The Health Foundation’s submission to the Health Select Committee’s inquiry into public expenditure
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The Health Foundation’s submission to the Health Select Committee’s inquiry into public expenditure
Background
The Health Select Committee has published the report of its inquiry into public expenditure in the NHS. In undertaking the inquiry, the committee wanted to examine how well the health and social care systems are coping with more stringent financial conditions and how well the NHS was meeting the Nicholson Challenge. A key area of focus for the Committee was examining the extent to which health and social care authorities have been able to do more with the same level of real resources or whether they have had to reduce the quality of services provided in order to make ends meet.
Key findings from the report were:
- The Nicholson challenge – it is generally accepted that fundamental changes to the way NHS delivers care are needed to deliver the necessary savings.
- More integration between health and social care is needed.
- Many organisations are making short term savings now which will not deliver savings in the longer term.
- The White Paper plans (as taken forward in the Health and Social Care Bill) are making it more difficult for the NHS to deliver savings.
Our submission
The Health Foundation submitted evidence to the Health Select Committee. Our submission considered:
- whether it is realistic to aim to make 4% a year efficiency gains without, at the same time, having to make cuts to services
- the evidence about how NHS teams may be able to improve quality whilst saving money at a micro clinical system level.
Our submission draws on our extensive learning about implementing quality improvement programmes in the NHS as well as our commissioned research on value for money in the NHS. It provides examples of and learning from our Shine projects which have aimed to find potential to increase quality while reduce cost at the micro clinical level. It also provides evidence from our 2009 review of the evidence Does improving quality save money?
The submission concludes that it is important that the Government is realistic about how services will need to change to meet the “Nicholson challenge”. Scaling up small scale quality improvement programmes can make a small contribution towards improving efficiency and quality but is unlikely to result in the scale of savings across the whole health system that are required. The degree of reorganisation and reform in the NHS means it is important that there is consideration of how local NHS bodies will be supported to make large scale changes to how services are delivered which release resource without adversely impacting on quality. We therefore recommended that the Health Select Committee should:
- urge the Department of Health to be realistic about the level of efficiency savings which will be made through micro level quality improvement initiatives
- highlight the difficulty of using existing data systems to enable NHS organisations to make accurate assessments of the savings they have made
- recognise that clinical leadership is essential if microsystem changes are going to be achieved and that clinicians need help to develop the knowledge skills required to deliver efficiency savings
- reflect back to the Department of Health that initiating improvements in quality and cost is particularly difficult during periods of transition. The NHS is undergoing considerable change which will continue over the next two years, making it doubly hard to make and sustain efficiency improvements.
