Part Three The QIPP challenge at a regional and local level

3.1 After being asked by the Department, in December 2009, to identify the level of efficiency savings that could be achieved in their region, each strategic health authority established a QIPP lead to develop their response to the quality and productivity challenge, and to produce a QIPP plan for 2010-11. Figure 5 shows the timeline for the development of the 2010-11 QIPP plans. Some strategic health authorities had started to estimate the impact of the economic downturn prior to the introduction of the QIPP challenge. Most authorities commissioned consultants to identify how much they could realistically contribute to the overall savings.
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Figure 5 Timeline for the development of strategic health authority QIPP plans and integrated plans

Source: Department of Health
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3.2 The initial planning phase took around four months. Most strategic health authorities used the financial assumptions set out by the Department in the NHS Operating Framework for 2010-11 and a set of growth assumptions supplied by external consultants. In order to decide on areas where efficiency savings could be made and to give some structure to the process, all ten strategic health authorities developed regional workstreams in which savings were calculated and allocated, led by regional workstream leads or teams. These regional workstreams tended to overlap with the national workstreams but did not necessarily match them.

3.3 In each region, this initial planning phase was followed by a more detailed bottom-up planning phase whereby primary care trusts were consulted on the feasibility and achievability of all the proposed savings. Primary care trusts were asked to develop their local plans, working with their main providers, emerging GP consortia and social services, using some of the assumptions, tools and methodologies developed by strategic health authorities. Strategic health authority plans were then revised to reflect the aggregation of their primary care trusts' plans.

3.4 In 2011-12, the Department and the NHS moved to an integrated planning process to reflect the challenges of QIPP, reform and operational delivery, as set out in the NHS Operating Framework for 2011-12. QIPP work was included in the strategic health authorities' integrated plans, which brought together all of the key requirements across the three areas of quality, resources and reform. Figure 5 shows the timeline for the development of integrated plans. The QIPP elements of the plans evolved from the 2010-11 QIPP plans, and set out their expectations over the next four years, with delivery commitments and milestones for 2011-12. The plans describe the overall improvements required in terms of quality, productivity, management of resources and capacity building for the new system.

3.5 Some strategic health authorities have more comprehensive integrated plans than others. For example, some plans clearly demonstrate how the national workstreams are being taken forward at the regional and local level. The least comprehensive plans tended to be from those authorities which operate in a more decentralised way.

3.6 A significant reduction in management and administrative costs is expected to be made through the changes to commissioning and the dissolution of the strategic health authorities and primary care trusts. These savings form part of the one-third real-terms savings in administration costs and will vary by strategic health authority. All the integrated plans of strategic health authorities take account of the management cost savings, in line with local flexibility, although some include this saving as part of their QIPP savings whereas others do not. For example, the approach taken in one authority was to keep management cost savings separate from the QIPP savings because the management cost savings were used to fund the £2 per head for clinical commissioning groups, in line with NHS Operating Framework for 2011-12.

3.7 Communication is seen as key to delivering the QIPP savings (paragraphs 2.19-2.20). Most regional workstreams have engagement programmes and each strategic health authority has a strategy for communicating the changes that will take place as a result of work to meet the QIPP challenge to their locale and the wider public.

3.8 Each strategic health authority plan should be an aggregate of primary care trust or cluster information. The primary care trusts that we spoke to had identified early on that engagement of clinical staff was key to successfully achieving the QIPP challenge and that planning should be led by clinicians. Primary care trusts recalculated the savings from the bottom-up level. Some primary care trusts had already started to identify savings prior to the QIPP challenge (often as result of being in financial deficit in the past) and believe that they are now in a better position to realise savings.

3.9 Each primary care trust or cluster has a four-year QIPP plan, with a number of work programmes which are aligned to regional and national workstreams. As the plans are likely to outlive the lifespan of strategic health authorities and primary care trusts, the Department recommended that existing and emerging clinical commissioning groups (formerly GP consortia) should be fully involved in shaping the development of their primary care trusts' plans. They also recommended that emerging clusters should be involved in the planning process. The level of engagement with consortia varies across the country depending on how well developed the consortia are in the region. These plans are continuing to evolve.