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Adoption of five good practices will lop 20% off hospital planned services bill

Applies to ophthalmology and orthopaedic elective procedures, but scope to extend further afield

Caroline White

Monday, 12 October 2015

Adopting nine good practices, such as stratifying patients by risk, hospitals could not only boost productivity in planned procedures, but also cut costs by up to 20%, says sector regulator Monitor, in a report* published today.

But just adopting five will realise most of the gains to be made, says the regulator.

The report and its appendices draw on research, jointly developed with the Royal College of Ophthalmologists and the British Orthopaedic Association, looking at the efficiency and productivity of elective ophthalmology and orthopaedic services at a range of NHS providers, as well as at five international centres in Australia, Europe, Finland and the US.

The services were all selected on the basis of their strong performance on both quality and cost containment.

Planned care accounts for around 18% of providers’ total annual expenditure, rising to over 30% if outpatient spend is included. It represents 34% of activity in acute specialist trusts, 23% in acute teaching trusts, and 21% in district general hospital, says Monitor.

Orthopaedics and ophthalmology together make up almost a third of total overheads on elective admitted patient care.

The report outlines where and how elective teams can best focus their efforts to maximise quality and efficiency across the patient pathway, from first consultation to postoperative follow-up.

The results include an assessment of the variability in NHS practice and the benefits for patients, such as shorter hospital stays.

NHS providers delivering ophthalmology and orthopaedic elective care procedures vary considerably in their staff and overhead costs per patient and number of patient contacts at each stage of the elective care pathway, offering the scope to iron out these differences and make productivity gains, says the report.

Among the various recommended measures, it suggests that patients should be stratified by risk, with lower risk patients offered simpler care pathways.

It recommends extending clinical roles to enable lower grade staff to undertake routine tasks in theatre or outpatient departments usually performed by consultants and increasing operating efficiency by better measuring, communicating, and managing the number of procedures carried out in each theatre session.

The implementation of enhanced and rapid recovery practices would also help to reduce length of stay, it says, while virtual follow up could be provided for patients without postoperative complications.

Dr David Bennett, who heads up Monitor, commented: “The financial challenge facing the NHS is growing and hospitals up and down the country are being asked to do more to make sure they live within their means. We are seeking to play our part by offering practical support to the clinicians, managers and frontline staff.”

He added that the money saved could trim planned surgery bills by up to 20% and be reinvested in improving patient care.

The report emphasises that the potential gains to be made extend beyond orthopaedics and ophthalmology, and are likely to apply to other elective procedures.

* Helping NHS providers improve productivity in elective care. Monitor, 2015

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