Maximising outcomes for every euro spent

Finance managers needed to have a knowledge of clinical quality and clinicians needed to have a basic financial knowledge of hospital costs, Dr. Mahmood Adil, National Quality & Efficiency Advisor, Department of Health, England told the 9th National Health Summit in Dublin.  Maureen Browne reports.

Finance managers needed to have a knowledge of clinical quality and clinicians needed to have a basic financial knowledge of hospital costs, Dr. Mahmood Adil, National Quality & Efficiency Advisor, Department of Health, England told the Conference.

He was speaking on “Value-Based Healthcare: Maximising Outcomes for every Euro Spent

“The old way was to work on quality, think about the financial impact later and hope it would be positive. The new approach is to reduce cost, waste and unnecessary variation, while maintaining or improving quality.

The new approach is to reduce cost, waste and unnecessary variation, while maintaining or improving quality.

“In England we did two national surveys on all the 248 trusts in England, where we asked them what were the barriers to developing effective engagement.  The consensus was that it was lack of basic financial knowledge among clinicians, lack of robust integrated clinical and cost data, poor preparation of financial data and lack of basic awareness of medicine/service improvement among financial managers.

“We came up with four levels of engagement – Level 1 at board level, level 2 on an ad hoc basis for a specific project, level 3 in at least one clinical specialty/department and level 4 across all clinical specialties. We need to get to Level 4 in all our hospitals.”

Dr. Adil said that a key change in NHS costing methodology was a patient level information and costing system for patients by hospital.  “This brings the knowledge of the clinical system and the financial system together and I want to change this knowledge into action.”

He said he would like to see finance modules included in undergraduate and postgraduate medical education, include it in Continuing Professional Development for the Royal Colleges and to improve the understanding of clinical care and quality improvement among financial professionals.

Value based healthcare was quality divided by costs. Austerity was going to last for a while and the UK had a time bomb with chronic disease.

He said he would like to see finance modules included in undergraduate and postgraduate medical education.

The NHS needed €126 billion funding for 2013/2014 and would have a shortfall of €21 billion, with no prospect of any real rise for the next three years.

There were five essentials for value based health care:

  • Effective engagement between clinicians and finance managers and managers generally
  • Availability of reliable cost and quality data
  • To build capacity among the clinical and managerial workforce
  • Deal with low value interventions and clinical variations and promote technology and service innovations
  • Identify and spread best national and international practice.

Dr. Adil said that there were 285,000 falls in the NHS in a year and almost 30 people had died following falls last year. “We asked hospitals to look at falls and it emerged that the cost of falls in a hospital was €200,000 per year and you could put interventions in place for €15,000.  You can measure the cost of that in 248 hospitals.  Doctors and managers need to own this together and if the interventions were put in place nationally in the NHS, it would save €30 million a year.”

“It is also important to showcase best practice, so we are encouraging our clinicians to come forward for awards.”