Does it matter that the Department of Health now claims that year dot for its quality, innovation, productivity and prevention programme - aka “saving up to £20bn” - is 2008-09, not 2010-11 as previously assumed and stated?
As the focus has always been on the absolute aggregate value of the final “money in the tin” - as Sir David Nicholson puts it - rather than on a comparative saving against a specified cost baseline. This means the shift is unlikely to alter the target figure. What it does seem to do is throw in an extra financial year’s efficiency savings - 2009-10’s - to score against the final “up to” target come 2015. And with a bit of luck and a fair wind, the apocryphal £3.7bn revenue surpluses accumulated since 2007-08 - promised back for the 2009-10 onwards period yet swiped back by the Treasury that year - will also be thrown into the pot. All in all, that extra year might massage out another £8bn-£9bn.
That is not to say the QIPP challenge has just been made any easier, however, as the Department of Health is feeling the uncomfortably hot breath of the National Audit Office down its neck. The watchdog’s ongoing review of QIPP, due to be published in the autumn, is expected to issue strong warnings on the vaguer extremities of so-called “non cashable” efficiency savings - such as those which rely on hard-to-quantify quality improvements and savings made by denying patients “low priority treatments”.
To make matters worse, those cheeky independent auditors have already been soliciting QIPP monitoring returns directly from NHS organisations, cruelly denying the DH and strategic health authorities the ability to cook the numbers - sorry, I mean “sense check” - to make the sums add up.
The upshot of that will likely be a tougher approach to what “counts” as a genuine saving, making the inclusion of an extra year a welcome, but only a very relative, reprieve.
The real implication, however, is what the nominal extra year means for the next £20bn or more, from 2015 onwards. For that, there will be no opportunity to chuck in an extra year, or massage in unallocated and therefore unspent surpluses. If this £20bn has been tough, the next one is going to be even more so.
Sally Gainsbury is a news reporter for the Financial Times, firstname.lastname@example.org
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