Can we afford quality healthcare in the current financial climate?

New programme examines performance across the health sector and highlights the need for integration and data sharing

Ambulance outisde A & E

Crowded A&Es, long waiting times and the trend of slightly slower emergency ambulance response, show cracks in quality. Photograph: Bethany Clarke/Getty Images

Just one year after the last Francis report – yet it seems a lot has happened. Analysis by the Nuffield Trust indicates though “quality” has been “on the agenda” there are real concerns about the impact of financial constraints. Can we afford quality?


The QualityWatch programme was set up to help us understand what is happening to quality during periods of financial constraint. Much of our information is sourced from performance measures used within a service – and a lot of effort is going in to looking at what’s happening to quality within organisations. But we also need to look across services too. I think there are two areas where this is especially important.


The first, is a key focus on models of integration around the obviouspressures on A&E and urgent and emergency care. Though performance is still better than it was ten years ago, when you look across the measures you see worrying signs of cracks.


These appear as crowded A&Es with long waiting times, the trend of slightly slower emergency ambulance response and the continued rise in emergency admissions – especially for some key groups like the frail elderly. Moreover this group is also made more vulnerable by “unprecedented” reductions in social care spending.


As we, and many others, have observed, these changes are unlikely to be due to a single factor but are more about the broader systems of care and our ability to prevent health crises and alternatives to hospital and A&E visits.


The second area has received less attention of late and is around the public health indicators – particularly the ones linked with prevention. These basic measures of population health are generally a reflection of much more than NHS care, but they can be slow to create change.


However there are some markers that are more sensitive and need to be watched, because they give early warnings of potential problems in the longer term. These include indicators around health related behaviours such as teenage conceptions, or those linked with the supporting processes around health screening and promotion.


There is also the question of health inequalities – which have stubbornly persisted whilst our general health improves. As money gets tighter it’s increasingly important that we watch carefully to ensure that economies do not adversely affect the quality of services and the well being of disadvantaged subgroups of the population.


Both these issues suggest the need to collate information, sometimes from providers, at a population level. Where information like this was once analysed by primary care trusts – it now resides between three new organisational types – clinical commissioning groups, commissioning support units, health and wellbeing boards and Public Health England.


But these are challenging times, especially for those charged with developing this local perspective, and it’s important that these bodies are supported in taking these population based views.


This means making data accessible across a locality, and having the capability and tools to combine information from providers and primary and community care services directed at the same population.


One example is being able to access anonymised records that link care episodes for a defined population, and capture the critical events in terms of people’s health, wellbeing and service use (such as the type of information that can be gleaned from initiatives such as For example we need to know, not just how well people recover from a hip fracture, but how well local preventive strategies are reducing theprevalence of hip fracture.


So yes we do have to improve the way we look at quality within organisations – and yes we do have to fill in the holes in our data sets – but we also need to invest in understanding the information that spans services. This perspective is going to be essential if the fledgling models of integrated care are to be successful, and if health and local authorities are to commission better quality outcomes for the whole community.


Martin Bardsley is the director of research at Nuffield Trust; the Guardian Healthcare Professionals Network is media partner for the trust’s Health Policy Summit on March 6 and 7.


This article is published by Guardian Professional.

Source – Guardian