In the first in a series of new efficiency briefings, we ask what scope there is for improving the efficiency of the acute care pathway in adult mental health, while maximising quality.
Data shows there is wide variation between the use of inpatient beds and bed-days, and spending on crisis resolution and home treatment teams. And the data is only the starting point. Mental health trusts and primary care trusts need to work together to understand the detail behind the headline figures.
Our series of ‘Delivering more for less’ efficiency briefings look at areas of the NHS where our analysis of local and national data shows that potential efficiency savings could be made.
Download the briefing
PDF version In a speech at the NHS Confederation annual conference today, the Health Secretary will set out how a vision for patient-centred care will propel the NHS, the professionals and the front-line through the unique and challenging times ahead.
The coalition government has agreed to increase health spending in each year of this parliament. The commitment reflects the increasing demand on services. It does not negate the necessity to make the tough choices that are required in order to meet the scale of the demand and to drive up quality improvements.
The Health Secretary will show how the NHS can build on work done, remove obstacles, focus on outcomes and quality, and align the incentives and standards to support quality. He will describe a coherent, sustainable framework for the next five years and beyond, centred on the following five priorities:
- Making patients the starting point of everything we do, not just as beneficiaries of care but as participants in its design.
- Focussing on outcomes. Not process targets, not measuring inputs, but a consistent, rigorous focus on results for patients and health outcomes of the highest standards.
- Empowering professionals by setting them free to use their skills, judgement and creativity to drive up quality care.
- Improving the health and well-being of our families and communities by prioritising public health and preventing ill-health more effectively.
- Reforming social care by empowering care users and delivering further integration in how services are commissioned and provided.
Health Secretary Andrew Lansley said:
'I know the changes I propose are far reaching. And as decision-making shifts and as we work together to deliver change, I know there will be some uncertainty. But I can and will create a bridge between the past and the future and help map out the journey we need to take: I will be clear what the strategy is and the shape of new priorities and systems; I will build on the good work already being done; I will devolve real freedom and responsibility to competent managers, and I will engage all NHS staff – doctors, nurses, and managers in working out how to implement a strategy with one shared vision in mind – to improve NHS care for patients and the public it serves.'
There are three key requirements that combined will make the absolutely necessary changes happen: will, ideas and execution.
There's plenty of will to change in the NHS, evidenced in the many conversations we've been having on our stand at the conference. The will is driven by a clear realisation across the NHS of the national financial position and the need to find about £15 billion of productivity savings.
There’s also no shortage of ideas here. Almost every stand is offering some kind of solution, whether it’s technological innovation, better approaches to workforce planning, how to make best use of data or how to organise clinical services. There is a vast national and international literature about best practice, and no shortage of case studies.
The third key requirement is execution, and that is where the real challenge lies. Despite the will to change, despite the endless case studies and examples, there is still huge variation across the NHS and no one organisation or health system is doing everything right. Joanne Watson, a consultant in diabetes and endocrinology, gave the Geoff Scaife memorial lecture at the conference today and said: ‘the mediocrity of NHS care is not due to reluctance to change but to chronic inconsistency'. And that inconsistency must be tackled if the NHS is going to rise to the productivity challenge.
It is becoming clear that the scarcest resource in the NHS at the moment is the capacity to drive change, particularly when leaders are distracted by the kinds of organisational changes that strategic health authorities and primary care trusts will be facing.
Real change and improvement can only be delivered by front-line 'clinical microsystems' – that is the doctors, nurses and their teams – who make the majority of decisions on a day-to-day basis about how resources are used in the NHS. But these clinical microsystems need leaders who have the skills and the capacity to manage change. In the laudable goal of reducing management costs, we shouldn’t throw the baby out with the bathwater by removing the leaders who’ll be able to drive and guide change.
http://www.kingsfund.org.uk/blog/who_will_deliver_the.html