Are there too many managerial layers in providers?
1 March 2011
Tesco globally orchestrates half a million people and thousands of suppliers to deliver groceries, telecoms, financial services and more to support £50bn of revenues from 100m+ customers with 7 layers of management. How do NHS hospitals compare? The Office for National Statistics estimates that, since 2000, total UK NHS productivity fell by 0.2% per year; however, productivity in hospitals fell by c. 1.4% per year, with rumors that there has been a proliferation of managerial layers in some acute organisations during this period. Can hospitals and other providers work better, more simply and cheaper with fewer managers? Can the very adverse consequence of managerial de-layering experienced in some industries be avoided?
This session looked at the findings of two companies who have been investigating this trend, combining this with experiences in other sectors and health systems. We tested their findings and ideas with NHS leaders to identify the organisational design and development implications of this and how trusts should respond.
Our speakers were Max Weston, Director at Panthea Leadership Ltd and Stuart Francis, Chairman and Managing Director at Francis Group.
Read our summary of the salon discussion.
No patient left behind? Will (more) choice-based reforms avoid the inverse information law?
3 Feb 2011
Extending choice for patients, and publishing information to support it, was a consistent theme throughout the last government's health policy, and looks set to be accelerated by the current administration. An important question is what impact choice-based measures have on different sections of the population, particularly whether they disproportionately benefit or disadvantage those people with the greatest need.
Our speakers addressed this issue from two distinct perspectives. Dr Zack Cooper of the Centre for Economic Performance at LSE outlined his recent evaluation of hospital competition and how this impacts health inequalities. Independant Policy Analyst Angela Coulter presented insights for her extensive research experience on health literacy and informing choice.
Read our summary of the salon discussion.
What will happen in a liberated NHS? A commentator round-table
20 September 2010
It's 2013 and after a turbulent but effective transition period the white paper reforms are in place. What happens next?
This session looked beyond questions about transition to ask fundamental questions about the white paper agenda:
How do all the strands of the White Paper fit together?
- What are the trade-offs and choices?
- What are the implicit assumptions underlying the White Paper? Do they stand up?
Discussion kicked off with introductory remarks by:
- Paul Corrigan, former health policy adviser to the Prime Minister and independent consultant
- Anna Dixon, director of policy, King's Fund.
Round table discussion
Nigel Edwards, NHS Confederation Acting Chief Executive, facilitated a round-table discussion. Read a summary of the salon.
Employee ownership: aims, potential and pitfalls
2 March 2010
The NHS faces unprecedented challenges which will require increased engagement from employees. Engaged employees have higher productivity and are key to innovation and improved quality. Following recent research by the health services management centre, commentators and political parties have put forward ideas for implementing new models of employee ownership in public services including healthcare. This could signal a wider move towards mutualism and John Lewis style partnerships in public services.
This salon, which was held in association with NHS Employers, explored the evidence on the effects of employee ownership in the NHS and wider public services, considered if it would have benefits compared to existing models, and examined some of the challenges and solutions to achieve greater engagement and responsiveness. Speakers included:
• Jo Ellins, Health Services Management Centre, University of Birmingham
• John Adler, Sandwell and West Birmingham Hospitals NHS Trust
• Julian Le Grand, London School of Economics and Political Science
You can read a summary of the salon on Paul Corrigan's blog.
Labour's NHS Reform evaluation - reading results and learning lessons
18 May 2010
The English healthcare system reform has been one of the hot political topics of recent parliaments, dividing opinion amongst policy makers, professionals and service leaders. While policy decisions may have been based on theory, ideology or politics rather than evidence, there has been a determined attempt to evaluate the impact of reforms on service quality and efficiency. This salon, held jointly by the NHS Confederation and the King's Fund, heard from the co-ordinator and a lead researcher from the reform evaluation programme about some of the key emerging results - and about the key remaining questions that they raise. The discussion considered how the results should be interpreted to inform NHS policy and management in the next Parliament and beyond.
Speakers were:
- Prof Nicholas Mays, LSHTM - scientific coordinator, health reforms evaluation programme
- John Appleby, King's Fund chief economist and programme advisor
Please also see the Health Policy Insight website.
Variation of supply and cost: higher quality with fewer resources
21 January 2010
Healthcare systems around the world are facing constrained resources while trying to meet higher patient expectations in access and quality. In the US, John Wennberg and his colleagues at Dartmouth, New Hampshire have developed a 30 year portfolio of research on variations in the quality and resources of healthcare delivery systems.
At this salon, Prof David Goodman presented the Institute’s research on variation of supply and cost in the US health system. The talk focused particularly on variations in rates and costs of health care delivery and challenge the conventional beliefs that nothing can be done about variations in rates of health care delivery and that more is always better. In response, Gwyn Bevan from the London School of Economics and Jennifer Dixon, director of the Nuffield Trust, offered their thoughts.
Download Prof Goodman's presentation here.
Read Health Policy Insight editor's summary of the salon here.
Allocative efficiency in the downturn: Is it possible to 'disinvest' in existing health services and programmes?
4 November 2009
In theory, smarter prioritisation in the allocation of NHS funding will be key to delivering the savings required in the downturn while minimising negative impacts on health outcomes. In practice, this means restricting services with relatively higher-cost and lower population health benefit, including treatments that may be valued by clinicians, patients and the public. To release significant cash savings PCTs may have to close some services and stop certain programmes of activity altogether. But is this really feasible? Can such actions stand up to the tests of professional ethics, patient rights and political acceptability that must be met if theory is to be translated into practice?
This salon was jointly organised with the UK Forum on Priority Setting in Health Care and speakers were:
Cam Donaldson, Newcastle University and UK Forum on Priority Setting in Healthcare
Jeremy Hughes, Breakthrough BC
Jonathan Nicholls, Ipsos MORI
Health Policy Insight editor's Salon summary
Incentives for collaboration and empowerment: delivering NHS and public service efficiency
28 October 2009
In tough times it is natural for organisations to pull in their horns and focus on their core business. However, as Sir Michael Bichard's 2009 Budget Operational Efficiency Programme report set out, public services can only meet the economic, demographic and social challenges by focusing on greater joint working, front line engagement and innovation, and removing burdens. At this seminar, Sir Michael led discussion with DR Mark Britnell to explore how the NHS will deliver this vision and identify the key lessons for health policy and leadership.
Health Policy Insight editor's salon summary
Managing demand in the downturn - thinking the unthinkable? 22 October 2009
The NHS faces an unprecedented squeeze on resources as a result of the economic downturn. Whilst managers focus on transformation of efficiency and quality within the service, external factors of demographic change, epidemiology and public expectations will continue to drive rising demand. This seminar, explored themes from the Social Market Foundation's From Feast to Famine report, and asked if more radical solutions are needed to manage demand such as charging at the point of access. Presentations from Matthew Swendell, Health Tribal Group, and David Furness, SMF, are available to download.
Salon summary
Health Policy Insight Editor's blog of the salon
From payment for activity to payment for transformation - is PbR fit for the downturn?
24 September 2009
Payment by Results was introduced to stimulate expansion of capacity and increased hospital activity. This salon discussed whether a payment system designed in a period of expansion will be fit for purpose in a new financial environment? Can PbR be a barrier to collaboration and integration, transformational innovation and reducing activity? Are alternative mechanisms more appropriate, particularly for non-elective care, to incentivise efficiencies through pathway/value chain redesign? If so, what are the policy and management actions required? Presentations to spark off discussion were delivered by Rebecca Rosen, Nuffield Trust, Jon Sussex, Office for Health Economics and Ian Dodge, Department of Health.
Salon summary
Has Compassion got lost: is state intervention an answer?
14 September 2009
This salon discussed the troubling trend in many countries for compassion to be squeezed out of healthcare. Dr Robin Youngson, anaesthetist, founder of the Center for Compassionate care in New Zealand and spokesman for the WHO in the 2007 launch of the new strategy and policy, "People at the centre of health care: harmonising mind, body and systems", presented his ideas on what has gone wrong and what can be done. Robin has campaigned successfully for the Quality Improvement Committee (QIC) in NZ, a national quality and patient safety body, to endorse a campaign to amend the New Zealand Code of Rights to add "the right to be treated with compassion".
Read the salon summary here and see more details about the Confederation's work on this agenda on our delivering great patient experience webpage.
Why has the NHS not delivered on maternity care?
30 June 2009
The NHS is unlikely to deliver the government's commitments in Maternity Matters by the end of this year to deliver choice, access, and continuity of care for women. Despite the huge costs of litigation and a rising birth rate, the NHS has failed to invest energy and resources in delivering a women-centred, safe and efficient service. Why is this and how does the policy environment need to change if maternity care is to deliver for women and their families?
This seminar was led by Anna Dixon, Director of Policy at The King's Fund who worked of an independent enquiry into the Safety of Maternity Services in England and has been responsible for the recently launched Safer Births initiative, a service improvement partnership led by The King's Fund.
Mary Agnew who has been leading a review of maternity policy at the Department of Health responded.
Read the salon discussion summary.
Allocative efficiency 1: Radical answers for the downturn
25 June 2009
The scale of the economic down turn is such that the traditional methods of extracting efficiency improvements from health care will be completely inadequate. Efficiency will also have to be found by making choices about which interventions are commissioned, who provides care and by ensuring that the most effective care is provided.
This Chatham House seminar was led by Penny Dash and Nicolaus Henke from McKinsey & Co. who have been exploring some of the more radical approaches that commissioners and provider will need to adopt. Prof Gwyn Bevan of the London School of Economics and Prof Paul Corrigan, former health adviser to Tony Blair, contributed closing thoughts.
Read the salon salon discussion summary.
Competition and Co-operation - are we getting the balance right?
6 May 2009
Speakers:
- Professor Chris Ham, Health Service Management Centre, University of Birmingham
- Bob Ricketts, Director, Demand Side Reform, Department of Health
Three years since the introduction of choice at the point of referral, there are now a wider range of providers competing for patients, more active commissioning and a rules-based system overseen by a new Competiton and Cooperation Panel. As the Panel takes root, this seminar discussed where the NHS is now, and where it is going in the next three years. In particular it asked how the drive for clinically led change, new professionalism and integrated care, as set out by Lord Darzi, can be delivered in a more competitive environment.
Read the Salon Discussion Summary
Is there life after PFI?
29 April 2009
Speakers:
- Steve Wright, Executive Director, European Centre for Health Assets and Architecture (formerly of the European Investment Bank)
- Keith Palmer, Senior Associate, Kings Fund, Chairman of Cambridge Economic Policy Associates (CEPA) and of Barts and The London NHS Trust
- Peter Coates CBE, Managing Director - Commercial, Department of Health
The NHS Confederation hosted the second in series its policy salons on 29 April, bringing together a select mix of practitioners, policy experts and academics. Is there life after PFI? looked at the public private partnerships after the credit crunch and as the NHS faces falling capital spending.
Speakers discussed the impact of the increasing costs of private sector capital and the much lower capital spending for the public sector in the next ten years. Possible responses included leasing rather than owning estate to increase flexibility and the example of Alzare in Spain that separates clinical and infrastructure ownership.
How PFI can respond to the need for reconfiguration and whether smaller capital projects would be a better option, especially in the light of the NHS estate modernisation in last decade.
Read the salon discussion summary
Quality reporting and Quality Accounts
9 April 2009
Speakers:
- Dominic Hardy, Director, Quality Framework Programme, Department of Health
- Sue Baker, Head of Policy, Foundation Trust Network
- Dr Martin Marshall, Director of Clinical Quality, Health Foundation
Lord Darzi's NHS Next Stage Review firmly placed quality as the organising principle of the NHS. A key part of this is effective reporting and comparison of quality. The Department of Health is currently developing the policy to support this and create a culture of continuous quality improvement.
The first meeting of the NHS Policy Salon featured Dominic Hardy, director of the Quality Framework Programme at the Department of Health, and delegates explored the policy options and ideas that are emerging as part of this programme.
Also present were Sue Baker, head of policy for the Foundation Trust Network and Dr Martin Marshall, director of clinical quality at the Health Foundation. A former GP, Harkness Fellow and Deputy CMO, Martin is a prominent expert on the impact of publishing quality information, having led a major literature review in 2000.
Read the
salon discussion summary.