Comment / Driving efficiency across systems

02 March 2022 Paul Sheldon

As the NHS architecture prepares to shift once more with the establishment of integrated care boards (ICBs) during 2022, NHS organisations will have a new responsibility to deliver system financial balance as well as retaining individual trusts statutory duties.

This change comes at a time where the demand and acuity of patients is increasing, making it more difficult to deliver the quality of services patients deserve within the financial resources given to the NHS.

Efficiency requirements have effectively been on hold since April 2020 as a temporary financial regime was put in place to enable the service to concentrate on its response to Covid-19. Returning to a financial regime that involves delivering savings will need teams to work together across finance, clinical, operational and informatics disciplines.

The last two years have seen all NHS staff pull together to deliver services for patients in the most challenging and uncertain environments. This has left many exhausted. How do we develop and deliver savings programmes when clinical and operational teams are still dealing with delivering services under such sustained pressure? How do we deliver the productivity improvements set out in the planning guidance?

There will be some opportunities for improvement from traditional approaches and by borrowing from best practice. The NHS value and efficiency map is a good place to start, with a fully revised version published this week following work by the HFMA in partnership with NHS England and NHS Improvement.

However, there may also be an opportunity to think differently about how we deliver savings going forward. Thinking about how savings are delivered across each system should open new avenues to reduce the cost of some services.

The traditional approach to productivity improvement has viewed the ‘cost’ of services within each trust, with benchmarking used to validate the efficiency delivered by rank. But does that necessarily mean that we are adding value to a person’s care? Does efficiency in one part of the patient pathway equate to efficiency overall?

ICBs have a unique opportunity to explore the actual cost of patient care across the whole pathway – as patients move from primary care to acute settings to community rehab and back to primary care, for example – not just the cost of services within each trust. We may be efficient at delivering an elective knee replacement, but how does that compare with the use of resources consumed in the rest of the pathway?

We need to cost the whole pathway and present the information to clinical and operational colleagues from all providers involved in delivering that pathway. Then, with patient involvement, we can begin a conversation about how services can be changed to deliver value for patients, their families and carers. This in turn reinforces the message that safety and quality are paramount in delivering outcomes for patients.

Provider collaboratives, which can include local authorities, the police and third sector organisations, offer further opportunities to bring together costing information to help make decisions about how funding within ICBs can be deployed to improve outcomes for patients.

The challenges in costing across full patient pathways are considerable. But with commissioners and providers working together, within ICBs and collaboratives, there is a unique opportunity to use costing information to drive improvements in value for patients and efficiencies in service delivery.


Paul Sheldon is chief finance officer of Leicestershire Partnership and Northamptonshire Healthcare Group.