LEANER AND SMARTER Improved productivity is the answer to the NHS funding crisis, says Monitor. Stephanie Jones-Berry reports on how nurses are changing services
CORBIS
SUMMARY
‘Nurses are innovators,’ says Staffordshire and Stoke-on-Trent Partnership NHS Trust lead tissue viability nurse Sue Mason. ‘They excel at innovations that not only improve patient care, but also save the NHS money,’ she adds. Until recently Ms Mason’s trust was spending £1.4 million a year on wound dressings. Convinced that inefficiency was contributing to this ‘ridiculous’ expenditure, she introduced a traffic light system to stop waste. Dressing and products in the Green section of the wound care formulary are available for all to prescribe; to prescribe Amber products staff must complete an exemption form and explain their decision; Red products may only be used for tissue viability. ‘It has enabled nurses to use the right dressing at the right time,’ she says. The trust is calculating the savings it has made since the system was introduced in October 2012, and they are expected to be substantial. The benefits are also spreading beyond the hospital, with Ms Mason and nursing colleagues giving local GPs tuition on the principles of the waste-prevention traffic lights system. One GP has already saved 27 per cent of his entire wound-dressings budget thanks to Ms Mason’s efforts.
This is just the type of work the foundation trust regulator Monitor hopes to encourage. Its recent report, Closing the NHS Funding Gap, argues that getting better ‘health value’ for patients with each pound spent is by far the best strategy for coping with the unprecedented funding pressures in the NHS.
John Appleby, chief economist with the independent think tank the King’s Fund, says Monitor’s report is not suggesting anything new. Indeed, the King’s Fund produced a report with similar ideas for improving productivity three years ago. Ultimately, it is front line staff who will determine whether the NHS becomes more productive and efficient, he says. ‘Ideas have got to come from the ground up, from individual nurses or nurse teams. Front line nurses and doctors know the system, can see
Reshaping services
The report points out that since the NHS was established in 1948, its spending has increased in real terms by an average of 4 per cent a year, but for the decade ahead the budget is likely to remain flat. At the same time, rising demand from an ageing population is contributing to an estimated yearly funding gap of £30 billion by 2021. Improved productivity does not mean nurses and other staff working ‘longer and harder’, says Monitor. It means everyone working ‘differently and smarter’, reshaping NHS services so that they give patients the same or better care for less money. The NHS will have to improve productivity at a higher rate than ever before – and continue to do this year-on-year.
The NHS faces an estimated annual funding gap of £30 billion by 2021. Improved productivity is the only sustainable solution, according to a report by the health regulator Monitor, and nurses can do a great deal to help. Author Stephanie Jones-Berry is a freelance journalist
24 december :: vol 28 no 16-18 :: 2013 STANDARD Downloaded18from RCNi.com by ${individualUser.displayName} on Nov 24, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
blockages and difficulties, and hold the key to improving it,’ says Professor Appleby. Monitor identifies four areas where financial gains can be made, including looking abroad to find new ways of delivering care and allocating NHS spending more appropriately. However, the biggest gains can come from delivering care in the right setting (£4 billion) and improving productivity (£12.1 billion). In this spirit, district nursing teams at Liverpool Community Health (LCH) NHS Trust have been successful in piloting a scheme that will see the entire organisation mobile working and ‘paper light’ by 2015. Neighbourhood nurse manager Jayne Wood says: ‘We are looking to increase staff productivity and reduce the time spent on admin and travel.’ Nurses have been given tablet devices so they can update patient data without delay, as well as access patient information, and run email and
The productive ward programme – launched in 2008 by the now defunct NHS Institute for Innovation and Improvement – remains one of the ‘most exciting’ projects around, says Nottingham University Hospitals NHS Trust assistant director of nursing Kerry Bloodworth. It releases nursing staff to spend more time with patients by analysing how wards work and removing organisational blockages. Ms Bloodworth’s trust made one-off savings of £400,000 by applying productive ward principles at its 80 wards in 2008, and nurses now spend around 11 per cent more time with patients. ‘We are always looking for the next thing, but the next thing may not be any better,’ she says. RCN head of policy, Howard Catton, says bridging the £30 billion NHS funding gap will mean redistributing resources to the primary and community sector. ‘Saving the money against a difficult backdrop, without seeing falls in quality of service and safety, does
WE SHOULD DO MORE ON PREVENTION AND GETTING PEOPLE TO MANAGE THEIR OWN CONDITIONS – Howard Catton clinical apps. District nurses no longer need to return to the office to update records, says Ms Wood.
Time savings
Gemma Lloyd was district nursing team leader when she agreed to pilot the initial phase of the project. ‘When the system is tightened up and nurses see the benefits, there will be a huge difference in the time spent on administration,’ she says. LCH business transformation manager Kathyrn Kumeta says the changes will save ten to 15 minutes per staff member each day and the equivalent of £1,000 per staff member per year – £1.9 million over five years.
require reconfiguration in the way health care is delivered. ‘We should do more on prevention and getting people to manage their own conditions, then improve discharge processes to make them seamless.’ Monitor agrees that reconfiguring services and integrating care could yield recurring gains. But tackling service redesign is contentious. Mr Catton says that before any further shift from secondary to community care can be attempted, the question: ‘Have we got nurses in the right place?’ must be asked. ‘These are questions that go well beyond the role and remit of Monitor,’ he adds NS
New ward principles make best use of nurses’ time Nottingham University Hospitals NHS Trust has applied productive ward principles since 2008. Oncology matron and former charge nurse Robin Binks says ward processes were reviewed to cut out unnecessary nurse footfall, free up time with patients, and develop junior nurses’ skills. Applying ‘lean’ principles to stock levels meant storerooms could be reorganised and unwanted items redistributed throughout the hospital. Equipment was grouped together, maximum and minimum levels were decided, and new storage units and key sets were ordered. ‘It meant you spent a lot less time walking around looking for stuff,’ says Mr Binks. Assistant director of nursing Kerry Bloodworth says: ‘We found one ward had 130 sheets in the linen room after all the beds were made – not including spares by the bedsides – while the ward opposite did not have enough.’ Patient information is now available to all nurses at a glance on up-to-date ward boards, which helps to reduce waiting times and length of stay. Ms Bloodworth says nurses now have instant answers to everyday questions: ‘Who has been referred to a physiotherapist or to social services? Has a referral been made and if not, what are we waiting for?’ According to a 2012 impact report by the NHS Institute for Innovation and Improvement, a typical trust implementing the productive ward process will have gained a return on investment of £1.3 million and each ward an average of £71,000 by 2014.
NURSING december 18 No :: vol 28uses no 16-18 2013 25 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Nov 24, 2015. For personal use only. other without:: permission. Copyright © 2015 RCNi Ltd. All rights reserved.
CORBIS
SUMMARY
‘Nurses are innovators,’ says Staffordshire and Stoke-on-Trent Partnership NHS Trust lead tissue viability nurse Sue Mason. ‘They excel at innovations that not only improve patient care, but also save the NHS money,’ she adds. Until recently Ms Mason’s trust was spending £1.4 million a year on wound dressings. Convinced that inefficiency was contributing to this ‘ridiculous’ expenditure, she introduced a traffic light system to stop waste. Dressing and products in the Green section of the wound care formulary are available for all to prescribe; to prescribe Amber products staff must complete an exemption form and explain their decision; Red products may only be used for tissue viability. ‘It has enabled nurses to use the right dressing at the right time,’ she says. The trust is calculating the savings it has made since the system was introduced in October 2012, and they are expected to be substantial. The benefits are also spreading beyond the hospital, with Ms Mason and nursing colleagues giving local GPs tuition on the principles of the waste-prevention traffic lights system. One GP has already saved 27 per cent of his entire wound-dressings budget thanks to Ms Mason’s efforts.
This is just the type of work the foundation trust regulator Monitor hopes to encourage. Its recent report, Closing the NHS Funding Gap, argues that getting better ‘health value’ for patients with each pound spent is by far the best strategy for coping with the unprecedented funding pressures in the NHS.
John Appleby, chief economist with the independent think tank the King’s Fund, says Monitor’s report is not suggesting anything new. Indeed, the King’s Fund produced a report with similar ideas for improving productivity three years ago. Ultimately, it is front line staff who will determine whether the NHS becomes more productive and efficient, he says. ‘Ideas have got to come from the ground up, from individual nurses or nurse teams. Front line nurses and doctors know the system, can see
Reshaping services
The report points out that since the NHS was established in 1948, its spending has increased in real terms by an average of 4 per cent a year, but for the decade ahead the budget is likely to remain flat. At the same time, rising demand from an ageing population is contributing to an estimated yearly funding gap of £30 billion by 2021. Improved productivity does not mean nurses and other staff working ‘longer and harder’, says Monitor. It means everyone working ‘differently and smarter’, reshaping NHS services so that they give patients the same or better care for less money. The NHS will have to improve productivity at a higher rate than ever before – and continue to do this year-on-year.
The NHS faces an estimated annual funding gap of £30 billion by 2021. Improved productivity is the only sustainable solution, according to a report by the health regulator Monitor, and nurses can do a great deal to help. Author Stephanie Jones-Berry is a freelance journalist
24 december :: vol 28 no 16-18 :: 2013 STANDARD Downloaded18from RCNi.com by ${individualUser.displayName} on Nov 24, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
blockages and difficulties, and hold the key to improving it,’ says Professor Appleby. Monitor identifies four areas where financial gains can be made, including looking abroad to find new ways of delivering care and allocating NHS spending more appropriately. However, the biggest gains can come from delivering care in the right setting (£4 billion) and improving productivity (£12.1 billion). In this spirit, district nursing teams at Liverpool Community Health (LCH) NHS Trust have been successful in piloting a scheme that will see the entire organisation mobile working and ‘paper light’ by 2015. Neighbourhood nurse manager Jayne Wood says: ‘We are looking to increase staff productivity and reduce the time spent on admin and travel.’ Nurses have been given tablet devices so they can update patient data without delay, as well as access patient information, and run email and
The productive ward programme – launched in 2008 by the now defunct NHS Institute for Innovation and Improvement – remains one of the ‘most exciting’ projects around, says Nottingham University Hospitals NHS Trust assistant director of nursing Kerry Bloodworth. It releases nursing staff to spend more time with patients by analysing how wards work and removing organisational blockages. Ms Bloodworth’s trust made one-off savings of £400,000 by applying productive ward principles at its 80 wards in 2008, and nurses now spend around 11 per cent more time with patients. ‘We are always looking for the next thing, but the next thing may not be any better,’ she says. RCN head of policy, Howard Catton, says bridging the £30 billion NHS funding gap will mean redistributing resources to the primary and community sector. ‘Saving the money against a difficult backdrop, without seeing falls in quality of service and safety, does
WE SHOULD DO MORE ON PREVENTION AND GETTING PEOPLE TO MANAGE THEIR OWN CONDITIONS – Howard Catton clinical apps. District nurses no longer need to return to the office to update records, says Ms Wood.
Time savings
Gemma Lloyd was district nursing team leader when she agreed to pilot the initial phase of the project. ‘When the system is tightened up and nurses see the benefits, there will be a huge difference in the time spent on administration,’ she says. LCH business transformation manager Kathyrn Kumeta says the changes will save ten to 15 minutes per staff member each day and the equivalent of £1,000 per staff member per year – £1.9 million over five years.
require reconfiguration in the way health care is delivered. ‘We should do more on prevention and getting people to manage their own conditions, then improve discharge processes to make them seamless.’ Monitor agrees that reconfiguring services and integrating care could yield recurring gains. But tackling service redesign is contentious. Mr Catton says that before any further shift from secondary to community care can be attempted, the question: ‘Have we got nurses in the right place?’ must be asked. ‘These are questions that go well beyond the role and remit of Monitor,’ he adds NS
New ward principles make best use of nurses’ time Nottingham University Hospitals NHS Trust has applied productive ward principles since 2008. Oncology matron and former charge nurse Robin Binks says ward processes were reviewed to cut out unnecessary nurse footfall, free up time with patients, and develop junior nurses’ skills. Applying ‘lean’ principles to stock levels meant storerooms could be reorganised and unwanted items redistributed throughout the hospital. Equipment was grouped together, maximum and minimum levels were decided, and new storage units and key sets were ordered. ‘It meant you spent a lot less time walking around looking for stuff,’ says Mr Binks. Assistant director of nursing Kerry Bloodworth says: ‘We found one ward had 130 sheets in the linen room after all the beds were made – not including spares by the bedsides – while the ward opposite did not have enough.’ Patient information is now available to all nurses at a glance on up-to-date ward boards, which helps to reduce waiting times and length of stay. Ms Bloodworth says nurses now have instant answers to everyday questions: ‘Who has been referred to a physiotherapist or to social services? Has a referral been made and if not, what are we waiting for?’ According to a 2012 impact report by the NHS Institute for Innovation and Improvement, a typical trust implementing the productive ward process will have gained a return on investment of £1.3 million and each ward an average of £71,000 by 2014.
NURSING december 18 No :: vol 28uses no 16-18 2013 25 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Nov 24, 2015. For personal use only. other without:: permission. Copyright © 2015 RCNi Ltd. All rights reserved.
