Comment / A shared duty on efficiency

Efficiency will have to be delivered across whole health economies rather than relying on organisation-specific savings, says Rachel Hardy (pictured above)

The comprehensive spending review settlement confirmed growth for all PCTs of at least 10.6% for the next two financial years. This comes after years of growth that has driven improvements such as the 18-week targets and reduced healthcare-related infections. At the same time the service has generated a healthy surplus for reinvestment.

PCTs have known for some time that beyond the next two years growth will fall. But recent events mean the growth could be lower than anticipated. The global economic downturn means that from 20011/12 it could be as little as 1%.This will have a big impact on strategic planning for PCTs.

One much discussed solution is better commissioning to deliver benefits and efficiencies. PCTs’ readiness for this was tested in the recent world class commissioning assessment, which examined competencies such as leadership, clinical engagement, use of business processes and knowledge management. PCTs face key challenges when addressing their five-year financial strategies.

• How to maximise investments in the next two years to deliver returns and efficiencies in future
• How to contain the growing activity trends to ensure a planned approach to investment
• How to protect investment in areas of prevention and well-being to reap longer term benefits
• How to demonstrate that the whole portfolio of services commissioned demonstrates the best value and quality for the population
• How to disinvest and manage the impacts of disinvestments if services prove to be inefficient in both cost and quality or are no longer required to service the population.

This will be no mean feat. But we should not be making a standing start. We have had at least two years’ notice of future growth reductions, so there should be plans in development.

It will be important for efficiencies and productivity to be delivered across whole health economies and sectors. We cannot rely simply on organisation-specific savings. The levels of efficiency needed will call for cohesive working across primary, secondary and tertiary care and community and other agencies. It will also be vital to review care pathways across all sectors from both a clinical and business perspective. Only in this way can we drive productivity, quality and efficiency. Forming these networks and producing intelligent business and financial data across all sectors is necessary to underpin understanding of what happens to a patient in the health system. Practice-based commissioners will provide a key link to colleagues in other sectors.

Working as a health economy will also demand a mature approach to service redesign and contractual management. There has to be a shared vision and risk reflected in the contracts of all those involved.

We must ensure intelligent information is available so that not only new investments but the whole commissioning portfolio can be tested. If resources are not being used to best advantage, transparent clinical and business changes must be made.

Rules-based systems such as payment by results must be respected. We will also need a pragmatic and sensible approach to change across organisations.

The challenge is demanding. But it is deliverable.