There is a 23-fold variation in the scale of clinical commissioning groups’ efficiency targets, with at least 11 groups planning to make savings of under 1 per cent, HSJ can reveal.

Huge variation in savings targets

Huge variation in savings targets

The findings come from 143 CCGs’ non-integrated single financial environment reports obtained under the Freedom of Information Act, which also show a significant minority of groups are already falling behind on their savings plans.

The returns detail CCG performance on the quality, innovation, productivity and prevention programme, their expected financial risks and their use of the 2 per cent of their budget that is supposed to be spent non-recurrently.

The reports, for the first quarter of 2013-14, show NHS England is now focusing strongly on the level of savings, rather than monitoring how they are made. Last year it gathered progress reports on individual local savings schemes, showing exactly where in the system savings were being made, but this year’s reports only divide the savings into figures for “transformational” and “transactional”.

Although the median CCG QIPP target is 2.47 per cent, there is huge variation. Eleven CCGs are planning QIPP savings of less than 1 per cent of their annual budget − the smallest being Dorset CCG, whose savings plan of £2.4m accounts for just 0.28 per cent of its resource allocation.

Meanwhile, West Essex CCG has a QIPP target of 6.44 per cent, and another 17 CCGs have targets over 4 per cent.

HSJ found no correlation between the size of a CCG’s QIPP plan and whether or not it was forecasting a year-end shortfall. However, of the 15 CCGs with the biggest QIPP targets, seven were planning to use their 2 per cent non-recurrent fund to stay solvent.

Many CCGs were already behind on their efficiency plans, while some were already admitting they would fail to deliver their full QIPP target by the end of the year.

Thirty-four of the 143 CCGs from which HSJ obtained data were short of their QIPP target by 20 per cent or more at the end of the first quarter, with 59 reporting some slippage.

The CCG sector as a whole expects to make 96 per cent of its planned savings by the end of the year. Only 11 groups forecast a QIPP gap of 20 per cent or more. The discrepancy between full-year forecasts and quarter-one performance suggests many CCGs believe they can make up lost ground in the latter part of the year.

King’s Fund chief economist John Appleby said the focus on the financial aspect of QIPP undermined the central point of the programme, which was to improve quality and productivity without extra cash.

“It’s hard to know really whether these are improvements in quality and innovation,” he said.

“If it’s simply reduced to filling a box with the financial saving a CCG is supposed to make for this year, it hardly captures what the basis for QIPP was, and remains. Not to measure it properly seems ridiculous.”

CCG QIPP targets are set by CCGs themselves, and then presented to NHS England.

A spokesperson for NHS England said: “QIPP targets vary because they have been set based on the opportunities available to each CCG/local health economy and their overriding financial position.”


Exclusive: Huge variation emerges in CCGs' efficiency ambition