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Better value in the NHS

The role of changes in clinical practice

In a time of severe financial constraint, the NHS is being asked to make productivity savings of £22 billion by 2020/21. However, this report argues that, rather than looking at efficiency and costs, the NHS should be focusing on getting better value from its budget.

The report looks at trends in NHS productivity in three areas – generic prescribing, length of stay and day case surgery – in which the NHS has made significant and sustained gains in productivity over a number of years, allowing more (and often better) care to be delivered within the same budget. It then outlines a number of areas where the NHS has opportunities to improve value in the future, focusing in particular on changes in clinical practice. The opportunities identified are:

  • tackling inappropriate care – overuse, underuse and misuse

  • identifying and removing unwarranted variations in clinical practice

  • using evidence of to find better ways of delivering care and support services for specific patient groups – such as people with long-term conditions, older people living with frailty and complex needs and people at the end of their lives.

With the NHS facing a huge financial challenge over the next few years, the report argues that action is needed at all levels of the system focused on improving value for every pound spent in the NHS.

Contents of the report

Click the section titles to go directly to that page of the PDF.

Key messages (page 7)

An overview of the findings of the report including lessons we can learn from past experience and an agenda for action in the future.

Introduction (page 10)

An outline of the contents of the report.

Productivity in the NHS so far (page 12)

An analysis of three areas – generic prescribing, length of stay and day case activity – where significant and sustained improvements in productivity have been made in the past.

Inappropriate care (page 44)

The impact of inappropriate care delivered in the NHS and its cost, including examples of overuse of low-value care, underuse of high-value care and preventable harm. Variations in clinical practice across the country are discussed.

Service areas (page 74)

Highlighting the opportunities available for delivering better value care for people with long-term conditions, older people, and people at the end of their lives.

Case studies of clinical teams delivering better value (page 103)

Examples of better value care from Plymouth Hospitals NHS Trust (stroke pathway); Sheffield (older people); Alder Hey Children’s Hospital (children with abdominal pain); and Walsall (repeat prescribing).

Creating an environment for change (page 114)

An agenda for action calling on patients, clinical teams, providers, commissioners and national bodies to act to put the report’s recommendations into practice.

Summary presentation

Ruth Robertson presents an overview of The King's Fund report, Better value in the NHS.