The NHS is facing the most challenging period since its inception, with performance standards not being met, compromised quality, and low patient satisfaction and outcomes. Add to these issues a burnt out and undervalued workforce dealing with long waiting lists, a diagnostic backlog brought about by COVID and most systems facing deficit positions not seen before, and it’s clear that the NHS desperately needs to re-invent the Cost Improvement Programme.

Low-hanging fruit is non-existent, and has been for some time now, with most schemes focusing on income or non-recurring schemes that only seek to push the problem into the next year. In addition to historical overspending, savings and schemes aimed at improving these overspends are either one-off or income related. So, what approach can ensure that the NHS is productive and timely?

The response must start at a system level. No more inward-facing schemes but system solutions that seek to re-define healthcare to ensure workforce productivity and efficiency whilst meeting the needs of the population. Nothing new here in this message, other than I am yet to see a system tailor its health and social care provision to ensure this happens.

Service Provision

The system, in conjunction with Public Health, needs to assess the population’s health whilst ensuring future profiling and prevention are at the forefront of patient pathways. Laying that activity over current service delivery across the system will then enable the application of Value Based Healthcare principles. Analysing how much we are spending across the end-to-end pathway versus the activity and outcomes will provide us with insights on how we are utilising the funding and where we are achieving value. For example, if 70% of the funding is being utilised at the front end of the pathway but 80% of the activity is delivered at the end of the pathway where only 20% of the funding is allocated, then we know this will present a cost pressure and the pathway must be re-defined.

What opportunities will this provide us with?

This first step will enable us to review not only the pathway and activities but the models of care and the utilisation of the workforce. Workforce is the biggest cost pressure to the NHS. Workforce transformation, in conjunction with innovative new digital solutions across pathways, will enable us to review how we combine and allocate our resources and to think more creatively about roles and responsibilities and associated management structures.

Current models of delivery need to be tested and reviewed across pathways. The rise of digital innovations and self-management will enable systems to invest in keeping patients well, at home and in charge of their own condition/care. They can also reduce reliance on frontline staff and contribute to the net zero ambition. Services should not see digital solutions as add-ons; they need to be designed into the pathway from the conception stage so they are fully integrated and can evidence continuous improvement.

What Next?

Transformation in the NHS is not new but is also not core. At best it is utilised to drive savings but usually from an inward facing approach, with many projects and programmes being delivered with no real end in sight or substantial change to the system. Despite the number of NHS funded programmes with organisations such as Virginia Mason and the Institute of Health Improvement, we are yet to see a significant shift in outcomes and delivery on a systemwide basis. Transformation is a profession and should be accredited accordingly. The role of a transformation professional should be core to the ICB and should be leading on the development and ever-changing needs of the population. It is a key on-going role that warrants a variety of skill sets and abilities and one that never ends. Pathway, process, workforce, culture, board development, continuous improvement, best practice, population needs, prevention, evidence-based medicine, digital solutions and innovation are ongoing processes that command daily attention, review and development.

To find out more about how 4C can support you with your transformation and efficiency requirements contact Amanda Ramsay-Dunn.