Doing things differently
Trusts now have access to an increasing range of data sources that can help them to reshape the care they provide, including GIRFT, the NHS Benchmarking Network, RightCare and the Model Hospital. There are recognised challenges with reliability and validity within the datasets relating to interpretation of definitions and trusts’ coding practices but the clinical engagement and reflection on best practice that the GIRFT process is unlocking across the sector is creating strong opportunities to deliver tangible improvements in patient outcomes. Trusts have told us that they are positive about the potential for GIRFT data and further respectful, constructive clinical engagement to drive change.
We heard about early successes and improvements made in trusts that have used the GIRFT programme data to develop stretching plans to deliver improvements. As NHS Improvement develops its implementation support as part of the GIRFT programme, it is vital for trusts to engage and shape this work through providing regular feedback to regional teams. The programme is in an early stage and therefore it is crucial that trust perspectives and views shape its rollout.
Understanding value and patient outcomes
Trusts are charged by the national health bodies with delivering improvements in quality while controlling or reducing costs. NHS providers have demonstrated time and time again that, when given the appropriate support, they are capable of securing impressive improvements in operational productivity while maintaining high standards of patient care. It is understandable that trusts have sometimes regarded quality improvement and cost control as being in tension. One of the central premises of the GIRFT programme, however, is that improving clinical quality also tends to reduce costs for the relevant health and care system.
It is important that trusts are able to quantify the ‘value’ they add for a patient; the health outcomes achieved, relative to the cost of achieving those outcomes. As indicated by the increasing adoption of patient level information costing systems (PLICS) by trusts, providers are actively developing more detailed understandings of the health outcomes they achieve and the costs of achieving them.
Nonetheless, trusts should continue to make every effort to ensure they have the costing and coding resources, financial information systems, analysis capacity and strategic focus required to continue to deliver high quality care while improving operational productivity.
Aligning with other programmes of work
The inputs and outputs of the GIRFT programme should as far as possible be integrated within existing programmes of work rather than viewed as a programme in isolation. It is well known that trusts are under considerable pressure, facing capacity constraints to deliver on all the requirements expected of them locally and nationally, and at the same time, project management and change management resources are at a premium. The trusts we spoke to raised the importance of integrating the GIRFT programme within business as usual outputs as much as possible, such as clinical service strategy reviews and cost improvement programmes. That way the programme can accelerate existing programmes of work.
Some trusts are establishing a central corporate coordinating function for following up with clinical specialties on their implementation plans. In some places these teams are coordinating trust resources for both GIRFT derived and wider operational productivity programmes.