Taking on the productivity challenge | Jeremy Marlow

Jeremy Marlow

One year on from the Carter report, Jeremy Marlow, NHS Improvement’s director of operational productivity, details how the regulator is supporting trusts to rise to the productivity challenge. 

The NHS is the second largest public service after welfare and serves a million patients every 36 hours. While the NHS benefits from some of the best local and organisational leadership and innovation, there is also widespread unwarranted variation which affects patient outcomes, service costs and overall productivity. 

Of the over £100bn spent on NHS care annually, around £55bn is spent in our big hospitals in the acute provider sector. As we focus on improving the quality of patient care, we also need to make sure that hospitals’ investment in staff, estates, supplies and overheads deliver good value for money.

One year on from Lord Carter’s independent report into acute hospitals, NHS Improvement has taken on and accelerated efforts to support trusts to improve productivity while delivering better outcomes for patients. 

NHS Improvement established the Operational Productivity directorate in autumn 2016 and since then we’ve rapidly scaled up 15 projects – led by clinical and professional experts – to support trusts in implementing Carter’s recommendations. From staff to services, we’re continuously supporting trusts to define and identify what good looks like based on robust data and metrics to affect change. 

Our mission is to help all trusts perform at least as well as the current average performers in all areas of the hospital, meaning that £5bn can be better spent by 2020/21 while improving patient care.

The Model Hospital – our online information system, available to all acute trusts – is building up to include productivity, efficiency and quality of care metrics across every area of the hospital, including medical and surgical specialties. 

It is providing information to support trusts to better understand their performance, how they compare nationally as well as how a trust compares to smaller peer groups. With more than 3,000 acute trust users and over 530 metrics currently on the portal with more metrics going live each month, there is huge scope for the whole NHS to benefit from the tailored information given back to each trust. 

NHS Improvement is also working in partnership with dozens of leading surgeons and physicians to scale up and accelerate the delivery of the Getting It Right First Time (GIRFT) programme. GIRFT aims to improve clinical quality and efficiency in all the main surgical and medical specialities and uses datasets to help equip clinicians and trust management to focus on improving quality and productivity outcomes. 

This clinically led programme, pioneered by Professor Tim Briggs, initially looked at where improvements in clinical quality and efficiency could be made in orthopaedic surgery. GIRFT found that deep wound infection rates following surgery ranged between 0.2 per cent to 5 per cent. Each case can cost the NHS up to £100,000 and can cause huge distress and discomfort for patients. If we could get to a position where all hospitals stayed below a 1 per cent rate, this would transform the lives of 6,000 patients at a reduced cost to the NHS of around £300m per year. 

To date, the GIRFT pilot has saved the NHS over £50m in just one specialty over one year and helped improve the outcomes of thousands of patients. 

With an additional £60m of funding over the next three years to roll GIRFT out to 29 surgical and medical specialities, each led by a clinical expert in that field, the programme will ensure that less is spent on unnecessary treatment; patients will have to spend less time in hospital; clinical outcomes will be improved; and clinicians will be freed up to provide more care. 

This is all to the equivalent of £1.5bn worth of health service spending over the next three years. All of this can only be achieved through strong clinical leadership and engagement with a focus on improving patient care. 

Reflecting back on our mission, we want the whole NHS to understand what good looks like. We are now starting to investigate operational productivity and efficiency in mental health and community trusts. 

Mirroring the approach taken in the acute sector review, we have set up a cohort of 23 trusts across both sectors with which more detailed engagement will be focussed over the initial stages of the review process during the next six months. We are also looking at the scope to extend this review to all remaining providers, including ambulance trusts and specialist acute trusts.

With ever increasing demands being placed on the NHS, we cannot compromise on quality; nor should we compromise on running services in the most productive and efficient ways. 

My team will continue to support trusts – across all provider sectors – to identify what good looks like and deliver improvements for patients, colleagues who work in the NHS, and the taxpayer. 

Jeremy Marlow is executive director of operational productivity at NHS Improvement. Follow this organisation on Twitter @NHSImprovement

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