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Content ArticleIn March 2025, the UK Government announced that it was disbanding NHS England, the arm's length government body that oversees healthcare delivery in England. Although there is public support for change in the NHS, a polling report by UCL Policy Labs and More in Common concluded that the “British people are looking for change, but not chaos, radicalism, not recklessness.” This article looks at where the dissolution of NHS England falls in the current UK context.
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Content ArticleMost people acknowledge the limitations of discussing productivity in healthcare. The term productivity is taken from other sectors and easily applied to industrial settings but not to the complex, patient-centred business of caring for people. Productivity is essentially the output, in terms of quantity (and sometimes quality), produced relative to input. In its broadest sense in healthcare, productivity can encompass activities such as detecting diseases earlier, giving patients better quality of care, and getting better outcomes. However, it is often discussed in sweeping statistics and numbers. Despite recognising the limitations of productivity as a measure, people in healthcare continue to obsess about it and we really must stop, writes Jessamy Bagenal in this Lancet commentary, giving several compelling reasons why.
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Content ArticleThe UK faces a series of complex cross-cutting health challenges. Addressing these interrelated issues – from access to services to health and work – requires a fresh approach. Often, no single part of government can tackle these sorts of issues alone and too often the public sector is set up to treat the symptoms of a problem rather than an underlying cause. We must go further and think of the problem more dynamically through a whole-of-government approach (WGA). A perfect example of this is the recent sharp rise in the number of people out of the workforce due to long-term sickness. This has significant impacts on individuals’ wellbeing, as well as large fiscal and economic costs. It requires concerted cross-government action to reverse these impacts. This is why the NHS Confederation and Boston Consulting Group partnered on a project to identify a set of practical actions the government can take to make progress. This report explores these actions. It will be of interest to government and policymakers, as well as the NHS, local delivery partners, funding organisations and stakeholders involved in work addressing the wider social determinants of health.
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Content ArticleClinicians at Guy's & St Thomas' Foundation Trust in London are preparing to publish the results of 15 one-day HIT lists between February 2021 and August 2022, involving 300 patients across eight different specialties, in which they claim they have been able to carry out four times as many operations as they would normally expect to complete in a month using conventional lists. The HIT lists - which have been designed by Dr Imran Ahmad, consultant anaesthetist and deputy clinical director for Theatres, Anaesthetics, & Peri-operative medicine at Guy's and St Thomas', to eliminate 'turnaround time' - were inspired by Formula 1 motor-racing pitstop techniques, to achieve maximum efficiency and safety, by boosting the surgeon’s operating time (the most expensive and most scarce resource) from the 40% per session of a conventional list to an unexpected 90%, and eliminating all possible patient delays on the day. Dr Ahmad - working with his colleague Dr Kariem El-Boghdadly - confesses that the success of the HIT lists has exceeded his expectations. The one-day Saturday events at three sites across the Guy's and St Thomas' trust, have consistently delivered four times the number of operations normally expected using conventional 'one-surgeon one list' methods. No short-term or long-term complications have been observed and there were only two on-day cancellations across eight speciality areas (including gastrointestinal, gynaecology, orthopaedics, and ear nose and throat). The HIT lists are always scheduled for a Saturday, in order not to put pressure on the routine working of the Trust, and have used only volunteer surgeons, working to the following model: Clinician led. Two theatres with one surgeon and three surgical teams. Single centre environment, eliminating potential delays such as porters. 50% more theatre staff than two conventional lists. Specially-selected low-risk patients. Best results with operations lasting 30-45 minutes. Single speciality list. Intense list planning for maximum efficiency. Several pre-op meetings with patients to inform them, gain consent, eliminate risk factors, and arrange post-operative medication. Lists always finish at least 1 hour (sometimes 3 hours) before the end of the shift.
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Content ArticleThis article explores political barriers to integrated care, arguing that improving the US healthcare system requires the pursuit of three aims: improving the experience of care, improving the health of populations and reducing per capita costs of health care.
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Content ArticleThis study in the Journal of Health Organization and Management aimed to explore factors shaping the implementation of five new care model (NCM) initiatives in the North East of England. The study findings demonstrate that all five pilot sites experienced, and were subject to, unrealistic pressure placed upon them to deliver outcomes.
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Content ArticleThe health and care system in the UK is under intense pressure and as a result, patient and public satisfaction with services has dropped significantly, prompting debate and discussion about the future of health and care services. In this article, Charlotte Wickens, Policy Adviser at The King's Fund, looks at five 'myths' perpetuated about the NHS by politicians and the media. She analyses the extent to which each myth can be backed up or debunked by the available data and evidence. The myths she analyses are: The NHS is a bottomless pit, demanding more and more money The NHS is inefficient GPs aren't working hard enough to meet demand for appointments The government has 'fixed' social care The NHS is being privatised
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Content ArticleThe workforce crisis engulfing the health and care system is well documented. In the NHS, increases in staff numbers are not keeping pace with demand for staff and services; in 2021/22, for the first time, the number of people working in adult social care in England fell, and there are now 165,000 vacancies. In this long read, Sally Warren, Director of Policy at The King's Fund, looks at a report by Bill Morgan, commissioned by The King's Fund and Engage Britain, to consider why politicians have failed to act, where only they can, to deliver the workforce that the health and care system needs. The article covers the following areas: Transparency in workforce planning assumptions Training and international recruitment Retention: it’s not just about pay More than a numbers game, getting the culture and leadership right Productivity and skill mix Action at all levels Service improvement ambitions matched to the available workforce
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Content ArticleAs the NHS’s digital transformation journey enters a new phase, there are opportunities to improve the quality and productivity of the healthcare system. This phase is not just about advancing the maturity of electronic health records (EHRs) but also about embracing the vast potential of generative artificial intelligence tools. In this HSJ article, Robert Wachter and Harpreet Sood explore the reasons why EHRs have not yet delivered promised productivity improvements and look at how GenAI offers opportunities for the NHS to realise productivity benefits faster, cheaper and at a greater scale.
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Content ArticleIn this blog, Siva Anandaciva, Chief Policy Analyst at The King's Fund, examines NHS productivity—a top political priority. He highlights the difficulties in understanding the reasons for low productivity in the NHS after the Covid-19 pandemic and outlines the need to distinguish between productivity and delivery in order to really understand the issues.
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Content ArticleThis is the National Audit Office's (NAO's) ninth report on the financial management of the NHS in England. It's previous report published in February 2020 outlined that NHS England (NHSE) needed to carry out financial restructuring to put all NHS bodies were on a realistic path to breaking even. This report comes after a major change to the ways in which NHS services are funded—the Health and Care Act 2022 introduced Integrated Care Systems (ICSs) on a statutory footing. The 42 ICSs bring together NHS bodies, local government and other organisations. The report outlines: the NHS’s current financial position and operating context. whether NHSE’s financial management processes allow accurate and timely decision-making and support for NHS bodies that are struggling. the relationship between financial management and NHS performance, productivity and efficiency. the challenges to the NHS’s financial sustainability in the longer term. The report outlines the following conclusions about financial management and sustainability in the NHS in England: The scale of challenge facing the NHS today and foreseeable in the years ahead is unprecedented. While ICSs have resulted in some transformation, the pace of change has been slow as ICSs struggle to manage the day-to-day pressures of elective recovery following the pandemic, continual rising demand for NHS services and significant workforce and productivity issues. As they are statutorily required to do, NHS England and NHS systems have prioritised trying to live within their allocated funding. But, despite great in-year efforts to do so, an increasing number of NHS bodies have been unable to break even. The health needs of the population look set to increase and the NHS may be working at the limits of a system which might break before it is again able to provide patients with care that meets standards for timeliness and accessibility. There is a question for policymakers to answer about the growing mismatch between demand for NHS services and the funding the NHS receives. Either much future demand for healthcare must be avoided, or the NHS will need a great deal more funding, or service levels will continue to be unacceptable and may even deteriorate further.
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Content ArticleThe healthcare systems of nearly every country are straining to keep up with the demands placed on them by advances in both treatment and technology. In this article, Timothy Ferris explores ways in which technology can reduce the burden on already under-resourced healthcare workforces. Acknowledging the complexity of healthcare compared to other industries, and the highly professional nature of the workforce, he uses the concept of 'unit cost' to look at how the financial and time burden associated with healthcare interactions can be reduced.
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Content Article
NHS productivity (NHS England, 16 May 2024)
Patient-Safety-Learning posted an article in NHS England
This paper was presented to the NHS England board at its public session on 16 May 2024. It discusses the effect the pandemic has had on NHS productivity with details of NHS England’s estimates for the drivers of the loss of productivity observed. It also discusses the emerging plan to improve productivity in the coming years. The paper highlights the following areas as key to improving productivity: Operational and clinical excellence Building leadership and organisational capacity and capability to deliver improvement through NHS IMPACT as NHS England's single improvement approach for supporting systems and providers with continuous improvement. Continuing to expand Getting It Right First Time (GIRFT) methodologies, which now cover more than 40 surgical and medical workstreams. Driving adoption of less clinically demanding treatments, such as the world-first rollout of subcutaneous immunotherapy for lung cancer that cuts treatment time by 75%. Continuing to tackle interventions of limited or no clinical value through the evidence-base interventions programme, a clinically-led programme led by the Academy of Medical Royal Colleges in partnership with NHS England. A healthy motivated and engaged workforce Implementing the NHS Long Term Workforce Plan – listening to staff to improve, flexible working practices, optimising skills to better meet needs, developing a management culture and focus on improvement. Improving how we deploy our staff to meet the needs of patients and maximising the use of valuable staff time, reducing the need to rely on expensive agency staff when it can be avoided. Improving staff engagement and retention. It outlines that work is underway on a detailed plan and update to cover all aspects of productivity improvement, including the following priorities: Focussing on health rather than illness by investing in preventative care, keeping people independent for longer and caring for people as close to home as possible. Embracing 21st century technology by investing in IT systems that work well for both staff and patients. Maximising value for money by taking action such as cutting duplication. -
News Article
NHS finances so dire that whole service may collapse, says spending watchdog
Patient-Safety-Learning posted a news article in News
The NHS’s finances are so dire that the whole health service may break unless it receives a massive cash injection, Whitehall’s spending watchdog has warned. Years of underfunding have left the NHS in England so cash-strapped that it cannot treat patients quickly enough, and the rising tide of ill-health will make matters worse, the National Audit Office (NAO) said. The NAO does not specify how much extra funding the health service needs to get it back on its feet and ensure trusts that provide care can balance their books. But a leading thinktank recently put that figure at £38bn more a year by the end of this parliament. Its grim conclusions raise serious questions about whether Keir Starmer’s government can fulfil its ambitious pledges to rescue the NHS, and again meet key waiting time targets on surgery and A&E care, without spending significantly more money. The NAO said: “When we consider how the health needs of the population look set to increase, we are concerned that the NHS may be working at the limits of a system which might break before it is again able to provide patients with care that meets standards for timeliness and accessibility. There is a wider question for policymakers to answer about the potential growing mismatch between demand for NHS services and the funding the NHS will receive. Either much future demand for healthcare must be avoided, or the NHS will need a great deal more funding, or service levels will continue to be unacceptable and may even deteriorate further.” A Department of Health and Social Care spokesperson said, “Not only has this government inherited the worst economic circumstances since the second world war, but also an NHS in deficit. Getting the NHS back on its feet is our priority, but it will take time." Read the National Audit Office report NHS financial management and sustainability 2024 on the hub Read full story Source: Guardian, 23 July 2024 -
News Article
Safety to get more priority over cost in NHS buying decisions
Patient-Safety-Learning posted a news article in News
Medical devices should be judged more on the value they bring to a wider health economy than just the price of the items, according to draft Department of Health and Social Care procurement guidance seen by HSJ. The draft methodology, produced by Department of Health and Social Care’s MedTech directorate, outlines how “value” should be given a minimum weighting of 60 per cent while price should have a maximum weighting of 40 per cent when procurement teams are evaluating which products to buy. The “value” weighting will include a minimum of 10 per cent which must be applied to social value, which is already a requirement for all public procurements. This would reverse established practice across many procurements that sets the price of products or services as the most important factor, at times to the detriment of products that provide greater value to a health economy. It is intended to be used for all procurements of medical devices. It came from the 2023 MedTech strategy, which “identified that the value of medtech products should not be considered in isolation but across the whole patient pathway and that lowest price does not always translate to best value,” it said. The plan is for it to become one of a set of commercial ”playbooks” produced by NHS England as part of the implementation of its national commercial strategic framework, which it published in November 2023. The draft methodology should bring consistency to how the NHS judges value in a procurement and to the evidence suppliers produce to support their offering. This should mean effective products are adopted more widely and their system-wide benefits to patient pathways are realised at scale. Read full story (paywalled) Source: HSJ, 30 April 2024 -
Content ArticleA dilemma is a situation in which a difficult choice has to be made between two or more alternatives, especially ones that are equally undesirable. Healthcare is full of dilemmas as a result of the huge number of stakeholders with conflicting goals, multifaceted interactions and constraints, and multiple perspectives, which change daily. Dilemmas are created when safety conflicts with productivity, cost efficiency, and flow. A focus on one patent’s safety may conflict with a focus on all patients’ safety. It is vital that the different stakeholders talk to expose dilemmas and reveal the hidden trade-offs or adjustments that are kept secret because people are fearful of the consequences. Articulating dilemmas helps us to find a way to bring people with different interests and incentives into a conversation that meets everyone’s needs.
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Content ArticleSleep is fundamental to good health. Healthcare professionals receive little teaching on the importance of sleep, particularly with respect to their own health when working night shifts. Knowledge of basic sleep physiology, together with simple strategies to improve core sleep and the ability to cope with working nights, can result in significant improvements both for healthcare professionals and for the patients they care for. This article by Dr Mike Farquhar, published in the Archives of Disease in Childhood: Education & Practice, gives practical advice for night shift workers and, generally, how to improve your quality of sleep.
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Content Article'The Productive Ward: Releasing time to care' was a quality improvement programme developed by the NHS Institute for Innovation and Improvement (NHSI) and introduced in 2007. It was designed to improve efficiency, productivity and performance at ward level in acute hospitals. It was based on three principles: good ward organisation so that materials were readily accessible displaying ward-level metrics such as patient safety and experience use of visual aids to understand patient status at a glance. This NIHR (National Institute for Health Research) funded study, published in the Health Services and Delivery Research journal, used quantitative and qualitative methods to evaluate the programme in six acute hospitals in England. It found some evidence of a lasting impact, such as wards continuing to display metrics and using equipment storage systems. But most hospitals that adopted the programme had stopped using it after three years, often due to a change in their approach to quality improvement. Productive Ward resources are still available from NHS England’s Sustainable Improvement team, but are under review. This evaluation may be helpful in designing future similar schemes.
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Content ArticleThis project is led by the Department of Anaesthesia at Newcastle upon Tyne NHS Foundation Trust, in partnership with Northumbria University Newcastle. The aim is to co-design a fatigue risk management strategy at the Trust to help teams effectively manage night shift fatigue. This project will involve an action research, whole team approach to effective management of fatigue in theatre and labour ward teams during the night shift. The interventions will involve educating night shift workers about the impact of fatigue on work performance, and holding focus groups to explore experiences of fatigue, and suggested ways of mitigating night shift tiredness. Ideas will then be tested out, before the strategy is finalised and implemented. During the testing, staff will use wearable activity monitors and an app, which will help demonstrate the impact of new processes. This participatory approach and the interventions should improve team working at night, with breaks and powernaps built into the work schedule. This may improve decision-making, the management of emergencies, patient and staff safety, and staff morale. This project is currently underway and will be completed in March 2020.
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Content ArticleThe Safer Nursing Care Tool has been developed by the Shelford Group to help NHS hospital staff measure patient acuity and/or dependency to inform evidence-based decision making on staffing and workforce. The tool, when allied to Nurse Sensitive Indicators (NSIs), offers nurses a reliable method against which to deliver evidence-based workforce plans to support existing services or to develop new services. The Shelford Group is an organisation comprising Chief Executives of 10 of the leading NHS multi-specialty academic healthcare organisations in England. The Chief Nurses of each of these NHS Trusts belong to a subgroup of the organisation and they meet every two months to share best-practice, benchmark and work towards improving standards in nursing. What will I learn? This booklet offers brief guidance for people using the tool in practice. It includes: A brief overview of the tool How acuity and/or dependency are measured How to ensure that accurate data are collected What Nurse Sensitive Indicators will be allied to acuity and/or dependency measurement How to use nursing multipliers to support professional judgement What can be learned from the pilot sites and Frequently Asked Questions How to get help or support if needed.
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Content ArticlePresentation slides from Salford University's Patient Safety Conference. Topics include human factors, learning from deaths, neonatal and maternal patient safety, patient safety in primary care, medicines safety, safety in social care and patient engagement. 2. Master Slides (3).pdf AC_Salfordsafety_primary_care (1).pdf CW - Salford Apr 2019.pdf JH - Meds Safety Salford.pdf MT - Maternal and Neonatal Health Safety Collaborative Break out session.pdf Ursula Clarke PSP Patient Safety April 2019 final.pdf VC - Salford University Patient Safety Conference Glos_ Hosp_ Workshop_ 23 _April _2019.pdf
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Content ArticleThe Faculty of Medical Leadership and Management (FMLM) have developed a self-assessment tool for multi-professional healthcare teams, irrespective of their background or sector. Individuals, teams and organisations need clarity and support on how to establish and sustain high performing multi-professional healthcare teams. This self-assessment tool offers a simple and accessible measure of team performance to facilitate this process.
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Content ArticleIn its 75th anniversary year, the strains on the NHS are all too clear, with demand from an ageing population increasing, while the number of patients treated is still lower than before the pandemic. The Chancellor recently announced the “most ambitious productivity review ever undertaken by government”, yet it is unclear how to bring about the necessary productivity improvements in the NHS to meet the challenges of the future. For the 2023 REAL challenge lecture, Professor Dame Diane Coyle, Bennett Professor of Public Policy at the University of Cambridge, explored some of the key drivers of UK healthcare productivity and discuss what we might hope the NHS will look like when it reaches its centenary. You can watch the video of the lecture and download the slides below.
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Content ArticleThis narrative review in the journal Anaesthesia reviews the background to overlapping surgery, an approach in which a single senior surgeon operates across two parallel operating theatres. Anaesthesia is induced and surgery commenced by junior surgeons in the second operating theatre while the lead surgeon completes the operation in the first. The authors assessed whether there is any theoretical basis to expect increased productivity in terms of number of operations completed. A review of observational studies found that while there is a perception of increased surgical output for one surgeon, there is no evidence of increased productivity compared with two surgeons working in parallel. There is potential for overlapping surgery to have some positive impact in situations where turnover times between cases are long, operations are short and where ‘critical portions’ of surgery constitute about half of the total operation time. However, any advantages must be balanced against safety, ethical and training concerns.
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Content ArticleIn this blog, journalist Rory Cellan-Jones reflects on some major challenges the NHS currently faces. Sharing insights from a recent meeting with medtech companies and a lecture by economist Professor Diane Coyle, he shares concerns that productivity in the health service has decreased as a result of the pandemic, and that medtech companies face barriers in selling their solutions to the NHS. He highlights a growing consensus that policymakers need to think beyond immediate firefighting and look at how to transform the NHS over the long term.
