QIPP Programme (Quality, Innovation, Productivity and Prevention)

The Quality, Innovation, Productivity and Prevention (QIPP) programme is a large-scale programme developed by the Department of Health to drive forward quality improvements in NHS care, at the same time as making up to £20 billion of efficiency savings by 2014/15.1

QIPP represents a broad, policy agenda rather than a single, definable policy. There are a number of national workstreams within QIPP designed to support the NHS to improve care and lower costs. These range from improving commissioning (or purchasing) of care for patients with long-term conditions, to improving how organisations are run, staffed and supplied.1
However, the specific changes required to meet the agenda have been left to local providers and commissioners to identify and implement.

The underlying assumption of the QIPP approach, which originates from the US Institute for Healthcare Improvement (IHI), is that improved efficiency will lead to improved quality of care. Recently, the IHI has developed the Impacting Cost + Quality Programme. In 2010, a six-month pilot with a group of 40 US healthcare organisations, led to plans to remove a collective $30 million in ‘excess’ costs.2

Evidence of the potential benefits of QIPP

There is minimal evidence to date that the QIPP agenda as a whole will be able to deliver the required cost-savings. The US IHI pilot has not yet demonstrated that cost savings have been realised, despite reassurances that the programme is ‘on track’ to do so. Furthermore, a recent cost effectiveness review rated the NHS as the second most efficient health system of 19 developed countries; albeit using a simplistic economic model. The scope for improvement may be less than anticipated if, with more robust analysis, this is found to be true.3

To support the implementation of QIPP locally, The National Institute for Health and Clinical Excellence (NICE), NHS Evidence and The Information Centre for Health and Social Care have all published guidelines for providers and commissioners of healthcare services on how best to spend limited resources. These guidelines include case studies of attempts to improve quality and productivity; however the quality of the evaluations of these approaches and their likely impact is variable (See Further Reading).

Evidence of the potential risks of QIPP

There is a lack of robust evidence to date to show that there have been substantial savings made through QIPP activities. The NHS has never achieved efficiency savings on this scale before, so the principle risk associated with QIPP is its potential failure to deliver these efficiency gains now. In addition, this may lead to a lack of improvement in the quality of services, improvements in infrastructure, shorter waiting times etc.4
Given the efforts used to meet the QIPP challenge at all levels of the NHS, its failure would be associated with an inefficient use of resources that may have been better used elsewhere.

Implications for health

The QIPP agenda rests on the assumption that improving productivity will improve health via better, more productive health services. Reduction in unwarranted variation in healthcare delivery in the NHS, for example, has the potential to reduce health inequalities and improve population health.5,6
Numerous analyses have shown the opportunities to improve productivity in the NHS, but the focus now has to shift to execution and implementation. Evidence of how best to achieve this however remains limited.
The QIPP challenge also coincides with a period of major reorganisation for the NHS in England.7
The additional challenge therefore is to ensure that the focus remains firmly on QIPP and in addition, to ensure that organisational change itself does not detract from the aspiration to deliver better quality healthcare at reduced cost.

Author: Sarah Smith MSc MPH, Specialty Registrar in Public Health, NHS South Birmingham / West Midlands Deanery

UK area affected: England only

Further reading

1. National Institute for Health and Clinical Excellence. Using NICE guidance to help you cut costs [cited 2011 Oct 17]. Available from URL: (http://www.nice.org.uk/aboutnice/ whatwedo/niceandthenhs/CostSaving.jsp).
2. NHS Evidence. Quality, Innovation, Productivity and Prevention (QIPP) [cited 2011 Oct 17]. Available from URL: (http://www2.evidence.nhs.uk/qipp).
3. The Information Centre for Health and Social Care. Supporting the Quality, Innovation, Productivity and Prevention Programme [cited 2011 Oct 17]. Available from URL: (http://www.ic.nhs.uk/about-us/more-about-us/supporting-qipp).

References

1. Department of Health. Quality, Innovation, Productivity and Prevention (QIPP) [cited 2011 Oct 17]. Available from URL: (http://www.dh.gov.uk/en/Healthcare/Qualityandproductivity/ QIPP/index.htm).
2. Institute for Healthcare Improvement. Impacting Cost and Quality Program [cited 2011 Oct 17]. Available from URL: (http://www.ihi.org/offerings/Initiatives/IMPACTingCostQuality/ Documents /Impactingbrochure2011final.pdfInstitute for Healthcare Improvement).
3. Pritchard C, Wallace MS. Comparing the USA, UK and 17 Western countries’ efficiency and effectiveness in reducing mortality. J R Soc Sh Rep September 2011 201; 2: 60
4. The Kings Fund. Insight Magazine 7 July 2011. Available from URL: (http://www.kingsfund.org.uk)
5. Appleby J, Ham C, Imison C, Jennings M, The Kings Fund. Improving NHS productivity;more with the same not more of the same, July 2010. Available from URL: (http://www.kingsfund.org.uk)
6. Department of Health. The NHS Atlas of Variation in Healthcare November 2010. Available from URL: (http://www.rightcare.nhs.uk).
7. Department of Health Liberating the NHS, 12 July 2010. Available from URL: (http://www.dh.gov.uk/en/Healthcare/ LiberatingtheNHS/index.htm)