QIPP FOCUS
sible funding gap of £10-15bn by 2013/14 and that £13-20bn in effi ciency savings could be made over the next three to fi ve years. Subsequent analysis by The King’s Fund has confi rmed that effi ciency savings are required on this scale and the QIPP programme was born as a result.
The QIPP programme is supported by national workstreams which are produc- ing tools and programmes to help local decision-makers to successfully implement change. These workstreams are designed to support the NHS to achieve and maintain quality and productivity. They fall into two broad types:
Commissioning, which covers: • Long-term conditions; • Ensuring patients get the right care at the right time;
• Safe care; • Urgent and emergency care; • End of life care.
Healthcare providers: • Back offi ce effi ciency and optimal man- agement;
• Procurement; • Clinical support; • Workforce; • Medicine use and procurement.
In the two intervening years, much of the effort has been focussed on the ‘quality’ and ‘productivity’ elements of the programme. Innovation is a means to achieving greater productivity and it can also promote the prevention of illness or harm caused by illness. This is crucial to the sustainability of the NHS but may require some form of initial investment in either equipment or staff. Service providers are beginning to recognise the need to make the case for this investment to commissioners.
QIPP and competition
Now that the dust has settled following the ‘pause’ and listening exercise, the new landscape of the NHS is beginning to take shape, albeit not quite the same shape en- visaged in the Government’s White Paper of July 2010. New commissioning bodies are coming into being and existing com- missioning bodies are being rationalised. Care providers are being encouraged to strive for excellence and to ensure that they are able to compete with ‘any willing pro- vider’ in key areas of service provision.
In July 2011, the Government announced that around £1bn of community services were being opened up to greater competi- tion. These services include treatment for back pain, diabetes, mental health prob-
lems and chemotherapy at home. Existing providers of these services will have to be able to demonstrate that they provide bet- ter value for money than their potential competitors – that is, that they provide good quality services effi ciently and effec- tively. Increasing numbers of service pro- viders are recognising this and are begin- ning to look to the principles behind QIPP to show the value of their services.
It is important that existing NHS services are able to compete on a level playing fi eld with other organisations to win the right to continue to provide services. While pro- vider organisations have always been re- quired to meet fi nancial targets, individual services have not had to demonstrate their cost effectiveness.
Strategic Health Authorities currently have responsibility for developing integrated QIPP plans to address the quality and pro- ductivity aims of QIPP at a regional level. However, many QIPP initiatives are de- veloped at a local level, including innova- tive approaches that can be adopted more widely. The NHS Evidence website, hosted by NICE, includes a number of examples of health and social care improvements that have been undertaken as QIPP projects.
One example is the Camden Stroke REDS (Reach Early Discharge Scheme) which ac- cepts patients from acute and in-patient stroke units that are suitable for early sup- ported discharge and assists in identifying patients requiring further inpatient stroke rehabilitation. It is a specialist inter-disci- plinary team that can assess, facilitate and complete patient discharge within 24 hours of referral, including escorting the stroke survivor home. The team also includes enabling carers to ensure provision of care is focused on enabling the stroke survivor to regain as much functional independence as possible.
The team’s achievements in terms of out- comes are:
• Improved patient independence; • Reduced home care packages and de- pendence on social services by an aver- age of 15 hours a week, post six-week rehabilitation with Stroke REDS;
• 100% of clients maintained or improved their Barthel score;
• 100% of clients maintained or improved their Canadian Model of Occupational Therapy (COPM) Performance score;
• 96.6% of clients maintained or improved their COPM Satisfaction score;
• 87% of clients maintained or improved their Nottingham Extended Activities of Daily Living score;
• 70% of clients maintained or improved their score on the Stroke Quality of Life Questionnaire.
Between January and December 2009, the service discharged and rehabilitated 57 patients, which equates to 32% of stroke survivors (the target set prior to start of the service was 30%). This resulted in 580 acute and in-patient bed days being saved. On average the service has reduced inpa- tient stays by 10 days across acute and in- patient stroke units when compared to the national length of stay average.
This example demonstrates the value of in- novative approaches under the QIPP pro- gramme in terms of both quality and im- proved effi ciency and productivity.
York Health Economics Consortium (YHEC) is working with a number of NHS organisations to help them to build busi- ness cases in order to impress upon com- missioners the value that their services add, both in terms of quality for patients and in the potential to achieve cost savings.
Prof John Hutton FOR MORE INFORMATION
T: 01904 323620 E:
john.hutton@
york.ac.uk
national health executive Jul/Aug 11 | 31
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