medicines and communication of information. To improve patient discharge, patient perspectives of the discharge service must be explored to determine where patients feel problems arise. This study aimed to explore inpatient perceptions and experiences of the current discharge process.

Conclusions: This study showed that certain aspects of the discharge process need improving to provide safe, quality care for patients and improve patient experience of discharge. The findings from this study will inform the development of a new model of care for patient discharge from hospital.

Read the abstract here

What is involved in medicines management across care boundaries?

Phipps, D.L. et al. (2017) BMJ Open. 7:e011765


Objectives: To examine the role of individual and collective cognitive work in managing medicines for acute kidney injury (AKI), this being an example of a clinical scenario that crosses the boundaries of care organisations and specialties.

Conclusions: These themes indicate the critical role of cognitive work on the part of healthcare practitioners, as individuals and as teams, in ensuring effective medicines management during AKI. Our findings suggest that the capabilities underlying this work, for example decision-making, communication and team coordination, should be the focus of training and work design interventions to improve medicines management for AKI or for other conditions.

Read the full article here

Nearly 200 GP practices closed in 2016 alone NHS data suggest

Up to 181 GP practices closed in the 12 months to January 2017, official data show | GP Online

Image source: Nick Papakyriazis – Flickr // CC BY-NC-SA 2.0

Data on GP practice populations released by NHS Digital this month list just 7,532 GP practices – down 181 from the total a year earlier in January 2016.

Part of the drop in GP practice numbers in the NHS Digital data is likely to be driven by mergers, which could mean that some of the practice locations no longer listed in official figures remain open, but under the wing of a larger group.

However, BMA leaders have warned that closures are at ‘record levels’ and the latest figures suggest that the trend is not slowing down as GPs wait for government pledges of investment through the GP Forward View to take effect.

Read the full news story here

Nurse shifts left unfilled at nearly every hospital in England

Analysis of official data finds 96% of NHS hospital trusts had fewer nurses covering day shifts than they had planned | The Guardian


Almost every hospital in England has fewer nurses on duty than each believes are needed to guarantee safe patient care, research shows.

Analysis of official data by the Health Service Journal (HSJ) found that 96% of NHS hospital trusts in England had fewer nurses covering day shifts in October than they had planned and 85% did not have the desired number working at night.

The disclosure of such widespread failure to ensure hospitals are properly staffed has prompted fresh concern that a chronic lack of nurses and the NHS’s dire finances are putting patient safety at risk.

Read the full news story here

Reduction in adolescent depression after contact with mental health services

Neufeld, S. et al. The Lancet Psychiatry. Published online: 10 January 2017

Background: Evidence regarding the association between service contact and subsequent mental health in adolescents is scarce, and previous findings are mixed. We aimed to longitudinally assess the extent to which depressive symptoms in adolescents change after contact with mental health services.

Interpretation: Our findings show that contact with mental health services at age 14 years by adolescents with a mental disorder reduced the likelihood of depression by age 17 years. This finding supports the improvement of access to adolescent mental health services.

Read the full abstract here

PODCAST: Big Data – what effect is it going to have on EBM

In this discussion we went to the The Farr Institute which is a of 21 academic institutions and health partners in the UK – whose mission is to deliver high-quality, cutting-edge research using ‘big data” | BMJ Talk Medicine

We know what the problems are – but what would positive change, when it comes to the creation and use of medical evidence look like? To find out we’re doing a series of discussions at various places around the world – where we’re talking to people who have a particular insight into one area of the evidence ecosystem. Ultimately we’re collating this into what we’re calling the evidence manifesto.

Read the full over view here

Disadvantaged women at greater risk of heart disease than men

Women from low socioeconomic backgrounds are 25% more likely to suffer a heart attack than disadvantaged men. | OnMedica | Journal of Epidemiology and Community Health.


In a review of 116 studies, researchers from The George Institute for Global Health examined data from 22 million people from North America, Europe, Asia and Australasia and found, as expected, that markers of a lower socioeconomic status (education, occupation, income or area of residence), compared to a higher, are associated with a higher risk of cardiovascular disease for both sexes.  However, the results also showed women from more disadvantaged backgrounds were relatively more likely to suffer from coronary heart disease than men from similar backgrounds.

Read more at OnMedica

Full reference: Backholer K, Peters SAE, Bots SH, et al. Sex differences in the relationship between socioeconomic status and cardiovascular disease: a systematic review and meta-analysis. Journal of Epidemiology and  Community Health, published online first 14 December 2016

Early benefits of delegated commissioning

NHS England have produced a series of Delegated commissioning case studies to show how CCGs are using delegated commissioning to improve care for local people. 


CCGs have reported that delegated commissioning is leading to:

  • The development of clearer, more joined up visions for primary care, aligned to wider CCG and STP plans for improving health services;
  • Improved access to primary care;
  • Improved quality of care being delivered to patients;
  • Improved CCG relationships with member practices, including greater local ownership of the development of primary care services;
  • Increased clinical leadership in primary care commissioning, enabling more local decision making;
  • Greater involvement of patients in shaping services;
  • A more sustainable primary care system for the future.


NHS England have produced a series of case studies to show how CCGs are using delegated commissioning to improve care for local people:

Delirium could accelerate dementia-related mental decline

When hospitalized, people can become acutely confused and disorientated. This condition, known as delirium, affects a quarter of older patients and new research shows it may have long-lasting consequences, including accelerating the dementia process. | via ScienceDaily


New research by UCL and the University of Cambridge shows delirium may have long-lasting consequences, including accelerating the dementia process. Episodes of delirium in people who are not known to have dementia, might also reveal dementia at its earliest stages, the research found.

Scientists looked at three European populations — in Finland, Cambridge and UK-wide — and examined brain specimens in 987 people aged 65 and older. Each person’s memory, thinking and experience of delirium had been recorded over 10 years towards the end of their life.

When these were linked with pathology abnormalities due to Alzheimer’s and other dementias, those with both delirium and dementia-changes had the most severe change in memory.

Journal Reference: Daniel H. J. Davis et al. Association of Delirium With Cognitive Decline in Late Life  A Neuropathologic Study of 3 Population-Based Cohort Studies JAMA Psychiatry, January 2017