The man responsible for driving the NHS’s £20bn quality, innovation, productivity and prevention savings plan has warned that some schemes being pursued under its banner have “no semblance of quality in them at all”.

In an HSJ interview at the NHS Confederation conference, Department of Health improvement and efficiency director Jim Easton flagged “worrying signs” in some organisations’ performance, with only a third of all “health communities” having strong, shared QIPP plans.

“We see some differentiation between people who are doing what we would call your actual QIPP - which is through quality gains making financial efficiencies - and some people who are, in more parts of their plans than we would be comfortable with, reverting to just redlining [cutting] budgets through cost improvement plans,” he said.

“There are two ways of achieving changes in staffing. One is that you do something like productive ward work and you redesign the way nurses and support staff on a ward work in a way that delivers quality, and gains productivity.

“The other is that you just take your ‘off-duty’ rosters and take 3 per cent off them. The first is delivering QIPP, the second of those is not.”

Some commissioners, Mr Easton continued, were setting up “referral management systems” which appeared to be “administrative blockages to care that don’t actually solve the problem - they simply delay it”.

“We’re promoting a whole series of people who we see doing fantastic work on engaging clinicians in getting the right treatment for patients, which is different to saying if you want to be referred to your hospital you have to jump through 15 administrative hurdles,” he said.

Overall, he reported a “small percentage [of trusts] at the bottom” with big financial challenges before NHS funding was tightened. Meanwhile, “a large number” of trusts “are confident they’ve got a significant part of the answer, but switching to delivery is a big challenge, or they’ve got chunks they know they need to work on.”