Tag Archives: Benchmarking

Operational productivity and performance in English NHS Acute Hospitals: Unwarranted variations

Title of driver: Operational productivity and performance in English NHS Acute Hospitals: Unwarranted variations

Alternative Titles: Productivity in NHS hospitals Carter Review

Source: Lord Carter of Coles (Independent report commissioned by the Department of Health)

Link to main document https://www.gov.uk/government/publications/productivity-in-nhs-hospitals

Publication format: PDF

Date of publication: February 2016

Summary of driver:

Report sets out the findings of Lord Carter’s review of how non-specialist acute hospital trusts can reduce unwarranted variation in productivity and efficiency to save the NHS £5 billion each year by 2020 to 2021.

15 recommendations are made to reduce this variation, including proposing a set of metrics be developed for a ‘model hospital’ for trusts to be benchmarked against.

Key features of driver:

Various sources of unwarranted variation in productivity, costs and efficiency in acute hospitals were identified.

The review looked at clinical staffing, pharmacy and medicines, diagnostics and imaging, procurement, back-office functions, estates and facilities; and at the quality and efficiency of clinical specialties.

The report makes recommendations in 15 areas to reduce this variation, improve quality and productivity, make cost savings, use resources in a cost effective manner and increase efficiency.

The report calls for action by NHS Improvement, NHS England, the Department of Health and hospital trusts with recommendations for the below areas:

  • Developing and implementing a national people strategy – simplifying system structures, raising people management capacity, building greater engagement and improving leadership capability.
  • Ensuring hospital pharmacies and pathology and imaging departments achieve their benchmarks – resulting in pharmacists spending more time on clinical activities, and a consistent approach to the quality and cost of diagnostic services
  • Procurement – trusts should report procurement information monthly to NHS Improvement; collaborate with other trusts and the NHS Supply Chain; and commit to the NHS Procurement Transformation Programme – resulting in increasing transparency and at least 10% reduction in non-pay costs across the NHS.
  • Estates and facilities management – trusts should meet or operate above NHS Improvement’s benchmarks. Including not exceeding a maximum of 35% of floor space for non-clinical functions and 2.5 % of space unoccupied/underused.
  • Trust corporate and administration functions – should be rationalised so that costs don’t exceed 7% of their income by April 2018 and 6% of income by 2020, or have plans for shared service consolidation or outsourcing to other providers.
  • NHS Improvement and NHS England should establish joint clinical governance to set standards of best practice for all specialties.
  • Key digital information systems – should be in place in all trusts.
  • The Department of Health, NHS England and NHS Improvement should work with local government to provide a strategy for trusts focusing patient care on recovery and how patients can leave acute hospital beds as their clinical needs allow.
  • Quality and efficiency opportunities for better collaboration and coordination of clinical services across local health economies – NHS England and NHS Improvement should work with trust boards to identify these.
  • NHS Improvement should develop the Model Hospital and underlying metrics so there is one source of data, benchmarks and practice.
  • Metrics and reporting – NHS Improvement should develop an integrated performance framework to ensure there is one set of metrics and approach to reporting; reducing the reporting burden for trusts.
  • Various deadlines are suggested- all trusts should work towards these and national bodies should develop timetables for efficiency and productivity improvements.

Primary audience: Department of Health, NHS Improvement, NHS England, Acute Trust Boards

Impact on library policy/practice:

Libraries are not specifically mentioned but:

  • The focus on efficiency, quality and benchmarking may lead to increased interest in resources for business decision making, and clinical/service auditing.
  • Consortia purchasing of library resources could contribute towards cost reduction.
  • Libraries can supply resources on leadership and people management to support the staffing changes proposed.
  • Library staff could partake in any leadership training and development made available by their trusts – for CPD and to improve the structure and leadership of the library service.
  • Library services can highlight that by having trust computers available in their setting – they are supporting staff to have access to the digital information systems the report calls for.
  • Working in collaboration with other libraries to deliver projects and services e.g. inter-library loans could support the initiative of collaboration and cost reduction.

However with the stipulation for the maximum percentage of hospital floor space for non-clinical functions – if trusts feel they need to reduce non-clinical floor space, libraries may be one of the areas that faces challenges to their use of space. Library managers will need to highlight the value of the library service to counter this pressure.

Date last updated: November 2016

Due for review: November 2017

Group member responsible: FG

NHS Operational Planning and Contracting Guidance

Link to main document:

Publication format:  PDF

Date of publication: 22/09/2016

Summary of driver: This document outlines how NHS operational planning and contractual processes will change to support Sustainability and Transformation Plans (STPs) and the “financial reset”. STPs are a different way of working and are seen as the way forward with partnership behaviours and reducing silo working.

Key features of driver:

  • Streamlining of the annual round of NHS planning and contracting.
  • Move away from annual contracts towards two year contracts as default
  • Priorities and performance assessment – lists nine “must do” priorities, originally listed in 2016/17 and will remain in place for 2017/18 and 2018/19.  These must be delivered within the financial resources available each year
  • Developing operational plans and agreeing contracts for 2017-19
  • Finance and business rules – submission of local finance plans illustrating achievement  financial balance within available resources
  • Specialised services and other direct commissioning- new framework enabling STPs to contribute specialised care to population based health services and outcomes
  • Commissioning in the evolving system – continued evolvement of CCG ‘s role
  • System-wide set of changes in order to ensure NHS can deliver the right care in the right place with optimal value
  • Working with local government/patients/communities and creating wider partnerships with the third sector

List of annexes to support guidance.

  • Annex 1 – The Government’s Mandate to NHS England 2020 goals
  • Annex 2 – The CCG Improvement and Assessment Framework
  • Annex 3 – NHS Improvement Single Oversight Framework
  • Annex 4 – October Guidance on STPs
  • Annex 5 – NHS England and NHS Improvement approach to establishing shared financial control totals
  • Annex 6 – General Practice Forward View Planning requirements
  • Annex 7 – Cancer services transformation planning requirements
  • Annex 8 – Mental health transformation planning requirements

Primary audience: NHS/healthcare senior management, local government, third agency staff, public health staff, commissioners.

Impact on library policy/practice:

  • LKS already work collaboratively across boundaries- opportunities to expand and push to national as well as show in-house how collaborative and partnership working can benefit organisations. Initiative in working closer with LKS colleagues in relevant STP footprint
  • Opportunities to create and strengthen links with CCGs’ as their role evolves and increase
  • Support the Government’s Mandate to NHS England 2020 goals for the NHS to be the world’s largest learning organisation via the provision of resources to enable staff to deliver the required recommendations
  • Support/ provide evidence requests for information on service reconfiguration/collaboration, operational topics / efficiency savings

Date last updated: November 2016

Due for review:  November 2017

Group member responsible: LK

Darzi Framework

Title of driver: High quality care for all: NHS Next Stage Review final report (Darzi Framework)

Source: Department of Health

Link to main document

Publication format: pdf

Date of publication: 30 June 2008

Review date: None specified

Summary of driver: The Review sets out the government’s plans for NHS reform in England over the next 10 years. Its principal focus is on driving up the standards of quality in health care and putting clinicians at the heart of change. It is also intended to be locally driven. The review is based on the reports from strategic health authorities and clinical pathway working groups that presented a vision for change in their particular localities. It is not a ‘national blueprint’ but a means of enabling these local visions to become a reality (excerpt from summary on King’s Fund website April 2010)

Key features of driver:

  • Introduces a range of local quality indicators – measuring mortality, complication and survival rates as well as patient perceptions – that will enable clinicians to benchmark and improve their performance. A small proportion of trusts’ income will also become conditional on quality indicators. Trusts will be obliged to produce annual ‘quality accounts’ similar to their financial accounts.
  • The NHS will have a formal constitution, spelling out its underlying principles and values as well as the rights and responsibilities of patients, the public and staff. * Darzi identified a range of hospital services that could be delivered closer to the patient’s home, including minor surgery and many outpatient consultations, although some services such as stroke and heart disease should be more specialist and centralised.
  • PCTs together with local authorities will now be responsible for commissioning comprehensive well-being and prevention services. They will target six key goals: tackling obesity, reducing alcohol harm, treating drug addiction, reducing smoking rates, improving sexual health and improving mental health
  • Patients with complex long-term conditions will be entitled to a named care co-ordinator, such as a community matron, to help them access the services in their personal care plans

(From http://www.kingsfund.org.uk 14/4/10)

Primary audience: Health and Social Care Professionals (DH website)

Impact on library policy/practice:

Key headings / sections from the Review summary:

  • Easy access for NHS staff to information about high quality care. All NHS staff will have access to a new NHS Evidence service where they will be able to get, through a single web-based portal, authoritative clinical and non-clinical evidence and best practice.
  • A clear focus on improving the quality of NHS education and training. The system will be reformed in partnership with the professions.

Plus:

  • Chapter 6: High Quality Work in the NHS, particularly the section ‘High Quality Education and Training’ (11-29)* Many aspects of the review focus on quality improvement; library services can support their organisations to implement changes based on the best evidence

Case studies / Local service profile examples mapping to this driver: 

Case Studies: 
NW Clinical Librarian Systematic Review

Local service profiles:
Systematic Review
Mediated Literature Service
Hospital archive digitisation project
Journal Club support service

Information reviewed and updated: 4/10/2013

Due for review: April 2014

Group member responsible: TP

Opportunity Locator

Title of driver: Opportunity Locator

Source: Institute for Innovation and Improvement

Link to main document

Publication format: Online tool

Date of publication:

Summary of driver:The Opportunity Locator is a data tool to support the commissioning priorities of local health communities. The purpose of the Opportunity Locator tool is to stimulate ideas on where commissioners should focus their attention in re-designing and shifting services away from the traditional setting of the hospital and out towards community based care.

The tool allows your PCT to benchmark costs against other PCTs, which will identify areas they cannot make changes to create significant savings.

Key features of driver:

  • Can compare SHAs, PCTs and GP surgeries within PCTs
  • Can drill down to-
    Emergency Admissions
    Intermediate Care
    Outpatient 1st Attendance
    Outpatient Follow Up

Primary audience: Commissioners

Impact on library policy/practice:
Library services can show how they can support the PCT is the keys areas identified as over-spend, by providing evidence of best practice that will drive change.

Case studies / Local service profile examples mapping to this driver:

Date last updated: Sept 2009

Due for review: Sept 2010

Group member responsible: LE

Darzi Framework

Title of driver: High quality care for all: NHS Next Stage Review final report (Darzi Framework)

Source: Department of Health

Link to main document

Publication format: pdf

Date of publication: 30 June 2008

Review date: None specified

Summary of driver: The Review sets out the government’s plans for NHS reform in England over the next 10 years. Its principal focus is on driving up the standards of quality in health care and putting clinicians at the heart of change. It is also intended to be locally driven. The review is based on the reports from strategic health authorities and clinical pathway working groups that presented a vision for change in their particular localities. It is not a ‘national blueprint’ but a means of enabling these local visions to become a reality (excerpt from summary on King’s Fund website April 2010)

The Operating Framework: for the NHS in England 2010/11 (Dec 2009) sets out the enabling system that will deliver the Review

Key features of driver: Introduces a range of local quality indicators – measuring mortality, complication and survival rates as well as patient perceptions – that will enable clinicians to benchmark and improve their performance. A small proportion of trusts’ income will also become conditional on quality indicators. Trusts will be obliged to produce annual ‘quality accounts’ similar to their financial accounts.

The NHS will have a formal constitution, spelling out its underlying principles and values as well as the rights and responsibilities of patients, the public and staff. * Darzi identified a range of hospital services that could be delivered closer to the patient’s home, including minor surgery and many outpatient consultations, although some services such as stroke and heart disease should be more specialist and centralised.

PCTs together with local authorities will now be responsible for commissioning comprehensive well-being and prevention services. They will target six key goals: tackling obesity, reducing alcohol harm, treating drug addiction, reducing smoking rates, improving sexual health and improving mental health
Patients with complex long-term conditions will be entitled to a named care co-ordinator, such as a community matron, to help them access the services in their personal care plans.
(From http://www.kingsfund.org.uk 14/4/10)

Primary audience: Health and Social Care Professionals (DH website)

Impact on library policy/practice:

Key headings / sections from the Review summary: Easy access for NHS staff to information about high quality care. All NHS staff will have access to a new NHS Evidence service where they will be able to get, through a single web-based portal, authoritative clinical and non-clinical evidence and best practice.

A clear focus on improving the quality of NHS education and training. The system will be reformed in partnership with the professions.

Plus:

Chapter 6: High Quality Work in the NHS, particularly the section ‘High Quality Education and Training’ (11-29)* Many aspects of the review focus on quality improvement; library services can support their organisations to implement changes based on the best evidence

Keywords: darzi, reform, vision, quality, quality accounts, NHS constitution, obesity, alcohol, drug addiction, smoking, sexual health, mental health, long term conditions, NHS evidence

Case studies mapping to this driver:
NW Clinical Librarian Systematic Review

Local service profiles mapping to this driver:
Systematic Review
Mediated Literature Service
Hospital archive digitisation project
Journal Club support service

Information reviewed and updated: 14/4/10 (v1)

Due for review: March 2010

Group member responsible: HG