Efficiency Award

This award looks to showcase best practice in improving efficiency whilst also maintaining or improving quality with a particular focus on the finance team’s role.  It will also recognise projects that have tackled efficiency in a sustainable manner.

Winner NHS Oldham

Also shortlisted North East Lincolnshire Care Trust Plus; Sherwood Forest Hospitals NHS Foundation Trust; Wrightington, Wigan and Leigh NHS Foundation Trust

QIPP in action
The NHS is often labelled slow-moving, but there’s been no evidence of this in north-east Manchester, where primary care trusts set up a referral triage system in three weeks to tackle forecast deficits for commissioners and the local provider. NHS Oldham has won the HFMA Efficiency Award for leading the work, which has significantly reduced referrals and allowed the local provider to take out capacity.
As a result, the north-east Manchester sector saved £6m in the final half of the 2010/11 financial year and contracts for 2011/12 are about £20m less than the previous year for outpatients and scheduled care.
Referrals are still 15% lower than the high point in 2010/11 and Pennine Acute Hospitals NHS Trust is treating fewer elective patients. The provider has been able to reduce bed numbers. GPs’ acceptance of triage by the referral gateway was key to the scheme’s success, and now the emerging clinical commissioning group sees demand management as a key test for its authorisation.
In addition, a temporary second level of triage was put in place, with a clinical panel reviewing referrals each week – not just in services deemed to have little value, such as tonsillectomies, but to ensure evidence-based thresholds were met in referrals for hip and knee surgery. The largest savings were made in procedures with limited value and those where NHS provision may be inappropriate (some cosmetic procedures such as varicose veins). The most challenging area was knee and hip replacement and other interventions where risk and benefit are closely matched – the PCT believes this still has great potential.
Kath Wynne-Jones, deputy director of commissioning and system reform (below right, main picture), said that although it had won the Efficiency Award, the project was about improving quality. ‘It is fair to say there was quite a lot of turbulence at the time it was introduced, but when people saw the benefits they were happier. Quality is the real benefit. It was not just about finance; it was driven by tackling the quality agenda.’
There was scope to widen the scheme, she said. ‘We would like to improve the quality of referrals generated by allied health professionals and consultants using the same quality improvement gateway. We would also like to look at how we use the information from the gateway to improve services in future.’
The judging panel was impressed. ‘For years PCTs have sought to fight the rising tide of demand. Through the implementation of an independent GP triage capability and other actions, NHS Oldham has managed to achieve what King Canute failed to do,’ they said.
‘Through GP leadership and engagement, supported by finance staff, activity across a range of elective procedures has been reduced by 15% and sustainable savings of £6m a year produced. This is QIPP in action – the only way to significantly reduce the cost of the NHS long term is to manage demand better, ensuring patients get the right care at the right time in the right location and reduce hospital capacity. The scheme is transferable, and has the capacity to expand to areas such as prescribing.’

The Judges

Keith Wood, Chair, HFMA Financial Management & Research Committee

Jim Easton, NHS National Director for Improvement & Efficiency, Department of Health

Andy McKeon, Managing Director – Healthcare, Audit Commission

Rod Anthony, Director of Finance, NHS Institute for Innovation & Improvement

Mahmood Adil, National QIPP Advisor - Clinical & Financial Engagement, Department of Health