NHS England plans to lead 'radical' service change
NHS England is planning to continue the health service’s current savings drive after 2015, and to recast it as a programme of “ambitious and radical” service change led by its area teams.
The organisation, formerly known as the NHS Commissioning Board, will extend the quality, innovation, productivity and prevention savings programme beyond its current April 2015 end date, which is also the end of the current spending review period.
In an exclusive interview with HSJ, NHS England policy director Bill McCarthy revealed it was drawing up plans for the programme to focus in future on large-scale service reconfiguration, rather than on smaller incremental savings schemes.
Unlike the current QIPP programme, which was initiated by the Department of Health, the next phase will be developed and led by NHS England. The current programme is intended to generate about £20bn of NHS efficiency savings over the four years to April 2015.
However, Mr McCarthy told HSJ the bleak outlook for public finances beyond 2015, and the fact that the NHS was already relatively efficient by international standards, would force the service “into the direction of strategic change”.
He said “year after year whittling away of unit cost” did not “seem to me to be an answer to the challenges we’re facing”.
After the current comprehensive spending review period, “we’re going to have to be more ambitious and radical in the way we look at service change”, he continued.
NHS England is also in the process of drawing up a 10-year strategy for the health service.
Mr McCarthy said: “It will be surprising if that didn’t [also] lead us to a place where we’re [taking] some views, or decisions around configurations of services into the future.”
He added that NHS England’s 27 local area teams would drive reconfigurations, working within a national framework developed by the organisation.
This could include leading public consultation processes and coordinating input from clinical commissioning groups. Area teams will also ensure CCGs’ own service change and QIPP plans do not contradict one another.
He said: “We are all one organisation, and the benefit of NHS England happens locally. That’s where we’re improving outcomes for patients, engaging the public, and collaborating with local authorities and other partners.
“What we’re doing [centrally] is putting a consistent frame around that. The implications for that are for area teams to work with partners… and come up with the priorities for the change that will make the most difference in Newcastle as opposed to Oxford, for example.”
NHS England revealed in its business plan last week that it was drawing up a framework for “major service reconfiguration”. Mr McCarthy said the framework would be “fairly fundamental” to the future of QIPP.
The reconfiguration framework will be developed over the coming year, and will set out the roles of different commissioners in planning service change. Mr McCarthy said it would also give a clear signal to providers about how they should prepare for service changes, for instance giving indications of where they should or should not be making capital investments.
HSJ understands local area teams are already beginning work on reconfiguration, with a view to consulting on proposals in 2014 so savings can be made after 2015.
Charles Alessi, chair of NHS Clinical Commissioners, said: “I’ve got no problem with local area teams leading, but they need to understand what leading is. Leading does not mean telling people what to do. They should be convening, encouraging and educating [other players in the local health economies]. It’s an enabling role, rather than a dictatorial one.”
Mark Hayes, chief clinical officer of Vale of York CCG, said in his area CCGs were directly involved in reconfigurations.
And he added that local area teams “did not have the capacity or the contractual levers to force a foundation trust to do anything they don’t want to do”.
QIPP monitoring to be ‘lighter touch’
NHS England is to adopt a “lighter touch” approach to monitoring the quality, innovation, productivity and prevention programme in 2013-14, HSJ has learned.
Instead of the detailed monitoring of local QIPP milestones seen in 2012-13, this year local area teams will be checking clinical commissioning groups have a savings plan and that they have a project management structure in place to deliver it.
CCGs’ overall plans will be rated red, amber or green based on whether they are realistic and the extent to which they are being achieved.
Local area teams’ own QIPP plans will be similarly assessed by NHS England’s four regional teams.
HSJ has also learned that in many areas CCGs are signing off their provider trusts’ cost improvement plans.
Commissioning sources said CCGs were in effect taking more responsibility for ensuring providers’ savings did not harm service quality than local commissioners had done previously.
The move away from monitoring each individual local QIPP savings scheme was welcomed by one local area team director, who told HSJ that NHS England was not resourced sufficiently to micro-manage CCGs. “The degree of detail we had to produce in the QIPP plans last year was just frankly ridiculous”, he added.