Meeting the quality and productivity challenge

In July 2010, the White Paper: “Equity and excellence: Liberating the NHS” set out the coalition Government’s vision for the future of the NHS. Included in these plans was a commitment to a programme aimed at improving “Quality, Innovation, Prevention and Productivity” (QIPP). The initiative aims to take forward Lord Darzi’s desire to place quality at the heart of the health service – first outlined in his NHS blueprint, “High Quality Care for All”. However, in view of the current economic crisis, there is now a heightened sense of urgency to implement the fundamental principles of QIPP. The NHS has been tasked with identifying £15 billion to £20 billion in efficiency savings by the end of 2013/14, which must be reinvested into the service, if year-on-year quality improvements are to continue to be delivered. At a recent conference entitled: “A practical guide to delivering High Quality Care for All through QIPP”, Jim Easton, national director of the Quality and Productivity Challenge, Department of Heath, commented: “The Government has declared that the NHS will be protected from the cuts experienced by other public services – this is a great gift, but it comes at a price. There will be no excuses for failing to deliver; there will be tough times ahead and expectations will be raised... Complaining about financial pressures will not help to defend our privilege as a protected institution – instead, we must demonstrate that we are turning the NHS into a better service.”

He pointed out that the amount of money invested the NHS will remain flat for a number of years, with very little growth, which will present a significant challenge in terms of adjusting to the profound changes ahead. “In previous years, there have been significant increases in investment and, as a result, our mindset has become conditioned for growth – all our expectations are concerned with using new money in the NHS to do great things, but this will no longer be possible,” he warned. “We are therefore faced with a choice. We can either accept that there will be a decline in the levels of service, or we can make a commitment to drive up quality during this period of financial stringency – through clinical and managerial leadership. As the money becomes tight, there is a risk of letting quality drift and there will be significant outside pressures to lift the Government’s protection of the NHS.” Although the Commonwealth Fund report ranked the UK’s healthcare system as the most efficient out of seven industrialised countries,1 significant opportunities remain to reduce waste and inefficiency in the NHS. Jim Easton said the focus will be to improve staff productivity, procurement, management and use of medicines, staffing and backoffice support, as well as the way in which the NHS commissions primary care. There will also be a move towards delivering care in the home for chronic, long-term diseases, as opposed to hospitalisation, along with an emphasis on early diagnosis and prevention.

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