NHS finances and consultant productivity

The Health Foundation has published A year of plenty? An analysis of NHS finances and consultant productivity.

This report analyses the finances of NHS providers and the consultant productivity of acute NHS hospitals, drawing on their annual accounts from 2009/10 to 2015/16 and links this to wider NHS data. It shows that NHS providers saw relatively little of the income growth for the NHS as a whole, and that productivity for consultants and the wider workforce in acute hospitals has been falling.

Reducing hospital admissions by improving continuity of care in general practice

This briefing summarises research that analysed data from over 230,000 anonymised patient records for older people aged 62 – 82 years | The Health Foundation


Image source: The Health Foundation

  • Continuity of care is an aspect of general practice valued by patients and GPs alike. However, it seems to be in decline in England.
  • Our analysis, published in The BMJ and summarised in this briefing, looks at the link between continuity of care and hospital admissions for older patients in England. We looked specifically at admissions for conditions that could potentially be prevented through effective treatment in primary care.
  • We found there to be fewer hospital admissions – both elective and emergency – for these conditions for patients who experience higher continuity of care (ie those who see the same GP a greater proportion of the time). Controlling for patient characteristics, we estimate that if patients saw their most frequently seen GP two more times out of every 10 consultations, this would be associated with a 6% decrease in admissions.
  • To improve continuity for patients, general practices who are not already doing so could set prompts on their booking systems and encourage receptionists to book patients to their usual GP. Patients could also be encouraged to request their usual GP.
  • Clinical commissioning groups and NHS England Area Teams could work with general practices to support quality improvement initiatives that maintain or improve continuity of care.
  • Future national initiatives should have a well developed understanding of how and why the policy will impact on continuity in a particular context.

Read the full overview here

Read the full report here


Surgical site infections (SSI) surveillance: NHS hospitals in England

This annual report covers surgical site infection (SSI) data collected by NHS hospitals and independent sector NHS treatment centres.


Image source: PHE

This report is a summary of data on surgical site infections (SSIs) collected by NHS hospitals and independent sector (IS) NHS treatment centres in England participating in one of 17 surgical categories of surveillance between April 2004 and March 2015. The results include orthopaedic data submitted by hospitals following the mandatory surveillance requirement introduced by the Department of Health in April 2004 [1]. This requires all NHS trusts undertaking orthopaedic surgical procedures to carry out a minimum of three months’ surveillance in each financial year in at least one of four categories (hip prosthesis, knee prosthesis, repair of neck of femur or reduction of long bone fracture). Trusts with very small volumes are exempt from the mandatory surveillance but are expected to undertake surveillance in a category that reflects the largest component of their surgical activity.

Read the full report here

Morale of the medical workforce

The Royal College of Physicians has published Keeping medicine brilliant: improving working conditions in the acute setting.

This report focuses on developing the evidence base to support new ways of assessing and improving doctors’ morale.  The report also explores the issue of recruitment to the rank of medical registrar, and highlights that the perception of on-call roles as being extremely stressful and a significant deterrent to recruitment.

The RCP identify eight ‘domains’ of a doctor’s working life that need to be assessed and supported. The report suggests it is essential that all eight domains are addressed in a holistic way to improve the morale and wellbeing of doctors:

  • Work
  • Physical environment needed for work
  • Interpersonal relations in the workplace
  • Hospital administration and policies
  • Personal characteristics
  • Career, education and training
  • External/home circumstances
  • Patient safety

Managing doctors, doctors managing

Good working relationships between doctors and managers are critical for the safety and quality of NHS care. Yet recent reports have referred to a ‘gulf’ between the two groups | Nuffield Trust


Image source: Nuffield Trust

This research uses a detailed survey of doctors and managers at board and middle-management levels of NHS acute trusts, along with interviews and a focus group, to understand their views on the current state of the doctor–manager relationship in the UK, the pressures it is coming under, how it has changed, and the outlook for the future. Looking back on a survey from 2002 by the same authors, which identified similar themes, allows the research to examine what has changed over a decade of political turmoil, what has not, and where policy-makers and NHS leaders might look to improve the pivotal relationship between doctors and managers in future

Read the full report here

Market Structure, Patient Choice and Hospital Quality for Elective Patients

Moscelli, G. et al. (2016) CHE Research Paper 139


Image source: CHE

This paper examines the change in the effect of market structure on hospital quality for elective procedures (hip and knee replacements, and coronary artery bypass grafts) following the 2006 loosening of restrictions on patient choice of hospital in England.

We allow for time-varying endogeneity due to the effect of unobserved patient characteristics on patient choice of hospital using Two Stage Residual Inclusion. We find that the change in the effect of market structure due to the 2006 choice reforms was to reduce quality by increasing the probability of a post-operative emergency readmission for hip and knee replacement patients. There was no effect of the choice reform on hospital quality for coronary bypass patients. We find no evidence of self-selection of patients into hospitals, suggesting that a rich set of patient-level covariates controls for differences in casemix.

Read the full paper here

Stroke care: Only 20% of acute hospitals are meeting the standard for weekend nurse staffing levels.

National Report England, Wales and Northern Ireland. Prepared by Royal College of Physicians, Care Quality Improvement Department (CQID) on behalf of the Intercollegiate Stroke Working Party


Image source: HQIP

Other headline results from the 2016 acute organisational audit include:

  • Lack of essential psychology provision: Very few hospitals (6%) achieve the standard of one whole time equivalent (WTE) qualified clinical psychologist for every 30 stroke unit beds
  • Number of hospital sites with unfilled consultant vacancies rises by 14%.
  • There continues to be a reassuring increase in many areas of acute stroke organisation:
    – All hospitals now have a designated stroke unit
    –  7-day access to occupational and physiotherapy has increased to 31% and 40% of hospitals, however only    6% can provide speech and language therapy 7-days a week
    – 99% and 68% of hospitals are able to given their patients access to thrombolysis 24 hours a day, 7 days a    week and intra-arterial (thrombectomy) treatment on-site or by referral off-site respectively
    – 81% of hospitals have specialist early supported discharge (ESD) available to them meaning that patients     can return home sooner and receive specialist post-acute care

Read the overview here

Read the full report here