Local schemes fall behind in NHS’s drive for efficiency

The set of 10 documents compiled by strategic health authorities shows many areas are falling behind on one or more aspects of their local quality, innovation, productivity and prevention plans. Just under half of all savings across the country come from local innovation.

This forms the most comprehensive assessment yet seen of the progress of the programme, which is regarded as crucial to the long-term sustainability of the NHS.

The tracker, obtained by HSJ through a series of freedom of information requests, covers the first quarter of 2012-13, giving detailed assessments of each of the 53 local QIPP plans. It reveals that primary care trusts anticipate savings worth a total of £13bn from 2011-12 to 2014-15.

The savings are front-loaded. Annual totals amount to £3.8bn in 2011-12, £3.6bn in 2012-13, £2.9bn in 2013-14, and £2.6bn in 2014-15.

No details are given on how savings were made last year, although the totals given do not match the DH’s announcement that the NHS saved £5.8bn in 2011-12.

The tracker reveals local QIPP plans are being judged on their ability to account for half of the total local savings challenge for the next three years. The remainder is to be saved through national initiatives such as pay freezes or cuts to the tariff paid to NHS providers.

Across England as a whole, local QIPP savings schemes are expected to account for just £4.5bn over years two, three and four of QIPP - 49.5 per cent of the total saving required for that period.

The QIPP tracker’s detailed assessments of local initiatives show that even one quarter into 2012-13, many local schemes are slipping behind schedule, with either some QIPP milestones or entire workstreams rated “amber”.

The value of local QIPP initiatives that are completely on track totals £2bn across 2012-13, 2013-14, and 2014-15.

Just six local QIPP plans were fully on course at the end of June - all the rest had at least one workstream behind schedule.

Meanwhile, six areas did not report how much they were expecting to save over years two to four of QIPP, and another two submitted only partial data.

The local reports reveal that, with few exceptions, local QIPP schemes are aimed to bring about local service change and productivity gains.

Redesigns to care pathways for long-term conditions such as diabetes and chronic obstructive pulmonary disease, and the introduction of integrated clinical teams for dementia patients, commonly feature. But, although there are widespread moves to provide services such as dermatology, urology or orthopaedics in new ways, and many plans include individual ward closures, there is relatively little mention of large-scale reconfiguration.

One exception is a plan to move some cancer services on Merseyside from the Clatterbridge Centre for Oncology to the Royal Liverpool Hospital site.

Where structural changes are proposed, the savings counted during the QIPP period are sometimes small.

For example, a proposal by the Leicester, Leicestershire and Rutland primary care trust cluster to strip Leicester General Hospital of its non-elective work is expected to bring in only £3.2m. This is because it is scheduled to be completed in March 2015 - the very end of the QIPP period.

Meanwhile in Northamptonshire and Milton Keynes, a plan to reconfigure acute services currently on five sites had no savings figure attached.

Despite many areas making genuine attempts to save money through innovation, some QIPP plans overtly seek to make their savings by cutting spending on services.

The Midlands and East SHA cluster criticised NHS Cambridgeshire and Peterborough’s plan for being “mainly finance driven with savings captured in contractual agreements with the trusts”.

One of South of Tyne and Wear’s QIPP goals was simply to “reduce [the] price paid for Gateshead Health Foundation Trust older people’s mental health service by end of 2012-13”.

Two of the North West London cluster’s savings targets were also to be met through “contract negotiation”.

King’s Fund chief economist John Appleby questioned the tracker’s emphasis on “savings”, which he said “belied the point of QIPP, which is to improve value to patients”.

He said: “If money has been saved, then presumably it has been reinvested… but in what? Reporting the value of activity that has stopped or been changed as ‘savings’ is the wrong way of reporting QIPP.

“What we want to know is, given that there is essentially no extra money, have PCTs planned to meet increased demand and improved quality for patients? You can’t tell that from these data at all.”

A Department of Health spokesperson said: “It is impossible to draw conclusions on QIPP savings from the incomplete and draft figures in the QIPP milestone trackers. We will be publishing our official figures on the progress being made shortly.

“In 2011-12 the NHS achieved £5.8bn savings while keeping waiting times low, performing more tests, and reducing infections even further.

“Early indications for 2012-13 QIPP savings are promising and we work closely with SHAs to ensure any barriers to making efficiency savings and improving patient care are identified.”