News and Comment

Simon Stevens, the inherited QIPP challenge and the role of the nursing workforce

Tuesday 1 April 2014


On his first day as the chief executive of NHS England, Simon Stevens notes that the NHS is undergoing the most sustained budget crunch in its 66-year history, and that navigating the next few years will be enormously challenging. The ‘Quality, Innovation, Productivity and Prevention’ (QIPP) challenge was issued by his predecessor, Sir David Nicholson, to the NHS to improve quality whilst making efficiency savings to the tune of £20 billion by 2014/2015.

Reports from the National Audit Office repeatedly questioned the sustainability of savings made to date. The NAO found that the NHS, understandably, started by making the easiest savings first through the pay freeze for public sector staff, reductions in the prices primary care trusts pay for healthcare, and cutting back-office costs.

Simon Stevens will, today, argue that only by ‘radically transforming services’ will the NHS continue to thrive in a context of austerity. Yet the NAO continues to note that the savings to date have yet to be driven by fundamental service transformations.

More worryingly, doctors and nurses across the NHS complained that front-line NHS services are being cut, while the Royal College of Nursing found evidence of nursing numbers being slashed in order to meet the ‘savings’ target.

While some, including Sir David Nicholson himself, have argued that the savings can be achieved without cutting services and staff; the reality is that navigating the transformations require not only different ways of doing things, but also demand new skills. Without these, it is difficult to see how the NHS can make the requisite savings while keeping quality as its organising principle.

It has been calculated that innovations designed and implemented by clinicians could have a value of £9 billion per year in the UK. Yet, to date, little has been done to harness this potential. Conversely, with growing pressures on the frontline, there is every possibility that innovation may be stifled.

Investing in the right skills

Efficiency without quality is unacceptable, while quality without efficiency is unsustainable. The healthcare workforce needs skills to be able to understand improvement from both the quality and the efficiency perspectives.

At risk of oversimplification, clinicians are probably more familiar with understanding how their care affects clinical outcomes and patient experience than they are with understanding the economics underpinning service design and implementation. The latter is not, to date, a skill set associated with the healthcare workforce. Yet without these skills, there are real limits as to how we can expect the NHS to achieve both quality and efficiency without simply going for the easy option of salami-slicing.

Empowering the workforce to drive forward efficiency and quality

Efficiency and quality drives that are co-produced and led by the health service workforce are more likely to be meaningful and sustained. Taking a step in this direction, OPM was funded by the Burdett Trust for Nursing to deliver a programme aimed at building the capability of nurses to assess the economic costs and benefits of nurse-led innovations, and to use this evidence to guide the continuing improvement of services. Delivered, in partnership with the Royal College of Nursing, in Scotland, Wales and Northern Ireland throughout 2012 and 2013, the programme demonstrates that investment in this skill set empowers the healthcare workforce to achieve real efficiencies while enhancing the quality of care for patients and other users of health services. The following example brings this to life.

Jayne Miller, Assistant Clinical Nurse Manager, Early Years, Children and Families Community Nursing Service, NHS Ayrshire and Arran.

Jayne and her team developed an electronic Child Health Record to support professional record keeping and information sharing by a wide range of practitioners who provide care and support to children. Having participated in the OPM-RCN programme, Jayne was able to calculate direct and indirect costs associated with setting up and running the system and to compare these against the financial benefits resulting from the current pattern of usage of the electronic record. Jayne estimated that the electronic record system contributed to efficiencies amounting to around £85,000 per year.

By having clear evidence about the financial benefits experienced by different partner agencies, Jayne and her team have been able to persuade an increasing number NHS children’s services to use the system; and have been widening access to local authorities and social workers. These developments will generate further efficiencies within and beyond the healthcare system.

In the throes of its most sustained and challenging budget squeeze, the NHS will need to raise its game by being clear about how efficiencies may be secured while protecting quality. This vision can only materialize if everyone working within the NHS not only sees that they have a role to play, but also know how they can fulfil this role. This requires investing in the health service workforce to equip them with the skills vital for securing a positive future for the NHS.

Dr Chih Hoong Sin will be speaking with Jayne Miller, together with Dr Ann McMahon from the RCN at a symposium on 2nd April 2014 as part of the International Nursing Research Conference

OPM has published an edited volume, Valuing Public Services, that offers practical ideas about how we measure and demonstrate the value of our public services, based on our real life experiences of working with a broad range of public organisations, including charities and professional bodies.