QIPP FOCUS
NHE spoke to Liz Thiebe, Head of Programmes, Leadership Development, at The King’s Fund to get an expert view on the state of clinical engagement with QIPP two years in.
A
lthough outside observers and com- mentators assume that the pro-
tracted (and unconcluded) wrangle over the direction of the NHS reforms has been obsessing managers in the health service, there are clear signs that it is actually the QIPP agenda and the financial savings that have to be made as part of it that are caus- ing the real headaches.
Liz Thiebe of The King’s Fund says staff en- gagement is a key issue, but that the extent to which this is taking place depends on whether QIPP is defined in its broadest and most ‘positive’ sense around better work- ing, or as a more pejorative shorthand for efficiency savings alone.
She told NHE: “In primary care, GPs and practice managers are very aware of the financial challenges, especially as they are learning more about the commissioning functions. For many, the relationship with the PCT as it relates to the QIPP plans has been generally top-down. GPs in particu- lar are very interested in determining the clinical priorities for their population, and so are approaching the QIPP planning with the clinical needs first, and the money sav- ings second.
“So, if we define QIPP as cost savings, then the frontline staff in primary care are less involved. If we define QIPP in its broadest sense, then yes, clinicians in primary care are both interested and capable of leading the QIPP process.
“With acute trust leaders, I have seen the QIPP agenda blended with cost improve- ment plans, but with little focus on preven- tion and quality.”
Scorecard
The key question is the extent to which NHS organisations are on track to find the necessary efficiency savings – or whether they are going to have increasing difficul- ties in the next few years in making up ground lost now.
Thiebe told us: “There seems to be a lot of worry out there with the groups of leaders I work with across all three sectors. Some describe the QIPP plans as unrealistic. Many are worried personally about having a job and are distracted from the opera- tional focus because of this.”
There is an understandable divergence be- tween executives fully signed up to QIPP in the hope it can produce some genuine transformations to allow the NHS to han- dle increasing demand without the huge year-on-year budget increases to match. Others are more cynical, noting that the ‘ef- ficiency’ savings mandated by QIPP are in some areas resulting in job cuts and reduc- tions in service quality but without many apparent improvements to show for it.
Thiebe said: “The groups of cross-organi- sational professionals that I work with are very keen to make improvements. They
Although few GPs are worried about losing their employment because of the structural reforms shaking up the NHS, a recent sur- vey has suggested they are particularly un- engaged with QIPP.
Thiebe commented: “I would suggest that GPs are very interested in improving care for patients and reducing costs. They are less engaged with top-down directives mandating the amount of money that needs to be saved. So, if you frame the question to be about quality/prevention and improve- ment, you will find great interest in learn- ing how to make the changes required. We are finding a demand for leadership pro- grammes for GPs which focus on the ‘how’ part…how do we actually address variation in practice amongst our cluster GPs? How do we engage better with the acute trust or the local authority? How do we use social marketing to engage with our patients to affect their health choices?
“At the moment, the GPs will discuss their relationship with their cluster or PCT. The SHA is rarely mentioned.”
Trust in the top
So, overall, is the NHS organisationally ca- pable of the structural changes required to meet the whole QIPP challenge?
Thiebe said: “The view of my groups is no: it is not capable alone and needs to link with social care, edu- cation and the volun- tary sector to really meet the challenges ahead.”
Liz Thiebe
FOR MORE INFORMATION Visit
www.kingsfund.org.uk
national health executive Jul/Aug 11 | 33
are driven by their interest in improving the health of patients and the population. And they see that relationship-building between social care, acute care, mental health, primary care and the voluntary sec- tor are key to making the improvements.
“I work with a number of clinical teams making change happen. The clinicians bring their knowledge of the current sys- tem, which includes the frustrations of poorly coordinated or joined-up working. They see first-hand the effect this has on patients and outcomes. And they want to change to improve what they see as wasted NHS funding.
“For example, I am working with one group who are improving the care of dementia patients at the end of life. The driver for this improvement is not to save money – although we are seeing substantial savings in their business plan. Rather, the driver is to respect and protect the dignity of pa- tients and families at the end of life by cre- ating a system of care interventions which allows for the patient to die at home or in the care home. It is very powerful indeed.”
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