A business critical briefing from HSJ’s Achieving Savings and Efficiencies in the NHS conference
- Christopher Long, chief executive, NHS Hull
- Helen Bevan, director of service transformation, NHS Institute for Innovation and Improvement
- Robert Croft, category manager, professional services, Buying Solutions
- Steve Watkins, NHS Benchmarking
- Bob Ricketts, director of system management and new enterprise, Department of Health
Building more effective partnerships to maximise resources and deliver high quality, integrated care, Christopher Long, chief executive, NHS Hull
- Partnerships must define a strategy and be clear on the end point and outcomes.
- Outcomes must be real and partners must be able to measure the benefits, managing the criteria and thresholds to define any “unmet need”. If there is a requirement to meet “unmet need” this should be a planned outcome not just a capacity driven response by providers.
- There is a need to look wider for opportunities and savings, e.g. Hull invested £40,000 in polycarbonate beer glasses and saved £8m following reductions in hospital admissions due to fights, Durham invested in grit to prevent accidents.
- There are lessons from how US HMOs look at the whole system.
- Partnerships must be clear on the values, be in place and working before there are any stresses on the system, and also the disadvantages must also be considered.
- Vertical integration is not a good idea, it is rushed, merging even when just one is a poorly performing trust will create a bad organisation, and it ignores the reasons why community services were separated out from hospitals.
Embedding the principles of quality and productivity to ensure a world class, productive and efficient health service, Helen Bevan, director of service transformation, NHS Institute for Innovation and Improvement
- To make real changes in productivity it is necessary to consider the processes within the system, 80% of the opportunities to create efficiencies are linked to clinical decision making.
- There is perhaps a perception that everyone else has to save money, it is someone else’s problem.
- There is a need to tell the story linking to emotional and value driven reasons to ensure QIPP is integrated and understood by everyone.
- Use of language is key. Learn from the social movement literature and how people like Marshall Ganz used different methods to mobilise people to generate the excitement that made Barack Obama US president.
- Framing the message is key, including the language used. Generate positive emotions and the energy for change.
- There is a need to consider why the organisation is there, at a system level, and what its focus should be.
Driving better value for money through effective contract management and procurement, Robert Croft, category manager, professional services, Buying Solutions
- Identify KPIs that are essential to delivering value and are few and simple to manage.
- Relationships with suppliers are essential, working together to achieve desired outcomes.
- The aim of procurement is to ensure the most value is obtained and risk is managed.
- Identify the few risks which matter and effectively manage these risks.
- Negotiate what is appropriate, where the real value is. Without first understanding this, negotiations often miss the point.
Benchmarking your local performance and setting targets for improvement and benefits realisation, Steve Watkins, NHS Benchmarking
- NHS Benchmarking is a national organisation funded by subscription which shares good practice across the NHS and influences change.
- There are significant savings in understanding and taking out variations e.g. in the 19 conditions not clinically effective, in the costs of GMS per resident, etc. There are a lot of inefficient practices, and outliers to be reviewed.
- The main impact will be seen as the accumulation of a number of small gains.
Bob Ricketts, director of system management and new enterprise, Department of Health
- Benchmarking is a key aspect, with the amount of free or cheap comparative data there is no excuse for not comparing performance.
- There are a lot of technical efficiency gains to be made, 20-25% savings.
- Benchmarking has driven the national QIPP framework and McKinsey savings estimate.
- There are three main levers within the new contract that provide commissioners with all the powers they need to manage the contract effectively: a commissioner can insist on a utilisation review if there are any concerns and the trust has to carry out this review; a prior approval system can be in place, especially for any interventions of limited clinical value; the plan can have ratios and caps.
- PROMs are seen as the future, and further guidance will be published in the next few months.
Engaging clinicians and finance teams to understand patient level costs and drive efficiencies, feedback from the afternoon session
- There is a need to engage GPs and understand their values.
- The quality of information needs to be improved.
- There is a need to understand data coding, capture direct costs and apportion overheads.
- There needs to be a common language between finance and clinicians.
- Most clinicians are good business managers and interested in performance and financial position of NHS and individual service, this engagement should be encouraged.
Derek Miller is associate director of commissioning, Southwest London Acute Commissioning Unit.
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