This project completed on
20 Sep 2012

The NHS is facing one of the most significant financial challenges in its history, with efficiency savings of four per cent per year now required. This comprehensive programme of research aimed to help the NHS respond to the financial challenges ahead by examining how health services can improve productivity and deliver more for less.

There are two broad ways in which the NHS can achieve greater efficiencies. First, providers can cut their costs and improve productivity and value, getting more for less. Second, commissioners can invest their money where it really adds value, through robust and evidence-based processes of setting priorities in a way that shapes new forms of service provision.

This programme of research examined the scope for greater efficiencies by providers and commissioners of care. The quest for efficiency in the English NHS was informed by rigorous analysis of existing UK and international research evidence and set out practical recommendations for managers, clinicians and policy-makers about how the NHS can improve productivity and respond to what has been dubbed the ‘Nicholson challenge’ – the requirement to make £15-20 billion in efficiency savings by 2015.

We made practical recommendations for how the NHS could deliver more value for less

We funded several linked projects which used new and existing research evidence to make recommendations for improving policy-making and practice in respect of NHS efficiency. The research projects are outlined here:

Can patient-level data help hospitals make savings?

With the need to make efficiency savings pressing heavily on providers, this project looked at whether new patient-level information and costing systems (PLICS) could help managers to improve technical efficiency.

Authors Ian Blunt and Dr Martin Bardsley carried out an in-depth study of an early adopter hospital trust where a patient-level costing system was being used to monitor costs by patient, consultant, and ward.

Their report: Patient-level costing: can it yield efficiency savings? (Nuffield Trust, September 2012), found that the new system gave a more detailed picture of the relationship between costs and care compared with traditional alternatives.

The data it provided showed notable variation in the costs of apparently similar treatments, and large disparity between costs of care and how much hospitals are paid at case level.

So far, there is limited evidence for cost savings as a result of patient-level costing, which emphasises that knowing the costs doesn’t by itself save any money. The report urges managers and clinicians to make more use of this information in terms of influencing practice to become more efficient.

Is it time to specify an ‘NHS benefits package’?

This project explored the nature and extent of the current NHS ‘benefits package’, considering in detail the advantages and disadvantages of introducing a more explicit list of NHS entitlements (and exclusions), as well as the potential role of co-payments or top-up funding in future.

The Nuffield Trust report: Rationing health care: is it time to set out more clearly what is funded by the NHS? (Nuffield Trust, February 2012), by Benedict Rumbold, Vidhya Alakeson, and Peter C Smith draws out learning for the NHS from countries that have sought to describe explicitly the health care benefits that are paid for by their publicly funded health systems.

Alongside this report, the Nuffield Trust and, the largest online professional network of doctors, conducted a survey of GPs in England to test opinion on whether – given the financial challenge facing the NHS – they believe the NHS will have to further restrict what is, and what is not, available to patients free at the point of use.

A regionally representative sample of 1,009 UK GPs took part in the survey – of which 821 were practising in the NHS in England. As the issues raised in the survey are most pertinent to the English NHS, all results included in this slideshow relate to the 821 GPs in England alone.

The findings from the survey can be accessed in a slideshow, as well as a downloadable document which includes a full breakdown of the survey data.

As part of this project the Nuffield Trust and The Royal College of Surgeons of England hosted a debate on whether the NHS should further restrict the services it provides to offer a core package of services for all patients. For further information and to access exclusive video interviews with speakers, visit the dedicated event page.

Making savings whilst improving quality in health care

Through interviews with NHS managers, turnaround experts and policy-makers, and a review of the international literature, this project sought to identify the main lessons from previous attempts to achieve greater technical efficiency within health systems.

The resulting report: Can NHS hospitals do more with less? (January 2012), by Jeremy Hurst and Sally Williams, focused on the key determinants of technical efficiency in hospitals, including: leadership, management and staff engagement; technology adoption; hospital operational processes; staff productivity; and the external policy environment. An accompanying research summary by the Nuffield Trust discussed the implications of their findings for policy and practice, in light of NHS reforms and the efficiency challenge.

Commissioning integrated care in a liberated NHS

With integrated care at the heart of the proposed reforms to the NHS, this project – led by Dr Judith Smith, Director of Policy, Nuffield Trust, and Professor Chris Ham, Chief Executive, The King’s Fund – examined the role of commissioners in promoting more integrated care services.

The full findings were published in the research report and accompanying summary: Commissioning integrated care in a liberated NHS (Nuffield Trust, Sep 2011) by Chris Ham, Judith Smith, and Elizabeth Eastmure. The report warns that the new generation of clinical commissioners will need significant support if patients are to benefit from more integrated and efficient care.

Setting priorities in health

This research project, carried out in partnership with the Health Services Management Centre (HSMC), University of Birmingham, explored how primary care trusts (PCTs) make decisions about funding priorities.

Full findings are available in the research report: Setting priorities in health: A study of English primary care trusts (Nuffield Trust, Sep 2011), by Suzanne Robinson, Helen Dickinson, Iestyn Williams, Tim Freeman, Benedict Rumbold and Katie Spence of HSMC and Nuffield Trust. The research summary: Setting priorities in health: The challenge for clinical commissioning by Nuffield Trust Director of Policy Dr Judith Smith, explores the implications of the results for the coming generation of clinical commissioners.

A steering group oversaw The quest for efficiency in the English NHS research programme – it was chaired by Nuffield Trust Trustee Andy McKeon, Managing Director of Health at the Audit Commission. The group included NHS chief executives, UK and international academics with expertise in health economics and health policy, and trustees and senior associates from the Nuffield Trust.

Project outputs


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