David Nicholson: ride the wave of NHS innovation

It is fantastic to see the NHS united in the common goal of improving the quality of services for our patients. With 5.5 per cent growth both this year and next, the NHS still has time to plan and invest for the future. But the financial situation after that is going to be much tougher. There is a real urgency to go further and faster with reform.

The biggest productivity gains are in the interfaces between primary and secondary care, and between health and social health

To realise our vision on quality, the NHS needs to plan to release efficiency savings over the next few years on a scale not attempted before.

One of the biggest cultural issues we need to tackle is the view that higher quality means higher costs. It is perfectly possible to improve quality and productivity at the same time. It is a lesson much of the rest of the economy has already learned and there are examples in the NHS. Our success in reducing healthcare associated infections has saved more than £140m while improving the quality and safety of care.

The evidence shows us that the way to link quality and productivity is by innovation driving best practice and embedding change across the system. Innovation doesn’t just mean invention. It means the adoption and diffusion of effective treatments and practices across the system.

Coupled with a strong focus on prevention, this linking of quality and productivity via innovation to produce efficiency gains is the most important long term challenge facing the NHS.

It will require all parts of the NHS to work together and it will require action at local, regional and national level. It is not something we can address through a national programme or top-down initiatives. The real changes will be designed and delivered locally, built on what patients, public, staff and clinicians tell us.

Power of four

A year ago, I set out four principles - coproduction, subsidiarity, clinical leadership and system alignment - to guide our work. They have become an important part of the way we do business in the NHS and I am determined that they will remain at the heart of our approach.

There are four particular elements of the quality and productivity challenge that I am encouraging the NHS to consider at the moment.

The first is being clear about what things need to be prioritised at each level of the system. What are the things we need to do once and what do we need to do 10 or 152 times? It may be that, given the size of the challenge, we need to organise some programmes above the level of local health systems. However change is organised, we need to ensure that the NHS has the right people with the support they need to take on the scale and pace of this challenge.

The second element is getting the right leadership focus and behaviours at every level. We have strengthened our capacity by a national director for improvement and efficiency and refocusing the NHS management board to spend more time on the quality and productivity challenge. As chair of the national quality board, I will also be ensuring this group has a role in overseeing and challenging our approach. I welcome feedback on the leadership signals we are sending.

This is only a small part of the picture. Great clinical leadership is fundamental to this, and NHS boards should be seeking assurance that clinical leaders are being supported to drive change locally and across organisational boundaries.

The third element is engaging properly with staff, partners and the public. NHS organisations need to have a clear narrative about what this challenge means for them. It’s critical that the NHS works effectively with local partners. Local authorities are already experiencing these challenges and they present both risks to effective joint working and significant opportunities. The biggest productivity gains are in the interfaces between primary and secondary care, and between health and social health. I am seeking views on what we should be doing to assist this engagement work.

The fourth element is being clear about what changes the NHS thinks are necessary to the national policy framework to support work on the quality and productivity. We have a strong overall policy framework set out in High Quality Care for All and now secured through the NHS constitution.

A range of policy issues are already under consideration. While we should be cautious about spending too much time and energy on policy change at the expense of real change on the ground, some is essential to enable change locally.

If you haven’t already done so, I would like to encourage feedback on what needs to be taken forward at national level. Views can be sent to QIPPChallenge@dh.gsi.gov.uk and will inform the operating framework for 2010-2011.