In the face of public sector cutbacks there is a drive to improve efficiency but not at the expense of quality. A number of national work streams have been initiated to drive this forward. This approach, when combined with service targets, has been very effective at cutting hospital-acquired infection by MRSA and Clostridium difficile. The national work streams fit into three key areas: commissioning, provider efficiency and system enablers.

Commissioning

• Safe care – will cut pressure ulcers, catheter-acquired urinary tract infections and falls

• Right care – will focus commissioning on high value, whole system pathways and networks rather than institutions. A key is the analysis of unexplained variations in spend on healthcare and health outcomes for the commissioners' population

• Long-term conditions – target management of those at risk to prevent disease progression, maximizing self-management, providing joined up and personal services and workforce development

• Urgent care – seeks a 10% reduction in the number of patients attending accident and emergency

• End-of-life care – aims to improve provision of services and management of the cohort of end-of-life patients.