Health trust mounts heavy attack on traditional NHS culture

As politicians trade blows over the state of the health service, Salford Royal NHS Foundation Trust in Greater Manchester illustrates the heights Britain's taxpayer-funded behemoth can still attain.

Amid the hospital's buzz and bustle, it would be easy to conclude that the entire health service is in rude health.

In fact, as the NHS grapples with an unprecedented financial squeeze, Salford serves to show how far much of the rest of the NHS still has to go.

Sir David Dalton, the trust's chief executive, has in recent years introduced an array of approaches that amount to a multi-pronged assault on traditional NHS culture.

Its staff receive annual pay increments only if they can satisfy superiors they are meeting key yardsticks - a move towards performance-related pay that the wider NHS has been slow to embrace.

At almost every step, Sir David's belief in data as a tool to drive up standards and foster a culture of accountability is on display. Whiteboards outside each ward offer information such as when a patient last fell and the proportion suffering from pressure ulcers.

This rigorous focus on safety has helped to cement the hospital's reputation as one of the best-run in the country. "We know patients with infections or pressure ulcers stay in hospital longer to recover [and] that if we can reduce harmful events in the organisation we can treat more patients through the same number of beds so it improves our productivity," Sir David says.

Research for the Financial Times by the Health Foundation, an independent think-tank, reveals that hospitals became more productive in the first two years of the coalition government, but much of this ground was lost after 2012, as managers became absorbed in preparing for a big structural shake-up.

A report that disclosed substandard and cruel care at Mid-Staffordshire NHS Foundation Trust in the mid-2000s also played an important part in increasing hospital costs without a corresponding increase in the amount of care provided.

Amid a panic over quality and safety standards, hospitals found themselves under intense pressure to increase nurse numbers, and shortages led many to pay inflated prices to hire temporary nurses from agencies.

This has further raised costs even as activity growth has slowed in some parts of the health service.

Anita Charlesworth, the foundation's chief economist, says the "significant variation" in productivity her analysis had uncovered underlined the scale of the savings that could be achieved if the poorer performers caught up with high-flyers such as Salford.

However, since 2010, the NHS has "really struggled to make any inroads at all into that variation in productivity". Nor did health leaders appear to have "a strategy for how to narrow that productivity gap, and to get the poor performers to learn from the best and spread that expertise".

A report quietly commissioned last year from Lord Carter of Coles, a Labour peer, at the behest of Number 10 and the Treasury, as well as the health department, is emerging as pivotal to the case that ministers will make for funding in the next spending round.

It is understood to be focusing on how to improve the NHS's traditionally woeful record on procurement. Research commissioned by the Financial Times last year showed variations of as much as fivefold in the sums being paid for the same procedure in different hospitals.

In some instances, hospitals are paying different prices for the same piece of equipment from the same manufacturer.

Pay is another frontier that will have to be tackled by whichever party wins power at the next general election. Such efficiency gains as have been achieved in the past five years have owed much to a public sector wage freeze, an approach that is unlikely to be sustainable.

As the price of loosening the purse strings, Treasury officials are understood to be keen to tie payment of annual increments to specific outcomes, just as Salford has done.

Ms Charlesworth argues the notion that quality and financial control can go hand in hand has been lost in recent years and must now be reclaimed.

"[Hospital] boards and chief executives are saying, 'if I'm going to be shot for something, I'd rather be shot for money than for quality'. And then you've lost financial control and discipline in the system," she warns.

© The Financial Times Limited 2015. All rights reserved.
FT and Financial Times are trademarks of the Financial Times Ltd.
Not to be redistributed, copied or modified in any way.
Euro2day.gr is solely responsible for providing this translation and the Financial Times Limited does not accept any liability for the accuracy or quality of the translation