NHS funding in England: money’s too tight to mention
BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i4204 (Published 01 August 2016) Cite this as: BMJ 2016;354:i4204
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This is an extremely timely editorial. I think however that an even stronger case could be made for the role of quality improvement in offering solutions to the slowly burning crisis of NHS finances. Without active efforts to increase clinical effectivenss, efficiency and productivity, health services will be doomed to continue the current trajectory of implementing increasingly reactive and short term policies to balance the books, come what may.
Beyond involving more clinicians in quality improvement, there is a lot more that could potentially be done:
1) Reduce the non-financial barriers to measuring and improving quality. For example, too many promising improvement initiatives end up having to waste time and resources in tackling burdensome information governance rules for accessing and using data.
2) Focus our improvement capacity on high impact problems. A multitude of small scale, low value, and low impact improvement projects is a waste of talent and resources.
3) Make improving productivity a key goal of improvement projects. This includes helping projects understand and measure financial impact
4) Avoid wasteful reinvention: scale up and replicate what has been demonstrated to work elsewhere
5) Ask hard questions about the value of some existing quality initiatives. Does, for example, the Friends and Family Test offer enough value to continue the large amount of resources invested in collecting the data? Why do we invest so much more money in regulation than in improvement?
6) Making much more sophisticated use of data to understand where and how services could be improved
In summary, improvement is not a "nice to have if we could afford it" part of healthcare, but central to avoiding the NHS entering a death spiral of simultaneously deteriorating finances and quality.
Competing interests: No competing interests
Learning from athletes
Perhaps there is a lesson from the performance of Team GB in the current Olympic Games. The swimming team has developed strongly in the past 20 years through a well-funded training programme which has identified ways in which each athlete can do a bit better. Incremental improvements have made a difference in performance. The alternative is to produce a new Michael Phelps; the original won an unprecedented career total of 23 medals. Neither approach works if the athletes are starved.
Governments have sought to improve NHS performance over the years by telling us that each new wave of reorganisation is the administrative equivalent of a Phelps. Small service improvements do add up to an overall improvement in quality and value provided their introduction is properly funded.
They have to be tested. It is a major error to impose large-scale change without confirming that its principles are valid. The effects are costly in treasure and in patients’ lives and wellbeing. That, surely, is the lesson of the NHS over the past 30 years.
Competing interests: No competing interests