Innovation: meeting the QIPP agenda

At the end of last year, Sir David Nicholson, chief executive of the NHS in England, reminded the health service of the importance of adopting innovation. At a time when Trusts are facing major financial challenges, the temptation is to cut back on investment in new technologies. However, he argued that it is because of these challenges that investment in innovation is now crucial. “Searching for and applying innovative approaches to delivering healthcare must be an integral part of the way the NHS does business,” he commented. “Doing this consistently and comprehensively will dramatically improve the quality of care and services for patients. It will deliver the productivity savings we need to meet the growing demand for services, and it will also support our role as a major investor and wealth creator in the UK.” (Innovation, Health and Wealth, December 2011). The report Innovation, Health and Wealth stated that the challenge for the NHS is to pursue innovations that ‘genuinely add value, but not cost’, while helping the NHS meet its productivity and quality goals: “Adding value and reducing cost is the basis of the NHS Quality, Innovation, Productivity and Prevention (QIPP) challenge. This puts a premium on game-changing innovations that change patient pathways and traditional delivery systems, and that are implemented in a way that strips out the processes that no longer add value.” The 2012/13 NHS Operating Framework also makes it clear that innovation is critical to improving quality and productivity. A number of ‘high impact innovations’ have been identified that will make a significant difference to the quality and experience of people’s lives, as well as delivering productivity improvements. These include the rapid spread of telehealth technology and routine use of fluid monitoring technologies. From April 2013, compliance with the ‘high impact innovations’ will become a prequalification requirement for the Commissioning for Quality and Innovation (CQUIN) payment framework. While healthcare leaders and key policy documents have emphasised the importance of innovation in meeting NHS QIPP challenges, UK healthcare organisations continue to lag behind the rest of the developed world in terms of implementation of innovative technologies. One example of how the NHS is missing out on valuable opportunities is the slow adoption of fluid management monitoring technology. The approach, which helps anaesthetists to monitor hydration of patients during surgery, has the potential to reduce mortality, improve the quality of care for more than 800,000 patients per year and save the NHS at least £400 m annually, yet it is currently being used on less than 10% of applicable patients (Innovation, Health and Wealth, December 2011).

NHS Technology and Adoption Centre

In 2007, the NHS Technology and Adoption Centre (NTAC) was established to address the slow take-up of innovation – by helping to identify and overcome the barriers to adoption. Sally Chisholm, chief executive of NTAC, commented: “At present, in an attempt to contain costs, many NHS organisations are almost in ‘lock down’ and wary of making investments. However, following the publication of the Innovation, Health and Wealth document, the Department of Health and, potentially, the NHS Commissioning Board Authority, will be encouraging innovation adoption.” She pointed out that there has not always been a culture of adoption of innovation in many NHS organisations in the past. However, the need for efficiency gains is now being widely recognised and, as a result of the report, more and more clinicians and managers are keen to engage with the adoption of technology that can help deliver savings, as well as improve quality of care. She went on to add: “If we are to deliver the targeted efficiency savings of £20 bn, we will have to do things differently – innovation adoption will be key to this. Crucially, innovations such as intra-operative fluid management monitoring will be linked to CQUIN payments. Organisations will not qualify for CQUIN if they cannot demonstrate that it is being utilised to the specified level.”