How staff can lead the way in a redesign

£20bn - it is a figure known by every professional working in the NHS in England. We all know that the government’s efficiency target is meant to be reached by 2015, but in a service that is caring for an increasing number of patients each year, many wonder how it will ever be achieved.

They are not wrong to have reservations. No organisation with the operational size of the NHS has ever been tasked with saving such a vast amount of money in such a short time.

What is more, the painful irony of the situation is that when short-sighted cuts are made to frontline staffing, the NHS becomes less efficient, not more. The RCN’s own analysis has highlighted that at least 56,000 jobs in the NHS are earmarked to go, a figure which has grown exponentially since we started monitoring cuts in 2010.

But the intense pressure being placed on frontline services, both in primary and secondary care, is not going to ease, with more and more people requiring long term, complex treatment.

So, with that efficiency target, more patients and a need to fundamentally change the way care is delivered, you could be forgiven for thinking progress is impossible.

However, there is a way to overcome the biggest challenges; to save money, care for more patients and deliver a better service: namely, innovative staff-led service redesign.

Elephant in the room

I am well aware that for many, the idea of redesigning services at a time of apparent financial crisis will seem like a naive distraction. However, the only way in which our NHS will be able to be cope with the demands of tomorrow is by radically changing things today.

When most of us think about service redesign, we undoubtedly imagine small changes to practice and procedure. There is, however, a bigger “elephant in the room” when it comes to changing the way care is provided.

I am on record in this journal as questioning the sheer extent of services delivered in acute settings. Often built in the age of Queen Victoria, stuck in the middle of our biggest cities, these acute centres duplicate much of the care delivered in our communities.

A dramatic and politically awkward question lies before us: just how “fit for purpose” is this way of caring for patients? It isn’t. Our politicians need to have the courage to accept the inevitable flak and do what we know is right - move care from the ward to the community, from the hospital bed to the living room.

In terms of more immediate possibilities, however, a quick glance at some of the financial savings of service redesign should convince even the most pessimistic commentators that the future lies in doing things differently. According to NHS Improvement, halving the length of stay for patients having day case or one-night-stay breast surgery could save £10.5m.

An astonishing 8,000 strokes could be prevented every year by using new detection tools, saving the NHS £96m, and £106m could be saved by working to free up avoidable bed days for non-elective cardiac patients.

These numbers are not just idealistic, there are tangible examples of where changing the way care is delivered can dramatically improve the patient experience, and save money.

Empowered staff

In cytology, NHS Improvement and staff on the ground implemented new procedures where all women would have their screening test results within two weeks. At 16 pilot sites, the move benefited one million women, removed 10 million waiting days and saved £1.6m, or around £100,000 per site.

Care delivered to our older patients is another area where, if empowered to do so, staff can redesign a service. A project in Lewisham saw staff work together to improve the service for stroke patients when moving from hospital to home.

Before the project began, a stroke patient would need to pass through seven teams, with seven different levels of quality of service. The average length of stay was 22.5 days and only 41 per cent of patients spent the majority of their time in the dedicated stroke unit.

With real input from staff, the entire pathway was redesigned; there was a focus on joint working and stroke rehabilitation moved from several teams, to a single unit. The results speak for themselves; the length of stay has dropped to 19 days and 80 per cent of patients now spend the majority of time in the stroke unit, where they get the very best care.

Examples like these should give us all hope; staff-led redesign is not just something to daydream about, it can be done. However, it can only be achieved if staff are empowered to lead, given the tools to do the job and encouraged to think innovatively.

The seemingly impossible triple task of saving money, coping with more patients and improving care can be overcome, but only if we think a little differently.