Mike Farrar on QIPP - quality, innovation, productivity and prevention

Only 18 months ago, the NHS was reflecting on its first 60 years and setting out on a new optimistic phase in its history: the shift of emphasis from speed of access to quality of care, from centralised targets to devolved local priority setting, from ivory tower administration to clinically driven leadership and from spending on supply side expansion to genuine demand side management.

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Now all the talk is of the impact the recession will have on public spending and how the NHS will fare. Commentators study the Treasury forecasts, while politicians, with less than a year until an election, try hard to protect some form of financial growth for the service as future spending plans are crystallised.

Into the NHS too has come the acronym QIPP - quality, innovation, productivity and prevention. In true NHS fashion, we tease it out until it becomes seen as the new god to follow, risking another decade of Whitehall-gazing and alienation of NHS reform from our staff and the people we serve.

Having a frame of reference for our challenge is excellent and QIPP does this well. It has emanated from responsible leadership at absolutely the right point in the resource cycle. The truth, however, is that while the economic world might have changed dramatically around us, our vision for the NHS has not and must not.

What we face is the reality of achieving everything we wanted 18 months ago but with economic constraint as a major second driver for change. Mainstreaming and delivering improvements in the concepts enshrined in QIPP is the way we will bank the benefits we made in the good times and continue to improve services into the future.

We know there is much that needs to be done and that could be achieved quickly. Our current business models, practices and behaviours, underpinned by mindsets fashioned by financial growth and incentives created in an atmosphere of rapid supply side expansion, have left an NHS which would benefit greatly from improvements in efficiency, more effective partnerships and the slavish pursuit and delivery of evidence based practice.

So, necessity becomes the mother of invention, as we have discovered in the North West, having woven it into the NHS’s collective DNA. This was clearly demonstrated at the summit on delivering improvements in a resource-constrained environment attended by the NHS leadership in the North West in July.

Our new mindset is clear. QIPP is not an add-on program - it is the new landscape in which we operate. Learning from the past, we have engaged our clinicians and boards right from the start. All our organisations, including the strategic health authority, are reframing all our strategic objectives to make them fit for a resource-constrained world as we speak, pre-empting national regulators.

Whole systems answer

Actions in the North West post summit have flowed in abundance, reflecting the importance of taking a whole systems view. Commissioners bankrupting providers is not seen as a solution; and neither is operating as an Independent Republic of the NHS, ignoring the views of local government, local people or the role that third sector and independent providers can play. Indeed one of our strongest emerging programmes is the commitment to strengthen the conversation with the North West public on the avoidable use of NHS resources. And there is a real appetite to exploit the potential the Total Place initiative offers to get agencies working together to deliver services more efficiently, and to pursue a number of exciting new vehicles for asset stewardship and management.

Urgent care is also in our sights. We have undertaken a major review of this care pathway and believe that improving the management of unplanned care will be key to our overall success. It is also the area that exposes the flaws in our current system incentives most. So we are talking to the Department of Health about new models of governance and payment for integrated care in order to ensure all parties benefit from managing demand for services more effectively.

Finally we have actively considered what mindsets we, as leaders, will need to have if we are to deliver our strategic goals for the North West within the resources we expect to be on offer. Crucially, our commitment is not to have organisations in the region survive at the expense of others, nor to try and financially grow our way out of trouble but positively to embrace known best practice, by being brave enough to follow quickly.

When, 18 months ago, we in NHS North West committed ourselves to try and create one of the best health systems in the world, we did not say that we could only do that if the money was right. Neither do we take that attitude now.