I might not be popular for this blog.   I will take the risk.   Please could someone explain why we are all talking about QIPP like it’s a new revolutionary framework that is going to transform the NHS?   Mike Farrar said a while ago that ‘our new mindset is clear, it is the new landscape in which we operate’, David Nicholson wrote to CEO’s in August 2009 suggesting an evidence based approach to the QIPP challenge, but most CEO’s until relatively recently when asked about QIPP firstly said ‘what is it?’ and then when explained said ‘oh, you mean our day job’.    This just shows that a. writing to CEO’s telling them something needs to be on their radar isn’t necessarily effective and furthermore if it’s not on the CEO’s radar then there is a problem.As far as I see it, it is not the ‘new landscape’ at all, it is actually the old landscape rebranded, the new part is the acronym.   If we want to deliver efficiencies in a sensible way, not just to survive but to survive maintaining quality and through a sensible approach (i.e. taking money out of the system where there is currently waste and not by cutting front line staff, or for example reducing the availability of certain drugs or treatment options) the part that is new, or at least what needs to have a renewed emphasis is our approach.   The fundamentals behind QIPP, well most of them certainly, are not new.   Sure it’s a snazzy new acronym but snazzy alone will not deliver, even if each SHA has a very in depth, lengthy delivery plan.Quality, innovation, productivity and prevention.   New?   No.  Did we deliver it previously?  Some aspects of it in certain areas, but it was patchy.   Are we going to deliver it now?  No, because there is no ‘it’.   Can we improve quality?  Yes.   Can we be more innovative?   Yes, although true innovation is hard.   Can we improve productivity?  Yes.  Can we focus more on prevention?  Yes.   But ‘the QIPP agenda’ is not going to deliver it – people are.  Best practice evidence has been available in the bucket load for the last goodness knows how long but relatively few have adopted it to date.   We all have had the opportunity to be innovative but have not been, it requires too much effort and requires a certain skill set.   Talking about ‘productivity’ is often almost blasphemous amongst some medical staff, as many automatically assume it means their practice is being criticised rather than the inefficiencies of the system preventing them maximising resources and prevention, well we all know we can and should do better, but we haven’t to date.   I have just come back from a week and a half in Australia presenting on a number of different aspects around healthcare.   What was reinforced in my mind, from talking to people and hearing others speak, is the fact that the success in most things and definitively with the delivery of QIPP, is down to behaviour.   It is easy to criticise other people’s behaviour; I do it, you will do it, but let’s start with our own.   When was the last time you considered whether something you were doing was adding value or not?     I Googled the QIPP national work streams a few weeks ago and the first thing that came up was an article on quality from NHS Milton Keynes.   Now I am not the most IT literate person that there is but I can do a Google search.   No disrespect to NHS Milton Keynes but I’m not sure they should be popping up first.   QIPP has been discussed for months, the national work streams have been discussed for months, I think there are now 13 but only 12 are listed.   I’m not sure why there is little or no information published on them nor why it is not available for people to look up and heaven forbid, see how they can support, help or get ideas.Sitting in a room in DH or in the SHA drinking bad coffee out of Styrofoam cups and discussing the strategy isn’t helpful if someone forgets to communicate the strategy.    Nor is thinking that adding the word QIPP to everything we do will deliver.   We are at risk of ticking the box but missing the point.Organisations can have the most sophisticated and well written strategy and plans, they can have action plans and any other tools and techniques in place to deliver, but plans are only as good as the people who are leading or delivering these plans.   Perhaps if we all chant QIPP three times before we go to bed at night we will deliver it or perhaps if the national work streams are open, transparent, give regular updates, explain how local work can tie into national plans and ideas for success etc we might, just might, have some hope of doing what we need to do.Perhaps each of us should QIPP ourselves.   Do you pass the QIPP test?   Are you a quality employee, are you innovative, are you productive and do you prevent inefficiencies?  Let’s all think about that and if the answer to any of them is no, well as they say ‘Houston, we have a problem’.If we add the word QIPP to it though, perhaps it will all be ok.