The NHS could save more than £9bn in a year if trusts improved their performance in just eight “high impact” clinical areas, the chief nursing officer for England has said.

More than £7bn a year is spent on dealing with the effects of patient malnutrition and dehydration in hospitals and care homes, which would not need to be spent at all if care improved.

A further £1bn could be saved if the number of patients admitted into hospital due to pressure sores - also a symptom of neglect - were halved.

The “high impact actions” were unveiled by chief nursing officer Dame Christine Beasley last week alongside a report by the NHS Institute for Innovation and Improvement. The report shows reforms to nursing practice could make substantial contributions to the NHS’s £15bn-£20bn savings target.

High impact savings

  • £1,050m - Cut pressure ulcer admissions in half
  • £3.8m - Cut patient falls in hospital by 25 per cent
  • £7,300m - Stop malnutrition and dehydration in hospitals and care homes
  • £10m - Reduce caesarean sections by 2.2 per cent a year
  • £105m - Give patients choice to die at home
  • £555m - Reduce sickness absence by a third
  • £31m - Nurse-led discharge to reduce unnecessary bed days
  • £124m - Prevent urinary tract infections
  • Total: £9.2bn

In a move parallel with the Department of Health’s “quality and innovation” challenge last month, Dame Christine had asked nurses to come forward with details of changes they had already made that improved both quality and productivity.

More than 600 nurses contributed proposals and the best eight have been selected and published alongside “how to” guides and further details on potential financial savings.

Dame Christine told HSJ she wanted trusts to get on with implementing the eight actions now, rather than wait for instructions from the operating framework. However, she said the DH was considering using some “national levers” to ensure the changes were made and those would be detailed in the framework.

That is most likely to involve incorporating the actions into the commissioning for quality and innovation (CQUIN) payments that primary care trusts make to providers.

HSJ revealed last month the DH is considering making the entirety of any increase to tariff prices next financial year dependent on meeting local and national CQUIN targets.

Dame Christine is also considering ways to ensure accountability is cascaded down to individual nurse and ward level. She said there was “absolutely” a role for performance related pay.

Additionally, directors of nursing are being candid that savings from the high impact actions could lead to a diminished need for healthcare staff.

NHS South Central chief nurse Katherine Fenton said the changes “possibly could” lead to a lower demand for nursing staff, but that would be met by reducing the number of training posts rather than making people redundant. “That’s much cleverer than we’ve been in the past,” she said.

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