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

Financial challenges facing the NHS

The Healthcare Financial Management Association (HFMA) has published NHS financial temperature check: finance directors’ views on financial challenges facing the NHS in England. 

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This briefing draws on the responses of finance directors of trusts and foundation trusts and chief finance officers of CCGs.  It finds the financial performance of the NHS remains under significant financial pressure.

Trusts reported a combined deficit of £791m in 2016/17, after receiving additional funds of £1.8bn from the sustainability and transformation fund (STF).

The performance of CCGs, based on month 11 forecasts, looks better than that of trusts with a forecast in-year underspend of £250m, but this is after the release of the £800m risk reserve to CCGs’ bottom line.

Full document: NHS financial temperature check – briefing July 2017

Additional link: NHS Providers

The rising cost of clinical negligence: who pays?

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The Medical Protection Society estimates that clinical negligence costs in the NHS have increased by 72% over the last five years and that costs could reach £2.6bn a year by 2022.

It argues that there should be reasonable compensation for patients who suffer harm due to clinical negligence but that this must be balanced against society’s ability to pay. The report makes recommendations for legal reforms around clinical negligence compensation.

More detail: Clinical Negligence Costs: Striking a balance

 

 

The impact of NHS financial pressures – a mixed picture

Recent figures reveal a provider deficit of nearly £900 million for the first three quarters of 2016/17 – a clear sign that NHS organisations are struggling in the face of constrained budgets and growing demand | Lillie Wenzel – The King’s Fund Blog

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As NHS organisations seek to manage current pressures, the number of media stories suggesting that tight health budgets are having a negative impact on patient care is increasing. But is this the whole picture?

For the NHS, the relationship between financial performance and quality of care is complex. Indeed, a recent Public Accounts Committee report recommended that the Department of Health and NHS England undertake work to better understand the association between the two. We know that the actions NHS organisations take when they are under financial pressure can affect patient care in a number of ways. We also know that patient care is affected by many factors besides funding, and that both national data and public attention tend to focus on care delivered within hospitals.

Our research, set out in Understanding NHS financial pressures, aimed to get beneath the top-level data and explore in more detail how patients are being affected by the financial pressures facing the NHS. We looked at four different service areas – genito-urinary medicine (GUM), district nursing, elective hip replacement and neonatal – to try to understand the impact in different parts of the system.

Read the full blog post here

NHS efficiency map

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

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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.

 

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

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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

Children’s Mental Health Funding Not Going Where it Should

YoungMinds analysis reveals that many local health bodies are diverting some of the new funding received for children’s mental health services to other priorities.

In 2015, the government pledged an extra £1.4 billion over five years to “transform” Child and Adolescent Mental Health Services (CAMHS). Research undertaken by YoungMinds into the responses of 199 Clinical Commissioning Groups (CCGs) from Freedom of Information requests has revealed that:

  • Fewer than half of the CCGs who responded were able to provide full information about their CAMHS budgets. If CAMHS services are to improve, there needs to be far greater accountability about where money is being spent.
  • In the first year of extra funding (2015-16), only 36% of CCGs who responded increased their CAMHS spend to reflect their additional government funds. Nearly two-thirds (64%) of CCGs used some or all of the extra money to backfill cuts or to spend on other priorities.
  • In the second year of extra funding (2016-17), only half of CCGs (50%) who responded increased their CAMHS spend to reflect their additional government funds. The other half (50%) are using some or all of the extra money for other priorities.

Read the full news story here