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Driving quality will help “unprecedented financial position”

Cost savings in the NHS should be achieved by driving up quality rather than slashing services, according to Jim Easton, national director for improvement and efficiency for the Department of Health (England).

Speaking at a recent procurement and distribution interest group meeting of the Guild of Healthcare Pharmacists, Mr Easton described the need for cuts in public spending and the economic challenges facing the NHS.

“For us — and I say this factually not as an exaggeration — it is an unprecedentedly difficult financial position. It is the most difficult, sustained financial settlement the NHS has faced.” He said that there have been periods where funding has been flat or dipped slightly for a year, but that has never happened over an extended period. The NHS has been allowed 0.4% growth each year, he told the audience, but this is broadly flat in real terms.

“The problem,” he explained, “is that demographic changes and the growing elderly population mean that virtually all healthcare systems around the world spend more each year just to stand still. If you take in new technologies, our estimate [for the NHS] is that this creates £20bn of pressure over the next four years.”

He went on: “So it’s not that our budget has been cut by £20bn — the money coming in in a few years’ time will be broadly the same as it is now in real terms — but if we carry on running the NHS as we do today then we would be £20bn in deficit by 2014. And long before that we would be in deep, deep trouble.”

It is poor quality that costs, rather than high quality, Mr Easton made clear: “It costs in terms of wasted time and effort, it costs in terms of the patients who we harm, it costs in terms of those harmed patients staying longer in hospital or being readmitted.

In most healthcare systems the “basic belief is that we can improve quality if you give [us] some more money”, he said. The difficult choice the DH has made is to tackle the financial challenge by driving quality up, a decision he described as “deeply counter-cultural”.

Tony West, chief pharmacist at Guy’s and St Thomas’ NHS Foundation Trust, London, told the audience that there will still need to be decisions made by NHS organisations about what activities to stop doing.

He agreed with Mr Easton that “cash will be incredibly tight”. Mr West added: “We simply cannot afford waste. We must drive efficiency. And we must get value for the NHS, our patients and, above all, me as a taxpayer. But in doing that, we can’t compromise on quality.”


The autumn symposium of the Guild of Healthcare Pharmacists procurement and distribution interest group was held in Birmingham on 11 November 2010. Matthew Wright attended the meeting.


Citation: Clinical Pharmacist URI: 11049269

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