NHS ‘should increase efficiency, not cut services’

12 Jan 12
The NHS could save money and services by ensuring more efficient practices, such as cutting the time patients spend in hospital and increasing day surgery, are adopted across the board, according to the Nuffield Trust.

By Nick Mann | 12 January 2012

The NHS could save money and services by ensuring more efficient practices, such as cutting the time patients spend in hospital and increasing day surgery, are adopted across the board, according to the Nuffield Trust.

In Can hospitals do more for less?, the think-tank found a continued variation in productivity both between and within hospitals. Addressing this will be essential if the NHS is to maintain and improve services in the face of cuts that require it to save £20bn over the next four years, it said.

The trust advocates a ‘concerted programme’ of efficiency changes to meet the challenge. These include the clinical commissioning groups being established under the government’s health reforms setting clear goals with local providers on day surgery rates and length of stay.

The NHS Commissioning Board, which will have overall responsibility for commissioning services under the reforms, should explore how it can encourage commissioners to make these goals a priority, it adds.

Savings in staff costs could be better found by employing a higher ratio of qualified and senior staff than putting a freeze on new vacancies, the trust says. This could mitigate reductions in overall staff numbers while still increasing productivity and improving patient care.

The trust is sceptical about the cost-savings from organisational mergers and warns hospital boards to proceed ‘cautiously’ when exploring this option. Its research found that mergers do not automatically lead to efficiency savings unless beds and services are closed. Hospitals with more than 600 beds can actually create ‘diseconomies of scale’ as they become too large to manage.

Judith Smith, head of policy at the Nuffield Trust, said the continued variation in productivity was due to a combination of factors. These range from an earlier emphasis on increasing hospital capacity during a ‘period of plenty’ to managers not giving enough priority to changing long-standing working practices in hospitals. 

‘It is very difficult to justify cuts if inefficiencies in areas such as rates of day case surgery, length of stay, and the purchasing of hospital supplies remain untackled. The financial challenge facing the NHS will concentrate minds, but much more needs to be done.’

Health minister Simon Burns said the government agreed that the NHS should and could be more efficient, while improving the quality of its services.

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