Comment / Shifting the focus to cost and quality

Focusing on quality can have a huge financial payback argues Tony Whitfield

We are about to enter a new phase in the NHS at a time when all the economic pundits suggest tougher times are ahead for the UK economy and, more importantly, for the citizens of the UK personally.  Therefore, as a service that has seen unprecedented levels of investment through the ‘good times’, it is for us to find new ways of working to ensure we can improve quality regardless of a different fiscal environment. 

The consultation has begun as to how this might happen and, importantly, what the ‘measures’ are by which we can be judged.

If the concept of quality accounts is to be realised, the processes in place and claimed improvements need to be capable of being independently verified and audited and the impact of small improvements aggregated to demonstrate organisational and system-wide change.  The challenge will be to do this without creating a new industry.  

The financial case for quality is compelling. And for organisations that have embarked upon the journey of service line management, what becomes paramount is looking at typical patient journeys and the opportunity these provide for improving care and reducing costs.    Adverse events often lengthen stay and require more intensive (and costly) treatment. Yet we have few tools to calculate this impact. 

Eliminating ‘harms’ is also key. Otherwise these often small imperfections in the way patients are looked after can similarly add-up to lengthen stay and offer the patient a poorer experience than necessary. 

If we in finance are to play an important part in this journey, we need to ensure we have the skills to understand the business and support those seeking improvement by tracking the financial impact of quality change.  If any of us reflect on the stories we are told on a daily basis – things that have frustrated patients, clinical colleagues, administrative staff – then we will quickly identify rich veins of opportunity for improvement. 

In Salford we began our new quality journey about 18 months ago, working with small projects of improvement on problems that, until then, seemed intractable.  What’s the outcome? We have calculated the financial benefit of reduced levels of MRSA and C. diff at over £500,000. 

We are embarking on a number of other such initiatives, where the touchstone will be reduction in hospital standardised mortality ratio. These schemes will be vital in helping to improve our financial position.

Quality can never be absolute although, from time to time, it may need to be measured in a relative way.  What matters is the journey of improvement, from which we will all start from different places with different priorities, so we should develop quality promises on the improvements that matter most to the constituencies we serve.

If we are to retain public support for the NHS we will need to work at both micro and macro levels to confirm that the huge taxpayer investment, which has undoubtedly brought about improvement, can be optimised to deliver even safer, more effective personalised care.  As finance professionals, our remit is to oversee the transformation where the ‘cost improvement programme’ becomes a ‘cost and quality’ improvement programme.