The man in charge of reviewing NHS savings has declared that the service “doesn’t deserve more money” until it stops wasting so much of it on poor quality care. Professor Tim Briggs, a top surgeon turned NHS executive, believes the service needs to “put [its] house in order” before receiving further funding. Does his judgement hold water or is it just another attack on an already heavily-wounded service?
Achieving the “Near-Impossible”
Briggs’s announcement comes just months after his NHS Improvement colleague and chief executive Jim Mackey praised the service’s 2016-17 savings of £3.1bn. Mackey said the sum would be “near-impossible” for any other health system in the world to achieve. According to the British Medical Association, these already impressive savings would have been far higher had £1.8bn not been given to the Government’s NHS sustainability and transformation fund, which is there to cut spending and save money. Go figure.
The Government has demanded that the NHS save £22bn by 2020 – a £5bn annual saving. Though the £3.1bn achieved is well under the Government’s demand, BMA council chair Mark Porter said the target was virtually impossible.
Porter stated that these savings mean the NHS “can no longer deliver according to its promises” yet “the Government’s message is – do it all again next year”. The audit from Professor Briggs will guide how even more money can be saved.
What would he know?
Tim Briggs (left) joined the NHS Improvement team in 2015 as national director for clinical quality and efficiency. He’s tasked with solving the age-old NHS problem: how to make savings while at the same time becoming safer and more effective. Alongside Lord Carter – the non-executive director of NHS Improvement who came up with the £22bn target – Briggs has been delving into NHS inner workings and operations to see where costs might be cut.
Thankfully Briggs at least understands the profession and isn’t just another bureaucrat hired to slash spending. He’s a leading orthopaedic surgeon who’s worked in the NHS for 35 years. Briggs also has experience in streamlining medical practice. As president of the British Orthopaedic Association he visited more than 250 hospitals and found mixed levels of care and procedure.
That insight has been channelled into his new audit. Briggs believes that further funding won’t be put to best use if hospitals with poor practice don’t improve. It’s actually one of the least controversial proposals so far, which have included closing wards, limiting operations and extending waiting times.
It’s All in the Hip
Briggs naturally uses orthopaedic examples to make his point; hip and knee operations are his favourite. Speaking at The King’s Fund conference in June 2016, Briggs explained how the different options and approaches used by doctors and clinical commissioning groups can have extraordinary effects on cost.
An ageing population inevitably means more hip and knee replacements but some areas of the UK are seeing fewer of those operations because CCGs think they are “of limited clinical value”. Briggs explains that this is “absolutely crazy because if a hip and knee replacement lasts you 15 years it works out about £7.50 a week which is cheaper than lots of x-rays, lots of physiotherapy and anti-inflammatories”.
Another of his overspending examples is in a surgeon’s choice of tools. A cemented hip replacement costs £650 while a more expensive implant that does the same job costs £5,000. There’s no evidence that one is better than the other but the more expensive component is still used on the NHS.
Briggs preaches a “getting it right first time” initiative. He argues that surgeries must be carried out to the best of a doctor’s abilities to avoid unnecessary revisions and infection rates, which are causing damage to both patient and purse. “If you could get the infection rate across the country down to 0.2% just in hip and knee replacements, you’d save the NHS every year £250m [to] £300m, just by improving the quality of care.”
Chicken or Egg
Briggs’s recommendations do have merit. He wants doctors to follow best practice guidelines and be consistent across the NHS. Such measures will not only improve care and reduce the need for more treatments, they will also save billions. It’s an NHS proposal that’s worth backing.
Unfortunately his plan glosses over the fact that quality of care relies on happy, well-rested and well-paid staff. Care won’t improve until the Government addresses that simple fact. Cuts and wage caps cause stress and staff shortages, and withholding more money is not going to undo this cycle.
Everyone else in this austerity-fuelled equation has held up their end of the unreasonable bargain. Briggs has found a workable solution to the seemingly impossible and the NHS has produced unimaginable results. Isn’t it about time the Government achieved something incredible too?
by Jo Davey
The post NHS Savings Boss: Service “Does Not Deserve” More Money appeared first on Felix Magazine.
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