Implementing QIPP: A Regional Perspective

1. Making it Happen A Regional Perspective Steve Fairman Director of Improvement & Efficiency South Central SHA King’s Fund, 17 January 2011

2. Population of 4 million • 9 PCTs • 7 Foundation Trusts • 8 NHS Trusts and 2 potential NHS Trusts • 2900 GPs • 547 Practices

3. South Central overview • High life expectancy • Low deprivation (some pockets) • Population growing and ageing • Complex system / borders • Politically high profile

4. South Central overview (2) • Current spend £6.1bn; population 4.2m • Funding gap is £1.4bn by 2014/15 • 55% provider efficiency • 45% pathway changes

5. South Central context • Funded at £1,416 per head v. England average £1,612; • G&A bed ratio of 2.54 per 1,000 v. England average 3.18 • NEL hospital admissions 0% growth and • EL hospital admissions 2.4% reduction

8. Where are we now? • We understand the size of the challenge and that doing more of the same is not enough – we must do more for the same • We are making good progress – we are already in implementation • We have some good delivery mechanisms in place • We have a good regional focus • We are moving into organisational transition

9. QIPP – how are you going to cut the cake… Hint: A hip replacement costs £7599…

11. The essential elements of effective Regional leadership of QIPP • Understanding YOU don’t actually make any of the changes that deliver on QIPP savings • A ‘profile’ with local leaders • Very well organised Programme Management and Governance arrangements • Standardisation • Integration with normal processes

12. Key risks and barriers to QIPP delivery at a Regional level • Gaining front-line engagement on QIPP • Organisations look internally for savings (or growth!) • No record of change on the scale required • Priorities not always properly aligned with the challenge • Management / leadership capability • Organisational sustainability

13. The South Central QIPP Challenge (Draft)

14. Key risks and barriers to QIPP delivery at a Regional level (2) …and a new one – leadership and delivery through, and beyond, organisational transition

15. What have we done at a regional level to mitigate the effects of these? • A relentless focus on quality • Maximise safety • Drive out unwarranted variation • Developing people • Tailored our leadership programmes • Mobilised our Clinical Leadership Network • Working with the new commissioners • Building ownership • Developed a communications strategy • Been open and honest about the scale of change necessary

16. What have we done at a regional level to mitigate the effects of these? (2) • Focused effort and resource around the 5 clinical programme areas that evidence shows us will really make a difference: • Planned Care – e.g. enhanced recovery programme • Acute Care – e.g. improved stroke care pathway • Long Term Conditions – e.g. COPD management • End of Life Care – e.g. choice of place of death • Maternity & Newborn Care – e.g. cut caesarean sections

17. What have we done at a regional level to mitigate the effects of these? (3) • Facilitated joint work between local organisations on other system-wide initiatives • Integrated Supply Chain • Estates rationalisation • Pathology services • Medicines Use and Procurement • The ‘productives’

18. Conclusions • Regional leadership of the QIPP agenda is essential – but can easily be ineffective • You must build an understanding of the scale and nature of change needed • You must build a ‘movement’ for change • Clinicians must be at the forefront • You must be organised • You must be resilient!

19. You can’t solve a problem by using the same thinking that created it Albert Einstein