Comment / Patient focus

Keeping a focus on patient safety and outcomes rather than facilities will be the key to successful transformational change

The government last month hit the pause button on its health bill, beginning a month of listening to concerns about the proposed changes to the NHS. While the key goals and deadlines remain unchanged (principally those relating to GP commissioning and FT creation), this moment of reflection will bring some changes to the timetable.

Those changes due to happen next April – for example, the abolition of strategic health authorities – will now not happen until at least July 2012. We can only wait to see if the listening exercise leads to any more fundamental changes.

Whatever the outcome, the economic challenge the NHS faces remains unchanged. The £20bn productivity improvement needed over the coming four years may be something of an informed ball park estimate. But the pressures are very real.

The Department of Health’s (perhaps belated) attempts to explain the need for modernisation in terms the public will understand may have had the feel of a public relations exercise, but it threw out some interesting facts that perhaps crystallise the challenges we in the finance community recognise all too clearly. The number of people aged over 85 in England will double in the next 20 years. Meanwhile, over the past decade, we have seen the cost of medicines rise by an average of £600m a year, reflecting increased prescribing activity in some clinical areas and the cost of new medicines.

Just getting close to £20bn of productivity savings while maintaining and improving the quality of care will only be achieved by a transformational change in service provision. Reconcentrating services in the community has to play a key part in this. But the quid pro quo for such a change in approach is surely a reduction in the size of the acute sector.

Understandably this has always been difficult political territory. But given the economic challenge we face, we cannot afford to pretend otherwise. Expansion of the community sector should deliver better services closer to patients in line with patient choice, but it will need to be accompanied by changes to the acute side. Indeed, in a tax-funded system, why would we want to retain over-capacity?

In a joint statement with the Academy of Medical Royal Colleges and the NHS Confederation last year, the HFMA said clearly that ‘a reduction in hospital capacity can be a consequence of improving quality, patient safety or cost-effectiveness and not simply a contraction in service’. It is a message worth repeating and one we need to build understanding around. After all, the focus surely needs to be patients and outcomes, not facilities.

Of course, this is easier said than done. But the first steps have to be towards building consensus for the changes between clinicians and managers.

And we need to take the public with us. It won’t be straightforward but keeping issues around patient safety and quality front and centre at all times will help to dispel accusations that changes are purely driven by financial considerations. At the same time ‘cost-effective’ must not be seen as a dirty word.

Finance professionals have an important role.

We need to ensure that financial issues are presented in easy-to-understand formats.  Equally important, we also need to pause to understand our colleagues’ vision and concerns about services. 

Only by fully understanding the issues can we deliver in our role as enablers for service change and help ensure that safe, quality services are the outcome of the productivity challenge.