The new health secretary, Andrew Lansley, has already gone on public record to suggest that £15-20bn in efficiency savings may be needed.
He was also quick to point out that the coalition has maintained its commitment to increase, in real terms, NHS funding year on year during the lifetime of the parliament. Savings, therefore, will be reinvested to offset higher than average inflationary pressures within healthcare.
Dramatic improvements in productivity seem to occur when a single organisation and dedicated team of clinical staff take responsibility for the entire “value chain”
At a KPMG global healthcare partners meeting earlier this year, it was evident that healthcare systems around the developed world are facing similar challenges - more quality for less cost. In the UK context, it is likely that a pay freeze plus a debate about incremental point pay inflation could provide efficiency gains in the order of 7 per cent. The balance can be achieved through transformational change of healthcare delivery. There are plenty of examples from around the world which have delivered improved patient care and efficiency improvement of 10-30 per cent.
In New South Wales, Australia, large-scale clinical system redesign saved over three million bed days while at McMaster, Ontario, expertly stratified long-term condition care provided active case management at around 20 per cent of traditional costs. At the Techniker Krankenkasse insurance fund in Germany, active health coaching for “at risk” groups has reduced costs dramatically. At Castelldefels Agents de Salut in Catalonia, Spain, improved staff motivation, training and appraisal systems have incentivised dramatic improvements in primary care productivity while at PHARMAC, the Pharmaceutical Management Agency in New Zealand, we have seen significant savings in the purchase and use of pharmaceuticals through a dynamic, commercial approach to suppliers.
In Torbay, which has similar demographic profiles to that predicted for the UK overall by 2050, an innovative health and social care organisation offers holistic, cost-effective health and social care which, against its benchmarked group, has resulted in only 47 per cent of the anticipated emergency bed days for people over 85.
Finally, the NHS Institute for Innovation and Improvement’s Productive Ward series has dramatically released more time for nurses to care for patients through patient flow redesign. This is being adopted throughout the world, a striking example of how the globalised nature of health can spread rapid improvements to care.
What conclusions can we draw from these case studies?
Three characteristics dominate. First, the projects all have inspirational and determined sponsorship from leaders. Second, clinicians are supported in a variety of ways to critically re-examine care process and simplify patient flow. Third, and most importantly, the most successful and sustainable changes have been made by looking at the care process from the patient’s view.
High-quality, patient-focused care can, and does, save money but these benefits will not materialise without dedicated planning, programme management, excellent information and highly supportive technology.
A key facet of high performance also seems to relate to the individual and organisational capacity to partner. In Torbay and Ontario, the ability to look holistically at an individual’s needs and provide funding and care support from “pooled” budgets has reduced unnecessary bureaucracy and streamlined the care process.
Dramatic improvements in productivity seem to occur when a single organisation and dedicated team of clinical staff take responsibility for the entire “value chain” and use sophisticated information technology to stratify patient need and focus attention and effort for those “at risk”.
All of the major clinical change programmes noted rely heavily on good baseline information, excellent modelling capability, risk stratification and change management skill, often facilitated by external agencies.
Finally, countries have different funding and payment systems, reflecting cultural and political differences, which range from socialised insurance and state-run provision to private cover and private supply of healthcare.
This diversity makes meaningful comparison of incentives difficult to ascertain on a global scale but it would appear that clear clinical objectives when coupled with full professional accountability, linked to well-defined incentives seem to deliver high-quality and cost-effective care.