5.1 Given the scale of the proposed efficiencies over the next four years and the fact that it coincides with the period of transformation of the NHS to achieve the wider reforms, effective risk management will be crucial. Risk registers are maintained on the QIPP challenge, at national, regional and local levels. Maintaining momentum over this four-year period, during a period of organisational change will be challenging. For example:
● can clear governance and monitoring arrangements be maintained over a period where new structures are being created and where roles and responsibilities are changing?
● can strong management of the QIPP challenge be maintained at a time when management capacity is diminishing with clustering and the dissolution of strategic health authorities and primary care trusts?
● can staff at all levels remain focused on the achievement of efficiency improvements during the abolition of strategic health authorities and primary care trusts, which have a lead role in delivering the QIPP agenda, and the establishment of new organisations?
● will those clinical commissioning groups that are not ready in 2013 still be able to deliver the level of efficiency savings needed, especially as the QIPP challenge is likely to get harder each year?
● can those GPs who will not be directly involved in commissioning as part of a clinical commissioning consortium be engaged on the QIPP challenge?
● can all providers be encouraged to make efficiency savings, given that we were told some providers are unwilling or unable to make efficiency savings?
● can efficiency savings be delivered though the tariff without financially destabilising trusts?
● can efficiency savings be delivered when local authorities are looking to reduce their social care budgets, which may increase demand for NHS services?
● can a programme of support that is more focused on enabling and encouraging, rather than enforcing, deliver savings at the right pace?
● can, as a minimum, quality and patient safety levels be maintained?
5.2 Achieving the efficiency savings will require a culture change involving clinicians, commissioners, patients and the wider public, and politicians:
● can clinicians change their referral behaviour and patterns of work?
● can commissioners drive service transformation through better commissioning of services?
● will patients and the wider public accept that where they receive services may change, and that acute providers may reduce in size or even close?
● will politicians support changes to the delivery of their local health service?