Comment / Finance must champion quality, conference told (HFMA 2010 latest)

Finance directors have a major role in ensuring that quality is not dropped from the QIPP agenda, Jim Easton told the HFMA annual conference fringe event on Wednesday.

Speaking ahead of the main conference programme, the Department of Health’s national director for improvement and efficiency said that there were significant challenges in delivering the ‘Nicholson challenge’ – delivering up to £20bn of efficiency improvement over the next four years – while also overseeing significant structural changes. ‘One risk is dropping the Q in QIPP [quality, innovation, productivity and prevention],’ he told the audience of finance managers. ‘But I want the finance community to be advocates of retaining this approach.’

Mr Easton said there was ‘any amount of evidence’ about the potential to improve quality and reduce cost. And he insisted the £20bn productivity improvement was credible. But he said that finance leaders had to drive the agenda. ‘Your community is powerfully at the heart of this,’ he said. ‘Your actions will determine if this is an exercise in driving down costs or driving up quality’

Mr Easton said that mindsets in the NHS had been ‘grooved for growth’. He pointed to the health service’s good record in achieving financial turnaround, but warned that the current challenge was different. He said that turnaround had been about slowing down expenditure to below the level of growth, but that now the service faced a ‘seismic shift in its environment’. Simply stopping services or allowing waiting times to expand would not be acceptable. Instead the unprecedented financial challenge would have to be met by driving quality up.

‘There is a deep mindset around the world that you can have quality [in healthcare services] but it will cost,’ he said, adding that a new thought process was needed. ‘At some point our generation of leaders has to change the relationship between quality and cost in healthcare.’

He said that current QIPP plans contained significant common elements – for instance around procurement, back office functions, chronic disease management and medicines management. Suggesting it would be a ‘nonsense’ for every local health economy to make up its own solutions, he promised central support in achieving some of the efficiencies and economies of scale, although participation would be on a voluntary basis.

He said few organisations, if any, would have all the answers and resources within their own organisations.

Mr Easton acknowledged that difficult decisions would have to be taken. One delegate asked whether there would be central and political support for acute capacity reductions that might flow from improving quality by reproviding services in the community. Mr Easton acknowledged the difficulties around closing beds, but said there would be central support in the right cases. ‘There is no problem around reconfiguration where the evidence is clear,’ he said.