The NHS currently faces a big challenge on the way in which it delivers healthcare to patients as a result of budget pressure.
The harsh reality is that savings of £20 billion over the next four years must be achieved despite the continuous growth in demand for healthcare.
Although cabinet ministers in the new coalition government have promised that frontline services will be protected from cuts, many critics claim that this is unlikely given the dramatic scale of the savings needed inside the timescale.
They point to growing demand – due to issues such as ageing population and rising obesity levels – meaning that in real terms an overhaul in the way services are delivered will be required.
Some opponents have even argued that we can’t make savings without having any impact on frontline staff.
The challenge that the NHS is facing has led several trusts to scope out cost savings through operational efficiency at a new level of detail and depth.
The associated complexity can deter NHS decision-makers, but after having operated in a period of significant growth where our healthcare system has received record levels of investment, Trust managers are now becoming more willing to explore methods in which they can create savings on such a large scale.
People are often reluctant to change long-established methods of practice – and the energy and complexity of changing a structure can appear daunting and difficult for NHS managers, because of the barriers to making it happen.
Within relatively short timescales of several months key areas where efficiency improvements can be made are centred upon improving operations across a trust’s operating theatres, outpatient clinics and reducing length of stay.
We recently delivered a project on behalf of a major trust to improve the operational and financial performance of orthopaedic operating theatres.
The speciality was unable to meet demand and was being forced to send considerable numbers of patients to the private sector.
This was clearly unsustainable and the trust engaged with us to deliver the extra capacity required to perform these operations within existing theatre sessions.
Our initial objectives were to deliver a detailed audit to identify the areas of opportunity within the existing theatre list that could help us increase output by 10 per cent without requiring additional resource while improving patient and staff experience.
We then worked with the theatre teams and carried out performance studies and best practice trials within operating theatres to identify problems that were constraining performance to develop a strategy to overcome them.
Solutions ranged from implementing new session planning processes, optimising timetables and job plans, standard operating procedures for the daily management of patients to and from theatre, to optimising ‘start of day’ processes across 140 staff, and ensuring that consultants, anaesthetists, patients, paperwork and equipment were available on time and not causing delays in theatre.
Measurable results included a 35 per cent reduction in late starts, a 30 per cent reduction in turnaround, a 26 per cent reduction in early finishes and a 28 per cent reduction in surgery cancellations on the day of surgery.
The efficiency measures have saved the trust in the region of £1million per annum and supported it in meeting its strategic objective of being ranked amongst the best performing trusts throughout the country.
Sustainability has also been achieved through a programme of knowledge and skills transfer to the local team and fundamental improvement to the IT systems and management information which allows performance tracking, better session planning and enhanced patient communication.
Another recent project on behalf of a foundation trust to improve bed utilisation delivered recurring savings of £600,000.
These savings were realised through focusing on increasing the visibility and accuracy of information concerning a patient’s recovery after surgery.
A standardised IT-based handover sheet delivered the vital information for nursing staff and bed managers to manage a patient’s pathway towards an estimated day of discharge and ensure effective administration on their final day in hospital.
The new standardised system and increased visibility of discharge information led to a 74 per cent increase in the number of patients leaving their beds earlier in the day.
Realising and implementing these significant efficiency improvements across a trust is a challenge because it can require working at a detailed level with dozens of clinicians, managers and staff who already have an established effective way of working.
Booking theatres and clinics accurately is also difficult because you need the right information systems in place to optimise lists and to provide future visibility.
What is essential with all changes is that you have full clinical and management buy-in to change things like clinic templates, session times, and patient pathways.
This strategy will cut out waste, greatly improve service provision to patients and deliver essential cost savings.
The efficiency challenge remains critical for the future success of the NHS – but this means looking more closely at the operational areas where there’s still opportunity to squeeze out cost.
With the pressure growing for Trusts to realise such dramatic cost and service improvements, there is an increasing need for clinicians and managers to deliver complex and hard to reach opportunities such as these.
Andrew Hawes is director of Newton