A new report published by the Health Foundation ‘Does improving quality save money?’ demonstrates significant savings will only be made if there are changes to national incentives and stronger local leadership and capability over a sustained period. A leading academic reviewed the research evidence to answer whether improving quality can also help to address the need for costs to be saved.
The Health Foundation which commissioned the research commented the evidence suggests that quality improvement could make an important contribution to addressing financial pressures but only if there is careful planning, leadership, expertise, perseverance, and not a little healthy scepticism. It also requires a sustained and relentless focus on high quality implementation.
The research shows that poor quality services are common and costly. It has been estimated that the costs to the NHS of hospital acquired infections are £1bn a year and adverse drug events are estimated to be between £0.5bn.
There is evidence that some solutions for poor quality are effective. There is strong evidence that simple clinical-level changes are effective in reducing adverse events, such as prophylaxis before surgery, but there is less evidence of the effectiveness of other proposed solutions.
When looking at organisational changes, the potential is greater for reducing waste and poor quality and making savings but so are the risks. This is probably due to the number of professions and organisational units that need to change.
In the report John Overtveit says, 'To make it more financially advantageous for providers to increase quality, changes are needed in routine financing systems, in how performance is measured to include quality measures, and in expert support and information on how to make successful improvements'.
Research shows that improving quality can save money, though the current evidence is limited. The review found that many studies which reported savings did not assess the cost of the intervention, left out some costs, or did not use actual cost data from the service.
Stephen Thornton, chief executive of the Health Foundation commented on the report and said, 'Persistent poor quality services and the use of ineffective treatments cost the NHS money it can ill afford.
'The report suggests that although the available evidence isn’t strong, improvement initiatives can reduce costs to service providers and improve quality. There is evidence that adapting patient safety practices and proven treatments have the potential to improve outcomes and save money. This requires careful planning, leadership, expertise, perseverance and a sustained and relentless focus on high quality skilful implementation.
We want managers and clinicians in the health service to be asking themselves the important question of how they can continue to improve quality while also cutting costs'.
At a local level, the evidence in the report suggests that clinicians and managers can increase their likelihood of success by: working together to meet the challenge, using tested improvements that are adapted to local circumstances, using reported experiential evidence; measuring and monitoring the improvement, including how much it has cost and how much it has saved; and above all by managing implementation skilfully.
At a national level, the evidence suggests that the Department of Health and SHAs could improve chances of success by providing NHS organisations with expert support, supporting the development of skills and addressing the barriers created by the financial and performance management systems.