Healthcare quality and efficiency support team: annual report 2013

Introduction and Context

Strategic Context

The Healthcare Quality Strategy for Scotland (Quality Strategy), launched in May 2010, provides the basis for the people who deliver healthcare services in Scotland to work with partners and the public towards our three Quality Ambitions and shared vision of world-leading safe, effective and person-centred healthcare.

In 2011 the Scottish Government announced its ambitious plan for integrated health and social care and set out the 2020 Vision and Strategic Narrative for achieving sustainable quality in the delivery of health and social care across Scotland.

This vision is supported by A Route Map to the 2020 Vision for Health and Social Care Care (Route Map) launched at the NHSScotland Event in June 2013. The Route Map sets out a new and accelerated focus on 12 priority areas for action and has been designed to retain focus on improving quality and to make measureable progress towards the 2020 Vision.

The Quality and Efficiency Support Team (QuEST) plays a key part in supporting NHSScotland to deliver the priority areas for improvement. In particular, QuEST will support delivery of the following priority areas through its programmes:

• Efficiency and Productivity - the Efficiency and Productivity Portfolio Office will support NHS Boards to achieve value and sustainability, for example by increasing shared services where appropriate to reduce waste,
  duplication and variation
• Unscheduled and Emergency Care - the Whole System Patient Flow Programme* will support NHS Boards to increase flow through the healthcare system
• Primary Care - the Outpatients, Primary and Community Care Programme supports NHS Boards to shift the balance of care from acute to primary care and home to meet increasing demand
• Prevention - the Cancer Performance Support Team supports NHS Boards to improve survival for people with cancer in Scotland by diagnosing and treating the disease at an earlier stage

The 2020 Vision and the Strategic Narrative describe the challenges for health and social care for the future and our direction of travel. The Quality Strategy provides the approach and the required actions to improve both quality and efficiency in order to achieve financial sustainability.

The Quality Strategy is supported by the NHSScotland Efficiency and Productivity Framework for SR10 (Framework) which emphasises the need for quality healthcare to be delivered in a sustainable way.

A key priority for QuEST for 2013-14 will be a refresh of this Framework to ensure it continues to reflect the context within which NHSScotland operates, and provides practical tools and guidance to support NHS Boards to deliver quality healthcare, whilst achieving efficiencies to ensure the sustainability of the service.

NHSScotland is committed to becoming a world leader in healthcare quality and to meeting the overall aim of the Quality Strategy 'to deliver the highest quality healthcare services to people in Scotland and through this to ensure that NHSScotland is recognised by the people of Scotland as amongst the best in the world'.

The Quality and Efficiency Support Team

* Formerly the Acute Flow and Capacity Management Programme

QuEST provides support to NHS Boards to enable the delivery of key NHS priorities with a particular focus on achieving these through actions which improve both the quality and the efficiency of services including:

• identifying, testing and spreading changes which could significantly improve both the quality and efficiency of services
• developing guidance and tools to support NHS Boards to deliver key NHS priorities
• providing targeted support to NHS Boards who may require additional help to deliver NHS priorities
• supporting NHS Boards to use data to identify opportunities for improving the quality and efficiency of services
• coordinating the implementation of the NHSScotland Efficiency and Productivity Framework for SR10
• coordinating emerging innovation and best practice across programmes to support a whole system approach
• supporting NHS Boards to develop their capacity and capability for continuous quality improvement
• contributing to national partnerships such as the Quality Improvement Hub

Quality Improvements and Efficiency Savings

QuEST works with NHS Boards to identify opportunities to deliver improvements in quality at lower cost. While seeking greater efficiency to counteract the cost pressures facing NHSScotland, everything should be done to prevent cost reduction measures that decrease the quality of services. Our approach seeks to maximise opportunities for quality and efficiency to deliver sustainable services now and in the future.

Headlines

• During 2012-13 NHS Boards reported efficiency savings of £270 million (2011-12, £319 million) against an efficiency savings target of £264 million.
• Over three quarters (78 per cent) of reported efficiency savings achieved during 2012-13 are recurring.
• This equates to an efficiency saving of 3.1 per cent of baseline funding made available to NHS Boards across the whole of NHSScotland.
• This was the fifth year in a row that NHS Boards have exceeded their efficiency target of 3 per cent of baseline funding across NHSScotland. NHS Boards have delivered cumulative Efficient Government savings of £595 million between 2008 and 2011, £251 million recurring efficiency savings in 2011-12 and £270 million efficiency savings in 2012-13. This equates to over £1.1 billion (11 per cent of the revenue budget for NHS Boards in 2012-13) being reinvested to fund front-line services for patients.
• Efficiency savings are retained by Territorial NHS Boards helping to ensure on-going financial balance.
• NHS Boards delivered these efficiencies at the same time as making significant improvements to the quality of services:
  • Patients continue to be treated more quickly: 90.6 per cent of patients were seen and treated within 18 weeks from initial referral during March 2013 (the expected standard is 90 per cent).
  • The Scottish Government has delivered major improvements in cancer waiting times and is committed to improving the early detection of cancer. In October - December 2012, 98.1 per cent of patients diagnosed with cancer started treatment within 31 days of their decision to treat.
  • The overwhelming majority of patients are very positive about their experiences of NHSScotland services. The most recent survey of patients in Scotland showed that 89 per cent of Scottish patients rated their care and treatment at their General Practice as excellent or good.
  • Healthcare associated infections have fallen substantially. Between 2007 and 2012 there was a 78 per cent reduction in rates of Clostridium difficile and a 37 per cent reduction in Staphylococcus aureus bacteremia (i.e. MRSA/MSSA).