Perhaps one positive side effect to the bleak financial situation we currently face is that a renewed focus on productivity will encourage space for creative thinking about how to do things differently. Certainly this is something the NHS has struggled with in the past. The Cooksey review in 2006 found that it has a conservative approach to innovation which can act as a barrier to the take-up of new ideas.
Each year, the Health Foundation’s Shine programme challenges healthcare teams to improve the quality of services while also obtaining value for money, creating the space for innovation at a local level.
This has proved a successful approach. In 2011, four Shine projects were recognised for their hard work, winning separate awards for their innovative projects:
- The Shine project at University Hospital North Staffordshire Foundation Trust won the Nursing Times Cardiac Nursing award for their work to set up an acute ambulatory heart failure unit. This is a nurse-led unit providing specialist care that would normally be delivered in hospital, on an outpatient basis.
- The Shine project at University Hospital Southampton Foundation Trust, won the HSJ Acute and Primary Care Innovation Award for its work in improving chronic obstructive pulmonary disease (COPD) management at primary care level, thereby reducing admissions to secondary care.
- The Shine project at Derby Hospitals NHS Foundation Trust, won the prevention category in the HSJ and Capgemini Liberating Ideas Award for their work developing an integrated ‘team without walls’ approach to providing pre-pregnancy care for women with diabetes.
- The Shine project team from Salford Community Health won the CSP Research in Practice award for their Working Well project, which reduced the costs associated with sickness absence for NHS staff in Salford.
All projects managed to reconfigure the use of existing resources in ways that saved money but also improved staff and patient experience. If the NHS is to survive the financial austerity ahead, it needs to become more adept at finding value for money like this at every level.
While these projects only show how innovation can help find value for money at a micro-clinical level, they give us hope that this kind of approach to improvement could offer positive solutions for the whole health economy. The priority is to allow good ideas to become good practice by providing the opportunity to test and develop them. We also need to find ways to scale up our learning (see blog post by Helen Crisp).
So have the clinicians involved in Shine project found the financial crisis has helped or hindered innovation?
Some of the projects involved in our Shine programme found that emphasising the cost benefits of improvement ideas helped them gain senior support for their projects.
Victoria Dickens, Consultant Physiotherapist from Salford Community Health, led the Working Well project in Salford:
‘It was interesting, the new NHS operating framework was published around the time we began the project and it meant that everyone’s focus really shifted from not just “how can you improve things?” but “how can you release money?” We’d presented our ideas to senior management in the past and they’d all said it was a great idea but they couldn’t fund the project. The support from the Health Foundation allowed us to demonstrate that the project was truly sustainable.’
Dr King, who led the Shine project in Derbyshire, also believes her project wouldn’t have happened without external funding:
‘It is hard to build in the time and capacity to explore our new ideas in a busy NHS job. The changes in commissioning and local financial pressures have made this even more difficult. Our Shine award helped us to create a space so that we could really innovate and test things out.’
The project needed some initial funding, but has helped to release savings in the long term by moving patients away from expensive hospital-based care, reducing length of stay in hospital and preventing disability. The new integrated model has now been commissioned going forward.
Dr King thinks that finding that space to innovate may become even harder as the focus on releasing savings becomes more urgent for trusts:
‘These are very difficult times. To encourage innovation you really need to give people time away from their day jobs, but at the moment trusts just can’t afford that luxury.’
The NHS faces a severe squeeze on budgets for the foreseeable future, but trusts shouldn’t dismiss the potential cost benefits of intelligent improvement work. Our Shine programmes illustrate that financial austerity and innovation can go hand in hand, but only for those NHS organisations who are brave enough to take a more strategic and long term approach to finding efficiencies.