Improving quality while saving money: is it really possible?

Health Minister Simon Burns explains how better care and listening to patients can result in the NHS having to spend less money

Later today, I will be speaking at the NHS Institute’s Patient Feedback Challenge event.

The Challenge is setting up a series of demonstration sites across the NHS to see how the NHS can get better at listening to patients – particularly to what they say about their experience of care, as well as their clinical care.

Did the doctors and nurses they saw listen to them and explain the treatment they needed clearly to them? Did they get the right information and support to help them when they return home? Did they get the help they needed with eating and drinking, or going to the toilet? In other words, were they treated like a decent human being – with dignity and respect?

It’s been too easy in the past to see such things as extras – clinical care comes first, and if people are decent to you then that’s a bonus.

But the two are certainly not unconnected. In the rare event of something going wrong with NHS care, the two often go hand in hand, with one greatly exacerbating the latter.

People have voiced concerns that the NHS’s efficiency drive will in some areas reduce the quality of care. I understand those concerns.

The NHS’s funding is, of course, protected. But because demand is increasing, it is in the middle of a major mission to find up to £20 billion of efficiency savings that it will then put back into frontline care. Back into frontline care, note – not back into Treasury coffers.

It is doing this not by cutting good services, but by discovering better models of caring for people. For example, making sure the 15 million people with long term conditions – on whom nearly three quarters of the NHS’s budget is spent – spend less time in A&E, and get more of the support they need to stay in good health.

People are understandably sceptical. The idea that you can improve quality while making savings sounds unlikely, particularly, I suspect, if it comes from the mouth of the politician.

But if you are a sceptic, consider this example.

One of the issues highlighted in the NHS Atlas of Variation is how the quality of care can differ so markedly from one area to another. And where standards are poor, costs are often much higher.

Two children with asthma who live in different towns, perhaps just a few miles from each other, could have radically different experiences.

For one child their condition is not properly controlled, their life is dominated by the illness and their time is spent coping with emergencies.  Waking up in the middle of the night, struggling to breathe. Frequent trips to A&E. Missed school days. A complicated calendar of appointments with different doctors or at different clinics that is practically impossible to follow.

For the other, life is a lot simpler. Their condition is under control – they have the right medication, they know how to take it and they know what they need to do if they are feeling unwell. They don’t miss weeks of school every year. They have lots of friends. One night a week, they might play football for their local under-11s team, or take part in a local theatre group.

If you are a parent, and it was your child, which would you prefer?

Perhaps surprisingly, the scenario where your child gets better care and is happier and has a better quality of life, the NHS usually spends a lot less.

Improving asthma care is one of the issues being explored by South East Essex Community Healthcare. They are piloting a home nursing service for children whose asthma is difficult to manage. Among the children they worked with, they have reduced the number of A&E visits by half and hospital admissions by nearly a third. Their example of how they are improving quality and saving money is one of many happening all over the country.

And, to come back to the point of today’s Patient Feedback Challenge Event, satisfaction levels among South East Essex’s young patients are incredibly high. And even more importantly, they feel confident and safe about managing their own condition. That, of course, is priceless.

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8 Responses to Improving quality while saving money: is it really possible?

  1. Anthony Lawton says:

    Attending to the experience of patients and their carers and companions is indeed vitally important.

    But I think you will always have a fundamental problem in getting this point adequately responded to if you continue with a theoretical framework that distinguishes between patient experience and clinical outcomes.

    My wife has been a cancer patient, or at least a patient first embroiled with the NHS (since childbirth) because of an advanced cancer four years ago. Her and my priority ‘dimension’ of experience is whether the medical help has actually helped, yet the NHS framework does not include that!

  2. Kathy Mason says:

    I feel that the NHS would only be able to save money whilst improving the quality of care when their staff are purely driven by passion for saving lives and for health improvement. To far too many, it is simply a job and a means of a pension; and this goes for Nurses, Doctors and Consultants alike.

  3. Jane Hosell says:

    If listening to patients is a priority then why has no one decided yet what to do with the Patient Advice & Liaison Service whose very remit was to listen and sort out issues arising from patient feedback – yet it was omitted from the Bill! Its a strange irony……………………

  4. john cornell says:

    I think this sort of thinking is rather too simplistic. There are hundreds of examples of cost effective good quality care across the whole range of services. However, they are dotted around the country. One never sees all the examples coming from one PCT, because I suspect, each initiative is not necessarily cheaper over all, though the quality may be improved, the money is just spent in different parts of the system. Such initiatives often require fairly major re-organisation in terms of how and where staff work and usual some initial capital and most importantly personal to lead the change. With reducing staff numbers and loss of managers such people are in even more short supply. PCTs / CCGs will still have to make choices about where their money goes so bringing in one “cost effective” initiative means they don’t bring in another. So frankly I think anyone who believes that by citing such individual examples and then expecting that model to be replicated whereby the whole raft of examples that are out there, to be introduced as the saviour of the NHS is likely to be disappointed.

    • Jane Hosell says:

      I suspect you therefore are not aware that the PALS service was rolled out nationally via the NHS Plan 2000. It was a mandatory requirement that there would be a PALS service in every Trust throughout the country to enable them to get better at listening to patients. It seems that the wheel is being reinvented and that is what I am referring to, not as you suggest a service unique to one Trust. Therefore there would be no need to replicate this model as it is already in situ nationally.

  5. paul chesters says:

    One of the simplest ways to save money within the NHS, surely, would be to bring it into the20th century, let alone the 21st administratively. Why are GP’s hospitals still reliant on paper and snail mail. All the local GP surgeries I know routinely send letters to specialists and the like via snail mail. Then on getting a reply they have to take time to scan them into patients electronic notes and then file the hard copy.

    All letters to consultants et al should be sent via e-mail, thus saving postage and writing materials. I have seen the vast amount of post that arrives daily at our local hospitals and GP surgeries, and would be surprised if 3% was needed to go via the post system,

    Even without a joined up NHS system which includes all hospitals and surgeries, the use of the humble e-mail would result in considerable savings to the NHS in postage, writing materials, and more importantly time. There is also the confidentiality aspect to consider. Is the snail mail any better than e-mail? I think not Yes e-mails can be hacked, as events in recent weeks have shown, but how many letters go adrift?

    The other saving that could be made is in the area of repeat prescriptions: A GP should, in my view, decide that a patient requires a certain drug for a period of time and then the GP should be able to electronically send a script to a nominated chemist of the patients choice which will run for the whole period of the repeat. People like myself, who have a number of items, should likewise have the whole lot sent, The whole system could be completely user friendly, no more lost scripts or people, who are incapable of looking at a calendar, presenting at surgery demanding that they jump the queue and have a script issued that day….it would already be at the chemists waiting for them. I sent a letter to the Times regarding this some fifteen yrs ago, and was told it could never happen. ten years ago the president of the Pharmacological Society said that a similar system should be set up…..and yet the old fashioned and outdated system prevails. Chemists were forced some years ago to have an area set aside for private consultations, so why not require them to have such a system, and why not require all GPs to adopt same.

    I have seen small GP surgeries go from a single GP with two part time members of staff, to one GP and a part timer, in fact two part time GPs with ten members of staff, albeit two part time nurses. Most of the time, excepting the sharp end at reception is spent doing scripts and sending letters to various specialists …..all are working full out chasing paper.

  6. Joe Fishman says:

    RE-INVEST the £20bn?? I thought the NHS needed to save £20bn to stay within it’s proteced but stilll tough budget? If that’s the case how can it be re-invested?

  7. Julie Edwards says:

    The sensor cushion is set up in our hospital when a patient is at high risk of falls. This sensor is to prevent a patient walking on their own if they are reluctant or too confused to use the calling system. Walking on their own could lead to a fall that could break a bone which is a costly business for the NHS. What is overlooked is many of the patients feel their independence is taken off them and are feeling like a prisoner. Many patients need to move to stop themselves going stiff which leads to a fall but not having the freedom to move frequently is causing the stiffness. Many patients feel they are disturbing staff if they use the calling system when all they want to do is move short distances.
    Most of the time patients go home still classed as at high risk of falls due to conditions like arthritis, but to stop falls in the hospital in some cases all it is achieving is anxiety of inevitable stiffening limbs from lack of frequent movement and then the reluctance of the patient wanting to stand up because they know they are more at risk of falls which in turn can cause incontinence. So much for dignity in care

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