2.2 In December 2009, the Department asked strategic health authorities to identify the level of efficiency savings that could be achieved in their area and to develop a QIPP savings plan covering the period 2010 to 2014. The Department required individual plans to be agreed by April 2010, although accepting they would change as the regional programmes to support the delivery of QIPP savings were developed. The Department asked strategic health authorities to refresh their plans by September 2010.
2.3 During the QIPP planning process, the Department provided strategic health authorities with a series of templates and criteria to assist in putting together their plans. For example:
● A quality and productivity template, co-produced with the strategic health authorities was issued in February 2010. It contained advice on financial analysis, identifying opportunities, developing an implementation plan, the process and structure for implementation, engagement, risks and issues.
● In February 2010, the Department launched a red, amber, green rating system which established the criteria against which it would assess the individual strategic health authority QIPP plans (Appendix One provides details of the green criteria).
● An implementation tracker template was issued in July 2010 to allow an organisation or workstream to monitor and track performance against milestones and key performance indicators (quality, activity, workforce and finance) for each QIPP initiative and to demonstrate how risks are being mitigated.
2.4 In 2010, a Gateway Review rated the confidence of delivering QIPP as 'amber', indicating that successful delivery appears feasible but issues require management attention. As part of a study on productivity in 20109, the National Audit Office reviewed regional and national QIPP plans in relation to savings in hospitals. The review found that some of the national workstream plans were not yet sufficiently explicit in how they intend to engage and work with acute providers to either realise savings or demonstrate and measure effectiveness. While workstreams included some specific targets, poor baseline data for some of these meant that it would be difficult to measure the savings delivered by hospitals and progress against the nationally expected improvements. Our report noted that it was too early to audit the implementation of the plans at the time.
2.5 In 2011-12, the Department and the NHS have moved to an integrated planning process to address the combined challenges of QIPP, wider health reform and operational delivery. The Department's expectation was that each locality would have a clear strategic vision for improvements in quality and productivity, together with plans for transition to the new system. It also expects NHS organisations to ensure that their plans support the delivery of the national priorities for the NHS, set out in the NHS Operating Framework for 2011-12.
2.6 The Department's guidance on the new integrated planning process included the criteria against which it would assess individual plans. Each plan includes trajectories on relevant quality and reform indicators, financial indicators and workforce indicators. In reviewing the plans, the Department aimed to gain assurance that they:
● represented a long-term vision with quality improvement and value for money at their heart;
● were based on robust demand and activity assumptions over four years;
● were supported by robust workforce planning;
● provided assurances on the delivery of national priorities, including transition;
● were resilient to organisational change and had the support of emerging consortia and clusters;
● were consistent with contracts agreed locally with providers; and
● were integrated with local authorities' priorities for health, public health, social care and children's services.
2.7 The Department had signed off all of the strategic health authorities' integrated plans by the end of July 2011. This means that the Department now considers all the plans to be 'workable' although some of the plans are subject to conditions (covering issues that need further work). These regions will be more closely managed and assisted by the Department.
2.8 The Department has also set up a website to facilitate the sharing of good practice, where strategic health authorities can view each other's integrated plans and QIPP plans. In reviewing the QIPP plans, the Department attempted to match similar plans and processes between strategic health authorities in an attempt to inform the less robust plans. The Department has also facilitated monthly meetings with all the strategic health authority QIPP leads to discuss progress and planning.
2.9 Most strategic health authorities told us that the model the Department had put in place to support the development of QIPP plans and integrated plans had been very helpful and effective. They considered that it had brought a necessary discipline to the process and that they received an appropriate level of follow-up, feedback and challenge.
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9 Comptroller and Auditor General report, Management of NHS hospital productivity, Session 2010-11, HC 491, National Audit Office, December 2010.