Comment / Finding time for value

There are things we know are good for us, though somehow we don’t have the time or resources to make them happen: getting fitter; learning or practising an instrument; changing utility supplier or insurance provision. Is there a danger that the value agenda is falling victim to similar excuses?

Few would argue with the theory of value-based healthcare. In a funding- limited system, all decisions should be focused on getting the best value from all decisions and treatment approaches – best value in terms of outcomes and patient experience and in terms of cost.

There is a growing consensus across the NHS that this is where we need to be. And we are in good company – many international health systems are on a similar journey. The HFMA Healthcare Costing for Value’s brilliant recent international symposium – its first such international gathering – provided a fascinating insight into some of the work going on in the UK and across the globe to further this agenda. There were real examples where value principles had been applied either at an individual service level or across whole local health economies with some great results. Have a read of our coverage of the symposium on page 19.

And of course there are lots of examples of organisations improving value, even without giving it an official ‘value’ label. Read the case studies on page 23 to see how some trusts are improving both quality and cost in the provision of one-to-one nursing care.

Yet still it sometimes feels like value is seen as the long-term solution, rather than the solution to the current problems. Or people are too busy meeting the near impossible demands of today to have the time to pursue new ‘initiatives’ – however well regarded.

Value-based healthcare isn’t – or at least shouldn’t be – viewed as an ‘initiative’. It has to become the way we do business – a constant process of improving value and then cranking the handle again to improve further; scrutinising pathways and eliminating unwarranted variation that adds no value but may add cost; checking that the outcomes you deliver are the outcomes that patients want.

But that is easy to say and hard to do. The current agenda is so extreme and staff are already so busy that new programmes or approaches stay firmly in the aspirational tray.

However, there are things that all organisations need to be doing right now to pave the way for better value-based decision-making in the short, medium and long term.

We have to get the data right. That means activity data, outcome data and cost data. For finance people, we have a major responsibility (though not sole responsibility) for the latter. NHS Improvement’s Costing Transformation Programme must seem like a distraction for finance directors at the moment. But getting robust, patient-level cost data – derived in a consistent way – is vital. This is not just for any future tariff-setting approach but, more importantly, to inform local decision-making.

Good cost data is also fundamental to engaging clinical staff in the financial management agenda. Cost data that doesn’t reflect clinical behaviour – or delivered so late that clinicians can’t remember the cases it relates to – is a sure-fire way to disengage the very people who commit the service’s resources. Finance professionals have long identified the importance of this engagement and right now what the service needs is the good existing examples of such engagement to be replicated on a grand scale.

With time as precious a resource as money at the moment, finance professionals need somehow to keep pursuing these core foundations for value-based decision-making.

The truth is that without robust data and widespread clinical engagement, value-based healthcare will remain just a good intention.