The continued importance of efficiency

by Emma Knowles

12 January 2018

Calls for increased NHS funding are growing louder – and are hard to argue against. But even if new funds are made available, the NHS will need to push even harder on efficiency.

The latest figures on A&E attendances and emergency admissions for December make for difficult reading. Attendances and admissions are both up, contributing to just 85% of patients being seen within four hours – equalling the worst performance for a single month since records began.

The sustained and increasing demand has led to even more urgent calls for increased funding. And while there is surely a strong argument to boost the NHS budget, the solution is likely to be more complex. First of all pressure on social care services also needs to be addressed as they are key to freeing up existing NHS capacity.

New models of care, delivering more multidisciplinary support proactively in the community, are also needed to stem and reverse the growing demand for urgent services.  And there needs to be a much greater focus on flow of patients within hospitals not just at the front-end – efficient and effective diagnostic services and discharge processes for example – to avoid simply shifting the bottleneck further upstream.

Increased funding will, as always be a political decision. But even with any new funds in place, the pressure to improve productivity and efficiency will remain. The Treasury will want to be assured that any additional funds given to the NHS will make a difference and not simply disappear into a black hole.

The extreme financial challenges facing services currently add a new dimension to cost improvement work. With providers under pressure to hit control totals or remain as close to them as possible, they need confidence that efficiency programmes will deliver – especially as upfront investment can be needed before financial improvements are seen.                                                       

Knowing what has worked for other providers can save time and provide inspiration. The NHS efficiency map provides a useful place to start. A revised version of the map was launched just over a year ago by the HFMA working with NHS Improvement. It brings together efficiency guidance and improvement tools with a growing series of case studies, explaining how different providers have made improvements in care and reductions in costs.

It might offer some new ideas to check into or simply act as a check list for the help that is already out there.

Different services and sectors are covered. The latest case study to be uploaded covers a project at East Midlands Ambulance Service NHS Trust to reduce the amount of normal retail price fuel used by its fleet. The plan was to replace this fuel wherever possible with ‘bunkered fuel’ – stock fuel stored at various sites around the trust patch and bought at cheaper wholesale rates.

Early results have shown a 13% reduction in garage-bought fuel in the first six-months. And with plans to improve existing poor data on bunkered fuel use (by sourcing an integrated computerised fuel monitoring system), the trust thinks it can significantly improve savings on one of its main non-pay costs.

Another recently added case study describes how one London trust has revamped its sexual health services, using on-line technology to help triage, test, diagnose and sometimes treat sexually transmitted infections. The trust expects to make revenue savings of around £4.2m over nine years and avoid capital expenditure that would otherwise have been needed for an expanding service. And there are hopes the approach could be used as a model for some other services such as pain services and chronic conditions.

Timescales are always difficult with improvement work. Knowing what has worked for other trusts doesn’t replace the need for business cases or locally-owned improvement programmes – the context will always be different. Many commentators suggest that all the ‘low hanging fruit’ in terms of efficiency has already been gathered. But the case studies demonstrate that there are still opportunities out there. The efficiency map and other sources of best practice case studies are perhaps more important than ever right now.

If you have a case study on efficiency improvement that you’d like to share, contact

See the NHS efficiency map

Case studies

Ambulance fuel - January 2018

Redesigning mental health services - December 2017

Reshaping cancer care - December 2017

eProcurement - December 2017

Developing online services - December 2017

Engaging staff with the efficiency agenda - September 2017

Theatre management - May 2017

Saving on printing costs - March 2017

Patient blood management - March 2017

Turning around procurement function - January 2017

Managing cost improvement programmes - January 2017

Improving arrangements for enhanced nursing care - December 2016