Quipping aside, this is no joke. Think tanks can be short sighted. They rightly identify QIPP: Quality, Innovation, Productivity and Prevention – as essential to the success of the NHS reforms. But these same smart people signally fail to identify the “X factor” needed to mobilise and deliver QIPP benefits: service users, carers and communities. Without them wanting to pull in the same direction as the clinicians and the managers, the QIPP chemistry won’t work. Not only that, service users may resist change for the justifiable reason that it has never been negotiated with them and seems to be imposed from above, posing a perceived threat to well-known local services. QIPP can’t work in that environment and it will turn into an expensive frustration.
The most recent example of this limited thinking comes from the Nuffield Trust, whose otherwise useful overview NHS Reforms in England: managing the transition sees the QIPP delivery challenge thus:
If PCT clusters and GP consortia are to ‘keep a grip’ and manage the financial pressures inherent in the PCT allocations for 2011/12, they will need to accelerate the QIPP agenda and ensure that providers deliver their cost improvement plans.
Nothing lasting can be achieved in terms of reduced costs and improved quality, productivity and – above all – prevention – without having the users of services, particularly people with long term conditions, fully on side. People who are heavy users of service have to want and cooperate in achieving new ways of doing things that result in higher quality, more satisfaction and – the holy grail – lower recurring expenditure. QIPP has to be co-created, so that service users will know what quality looks like and demand it. No PPI, no QIPP.
QIPP-thinkers should take a leaf out of Incentivising Welllness: improving the treatment of long term conditions from Policy Exchange. This looks at what could be done from the diabetes standpoint, one of the biggest potential wins for QIPP. It talks about co-producition: shared decision making, pathway collaboration, expert patients, encouragement of self care etc. Engaged patients want to go along the same pathways as enlightened clinicians.
Involvement from the outset
It’s obvious isn’t it? Most of this must happen in primary care and it will impact secondary care which is where the biggest cost savings need to occur. But without user and carer engagement in the change process from the outset it is likely to be a hard slog for little gain. Commissioners – whoever they are at PCT cluster level or GP led consortium level, and their providers – however “willing” they may be – cannot do this on their own. They don’t make up the whole system of behaviour: patients are the missing link. The Nuffield report doesn’t even include “engagement” or “involvement” as topics, even from the standpoint of staff engagement much less that of customers, aka “patients”.
Doing better with less
Want to make QIPP changes? Then talk to the customers first and listen to what they tell you about what could be improved or even stopped or done differently. Find ways for them to help lead the changes. It may be that small changes would make the biggest difference and, replicated many times over, the biggest savings. QIPP isn’t about doing more with less, it’s about doing BETTER with less.
The Moore Adamson Craig Partnership supports user and public participation, trains lay representatives and develops responsive health, care and education organisations. We are ready to work with and support all those who want to make sense and a success of the new structures of patient and public engagement within the new arrangements for health and social care commissioning and providing. Feel free to contact us to discuss the opportunities.