Has QIPP Become Another Cost Improvement Programme?
One of the greatest challenges facing the NHS is driving efficiencies, whilst maintaining a commitment to improving quality. There is speculation that the cuts being made to meet QIPP targets are negatively impacting the quality of care for patients. Has QIPP become less focused on patient outcomes?
The Quality, Innovation, Productivity and Prevention (QIPP) Programme was developed by the Department of Health to drive through quality improvements, at the same time as making efficiency savings.
But, improving quality and reducing costs appear to be conflicting aims. Are we assessing the potential risks that cost-saving schemes can have on quality? I have worked with the NHS market for over ten years and there appears to be tension between the short-term financial imperative of balancing the books, and the longer-term requirement for driving quality transformation.
Has the patient been forgotten?
The underlying principle of QIPP is that improved quality of care will lead to improved efficiency. Is the pursuit of cost reductions challenging the integrity of QIPP?
A common conversation I have with clients is the need to put the patient first. I have heard that it is commonplace that teams talk in figures and numbers, rather than the patient and the quality of care they are receiving. The NHS focuses on standardised care, rather than truly understanding patient-centred care.
Instead patient input should be gathered at the start and engaged through to the final (implemented) solution. An example of this is the national focus on managing the demand in unplanned care. The question should be how we shift reactive unplanned care for the frail and elderly to be more about planned care. There are deficits in the system of delivery that are not being properly challenged by QIPP.
A whole systems' approach
It has been suggested that the best QIPP schemes focus on a whole system approach. New models of care are looking to drive transformational change through prevention, coordinated care, better technology and new contracting approaches. This is about fundamentally doing things differently. If commissioners are going to engage with providers in a different way, perhaps the narrative needs to change from cost efficiencies to "how do we help you look after the patients that do not need to be in acute care?".
A Lean way forward
The Lean approach to continuous improvement would ask us to think about what is good for the patient and not the organisation. We would start from the standpoint of the patient, looking at the whole end-to-end pathway. We wouldn't look at the performance of individual departments, but the system in its entirety.
Everyone in the system would have clear responsibilities, thereby empowering them. A more empowered workforce, solving problems daily at all levels, would drive quality and therefore efficiencies (with costs falling as a result).
Whatever your view of QIPP, for the NHS to deliver its long-term plan, system leaders need to consider how their decisions impact on people using health and care services. The debate around whether to prioritise short term imperatives or long-term transformation needs to start from the perspective of the patient; taking a complete system-wide, joined-up approach.
As ever, I'm interested in your thoughts. What is your experience? Are there deficits in the system which QIPP is not addressing? If you would like to discuss your organisation's transformational needs, please don't hesitate to give me a call.