Page last updated at 00:14 GMT, Wednesday, 20 January 2010

Why efficiency in the NHS matters

By Nick Triggle
Health reporter, BBC News

The value for money being achieved in the NHS is under the spotlight. The system in England appears to be more efficient than other parts of the UK, according to independent researchers. But why is this and does it really matter?

Newcastle General Hospital
Newcastle General Hospital has a good record of hitting targets

About 75,000 patients pass through the doors of Newcastle General's A&E unit each year. It is a hive of activity - and efficiency.

All the patients are seen within the target of four hours and either treated and discharged or admitted into the hospital for more complex care.

Like many hospitals, the Newcastle General is part of a wider network of centres operated by one one body - the Newcastle Hospitals Trust.

The trust actually operates across seven sites providing a wide range of services, including pioneering heart and cancer services.

It is subject to intensive monitoring and hits its targets on everything from finances to MRSA.

In fact, it is so good that it is just one of 13 to have been given the top excellent rating by the regulator for two years running.


In many ways, the trust is symbolic of everything the government has sought to achieve with its reform of the NHS.

While Scotland and Wales may have hogged the headlines for decisions to scrap prescription fees and parking charges, ministers in England have preferred to concentrate more on close monitoring of performance and giving patients fast access to treatment.

So while the Newcastle trust is undoubtedly one of the best performers, it is not unique. Most of the 23 trusts across the north east of England have a good record - as the Nuffield Trust study confirmed.

The health service in England has more targets than elsewhere in the UK
Funding is also directly linked to performance under a series of public service agreements the NHS has with the Treasury
NHS trusts are also paid per patient they treat, unlike the rest of the UK which is given guaranteed lump sums

Indeed, the region has been used by the researchers to highlight the relatively poor performance of Scotland in terms of getting value for money.

The two areas have similar levels of deprivation and health need, but Scotland gets more funding and employs more health staff.

Despite this, the north east sees a fifth more outpatients, carries out 40% more day cases and admits 50% more people as inpatients for things such as hip and knee replacements. In a nutshell, it is more productive.

The findings make damning reading for ministers north of the border and some believe they can be used to justify the more target-driven and heavily regulated approach taken in England.

Nigel Edwards, director of policy at the NHS Confederation, which represents health mangers in England, Wales and Northern Ireland, says the report suggests "targets do have their place".

He believes there is a danger of "insularity" in the rest of the UK as the fewer people working in the service means less ideas being put forward to improve services.

Quality of care

Not everyone is convinced however.

British Medical Association chairman Dr Hamish Meldrum, who in the past has spoken glowingly of the approach taken in Scotland where doctors have much more involvement in decision-making than they do in England, says the report has ignored some important consequences of the English system.

He believes the drive for competition in England has "demoralised staff" and as a result not necessarily been in the best interest of patients.

And this, for the public, is what matters most. While ministers may worry about the balance sheets and productivity rates, patients tend to be more concerned about quality of care.

Unfortunately, there is no firm evidence either way as to who is getting the best deal. The Nuffield Trust only looked at satisfaction rates - and there were no marked differences for in any part of the UK.

A report last year by the Health Foundation carried out a more in-depth analysis. It analysed six measures of care, but again could not say any system was worse or better than another.

So what can be concluded from the Nuffield report? The researchers believe it should act as a warning to the health service and policy-makers.

At a time when the NHS is likely to face a squeeze on its funding in the future, it is becoming increasingly important to get more and more from every pound spent.

But as the research group clearly spelt out, the opposite is happening - even in England.


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