Intended for healthcare professionals


NHS funding in England: money’s too tight to mention

BMJ 2016; 354 doi: (Published 01 August 2016) Cite this as: BMJ 2016;354:i4204

Re: NHS funding in England: money’s too tight to mention

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

04 August 2016
Benjamin D Bray
Public Health Registrar
University College London