This week's budget held no great surprises for the NHS. We are increasingly aware of the gap between the money that will be available and what, even looking just at demographic trends, we need to spend to maintain services. Given this environment, can the experience of patients be improved, while spending less? The jury is out.
The Institute for Healthcare Improvement in the US adopts the useful concept of 'light green dollars' (improvements in efficiency, productivity, etc) and 'dark green dollars' (actual cost savings that release real cash). The economic climate, alongside the current policy push to provide financial incentives to improve the experience of patients, is beginning to focus attention on this in the UK too.
On the Point of Care programme, we are concerned with interventions that improve both patients' and staffs' experiences of care. But if such improvements don’t release dark green dollars are they still worth doing?
We think they are: what is crucial for any service improvement is that the anticipated impact on costs and productivity are clear (whether light or dark green), and whether light green improvements in productivity now might lead to dark green savings later.
Improvements in patients' experience should be understood as an integral part of the productivity challenge – delivering more for less. Streamlining a care pathway, reducing lengths of hospital stay, cutting waste and duplication will lead to a more efficient service and be better for patients: uncertainty, delays, repetition and inconsistency are costly and sap patients' confidence in the service. Clearer care pathways reduce error and lead to better communication between staff and patients, as well as improving self-management, and in some instances hastening healing. Many of these things are also positively linked with staff satisfaction.
These are 'light green pounds'. Their value shouldn't be underestimated, but they won't necessarily show up on this year's budgets. When these sort of changes free up actual capacity or actual finance (for example, reducing spend on agency staffing) then they become dark green.
There is a real opportunity to make improvements in quality and experience ultimately turn from light to dark green pounds if we focus on understanding their wider impact on services and costs and acknowledge the time it takes for this to happen.
Improving the experience of patients is compatible with improved productivity. But you won't always see it on this year's bottom line.