There are lessons to be learnt by sharing relevant data between NHS organisations to help drive clinical efficiency and enable better decision-making, says Peter Osborne of LOC Consulting.
The NHS’s implementation of Clinical Commissioning Groups in April this year is designed to streamline healthcare commissioning by placing clinicians at the heart of the commissioning process. The intent is to harness their knowledge of treatment pathways and drive down patient costs by realising improved levels of efficiency. Annual savings of £5 billion or more are needed – the so-called ‘Nicholson Challenge’ – so the project to introduce CCGs is seen as one way to combat rising patient demand when budgets are being allocated on a ‘flat cash’ basis.
The obvious saving of course, is to cut staffing levels, since pay accounts for almost 70 per cent of NHS trusts’ costs. However, given the findings of the Cavendish, Francis and Keogh reports, a much better approach would be to deploy staffing costs more effectively. One way to do this is to highlight those areas where there is duplication, irrelevancy or inefficiency at primary and secondary care level, and by optimising the flow of patients between them.
Although the benefits of working together are recognised, the restructuring has also led to inefficiency as healthcare professionals are not necessarily always experienced in management and forecasting. The ‘buy, build or share model’ available to them is complex, and they have no end-to-end view of the necessary relevant data to inform their decisions.
By reviewing data for individual incidents it is possible to provide separate costs for those incidents, however, a wider view of all the factors contributing to the costs is required in order to identify specific processes that need addressing. At a macro level, it is relatively simple to identify cost drivers – the difficulty lies in breaking them down to a level that allows organisations to understand them in order to implement change.
Handovers between services are particularly vital to understand, for example, a patient arrives at a primary care facility; a clinician examines them and, if required, sends them to a secondary care facility where they are re-examined and provided specific treatment if needed. The patient is then discharged, but if they have to make a repeat visit, the whole process may be replicated – with all the associated costs. Looking at this scenario the patient in question should be treated differently applying a different cost approach.
Lessons can be learnt from logistics and manufacturing supply-chains, where there is a need to assess the cost to produce, aligned wastage, the cost to expedite and the desire to achieve a just-in-time delivery. Much of this thinking could be transferred to the health sector, with pathways seen as an integrated process and individual patient data used to make more informed management decisions.
This requires a cultural shift as today, many trusts consider data collection a burden imposed on them by external parties, and therefore use data to tick boxes, to meet the imposed metrics rather than improve services. Yet information on the costs of treating individual patients can provide a more in-depth appreciation of what it costs to provide care and aid the decision-making process.
Adopting a more joined-up approach to healthcare data across organisations will provide greater insight to clinicians, resulting in an improvement in care quality, and optimising capacity. Although there is no common model for making patient pathways more efficient, ensuring that healthcare professionals have the necessary data to assess efficiency would certainly be a good start. Equipped with a more joined-up view of data, NHS organisations will be able to cast off the mistakes of the past decade, and target areas where real value can be added.