NHS Appointments Commission and National Patient Safety Agency abolished in Arms Length Body cull

July 27, 2010

Bureaucracy will be cut and the functions of several organisations will be streamlined, following a review of arm’s length bodies (ALBs), published by Health Secretary Andrew Lansley yesterday. In total, the changes outlined in yesterday’s report will reduce the number of health ALBs from eighteen to between eight and ten; they are expected to deliver savings of over £180m by 2014/15.

In line with the wider reforms set out in the White Paper, Equity and Excellence: Liberating the NHS, the Department of Health’s ALB sector will be transformed to cut cost and remove duplication and burdens on the NHS.

The review has assessed whether the work of each of the Department of Health’s 18 Arm’s Length Bodies’ remains essential nationally. It also looked at whether work is being duplicated or could be better carried out by a different body.
Subject to Parliamentary approval, organisations which are no longer needed will be removed from the sector, with essential work moved to other bodies. This process will increase the ability of the organisations to do their important work in the most efficient way. It is also part of the cross-Government strategy to increase accountability and transparency, and to reduce the number and cost of quangos.

Of particular note to those interested in ‘healthcare governance’ is the abolishing of the NHS Appointments Commission and the National Patient Safety Agency.

The NHS Appointments Commission is responsible for handling the appointment of chairs and non-executive directors (NEDs) to the boards of Strategic Health Authorities (SHAs), Primary Care Trusts (PCTs) and NHS trusts. Given that SHAs and PCTs are going, and all NHS trusts will become NHS foundation trusts, and therefore able to appoint their own chairs and NEDs, there will be little role for the NHS Appointments Commission. Hence its demise, with any outstanding work being transferred to the Department of Health.

The National Patient Safety Agency (NPSA) has, sadly, never met expectations originally set out for it in the Department of Health document Building a Safer NHS for Patients. From it’s establishment in 2001 it has suffered from poor CEO and board/chair leadership together with ineffective oversight from the Department of Health. The NPSA was castigated by the Public Accounts Committee (PAC) in 2006 for providing poor value for money.

For further information on which ALBs are being kept and which are being abolished, click here.


Rising to the challenge of saving money through quality improvement in the NHS

December 13, 2009

The recent period of unprecedented financial investment in the NHS is about to end. The NHS Chief Executive, David Nicholson, has said that the NHS will need to make efficiency savings of £15-£20bn. 
The aim is to make these savings while continuing to improve quality. However, what is less clear is which initiatives to improve quality have the potential to realise cash savings.

The Health Foundation has produced a briefing document that summarises the key challenges facing the NHS, the key findings of their earlier review of the evidence about whether improving quality saves money, and how the Health Foundation and other organisations are supporting the NHS.

The document Rising to the challenge – Using evidence about what works to improve quality and save money can be freely downloaded here.


NHS could save £9bn a year through clinical improvements

November 26, 2009

According to an article in the Health Service Journal (HSJ) “The NHS could save more than £9bn in a year if trusts improved their performance in just eight “high impact” clinical areas, the chief nursing officer for England has said.”

The eight “high impact” clinical areas identified by the chief nursing officer are

  • £1,050m – Cut pressure ulcer admissions in half
  • £3.8m – Cut patient falls in hospital by 25 per cent
  • £7,300m – Stop malnutrition and dehydration in hospitals and care homes
  • £10m – Reduce caesarean sections by 2.2 per cent a year
  • £105m – Give patients choice to die at home
  • £555m – Reduce sickness absence by a third
  • £31m – Nurse-led discharge to reduce unnecessary bed days
  • £124m – Prevent urinary tract infections
  • Total: £9.2bn
  • Healthcare Governance Review believes that given the NHS needs to save £15-20 billion, these clinical improvement savings, if realised, could go a long way to meet overall savings targets.

    Read the full HSJ article here.


    Does improving quality save money?

    September 26, 2009

    A new report published by the Health Foundation ‘Does improving quality save money?’ provides evidence that suggests quality improvement could make an important contribution to addressing financial pressures but only if there is careful planning, leadership, expertise, perseverance, and not a little healthy scepticism. It also requires a sustained and relentless focus on high quality implementation.

    The Health Foundation believes that managers and clinicians in the health service should be asking themselves the important question of how they can continue to improve quality while also cutting costs.

    The research, carried out by a leading academic, shows that poor quality services are common and costly. It has been estimated that the costs to the NHS of hospital acquired infections are £1bn a year and adverse drug events are estimated to be between £0.5bn.

    There is evidence that some solutions for poor quality are effective. There is strong evidence that simple clinical-level changes are effective in reducing adverse events, such as prophylaxis before surgery, but there is less evidence of the effectiveness of other proposed solutions.

    When looking at organisational changes, the potential is greater for reducing waste and poor quality and making savings but so are the risks. This is probably due to the number of professions and organisational units that need to change.

    The report’s author John Overtveit says, ‘To make it more financially advantageous for providers to increase quality, changes are needed in routine financing systems, in how performance is measured to include quality measures, and in expert support and information on how to make successful improvements’.

    Research shows that improving quality can save money, though the current evidence is limited. The review found that many studies which reported savings did not assess the cost of the intervention, left out some costs, or did not use actual cost data from the service.

    ‘The report suggests that although the available evidence isn’t strong, improvement initiatives can reduce costs to service providers and improve quality. There is evidence that adapting patient safety practices and proven treatments have the potential to improve outcomes and save money. This requires careful planning, leadership, expertise, perseverance and a sustained and relentless focus on high quality skilful implementation.

    At a local level, the evidence in the report suggests that clinicians and managers can increase their likelihood of success by: working together to meet the challenge, using tested improvements that are adapted to local circumstances, using reported experiential evidence; measuring and monitoring the improvement, including how much it has cost and how much it has saved; and above all by managing implementation skilfully.

    At a national level, the evidence suggests that the Department of Health and Strategic Health Authorities could improve chances of success by providing NHS organisations with expert support, supporting the development of skills and addressing the barriers created by the financial and performance management systems.

    Download the report Does improving quality save money? here.


    Missed appointments cost NHS £575million annually says Dr Foster

    August 27, 2009

    According to Dr Foster Intelligence, around 6 million appointments per year are being missed at a cost, in terms of lost income, of almost £100 per appointment.

    Read what Dr Foster says here.

    Read a BBC news article based on the Dr Foster figures here.


    “Efficient use of resources and good quality services go hand in hand” – new finance guide for doctors

    July 10, 2009

    The Audit Commission and Academy of Medical Royal Colleges have published A guide to finance for hospital doctors.

    In the publication, they state that “there are many examples where clinicians have led change and improved services, through taking greater responsibility for managing the money available to them. This is not about focusing on cost and cost alone, but how best money can be used to improve the quality of care, combining operational and clinical effectiveness. Efficient use of resources and good quality services go hand in hand.”

    Healthcare Governance Review believes that the guide, whilst written for doctors, may be of interest to board members and managers.

    Download A guide to finance for hospital doctors here.


    BBC Radio Four investigates how the NHS can save money

    June 29, 2009

    The BBC Radio 4 Today programme wants to find out practical ideas as to how the NHS can save money from people with first hand experience of the health service.

    The have devoted a section of their website to issues around saving money in the NHS. On the site you can listen to an interview with Kings Fund economist John Appleby and Roy Lilley, a former NHS trust chairman, where they discuss how the NHS can be more efficient.

    If you work in the NHS, or for an organisation which works with the NHS, the programme wants to hear where you think savings could be made. They will treat your emails in confidence and will not publish any information that could lead to your identification without contacting you directly beforehand.

    Access the Radio 4 site here.


    NHS wastes £900m a year having nurses hunt for missing medical items

    March 7, 2009

    Over a third of the UK’s 300,000 nurses spend up to two hours on an average shift trying to locate vital medical items such as pumps, drip stands and dressings, reveals a survey of nurses commissioned by GS1 UK, the not for profit data standards organisation, and Nursing Times magazine.

    According to GS1 UK, “This is equivalent to 40 hours per month, or a quarter of a working day spent looking for equipment that should be readily available to ensure effective patient care. It indicates that up to one week of a nurse’s salary is being wasted every month. For the NHS, this could mean that more than £900 million of salary expenditure each year is being spent looking for medical items.”

    GS1 UK says that these medical items “could be found instantly” by using bar code scanning technology that has been in our supermarkets for over 30 years. Readers should note that whilst GS1 UK may be a not for profit organisation, it does exist to help its members (which include the companies that sell bar code technology) increase their profits!

    Notwithstanding this point, the figures presented in their report are compelling and represent a tremendous barrier to providing safe, high quality patient care as well as beinga huge waste of NHS human and financial resources.

    For further information, click here.


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