Healthcare delivery
Transform care with value-based healthcare
Value-based healthcare in the NHS aims to reduce unwarranted variations, improve patient outcomes, optimise resource use and allocation, and minimise costs. Mary Muir provides an insight into the key considerations required to ensure equitable and sustainable healthcare, while improving the experience and outcomes for patients.
Hospitals play a crucial role in supporting the most vulnerable members of our society, and their importance will continue to grow with our ageing population. In recent years, the acute care setting has witnessed a paradigm shift in how value is perceived and measured. In this new paradigm, value-based healthcare is defined as the equitable, sustainable, and transparent use of the available resources to achieve better outcomes and experiences for every person.1 Value-based healthcare prioritises outcomes and cost-effectiveness, ensuring that patients receive high-quality care. This aligns with the CQC Single Assessment Framework that focuses on care that is safe, effective, caring, responsive to people’s needs and well-led.2,3 This framework is guided by the Health and
Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3),4
and Care Quality
Commission (Registration) Regulations 20095 part of their current inspection process.6
as
The challenge: quality care versus cost efficiency Healthcare facilities in the acute care setting must deliver high-quality care alongside managing costs, meeting CQC standards, and minimising litigation liability. Challenges in the healthcare sector include a changing patient population, staffing resources, staff knowledge and care skills, equipment provision, and care delivery methods. According to the NHS Long Term Workforce Plan, addressing staffing resources, knowledge, and skills is crucial to establishing a sustainable workforce and improving patient care.7
the development of a sustainable healthcare system through three priority areas “train, retain, and reform”.8 Value-based healthcare in the NHS aims
to reduce unwarranted variations, improve patient outcomes, optimise resource use and allocation, and minimise costs.1
This approach is particularly important for acutely ill patients,
where minimising the effects of immobility and deconditioning is crucial. Effective management of these acute patients9
includes tailored plans
of care to promote recovery, which could include early mobilisation.
Immobility, deconditioning and associated risks Patients of all ages are at risk of the consequences of immobility, particularly as they get older, which can lead to institutional care10 and deconditioning.11
Deconditioning refers This approach supports
to the decline in physical, psychological, and functional abilities due to prolonged bed rest and the associated loss of muscle strength.12 Challenges faced by older patients during hospital admissions include: l Frailty that is linked to higher two-year mortality rates in patients discharged from the hospital, regardless of whether their stay was short (less than 72 hours) or extended.13
l Up to 50% of older patients can become incontinent within 48 hours of admission.12
l In the first seven days of admission, inpatients can lose up to 10% of their muscle strength, and circulatory efficiency can decrease by up to 25%, leading to a reduction in dignity, quality of life, confidence, independence, and choice.12
Hospital-associated deconditioning, also known as post-hospital syndrome, is a state of poor functional performance following acute hospitalisation.14
A study by Chen et al (2022)
identifies hospital-associated deconditioning as a significant risk factor for mortality, rehospitalisation, and admission to care home facilities within the year following discharge. To enhance overall quality of life and reduce healthcare costs, targeted prevention and intervention strategies addressing deconditioning are essential.14,15 Rehabilitation and physical therapy are
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