Health Foundation Election Briefings on funding, quality of care and workforce

Three Election Briefings from the Health Foundation ahead of the general election June 2017:

• Election briefing: NHS and social care funding – three unavoidable challenges
• Election briefing: Quality of care in the English NHS
• Election briefing: A sustainable workforce

Provision of community care: who, what, how much?

Provision of community care: who, what, how much?
Health Foundation May 2017

• Analysis of information obtained through FOI  requests on the community care contracts held by 78% of CCGs found that NHS providers held more than half of the total annual value of contracts in the sample, while private providers held 5% of the total annual value, but 39% of the total number of contracts issued.
• Private providers tended to hold much smaller contracts, with 6 in 10 holding contracts with a combined value of less than £100,000. Additionally, most held just one contract.

A year of plenty? An analysis of NHS productivity

A year of plenty? An analysis of NHS finances and consultant productivity
Health Foundation March 2017

• This report analyses the commissioning budget and finances of the NHS, NHS providers performance and the consultant productivity based on hospital activity at the provider level. It draws on their accounts from 2009/10 to 2015/16 and linking this to wider NHS data.
• The analyses show 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.
• Predictors of consultant productivity were found to include skill mix, hospital characteristics and regional variation.
• Conclusions
• "The last six years have seen big changes in the composition of the NHS workforce – fast growth in consultant numbers but little growth in nurses. Meanwhile, productivity for consultants and the wider workforce in acute hospitals has been falling. This does not mean that staff are not working incredibly hard – they are. But people work in teams and in systems. No matter how hard people work, if they are not supported properly by these systems they will not be as productive as they could be, which is bad for finances and bad for staff morale. There may be good reasons for the growth in numbers of consultants, but the NHS is not using their skills well – as the fall in consultant productivity shows."

Improvement Analytics Unit - Health Foundation and England partnership

Improvement Analytics Unit

Health Foundation 2016-2019

• The Improvement Analytics Unit is a partnership between NHS England and the Health Foundation to provide quantitative evidence to show whether new, local health care initiatives are improving care and efficiency as part of major national programmes. 
• By 2019, the unit aims to provide regular, rapid feedback to approximately 20 local initiatives to inform learning and improvement. 
• Benchmarking reports will be provided to local initiatives on a quarterly basis for them to consider as part of their decision-making process, and will be used alongside wider work on local evaluation to determine what action to take.
• The Health Foundation will publish three annual reports, which will summarise the learning from the Improvement Analytics unit.

Press release 30 June 2016

How to build QI capability at scale - case studies

Building the foundations for improvement: How five UK trusts built quality improvement capability at scale within their organisations.
Health Foundation,  February 2015

• This report examines the improvement capability building approaches taken by five health and social care trusts across the UK - 
• East London NHS Foundation Trust
• Royal Devon and Exeter NHS Foundation Trust
• Salford Royal NHS Foundation Trust
• Sheffield Teaching Hospitals NHS Foundation Trust
• South Eastern Health and Social Care Trust 
• The report makes it clear that you can’t drive and sustain improvement across an organisation unless you have a process in place to develop the improvement knowledge and skills of clinicians and managers across health and social care.
• Key lessons for providers include
• Getting early board-level support is essential for any provider organisation considering building improvement capability at scale
• Provider organisations need to think carefully about how they will fund improvement capability programmes
• Provider organisations need to find ways of freeing up staff time to take part in training programmes
• Commissioners need to do more to support organisations developing improvement capability building programmes
• Arm’s length bodies need to give organisations the time and space to develop and embed their quality improvement programmes
• The report includes a checklist of points for provider organisations to consider before planning, designing and delivering an improvement capability building programme. 

QualityWatch - independent scrutiny of quality in health and social care

QualityWatch
Nuffield Trust, Health Foundation

• A research programme from the Nuffield Trust and Health Foundation providing independent scrutiny into how the quality of health and social care is changing over time  to both augment and inform the work of other statutory national bodies and initiatives.
• The work will include
• QualityWatch indicators - using a set of nearly 150 indicators we will explore changes in the quality of health and social care over time.
• Focus on’ reports - in-depth analysis of a number of key topics. Reports on Hip fracture and preventable admissions have already been published (Oct 2013).
• QualityWatch advisory group
• QualityWatch inaugural meeting was held on 9 October 2013

Updated guide to Quality Improvement

Quality improvement made simple 2nd ed
Health Foundation, August 2013

• This guide focuses on one important element of the quality agenda: quality improvement. It looks in particular at what are known as organisational or industrial approaches to quality improvement. These aim to bring about a measurable improvement by applying specific methods within a healthcare setting.
• A clear explanation of some common approaches used to improve quality, including where they have come from, their underlying principles and their efficacy and applicability within the healthcare arena.

Measuring patient experience - the evidence

Measuring patient experience - an evidence scan
Health Foundation, June 2013

• An overview of the range of methods that have been used to measure patient experience. This evidence scan addresses the following questions:
• How has the experience of patients and carers been measured in healthcare?
• What are the pros and cons of different approaches for measuring improvement over time?
• The evidence suggests 10 things that need to be considered when planning how to measure changes in patient and carer experience over time.
• Consider how patient experience is being defined to inform exactly what needs to be measured.
• Think about why patient experience is being measured and how the information will be used.
• Assess whether it would be useful to combine approaches so that both qualitative and more quantitative material is collected.
• Consider whether to ask everyone using the services or only a sample to provide feedback.
• Think about whether the best time to collect feedback is immediately after using the services, when experiences are fresh in people’s minds.
• Allocate enough time at the outset to plan and test measurement methods, particularly if these will be used for many years to monitor change over time.
• Think about how the end-result needs to be presented for various audiences as this may shape how data are collected. Potential outputs include statistical averages, in-depth quotes or graphs.
• Make sure that there is appropriate infrastructure at an organisational level to analyse and use patient experience information.
• Make sure that patients, carers, managers and health professionals are all comfortable with why feedback is being collected and how it will be used. Staff need to be on board as well as patients.
• Ensure that patient experience measures are seen as one component of a broader framework of measurement and that all of the approaches work well together, without excessive burden for either staff or patients.

How do we teach quality improvement?

Quality improvement training for healthcare professionals
Health Foundation, August 2012

• An evidence scan of the types of training about formal quality improvement techniqueswhich are available for health professionals, and discussion of the evidence about the most effective methods for training clinicians in quality improvement.

Value from limited resources thorough STAR

Looking for value in hard times
Health Foundation, August 2012

• A new approach to priority setting called Star (socio-technical allocation of resources) designed to help commissioners and others pinpoint where they may be able to get additional value from their resources by using them more effectively.
• An approach to comparing the value of different interventions with active input from staff, public and patients

Large scale change - what the evidence says

Cross sector working to support large-scale change – a scan of the evidence 
Health Foundation, August 2012

• A picture of research into cross sector working to support innovation and change including factors that are shown to help or hinder cross sectoral working.
•  The factors are grouped under the following categories:
• Leadership and vision
• Culture and attitudes
• Staff roles and training
• Infrastructure and processes

Large scale transformational change - how does it work?

Cross sector working to support large-scale change – a scan of the evidence

Health Foundation, August 2012

• A picture of research into cross sector working to support innovation and change
• An examination of the factors that are shown to help or hinder including, 
• Leadership and vision, 
• Culture and attitudes 
• Staff roles and training 
• Infrastructure and processes 

Challenges to quality improvement highlighted by the Health Foundation

Overcoming challenges to improving quality: Lessons from the improvement programme evaluations and relevant literature.

Health Foundation, April 2012

• A synthesis of learning from 14 of the Health Foundation’s improvement programme evaluations and set the learning in the context of the wider literature.
• 10 key challenges to improvement that consistently emerged in the programmes evaluated:
• convincing people that there is a problem 
• convincing people that the solution chosen is the right one 
• getting data collection and monitoring systems right 
• excess ambitions and ‘projectness’ 
• the organisational context, culture and capacities 
• tribalism and lack of staff engagement 
• leadership 
• balancing carrots and sticks – harnessing commitment through incentives and potential sanctions 
• securing sustainability 
• considering the side effects of change