Recently I was able to attend an Intellect (intellect.co.uk) event held in Fleet Street, London with Jim Easton (National Director for productivity and efficiency) speaking. It was made clear that the NHS cannot sustain itself with current funding levels and £20Bn is the ‘qualified estimate’ of how much needs to be saved, recurrently, between now and 2015. It’s a huge task ahead and Jim Easton has to lead one of the toughest challenges to face the NHS in England – it was noted by Jim that mental health services have changed radically for the better in the past 30 years and acute trusts now have 4 years to achieve the same effort – a very valid point.
With that thought I have two observations to make:
It’s absolutely vital to note that quality should always be at the core. The statement “cutting costs puts services at risk of poor quality” – I don’t doubt it one bit. I think in projects it wrongly comes down to the separation of cost and quality – I think sometimes it’s easy for there to become a disconnect because a new cost improvement has been defined and although quality is always considered at the start it doesn't necessarily get discussed in project monitoring – if something starts late it’s the finances that suffer and they become more prominent. Quality metrics are challenging to define but they are needed to report on.
If a new project to improve the services offered by the Trust is delayed it:
- Puts the financial plan at risk
- Takes away the opportunity for the patient to receive a service of better quality during care/treatment. This may mean a shorter stay in hospital, one less visit to the phlebotomist or fast referral to the correct specialist.
I’ll start by pointing to page 4 of this article:
The article refers to evidence found by The Health Foundation on whether increasing quality saves money. It identifies that poor quality is common and costly but says complex organisational change offer great potential for savings but there is risk of failure. The reason for less evidence is obvious – its change which requires engagement of stakeholders from possibly multiple organisations, the risk of failure is high (as identified), it’s hard to meausre the improvement and it’s a tough project/programme management challenge. These are all factors that can be addressed with the right skills and this change is possible – pathology is an example area of where huge savings are possible.
Changes in areas which improve the clinical service also stop protesters on the street because of cuts to front-line services; questions like-
- Does the patient need that pathology test or MRI scan?
- Does the patient need to be in hospital this long (http://www.hsj.co.uk/news/primary-care/discharge-delays-questioned-after-patient-deaths/5025224.article)?
- Do we need to pay that much for this special drug?
- Can we improve the scheduling of this service to reduce cancellations?
Some of these ideas and more are mentioned here: http://www.bmj.com/content/341/bmj.c7239.full