© Tyler Olson
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PATIENT SAFETY
Tackling variation: Getting it right first time
In February 2016,LordCarter’sreporthighlighted the opportunity to save up to £5 billion by tackling unwarranted variation – a potential contribution of at least 9%on the £55.6bnspent onNHSacute hospitals. Sowhat action has been taken to drive this forward and deliver these savings?
A key initiative aimed at tackling variation in the NHS has been the development of the Getting It Right First Time (GIRFT) programme. In essence, “getting it right first time” is about not wasting NHS money through preventable mistakes, readmissions, unwarranted variation and litigation. In tackling variation in practice, the aim is to identify recommendations that can help improve the quality of care and outcomes for patients, as well as improve efficiency for the health service.
The programme initially started as a pilot within orthopaedic surgery, led by orthopaedic surgeon Professor Tim Briggs and hosted by the Royal National Orthopaedic Hospital NHS Trust (RNOH). Following the pilot, NHS Improvement (NHSI) conducted a survey of more than 70 Trusts and found total savings of up to £30 million for 2014/15 and an estimated £20 m for 2015/16 as a result of adopting GIRFT’s recommendations. If extrapolated across the more than 140 providers, it was suggested that these savings could total almost £100 m.1 Prof Briggs was quoted as saying: “The waste and variation out there is unbelievable, and we have got to get our act together across all the specialties to improve quality and unwarranted variation and complications. And it is not just orthopaedics. “For example, if you have your tonsils taken out, you would think you could get that right, wouldn’t you? The re admission rate at 30 days varies from 4% to 27%. If you have a ventriculoperitoneal shunt, the revision rate at 28 surgical centres varies from 4% to
44% at two years, and the infection rate varies from 0.2 to 6%. Totally unacceptable. So we have got to put that right.”2
Expanding efforts across specialties
Further expansion of GIRFT was made possible by £60 m of funding from the Department of Health and was announced, in November 2016, as part of a package of measures intended, in part, to reduce infection rates in the NHS. The Health Secretary, at the time, claimed that GIRFT would help save the NHS £1.5 bn per year. Today, the GIRFT programme covers 35 surgical and medical specialties. The latest national reports, in this programme, focus on urology services, cardiothoracic surgery and
The report highlights the need for a better career structure for specialist urolog ical nurses, to extend their role and help deliver more treatment in an outpatient setting.
SEPTEMBER 2018
neurology, and examine how to avoid unnecessary admissions, reduce the length of stay in hospital and improve the care pathway. While the findings relate to the specialties under review, there is much that is applicable to other areas of the NHS. The learning from the programme offers an opportunity to drive improvement and help the NHS deliver much-needed efficiency savings.
Urology services: struggling to meet targets
For urology overall, the picture is largely positive, with large numbers of patients receiving effective and timely treatment. However, there are concerns within the speciality that certain pathways are not as effective as they should be; that, with an ageing population, patient numbers are set to grow faster than staff numbers, and that there is a small group of providers that are routinely struggling to meet key performance targets.3
According to the GIRFT report, two of the most important findings emerged from
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