Better value in the NHS: The role of changes in clinical practice

This content relates to the following topics:

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.

Related blogs


Pearl Baker

Independent Mental Health Advocate & Advisor/Carer,
Comment date
21 October 2015
My first comment is directed to the last paragraph page 114, there is no mention of Carer's input or are we now called patient's?

It is very clear that some 'groups' are getting more from the 'better care fund' than others! there should be a study of which groups these are, and who are 'missing' out?

My latest campaign is directed towards the MCA2005 code of practice particularly those subject to a COP 'Property and Finance' order.

The OPG have been contacted regarding my concerns with 'Safeguarding' where the LA/corporate Deputy's are not always applying the rules regarding Section 117 of the 1983 MHA and the Care Act 2014, they have accepted my concerns and now reviewing the OPG regulations.

No Monitoring takes place of the Corporate Deputies /LA and with no training in the latest Care Act 2014 or knowledge of the information in the MHA/mental Capacity Act code of practice it soon became very clear that the vulnerable were being exploited, particularly by the LA who are 'short of funds'.

My concerns above, has been identified and evidence provided that the system of protecting the vulnerable is 'not fit for purpose'. No Care Plans for the LTC patients subject to section 117 and the COP, this effects everything there is, that isn't right about the entire system of health and social care.

Until those attempting to make a difference know who can be involved in delivering 'GOOD' health and social care that is patient centred' nothing will every change.

I appear to be the 'lone ranger' trying to educate those attempting to put in a 'better system of health and social care' but you need to know what the old one is like first. Agree?

Add your comment