Hospital Dr News

Health Bill distracting NHS from making savings

Service integration to deliver the Nicholson Challenge is more important than NHS reform say MPs on the influential Health Select Committee.

The report on public expenditure, by the cross-party committee, says the reorganisation process in the NHS continues to complicate the push for efficiency gains. NHS chief executive David Nicholson wants £20bn of savings by 2015.

The MPs say that, although the push towards GP commissioning may have facilitated savings in some cases, it more often creates disruption and distraction that hinders the ability of organisations to consider truly effective ways of reforming service delivery and releasing savings.

The report expresses concern that trusts are currently making savings through “salami-slicing” existing processes and services instead of rethinking and redesigning the way services are delivered.

The Nicholson Challenge can only be achieved through a wide process of service redesign on both a small and large scale, the report says. These changes should not be deferred until later in the Spending Review period: they must happen early in the process if they are to release the recurring savings that will be vital in meeting the challenge.

Commenting on the report, Sir Richard Thompson, president of the Royal College of Physicians, said: “We agree that meeting the £20bn efficiency savings at the same time as dealing with the increasingly elderly population is a difficult challenge for the NHS. It is crucial that the proposed reforms help services meet this challenge, rather than distract from it. The government has failed to set out clearly how this will be achieved.

“While improving efficiency, the NHS must still at the same time invest in quality. A key priority is to provide consultant delivered care, which would both improve standards and patient experience, and save money. The health reforms must also improve the process for making decisions about service reconfiguration, for this will increase the availability of consultants, and facilitate seven day infrastructure to underpin consistent patient care. Clinicians and local communities should lead those decisions.”

The MPs says that more integration of services is vital. While the separate governance and funding systems make full-scale integration a challenging prospect, health and social care must be seen as two aspects of the same service and planned together for there to be any chance of a high quality and efficient service being provided which meets the needs of the local population within the funding available.

Dr Hamish Meldrum, chairman of BMA council, said: “Better integration of care is key to improving patient care yet many of the implications of the Health and Social Care Bill, including the government’s focus on competition, will make this harder to achieve.”

He described the Bill as a “distraction” and said it “is causing chaos on the ground even before the legislation has been passed. It is perhaps little wonder that those trying to make efficiencies are focussed on short-term issues, such as their job prospects, and making rushed decisions on savings rather than looking to the longer term”.

He added: “There is still time for the government to withdraw the Health and Social Care Bill – a bill which an increasing number of health professionals are opposed to – and work with healthcare professionals and others to agree a more pragmatic way forward.”

The MPs conclude that it is too early fully to assess the types of savings being made in 2011-12, the first year of the QIPP programme. However, the report says: “We are concerned that there appears to be evidence that NHS organisations are according the highest priority to achieving short-term savings which allow them to meet their financial objectives in the current year, apparently at the expense of planning service changes which would allow them to meet their financial and quality objectives in later years.”

Read the full report.

Read a blog on the Health Bill.

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3 Responses to “Health Bill distracting NHS from making savings”

  1. Malcolm Morrison says:

    I cannot recall ever seeing any figures to see how much each succesive ‘reorganisation’ of the NHS has cost – nor any figures to show that the proposed ‘savings’ that such reorganisation was supposed to achieve was ACTUALLY achieved!
    How much is all the ‘disruption’ caused by these ‘changes’ (already started even before the Bill has been passed!) estimated to cost? However much this is, it should be ‘set against’ the £20bn ‘savings’ demanded bythe Chief Exec.

    Whilst the budgets for health care and social care are held separately, there will ALWAYS be problems getting co-ordinated, let alone ‘seemless’, care for any individual patient.
    Retired Orthopod

  2. Mike, the editor says:

    I don’t know how much previous reorganisations have cost, but this one is being estimated at a cool £4bn. That’s a lot of potential healthcare being ‘lost’.
    http://blogs.lse.ac.uk/politicsandpolicy/2012/01/24/hsc-bill-policy-fiasco

  3. Wayne Sunman says:

    I agree with the comment from Mr Morrison. Focussing on the discharge process could dramatically improve the patient experience, particularly for frail, older patients. A lot of time and effort is wasted towards the end of an admission determining whether the patient, the PCT or social services will pay for ongoing care. If ‘health’ was given the appropriate funding for the immediate period after discharge, or if a pooled fund was created, then patients could be discharged at the point when it is appropriate for them and ongoing funding sorted out at leisure after discharge. There would be no need for social services and the PCT to be involved in the discharge process making the slicker, more predictable, more satisfactory to all concerned and a darned site more efficient. The PCT and social services can then focus their efforts on providing appropriate funding and care once the patient is back in the community. This system would remove the perverse incentives from social services and to some extent the PCTs to create extended assessment processes whilst the patient is still an inpatient and not costing them a penny.

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