A recent report has placed the NHS under the spotlight once again after predictions suggest that by 2020, hospitals in London could face a £4bn shortfall if they continue to operate under current policies and practices.
This report flies in the face of current predictions from the Department of Health that say the NHS should make £20bn of savings by 2015, and instead points towards increased birth rates and longer life expectancies as two factors amongst many to explain the discrepancy.
In light of this information, hospitals with centralised services, such as St George’s in Tooting, are under particular scrutiny from NHS England. As the organisation seeks to align budgets with the
most effective care provision possible, they believe centralising London hospitals will stretch resources to a point where they no longer become a practical solution.
With so much at stake, many are claiming that the NHS needs a radical overhaul; how can this be achieved?
Weighing up centralised and decentralised services
Whilst a centralised service provides all specialist services under one roof, such as a cancer care, screening, urology, etc., a decentralised system would instead see each hospital within a specific area becoming a specialist in a parti
cular condition or area of illness. Many believe that centralised hospitals are frequently subject to longer waiting times and subsequent compromises in patient care and experience. In contrast, decentralised hospitals may be more effective at managing care provision, but come with the disadvantage that staff at hospitals may not always be trained sufficiently to refer patients to the appropriate services. In order to deliver sufficient care and understands the costs associated with each option, additional resources will need to be dedicated to either improving patient experiences, or supplying further training to staff, particularly GPs, for effective diagnosis and referral.
Reducing the burden on care providers
Whilst further training may help to reduce the numbers of patients being treated at non-specialist hospitals or in accident and emergency departments, further figures from NHS England have suggested that as many as 80% of premature deaths in London can be attributed to lifestyle factors such as alcohol, smoking, poor diet or lack of exercise, with 1 in 5 children in London at risk of obesity. It is therefore a natural conclusion that future reductions to care provision budgets can only be achieved through investment in preventative measures. As well as joint campaigns between health authorities, service providers and local charities seeking to inform healthy lifestyle choices, increased awareness in areas such as strokes or heart conditions could lead to earlier diagnoses.
Whilst treating a patient at a hospital costs an estimated £190 per day, treatment from home costs a paltry £70 in comparison. Early diagnosis would facilitate early treatments to be given at home or at primary care level, thereby
drastically reducing required budgets. Information campaigns will likely play as vital a role in preventative means as they will in early treatment, particularly in areas such as alcoholism where, shockingly, almost 300 children aged 11 or younger were treated in A&E for alcohol-related conditions. Effective campaigning could drastically reduce these figures and their associated costs.
More effective use of care facilities
With such drastic costs associated with secondary care, a further means of reducing budgetary spends without negatively impacting upon care provision standards could be to extend those services provided through primary care fa
cilities. In this manner, certain health screening, treatment of minor cuts and wounds and mental health services could be more effectively provided for those in need, without associated increases in referral treatment times. Additionally, education programmes based at the primary care level could inform the public how to better look after themselves for minor ailments, or provide self-care assistance through changing circumstances such as old age.
With greater education and more effective care of different ailments, each of the above points will contribute to reduced repeat visits by individuals for the same problems. This can be further facilitated by ensuring excellent standards of infection control through both primary and secondary care providers, as well as PLACE assessments and other regulatory data that ensures care provided meets patient demands as well as budget requirements. Through any restructuring to the NHS or care provision, patient experience and outcomes should be closely monitored to ensure the need to meet more restricted budgets does not negatively impact upon the standard of care delivered.
Tracking and monitoring changes through data management
Whilst each of these changes may facilitate improvements to care provision or budgetary needs, it stands to reason that only a constant, consistent means of measuring these changes will indicate their effectiveness. Additionally, t
Some questions likely to be of particular interest to care providers include:hese measurements may provide a means of identifying where further changes and improvements can be made.
- How effective have any awareness campaigns been?
- How useful has training been? What has been taken from training and applied in a real life situation?
- How do infection control measures or PLACE figures compare to previous years or similar trusts?
- What are the barriers for our organisation in meeting our CQUINS target?
In order to answer these and many other questions and bring about effective NHS reforms, accurate, timely, recording of data with analysis and visualisation is essential.
We understand that people from all walks of life – including ourselves – will one day require the assistance of health and public sector services. Because of this, DCC is passionate about improving service with more capable data management, and we would view any small means of achieving effective change as an accomplishment. We have previously created a dynamic interactive dashboard for awareness campaigning, and also include activity analysis amongst the effective projects we have assisted in.