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Health reform risks QIPP progress

Health reform risks QIPP progress


Undertaking the QIPP challenge at a time of major NHS reorganisation risks compromising its progress, MPs have been warned.

In written evidence submitted to the Health Select Committee, the King's Fund argues it is not yet possible to evaluate the extent to which the NHS is succeeding in making efficiency gains rather than cuts.

This is due to the lack of systematic monitoring of the measures being taken locally through QIPP plans.

"In the absence of auditable data, we are concerned that ambitious QUIPP plans may in part only be achieved at the expense of quality and reductions in volume," the King's Fund writes.

The NHS Confederation also noted 85% of its members said delivering the reforms and savings simultaneously as one of their organisation's top three barriers to achieving QIPP. 

Seventy per cent of respondents identified the lack of certainty over the reforms as one of their top three barriers to achieving QIPP.

John Appleby, chief economist for health policy at the King's Fund, warned the Health Committee in Tuesday's (13 September) session on public expenditure of the dangers in the Department of Health measuring 'value for money' in an "implied way".

He claims the Department of Health works on the premise that if an organisation makes savings and increases productivity in one area, it  "assumes" value for money gains have been made.

While Appleby notes the progress that has been made in measuring efficiency thanks to the creation of The UK Centre for the Management of Government Activity, he claims the body still "falls short" in capturing what it means to be efficient and productive.

"A lot of primary and community care continues to be left out of the official measurement," said Appleby.

"For example, it is still unknown for sure how many people visit their GP."

Dr Judith Smith, head of policy at the Nuffield Trust, agrees. She claims the indicators being used to monitor performance are "heavily skewed" towards the acute sector rather than community and primary care services.

The King's Fund carried out surveys of NHS organisations in a bid to "fill the gap". Although not statistically valid, Appleby said they gave the think-tank a "feeling of what is going on".

"Most organisations will just about scrape together the money and national efficiency and savings targets will be met," said Appleby.

"Productivity went up last year in the face of cuts. We have seen this in the past with the NHS – it is a big organisation that steams ahead even when budgets decrease. It did it last year and it may very well do so this year.

"It is when spending its down over a number of years when the problem starts."


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