QIPP FOCUS
The survey asked doctors specifi c questions about investment and saving.
Bywater said: “We asked them what they would think would need to be invested in IT to make these target savings are found, and well over half of them said 10% or above. That is, if you want to save a pound, you probably have to spend 10p.
“If you look at the goals of the acute sector, and how much money they’re going to have to invest in IT and administration, it does suggest investment is going to have to be made now to save money later.”
He said that fi gure had some truth to it, but that it was very diffi cult to be sure about NHS IT spending: “It’s full of doubt. There’s no real benchmark to go back to, because the NHS never really relates IT expenditure to savings. The truth is that most of the NHS IT spend doesn’t save money anyway – it improves the way the NHS operates. You could turn it the other way round and say if the NHS didn’t invest that money, it would implode; it couldn’t do what it needs to do.
“The QIPP focus, and also the focus from Sir David Nicholson on the £20bn in sav- ings, is much nearer term. They’re looking over the next three or four years and really looking to achieve savings. The onus is go- ing to be on the Trusts to actually turn in those savings and they will be required to fund their own IT. They may be able to per- suade the suppliers to postpone payments, but eventually they are going to have to pay for their IT and will need to show the ben- efi ts. Normally you have to invest in the IT
fi rst – the benefi ts don’t come until later.
“What really came out of our survey work too is that GPs are saying that if you really want to save money, acute trusts are not going to be able to do it on their own local initiative. They are saying that the way to save money is to transform the delivery of care services and rebalance acute and com- munity services.”
That message has become a common re- frain for health observers in the UK – the trouble is taking the radical steps needed for such a shift.
Bywater agreed, saying: “Yes, it’s how you do it, and how you avoid it playing out into some kind of confrontation between the acute and community sectors. Experience had on things like the ‘virtual ward’ scheme is that it benefi ts both sides, by providing a whole lot of diagnostic tests and similar things in the community, which means the presentation of the patient to the acute sec- tor is much more orderly. They don’t stum- ble into A&E in a diabetic coma, which is what happens if you leave it uncontrolled.
“We’re seeing a massive increase in the use of A&E as a substitute for the GP, es- pecially for the younger generation, which is really disrupting the acute sector in a lot of respects. You need some more formal mechanism to keep diagnosis out in the community, so what we think will hap- pen is that the acute sector will become more acute. You’d expect to see the impact of the creation of critical care beds in the UK, which has been very slow compared to other parts of the world, way behind places
like Germany. But you’d expect to see acute units becoming almost 100% critical care beds, and anything sub-critical will move out into the community.
“It’s not necessarily diminishing the role of the consultants and the acute sector: it’s more of a re-balancing exercise.”
The key question is whether such a funda- mental structural change can be done at the same time as fi nding effi ciency savings in the short term.
Bywater concluded: “The problem is that change costs money. But we already know that if the NHS doesn’t change, it will face a crisis.
“Way before the election, The King’s Fund told us, via most optimistic, least optimistic and middle scenarios, that if you look at the way the NHS is evolving, demands on the NHS versus its funding, even allowing for a continuing increase in annual expenditure on health, the NHS is still going to implode in four or fi ve years unless it can achieve very substantial savings that can then be re-invested into a different way of working.
“So it’s a catch-22: peo- ple can say it’s too dif- fi cult to do, but if they do, there’s going to be a major funding crisis for the NHS within the next fi ve years.”
Murray Bywater
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national health executive Jul/Aug 11 | 35
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