COMMENT
Easton demurred, saying: “For those people who thought QIPP was a blip, anyone looking at the Chancellor’s Autumn Statement or the overall economic position knows that the run-up to the next comprehensive spending review is bound to be a challenging time for all public expenditure.
“We think we need to start having the conversation as a system about extending beyond the initial four year period of QIPP to thinking about how we get the NHS in shape.”
Aligning NHS improvement with the QIPP challenge
Easton continued: “We’re determined to learn from some of the mistakes from the past. Firstly, we need a place where we’re looking forward and looking around the world at what is ‘best in class’ in terms of change in health care systems and we think the new body should do that – horizon- scanning.
Above: Jim Easton (image courtesy Wellards)
Asked for an update on QIPP implementation, he said: “On one level the QIPP story is fantastic news; we continue to hit, in aggregate terms, and in virtually every place, all our main performance and quality markers, and the NHS overall continues to improve. A year and a half into this period of diffi cult restraint, we could easily have been telling a different story. That speaks volumes for the work people have done locally.
“Underneath that, the picture is more nuanced. You see some organisations struggling to hold onto the quality framework for QIPP and some commissioners complaining about it. You see some people struggling in the transition from the earlier saving element, the effi ciency element, to achieving more substantial service change.
“Our focus is on how we get more support to people to deliver quality and effi ciency together, because even if it was the right thing to deliver just fi nancial effi ciency – which it’s not – people are running out of road on that.”
After QIPP – more QIPP?
What about the future: after the current productivity challenge period is over? Many commentators have noted that rising demand and constrained budgets mean the principles of QIPP will become the new normal.
“The new improvement body is going to be relatively small – smaller by some margin than the sum of all the constituent parts.
“It should get support from partners who can help it deliver at scale.”
“We want really practical change- support products that are helpful at the frontline. If we think integrated care is the way forward, it’s all very well
talking about ‘at a global level’ but what are the seven or eight packages of support that we
“The new improvement body is going to be relatively small – smaller by some margin than the sum of all the constituent parts.”
could get working routinely and make available to accelerate change locally?
“We think it should help develop some of that with early implementers across the NHS, so we’re going to support people putting ideas into action.
“It should not try to gear itself up to be the only supplier of change-support or be big enough to try ‘do change’ across the whole NHS,” he said – and suggested the NHS Modernisation Agency, despite its strengths, was sometimes guilty of this.
Global horizons
NHE spoke to Easton in the same week another large UK organisation, Network Rail, launched an international consultancy business, to raise global profi le – and global revenue.
Easton noted that while he wants the new improvement body to look globally for best practice, the reverse also applies – the NHS Institute already has a “small but very valuable international arm” that does a lot of work in Canada, Scandinavia, Australia and New Zealand.
He said: “If you walk round most hospitals in the UK you’ll fi nd the Productive Series has been really valuable and is kind of endemic – although many chief executives will claim they don’t use it, even though it’s live and really active in their organisation. It’s part of our cultural overlay. But internationally the Institute is held in absolutely high regard and many of the other constituent parts are approached by international groups. As we try to tackle the QIPP problem through this change, given that that’s an international challenge, there’s huge interest in what the NHS is learning and some opportunity for us to get value for the NHS by exporting that.”
But he added: “We’re not in the business to make money from international work – our business is to support the NHS. The value in it will be ‘how does it support the NHS’, either in bringing in new knowledge, or by reputation gain, or frankly some income that we can re-use towards our R&D capacity to develop the NHS.”
He said potential partners could be the likes of the Academic Health Science Networks, AQuA in the North West, or NHS Quest, the quality- based organisation – “or indeed some of the commercial players”.
“Next, helping people to measure and evaluate – which is a big weakness across our system – whether we actually understand what works.
“We need very practical things that end up with a product on your desk or in your clinical offi ce and people who can help you make a difference: not telling you what to do if only you were clever enough, and second-guessing your work or doing interesting abstract thinking. In your real day-to-day operations running your trust, you need tools – tools which belong to the NHS that you should be able to access more cost effectively than other support packages –that should just help you get where you need to be more quickly.”
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national health executive Jul/Aug 12 | 15
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