Press Release

ACCA contributed to public sector efficiency debate at Labour Party Conference

Efficiency in the NHS is not necessarily about cost-cutting, but about good management and effective use of innovation and technology, ACCA’s (the Association of Chartered Certified Accountants) leading healthcare finance professional – Dean Westcott – said today at a fringe event at the Labour Party conference.

The fringe event - Bigger, Cheaper, Faster – Worse? Why we need to redefine efficiency -  was co-hosted with influential think-tank the new economics foundation (nef) and focused on achieving future efficiencies in public services. Discussions covered the areas of target-setting, long and short term strategies, challenges and innovation.

Drawing on a range of expertise, the event encompassed the views of senior finance professionals working in the NHS (represented by ACCA council member Dean Westcott); those representing local government workers (Paul Coen, Chief Executive of the Local Government Association); those charged with encouraging innovation in local government (Lucy de Groot, Executive Director IDeA - the Improvement and Development Agency for local government) and the forward thinking views of nef around the issue of measuring and evaluating well-being, as opposed to the more traditional targets found in the public sector.

At the event, Dean Westcott, a qualified accountant working as a Deputy Chief Executive and Finance Director for West Essex Primary Care Trust, explained that radical change is needed to meet and better control future demand for healthcare.

Westcott said: “In a recent PwC survey of 27 countries, it is estimated that if healthcare delivery does not become more efficient, costs could rise threefold by 2020. This is a startling fact which needs to be addressed now.”

Westcott also said that crucial distinctions are needed between long-term and short-term planning. He explained: “In my opinion, efficiency in the NHS has improved considerably in recent years, not least of all as a result of an enhanced performance target culture – but there is still a lot more that can be done.”

He added: “Whilst ACCA is broadly supportive of targets, there is a note of caution with regard to some which can have ‘unintended consequences’ and potentially hinder the delivery of efficiency.”

As an example, Westcott cited the implementation of Accident & Emergency maximum wait targets which have led to a position where the number of patients admitted for one night has increased significantly in some areas and it is questionable whether this leads to the most efficient use of NHS beds.

Dean Westcott also offered a series of six other recommendations for an efficient health service.

1. A challenging but important way of achieving efficiency is for the NHS to educate individuals about taking responsibility for their own health. But public health campaigns are obviously for the long-term.
2. The NHS’s mindset must allow for more financial ‘headroom’ to invest in the re-designing and implementation of healthcare services around the individual user. The target-setting process must be better managed and co-ordinated to ensure that short-term targets do not prevent wider longer-term goals being achieved.
3. ACCA recommends the introduction of policy impact assessments (PIAs) to improve the planning and efficiency situation. PIAs would help ensure better ‘buy in’ from those charged with implementing change, particularly clinicians, and ultimately lead the more efficient use of resources.
4. Lessons should be learned from the introduction of Payment by Results (PbR). For example, an ACCA survey of finance directors in England found that only 5% of organisations fully involved their clinicians in implementation, with 17% stating that their clinicians had not been involved at all in implementation. ‘Time constraints’ was the main reason given for poor clinical involvement.
5. Innovation is central to achieving greater efficiencies; in 2006, ACCA was commissioned by the European Union to research telecardiology services in Italy. The resulting report, called Telecardiology in Italy, revealed strong clinical evidence of how eHealth technologies can boost the effectiveness of health care and deliver greater value for money. But technologies are ever-changing and expensive, so re-investing for the future is crucial.
6. Effective information systems are also crucial to the efficiency drive. A main priority for the NHS Institute for Innovation and Improvement should be to gather economic analyses of areas they have identified as best practice. This information should then be disseminated to those charged with implementing policy – responsibility for improving the information systems to achieve this should be high on the agenda for NHS Connecting for Health.

Westcott concluded: “My everyday working life is in the NHS. I have the opportunity daily to observe and experience the vital contribution both clinicians and finance professionals make to the well-being, not only of individuals, but of society itself. With extended life expectancy and ever-rising demand for healthcare, increased efficiency in the health sector is essential. There are many challenges ahead, not least on how to motivate individuals to take responsibility for their own lifestyles, especially in a health system which is free at the point of care.”