Helping the NHS to deliver quality

Bernard Crump, Chief Executive of the NHS Institute for Innovation and Improvement, on delivering quality and value

The NHS Institute for Innovation and Improvement was set up in July 2005 following the Arms Length Body Review.

Its mission is to improve health outcomes and raise the quality of delivery in the NHS by accelerating the uptake of proven innovation and improvements in healthcare delivery models and processes, medical products and devices and healthcare leadership.

The NHS Institute works by concentrating on a number of priorities, jointly set with the Department of Health and the NHS.These are underpinned by generic development and activity in both learning and leadership.

Some priorities are long term, others are shorter term, to concentrate on key issues within the NHS.Current shorter term priorities, whose work will be completed by December this year, include:

  • No Delays, helping the NHS to achieve the 18 week wait target
  • Healthcare Associated Infections,creating specific tools to combat MRSA,C diff and other healthcare associated infections and
  • Primary care/long term conditions,helping the NHS to shift care for those with long term conditions from the acute sector to the primary care sector

In the longer term, the NHS Institute is the home for the National Innovation Centre, which will help catalyse the input of technology innovation into the NHS.

The NHS Institute also sees as a long term priority building capacity and capability for innovation and improvement, through helping the NHS introduce radical new ideas.

Of particular interest to readers of Public Sector Review will be the third long term priority - delivering quality and value.

Mark Jennings is the national lead for the NHS Institute’s Delivering Quality and Value team.

He explains: “The aim of the programme is to help the NHS improve the quality of clinical outcomes for patients, and the efficiency of care in terms of the amount of resource expended.”

The team is carrying out two strands of work. The first is a study of ten high volume healthcare resource groups or HRGs (for example, hip replacement,caesarean section).

The team has looked at the ‘highest performing’ organisations in terms of quality and value in these groups, and for each of them they are identifying the characteristics of the highest performing clinical pathways.

They have studied this in terms of clinical care, process organisation, and management.

They will turn this information into products to help guide those parts of the NHS which are ‘lower performing’ in each of the HRGs.

The team has already produced an initial document scoping the work, and this showed that there is a large variation in quality and value between organisations.

This initial document also highlighted some of the information that is already known about how to improve efficiency for each of the HRGs.

This is available from the NHS Institute website:

The main findings of this piece of work will be published in September. The second piece of work focuses on the issue of productivity.

The team has looked at nine essential areas where the NHS can improve productivity and efficiency and has produced a document entitled ‘Delivering Quality and Value: Focus on Productivity and Efficiency.’

For this study, they have identified the key areas as follows:

  • Reduce avoidable emergency admissions
  • Reduce unnecessary outpatient appointments, follow-ups and DNAs
  • Avoid unnecessary procedures
  • Improve day case performance
  • Reduce wasted bed days
  • Improve the accuracy of clinical coding
  • Reduce variation in length of stay
  • Improve staff productivity
  • Actively manage staff/recruitment costs

These nine areas have been linked to a set of 15 productivity metrics defined by the Department of Health, and on a quarterly basis the NHS Institute will publish these indicators from every PCT and Acute Hospital Trust.

The data is drawn from existing information sources including Trusts’ Hospital Episode Statistics.

When the data is published, the NHS Institute will give each organisation an indication of potential savings they could make.

For example, they might say that if the number of day cases was increased from a low percentage to the national average,the Trust could save £100,000.

A scorecard covering all of the metrics will be emailed to each organisation. Mark Jennings says

“The metrics are not intended to rank performance, but to help identify potential opportunities for improving services and savings.”

He has found, as the team have looked at these figures, that there have been some surprises.

For example, I was surprised at the huge variation between hospitals in the number of patients admitted the day before procedures.

“I thought that it was now normal to admit patients on the day of their procedure, but this relatively standard improvement has not been comprehensively adopted by the NHS.

“This results in pre-operative bed days accounting for over a million bed days annually across the NHS.” This ties up beds which could be used for various other purposes.”

Mark Jennings is also very keen to emphasise that there can be ‘quick wins’ for organisations.

Reducing length of stay is one of the biggest opportunities, combined with focusing on the basics.

This may be, for example, not admitting people the day before a procedure; not having excessive follow up outpatient appointments; and the pro-active management of ‘did not attends’ - which is of course people who do not turn up for appointments.

“We are simply urging NHS organisations to identify where they are out of line with the rest of the NHS and have action plans to change their practice.”

As the team’s work moves into its next phase, it expects to carry out more detailed studies of how organisations can convert improvements into real savings for reinvestment in various other healthcare priorities.

Mark says, “I feel privileged to work on this. I’ll feel we’ve done a good job if I can see this work has helped the NHS into financial balance, with resulting improvement in patient care.”

For more about Delivering Quality and Value, and about the NHS Institute’s work, go to: