The challenging QIPP targets NHS is aiming to achieve can be helped by the voluntary sector, argues Marie Curie Cancer Care chief executive Thomas Hughes-hallet.
Quality, innovation, productivity and prevention, in most people’s thoughts, is primarily a challenge for NHS managers and commissioners. I would like to challenge this view. It should also be a challenge for the voluntary sector as well. Without the active support of the voluntary sector, the NHS may struggle to meet its QIPP targets.
The voluntary sector has played a large and much-respected role in caring for patients and families since well before the creation of the NHS. We are not just providers of services; we are innovators as well. I would contend that in the present climate we might also be better placed to manage the financial risk of the kind of innovation that the NHS so desperately needs.
As the health select committee pointed out, even by itself the £20bn savings challenge will be difficult for the NHS to meet. The government’s reforms of the health service will only increase the pressures.
The NHS has performed admirably well in realising savings under QIPP and most have come through central actions such as pay and administrative cost reductions. As the operating framework makes clear, they will need to come from service redesign that can spread across the NHS.
In that same document, NHS chief executive Sir David Nicholson describes innovation as the “forgotten element of QIPP”. That is slightly unfair. Innovation requires investment in order to pilot and evaluate new ways of providing services. Where NHS managers and commissioners are struggling to maintain efficiencies and drive up quality, this kind of investment can be difficult for them to make.
The lack of integration between health and social care services can restrict innovation, but innovations in social care can realise savings in the health service and vice versa. However, managers often limit their field of vision to the funding mechanisms in which they work, ie NHS and social care. Where savings made may not be realised in their budgets, innovations that could save money overall and cater to patients’ preferences do not go ahead.
We know from our experience and the weight of evidence given to the palliative care funding review that the removal of means testing for people applying for social care at the end of life would help more people get home from hospital and be cared for until they die.
Too often people end up stuck in hospital – the place where they least want to be. We’ve calculated that removing the means test for patients at the end of life would cost the government an additional £32m nationally, but that reducing the hospital stay of 30,000 patients by just four days would save the NHS £34m.
As Marie Curie Cancer Care raises a significant amount of money charitably, we are not as tied into funding mechanisms. Because of this we may, at times, be better able to respond to patient and family needs because we work across the health and social care divide.
But, crucially, we can provide the investment in innovation that the NHS desperately needs to meet the Nicholson challenge. For years, Marie Curie has been working with commissioners, managers and providers to ensure joined-up services for people at the end of life in their locality. Working with forward-looking commissioners, we are able to help move people from hospital to home for care at the end of life.
It is a model that we think we could spread across the NHS. But we need NHS managers and commissioners to see us and the many charities that we work with as innovators who are prepared to invest our own resources into innovation that meets patients’ needs and realises savings for the NHS.
I am exceptionally proud that Marie Curie will be investing up to £2.5m in palliative care funding review pilots. This more than matches the government’s investment to help test the recommendations of the review regarding case management and coordination of patients and families through the health and social care system. This will go some way to demonstrating just how we are committed to driving innovation in the NHS.
Marie Curie has been around as long as the NHS, and is built on the same principles: that care should be free at the point of need. We want to help the NHS meet the challenges that it is currently facing and will continue to face. In the current climate we are well placed to manage the financial risk of delivering the type of innovation it needs to make savings and meet patients’ and families’ preferences for care.