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Financial and Operational Management of Nuclear Medicine Departments in the NHS Within the London Area

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Financial and Operational Management of Nuclear Medicine Departments in the NHS Within the London Area Imagem Sara Raquel Costa Soares Financial and Operational Management of Nuclear Medicine Departments in the NHS within the London Area Dissertação de Mestrado em Gestão e Economia da Saúde, apresentada à Faculdade de Economia da Universidade de Coimbra Orientadora: Drª. Prof. Carlota Quintal Setembro de 2015 Cover (FEUC template) and illustration: Sara Soares Sara Raquel Costa Soares Financial and Operational Management of Nuclear Medicine Departments in the NHS within the London Area Dissertação de Mestrado em Gestão e Economia da Saúde, apresentada à Faculdade de Economia da Universidade de Coimbra para obtenção do grau de Mestre Orientadora: Prof. Doutora Carlota Quintal Coimbra, 2015 Acknowledgments I would like to thank my supervisor, Prof. Drª. Carlota Quintal, for the patient guidance, encouragement and advice she has provided during this last year. I have been extremely lucky to have a supervisor who cared about my work, and who responded to my questions and queries so promptly. I am very grateful for all the interviewees that made this study possible. Without their cooperation and understanding, I would not have learnt so much like I did. I must express my gratitude to Stefan, my boyfriend, for his continued support and encouragement. He must know more about this work than me, after reading it so many times. Sorry for the sleepless nights. I am thankful for the patience of my mother, father and brother who experienced all of the ups and downs of my research. Completing this work would have been all the more difficult were it not for the support and friendship provided by my work colleagues of the Nuclear Medicine department at King´s College Hospital. Similar, profound gratitude goes to Andrew Cheetham that contributed with his scientific knowledge to take all my doubts and to Gillian Clarke that recruited and convinced some of the participants. A very special thanks for all my friends and family for almost unbelievable support. iii iv Abstract Nuclear Medicine departments have a very complex structural organisation. These offer a variety of diagnostic and therapeutic procedures, which often play a central role in patient management. A diversity of professionals work together to provide the best possible care to patients, by using the available resources in the most efficient way. The financial and operational management of these departments is dependent on the payment system model, Trust policies and actions taken by the service/divisional managers. It is expected that 2015/16 will be one of the toughest financial years that the NHS in England has ever faced. In this circumstances, providers and commissioners will need to work together to identify opportunities for improving system efficiencies. Taking that into consideration, the main objective of this dissertation is to analyse Nuclear Medicine department service leaders perspectives of how to increase efficiency and productivity, considering the context in which they operate. For that, semi-structured interviews were conducted, face-to-face, to 10 Nuclear Medicine department´ service leaders in their workplace. The adopted methodology was qualitative and applied the techniques of thematic analysis in the study of the interviews. One part of the results reveals that the service leaders are trying to reduce costs and improve the department performance, to meet the Trust Cost Improvement Plan target. To improve the efficiency, each department needs to evaluate and optimize all processes, since receiving the referral to report the results. Service improvements methodologies can be an asset. For some it is being difficult to meet the demand requirements, because there are not sufficient human and material resources. More preventive actions (cost savings) actions need to be taken. Service leaders need to fulfil their managerial responsibilities and the Trust needs to provide the correct incentives to make that happen. Keywords: Nuclear Medicine, Trusts, Payment by Results system, Operational Management, Financial Management. v vi Resumo Os departamentos de Medicina Nuclear têm uma organização estrutural muito complexa. Estes fornecem uma grande variedade de procedimentos diagnósticos e terapêuticos, que muitas vezes desempenham um papel central na gestão paciente. Diversos profissionais trabalham em conjunto para proporcionar os melhores cuidados possíveis aos pacientes, usando da maneira mais eficiente os recursos disponíveis. A gestão operacional e financeira destes departamentos é dependente do modelo de pagamento, políticas do hospital e ações adotadas pelo gestor do serviço ou gestores divisionais. Espera-se que 2015/16 seja um dos anos financeiros mais complicados de enfrentar. Nestas circunstâncias, os prestadores e comissários terão que trabalhar em conjunto para identificar oportunidades em que possam melhorar a eficiência do sistema. Tendo estes fatores em consideração, o objetivo principal deste trabalho é identificar as variáveis que levam ao aumento da eficiência e produtividade dos departamentos de Medicina Nuclear, na perspectiva dos seus líderes. Para isso, foram conduzidas entrevistas semi- estruturadas e presenciais, a líderes de 10 serviços de Medicina Nuclear nos seus respectivos locais de trabalho. A metodologia adotada foi qualitativa e foram aplicadas as técnicas de análise temática no estudo das entrevistas. Uma parte dos resultados revela que os líderes dos serviços estão a tentar reduzir os custos e a melhorar o desempenho do departamento, para atingir a meta do Trust Cost Improvement Plan. Para melhorar a eficiência, cada departamento deve avaliar e otimizar todos os processos envolvidos desde a entrega da prescrição até os resultados do exame. A aplicação de metodologias para otimizar estes processos, podem ser uma mais-valia. Para alguns, está a ser difícil satisfazer as necessidades da procura, uma vez que os recursos humanos e materiais são insuficientes. Assim, mais ações preventivas (com o intuito de reduzir custos) precisam de ser tomadas. Os gestores dos departamentos precisam de cumprir as suas responsabilidades gerenciais e os hospitais devem fornecer os incentivos corretos para fazer isso acontecer. Palavras-chave: Medicina Nuclear, Trusts, Sistema por Pagamento de Resultados, Gestão Operacional, Gestão Financeira. vii viii List of Abbreviations A&E- Accident & Emergency APC- Admitted Patient Care ARSAC- Administration of Radioactive Substances Advisory Committee BNMS- British Nuclear Medicine Society BSc- Bachelor of Science CCGs- Clinical Commisioning Groups CIP- Cost Improvement Plan CSU- Commissioning support units CT- Computed Tomography DATScan- Dopamine Transporters Scan (tradename) DCR- Diploma of the College of Radiographers DEXA- Dual-energy X-ray absorptiometry DH- Department of Health DMSA- Dimercaptosuccinic Acid DNA-Did Not Attend DTPA- Diethylene Triamine Pentaacetic Acid DVLA- Driver and Vehicle Licensing Agency EBS- Electronic booking compliant e.g.- exempli gratia (for example) EPR- Electronic Patient Record Euratom- European Atomic Energy Community FDG- Fludeoxyglucose FT- Foundation Trust GBq- Gigabecquerel GFR- Glomerular Filtration Rate GP- General Practitioners HIDA- Hepatobiliary Iminodiacetic Acid HIS- Hospital Information System HMPAO- Hexamethylpropyleneamine Oxime ix HRG- Healthcare Resource Groups HSCIC-Health & Social Care Information Centre ICD-10- International Classification of Diseases tenth revision i.e.- id est (that is to say) IRMER- Ionising Radiation Medical Exposure Regulations IT- Information Technology MAG3- Mercaptoacetyltriglycine MBq- Megabecquerel MDP- Methylene Diphosphonate MDT- Multidisciplinary Team MFF- Market Forces Factor MIBG- Metaiodobenzylguanidine MPS or cardiacs- Myocardial perfusion scans MRI- Magnetic resonance imaging MSc- Master of Science mSv- Millisievert MUGA- Multi Gated Acquisition (Scan) n.d. - no date NFSIR- National Framework for Service Improvement In Radiology NHS- National Health Service NICIP- National Interim Departmental Imaging Procedure NM-Nuclear Medicine NMD-Nuclear Medicine departments OP- Outpatients Procedures OPCS-4- Office of Population Censuses and Surveys 4 OT- Outpatients Attendance PACS- Picture archiving and communication system PbR-Payment by results PCT-Primary Care Trusts PET/CT- Positron Emission Tomography/Computed Tomography x PGDip- Postgraduate Diploma QIPPs- Quality, Innovation, Productivity and Prevention RIS or CRIS- Radiological Information System RIT- Radioisotope Therapy SeHCAT- Selenium Homocholic Acid Taurine SLA- Service Level Agreement SLR- Service-Line Reporting SMS- Short Message Service SPECT/CT- Single-Photon Emission/Computed Tomography SUS- Secondary Uses Service TFC-Treatment function codes TRUD- Terminology Reference-data Update Service UK- United Kingdom V/Q- Pulmonary Ventilation/Perfusion Scan VR- Voice Recognition xi xii Index Chapter 1: The NHS structure, its funding and financing .................................................... 5 1.1 Overview of the main organisations responsible for NHS financing and their role ....... 5 1.1.1 The Department of Health ........................................................................................ 5 1.1.2 NHS England ............................................................................................................. 6 1.1.3 Clinical Commissioning Groups ................................................................................. 7 1.1.4 Commissioning Support Units ..................................................................................
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