Attitudes on cost-effectiveness and equity: viewpoints of medical professionals

The aim of this study is to determine the attitudes of physicians and trainees in regard to the roles of both cost-effectiveness and equity in clinical decision making | BMJ Open

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Cost-effectiveness analysis does not accurately reflect the importance that medical professionals place on equity. Among medical professionals, practising physicians appear to be more egalitarian than residents-in-training, while medical students appear to be most utilitarian and cost-effective. Meanwhile, female respondents in all three cohorts favoured the more equitable option to a greater degree than their male counterparts. Healthcare policies that trade off equity in favour of cost-effectiveness may be unacceptable to many medical professionals, especially practising physicians and women.

Full reference: Li, D.G. et al. (2017) Attitudes on cost-effectiveness and equity: a cross-sectional study examining the viewpoints of medical professionals. BMJ Open 7:e017251.

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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

NHS continuing healthcare funding

The National Audit Office has published Investigation into NHS continuing healthcare funding. This investigation sets out the facts relating to NHS continuing healthcare (CHC) funding and, in particular, access to CHC funding. It covers

  • Who is eligible for CHC funding and what the assessment process is
  • How long the assessment and decision-making process takes
  • Access to CHC funding
  • The cost of CHC to the NHS
  • Variation in access to CHC funding
  • Arrangements for reviewing access to CHC funding.

NHS Commissioning of Specialised Services

This Commons Library briefing paper looks at the commissioning of specialised services by the NHS in England, for patients with rare or complex conditions | House of Commons Library

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How the commissioning process works is set out in further detail, as well as analysis of the financial management and transparency of specialised commissioning, and recent reforms introduced by NICE and NHS England, including reforms to the Cancer Drugs Fund.

The specialised commissioning budget for 2017/18 is £16.4 billion, 14.9% of the total NHS budget, and is set to rise to 15.8% by 2020/21 to reflect the increasing use of new treatments for previously untreatable conditions.

In its 2016 report, the National Audit Office (NAO) highlighted problems that NHS England had experienced in living within its budget. Some of the reasons for this included an underestimation of the budget required to effectively commission services when NHS England took over commissioning responsibility in 2013, as well as a lack of effective data on how services are commissioned on a regional basis, and problems with effective negotiation of prices with pharmaceutical companies.

This briefing paper looks in details at some of the issues highlighted by the NAO, and recent changes to the commissioning process that allow for a greater degree of cost control.

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.

Cutting smoking rates could save NHS £67m a year

Study highlights the burden that smoking places on UK society, particularly on the poorest and least advantaged groups | OnMedica | Tobacco control

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If smoking rates dropped to 5% in the UK by 2035, the NHS could save £67 million in just one year. This is according to research published this week in Tobacco Control.

Researchers at the UK Health Forum, commissioned by Cancer Research UK, examined the health and economic impact of the UK becoming ‘tobacco-free’ – where less than 5% of the population smoke. The study predicts that achieving this target would avoid nearly 100,000 new cases of smoking-related disease, including 35,900 cancers over 20 years.

The impact of this health improvement amounts to a saving of £67 million in direct NHS and social care costs and an incredible £548 million in additional costs to the economy in 2035 alone.

If today’s trends continue, around 15% of people from the most deprived groups are predicted to smoke in 2035, compared to just 2.5% from the wealthiest.

Read more via OnMedica

Full reference: Hunt D, Knuchel-Takano A, Jaccard A, et al. Modelling the implications of reducing smoking prevalence: the public health and economic benefits of achieving a ‘tobacco-free’ UK

NHS efficiency map

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

The map is a tool that 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 bodies improve their efficiency.

Aimed at NHS finance directors and their teams and other NHS staff with an interest in the delivery of cost improvement programmes, the purpose of the NHS efficiency map is to highlight existing resources on eliminating waste, increasing efficiency and at the same time improving quality and safety.