Can NHS hospitals do more with less?
- Published on Friday, 20 January 2012 09:40
- Written by Dr Judith Smith
NHS hospitals have been tasked with delivering four per cent efficiency savings per year up until 2015, an unprecedented challenge. Nor is this an issue just for hospitals and those who run them
Structural deficits within the acute sector inevitably have a knock on effect on the amounts available to commissioners to fund a full range of locally appropriate services, whether they be health visitors, urgent care centres or the myriad other types of support communities have come to expect.
The job facing hospital managers is further complicated by the decision, endorsed by successive governments in line with international best practice to move more of the care the NHS provides into the community, closer to patients. As a result hospitals’ traditional fall back strategy of increasing activity or ‘growing their way out of recession’ no longer yields the results that it once did.
Anticipating this the Nuffield Trust commissioned a team of researchers to identify the factors that determine efficiency within hospitals and recommend how acute trusts could best improve productivity, without cutting back services or undermining quality. Their report Can NHS hospitals do more with less? was published earlier this month.
It is clear from their extensive analysis that much is known about what can be done to make efficiencies. Indeed the areas highlighted for action read like the contents page of a textbook on health care management, with topics such as: ensuring that length of stay and day case rates are in line with international best practice; exploring ways of using new technology to improve hospital processes; rationalising back-office functions; and carrying out procurement according to national benchmarks.
Less frequently discussed areas are also highlighted for action. They include ensuring a richness of skill-mix if seeking to reduce staff numbers; focusing re-engineering efforts on those services that carry the highest charges for commissioners; and using IT to streamline administrative processes within hospitals.
Of course, as with so much within health care management (and indeed clinical practice) getting the evidence translated into the reality of day to day working is a difficult task. Indeed for a health care manager, finding ways to change the longstanding 'way we do things round here', is probably the most challenging and enduring part of their role.
Thus while many of the action points identified are directed towards clinicians and administrators, we also highlight the contributions that the Department of Health, the new NHS Commissioning Board and Monitor (the NHS foundation trust regulator) can make. Key among these would be support for hospitals to develop better and more timely benchmarking information across administrative and clinical activities, the introduction of stronger incentives for hospitals to reduce variation, perhaps through the as yet to be finalised NHS performance framework, and encouraging a culture in which NHS leadership feels able to be creative and bold in challenging and changing local management and clinical practice.
The study reaffirms the importance of good management in general, and specific management practices when it comes to achieving greater productivity without compromising quality. The last year has been a difficult one for NHS managers as they have sought to make financial savings, sustain the quality of services, and implement a radical programme of health service reform.
Going forward it is imperative that they are given support and incentives by those who set direction and manage performance, so that they can indeed work with local clinicians to do more with less