QIPP national workstreams updated
The Quality, Innovation, Productivity and Prevention (QIPP) national workstreams will cease in their current Department of Health (DH) format by 31 March 2013, in line with changes and responsibility shifts in the wider health and care system.
A summary of each workstream’s key achievements is below.
Progress has been made in all the workstreams, and they have produced tools and materials aimed at providing this evidence-based approach to change, to support the changes all NHS organisations are trying to make.
Information on methodologies and assets will continue to be available to support future thinking as outlined below.
Future programmes of work from 1 April 2013 to support improvement, including in relation to quality and productivity, will be a matter for the NHS Commissioning Board and other relevant organisations to determine. This is in line with their own approach to delivering the objectives set for them, including through the Mandate and outcomes frameworks.The QIPP national workstreams were established to offer opportunities and support for the local NHS in the changes they were trying to make, by offering evidence based approaches to change.
End of life care** **
Workstream leads: Claire Henry and Tessa Ing
The QIPP end of life care workstream aimed to increase the number of people identified approaching the end of their lives, in order to support them to live and die well in their preferred place.
The workstream helped achieve a reduction in the number of people dying in hospital, with 46,000 more people dying in their usual place of residence.
Electronic palliative care co-ordination systems played a main part in achieving this and are now being rolled out across the country. A national information standard is in place to support their use.
There is more work still to be done to improve end of life care for people who are dying and their families and elements of this workstream will continue as part of the new system.
Historic information and intellectual property assets in relation to this workstream will be used to support the development of a proposed future programme of work in the NHS Commissioning Board, new Improvement Body, and Public Health England where relevant and appropriate.
Any future action from 1st April 2013, including funding and resources, mechanisms for discharging any programmes of work and the detail of the individual future programmes will be matter for these organisations to decide.
Long term conditions
Workstream lead: Sir John Oldham
The long term conditions (LTC) QIPP national workstream has changed the debate from a disease specific model of care to recognising two or more coexisting medical conditions or diseases as the main driver for health and social care, representing over 70% of activity and cost.
An expert panel created an evidence-based model of care consisting of risk stratification, creating integrated care teams between health and social care, and maximising the number of patients or carers, who could co-manage their condition. The workstream designed and delivered an implementation programme with multi-organisational teams covering around 30 million of the population. Nearly 70% have implemented risk stratification and nearly half now have integrated teams, already we are seeing a reduction of unscheduled admissions and length of stay for ambulatory sensitive LTC in some areas.
The workstream also changed the financial model to reinforce the care model described above. It has done this in two ways:
- firstly by creating the Year of Care (YoC) needs based capitation-funding model (an alternative to PbR for this group of patients) for implementation across the NHS. Ninety health economies expressed an interest in taking this work forward and currently 7 are developing the tariff further, with 25 as fast followers
- secondly, the workstream negotiated incorporating the 3 elements of the care model as part of the Quality and Outcomes Framework for general practice, currently being consulted upon.
The workstream created a suite of tools and resources for all clinical commissioning groups in December 2012, which is available at www.nhsnetworks/longtermconditions. A network of nearly 2000 clinicians, health and social care managers has been established and they have received fortnightly updates and a virtual learning programme.
Information and intellectual property assets in relation to this workstream will be used to support the development of a proposed future programme of work in the NHS Commissioning Board’s medical directorate.
Any future action from 1st April 2013, including funding and resources, mechanisms for discharging any programmes of work and the detail of the individual future programmes will be matter for NHS Commissioning Board to decide.
Medicines use and procurement
Workstream lead: Clare Howard
The QIPP medicines use and procurement workstream looked to support local organisations as they seek to make efficiencies, while continuing to improve quality.
Work looked across a wide range of medicines pathway, including primary and secondary care, and medication safety. The workstream supported improvements in medication safety, getting patients to take their medicines as intended, and efficiencies in the provision of medicines that are used in hospitals. It engaged strongly with key stakeholders in the area to support a culture shift to optimisation of medicines and enable local organisations to focus on quality and productivity.
This work includes:
- primary care QIPP comparators that focus on prescribing performance, but seek to achieve health benefits for patients, which are wider than prescribing alone. For example, changes to prescribing choice of non-steroidal anti-inflammatory medicines are likely to have led to an estimated 1,000 cardiac events per year in England
- top tips databases for NHS trusts and mental health trusts to support measurement of progress with initiatives aimed at improving quality and efficiency
- development of a national framework to support commissioners and providers in working collaboratively to achieve savings from high cost drugs (Achieving Savings from High Cost Drugs).
Looking to the future, medicines optimisation, seeking to deliver better value and outcomes from medicines, will be a key element of the NHS Commissioning Board’s work and the learning from the workstream should prove invaluable to this thinking.
Mobilisation
Workstream lead: Helen Bevan
The workstream has developed and tested the use of a values driven approach to transformation of care services. It identified three intolerable situations that required a call to action approach which were:
- the inappropriate prescribing of anti-psychotic medication in the treatment of people with dementia
- improving the experience of people with dementia, their families and carers in acute care settings
- shared decision making in end-stage kidney care.
The workstream took the shared concerns for urgent action reflecting a model that builds a broad constituency bringing together a wide range of people from different sectors across a community based upon shared purpose, commitment through relationships to take collective action to deliver significant improvements on an agreed time bounded goal.
Two examples of the outcomes have been the Information Centre’s 2011 audit, with results demonstrating an average of 52% reduction in the prescribing of antipsychotic medication in people with dementia across England. The Cabinet Office identified this work as a case study of best practice in wholesale engagement across the system to support achievement of a community goal. Over one third of acute hospitals have signed up to a call to action for creating dementia friendly hospitals since the launch on 15 October 2012.
Information and intellectual property assets in relation to this workstream will be used to support the development of a proposed future programme of work in the NHS Commissioning Board and the new Improvement Body where relevant and appropriate.
Any future action from 1st April 2013, including funding and resources, mechanisms for discharging any programmes of work and the detail of the individual future programmes will be matter for the NHS CB and new Improvement Body to decide.
Primary care
Workstream lead: Mo Dewji
The primary care workstream played a key role in:
- looking at increasing the efficiency of delivery of care within primary care
- publishing data on a single site of over 300 markers showing the care and quality delivered within general practice as a development tool as well as helping patients get insight into the care offered to them by their local practitioners
- supporting practices on how to free resources that could then be used to improve patient care by working closely with the NHS Institute to develop a support program called “Productive general practice”
- making links with the main stakeholders for general practice and ensure QIPP became central to the thinking, planning and delivering of general practice
- working closely with the other QIPP workstreams as primary care was central to the success of many of the other workstreams
The work continued with the productive series being spread widely by the NHS Institute. The learning and partners developed over the past few years will be incorporated within the work of the NHS Commissioning Board in its development of a strategy for general practice.
Information and intellectual property assets in relation to this workstream will be used to support the development of a proposed future programme of work in the NHS Commissioning Board’s medical directorate where relevant and appropriate.
Any future action from 1 April 2013, including funding and resources, mechanisms for discharging any programmes of work and the detail of the individual future programmes will be matter for the NHS Commissioning Board’s (NHS CB) to decide.
Procurement
Workstream lead: John Warrington
The procurement workstream was established in recognition of the significant financial efficiencies and improvements in healthcare that can be achieved through better management of the non-pay spend in the NHS.
The workstream has had significant impact with NHS trusts through engagement with boards and clinicians in order to raise the awareness of the strategic importance of good procurement.
Three main publications have been launched in tandem with the workstream’s work:
- NHS Procurement: Raising our Game
- NHS Standards of Procurement
- NHS Procurement: A call for evidence
The main impact has been hugely increased awareness within the NHS on the immediate steps to be taken to start improving procurement at a local level. The Department of Health continues to implement the committed actions for the centre.
A further strategy for NHS procurement is due to be published as a result of the call for evidence, which will build on the outputs of the workstream and ensure that actions are appropriately placed in the system for the future.
Productive care
Workstream lead: Lynn Callard
The productive care QIPP workstream’s objective was to have patients being cared for in a ‘productive’ environment by April 2013, whether this is in a ward, operating theatre or in their own home. This is an environment that is efficient, productive and safe, adding value not cost.
By September 2012, early indications were that the level of penetration for The productive ward was nearing 80%, with penetration for the other programmes steadily increasing. There have been noticeable improvements in patient and staff satisfaction, decreases in length of day and 30 day re-admission rates, which the productive programmes have contributed to.
Productive methodology will continue to be available as required to support thinking around any future large scale change programmes.
Information and intellectual property assets in relation to this workstream will be used to support the development of a proposed future programme of work in the NHS Commissioning Board (NHS CB) and the new Improvement Body where relevant and appropriate.
Any future action from 1 April 2013, including funding and resources, mechanisms for discharging any programmes of work and the detail of the individual future programmes will be matter for the NHS CB and new Improvement Body to decide, in line with their own due processes.
Right care
Workstream leads: Phil DaSilva and Sir Muir Gray
The right care QIPP national workstream plays the main role in maximising value, with value being defined as patient health outcomes relative to the total cost (inputs):
- the value that the patient derives from their own care and treatment
- the value the whole population derives from the investment in their healthcare
Key achievements include:
- two compendium atlases t have been published (2010 and 2011) in 2012, a focus on atlases themed by condition or patient group:
- approaching 20,000 printed copies requested
- 490,000 downloads
- widespread press coverage
The NHS Atlases have been widely used in local planning and right care continues to respond to approaches from local health economies to provide support and coaching to implement the right care approach locally.
- the successful launch of patient decision aids (PDAs)
- development of new tools such as the procedures explorer tool, a clinical commissioning group (CCG) level SPOT tool, and commissioning for value pack for CCGs, developed in Derbyshire. 152 Health Investment Packs for PCTs in 2010
- successful launch of a programme of commissioning guidance development, in collaboration with the Royal College of Surgeon, FSSA and East Midlands Quality.
All of the right care outputs will continue to be available to the NHS via the right care website www.rightcare.nhs.uk. If you want to keep in touch with transition you should register for eBulletins on the right care website at www.rightcare.nhs.uk.
Information and intellectual property assets in relation to this workstream will be used to support the development of a proposed future programme of work in the NHS Commissioning Board (NHS CB) where relevant and appropriate, including the below:
- Commissioning for Value - assets and information to NHS CB commissioning directorate
- Better Value Clinical Practice - assets and information to NHS CB medical directorate
- Atlases of Variation - information for production and publication to Public Health England, working with NHS CB.
Any future action from 1 April 2013, including funding and resources, mechanisms for discharging any programmes of work and the detail of the individual future programmes will be matter for the NHS CB to decide.
Right care shared decision making
Workstream lead: Steve Laitner
The Right Care Shared Decision Making Programme (Right Care for Patients) was commissioned to help embed shared decision making in routine NHS care.
Shared decision making (SDM) involves a patient and their clinician jointly engaging in the decision making process to choose the treatment, investigation or screening option that is most consistent with the patient’s needs, values and preferences.
By 31 March 2013, 38 patient decision aids will be available to support SDM in both patient and clinical environments. There has been substantial culture change engagement work with patient groups, NHS clinical and commissioning staff and others to help develop a receptive culture for SDM in the NHS, supported by a range of resources.
The workstream recognises that embedding SDM in routine NHS commissioning and provision systems is important for success and the workstream is developing a range of research and measurement tools to support a model of excellence and a series of recommendations for future consideration on embedding in local systems. This report will be supported by examples of work with local health economies, written up as case studies.
Overall the workstream has been heavily involved in supporting a step change towards SDM in the NHS.
Information and intellectual property assets in relation to this workstream will be used to support the development of a proposed future programme of work in the NHS Commissioning Board’s patient and information directorate, where relevant and appropriate.
Any future action from 1 April 2013, including funding and resources, mechanisms for discharging any programmes of work and the detail of the individual future programmes will be matter for the NHS CB to decide.
Safe care ** **
Workstream leads: Maxine Power and Lynne Winstanley
In 2011 the QIPP safe care programme brought together 1,000 frontline staff to test innovative ways of measuring and improving harm in a pilot programme called ‘safety express’. Participants worked to an ambitious goal and demonstrated that it was possible to deliver ‘harm free’ care, defined as the absence of pressure ulcers, harm from falls, urine infections (in patients with a catheter) and treatment for new venous thromboembolism (VTE), in a small number of NHS provider organisations. In 2012 the NHS Institute for Innovation and Improvement agreed to support the spread of the results from the safety express pilot and the resultant ‘harm free care’ programme. They designed bespoke regional improvement capability programmes, which were delivered through regional learning networks and local education and training (improvement capability programme). A series of improvement materials, videos, on-line learning and guides to support organisations wishing to replicate the pilot programme locally have been developed from the pilot and learning networks (improvement materials). All materials are open access and available via www.harmfreecare.org. The measurement instrument developed and used in the QIPP safe care pilot, the NHS Safety Thermometer, has been incentivised through national commissioning for quality and innovation (CQUIN). The 2012-13 CQUIN scheme resulted in national measures of the four harms across care settings. Since April 2012 over one million NHS patients have been proactively reviewed by frontline clinical staff for harm, the data are submitted to the Health and Social Care Information Centre and are published monthly. The 2013-14 national CQUIN scheme will reward organisations who deliver improvements in pressure ulcers, measured by the NHS Safety Thermometer.
The harm free care improvement capability programme and related improvement materials, historic information and intellectual property assets will be used to support the development of a proposed future programme of work in the NHS Commissioning Board and the new Improvement Body, where relevant and appropriate.
The NHS Safety Thermometer, CQUIN guidance and related historic information and intellectual property assets in relation to the QIPP safe care work stream will be used to support the development of a proposed future programme of work in the NHS Commissioning Board’s patient safety directorate, where relevant and appropriate.
Any future action from 1 April 2013, including funding and resources, mechanisms for discharging any programmes of work and the detail of the individual future programmes will be matter for the NHS CB and new Improvement Body to decide.
Workforce
Workstream leads: Peter Coates and Nic Greenfield
The workforce QIPP national workstream has been about how to plan, train, and engage with, reward and support NHS staff to respond to QIPP by commissioning work to:
- redesign priority pathways
- assure workforce safety and quality
- reduce agency staff costs and sickness absence
- support improvements in productivity.
In terms of priority pathways, a web based toolkit has been developed to support the NHS in designing care pathways for older people and is being evaluated by the Centre for Workforce Intelligence, the outcomes from which will be published on their website in March next year.
The National Quality Board has developed a quality and safety assurance framework, first trialled in 2011/12, which the NHS can use to assure the quality and safety of patient services when planning workforce changes. Work programmes to support the NHS in reducing agency staff costs and rates of sickness absence have helped the NHS deliver efficiencies and understanding of workforce benchmarking and productivity measurement has improved with expertise across Department of Health, Health Education England and local education and training boards .
Looking to the future, support for care pathways can be rolled out once Centre for Workforce Intelligence has completed its evaluation, the quality and safety assurance framework is embedded in the NHS and will continue to evolve.
NHS Employers is supporting the NHS in further agency costs and sickness absence reductions and there is now embedded expertise in the NHS to help improve productivity.
Urgent and emergency care
Workstream lead: Sir John Oldham
The urgent and emergency care QIPP national workstream has worked to create a paradigm shift in the principle underlying the architecture for urgent and emergency care in order to ensure that more patients receive care from the right person, in the right place, at the right time.
This shift is a move from professionals designing the architecture and operating mechanisms of the system and informing people what is urgent (or not), to creating a system that responds rationally to whatever anyone deems urgent. This system needs an easy point of entry (NHS111) with navigation to the best local place to go (directory of services). Where a person goes should have names and signage that resonates with them, is consistent, and has underpinning it robust clinical governance and protocols agreed by a network of primary and secondary clinicians in the relevant geography (Consistency of Offer). Finally general practices should receive real time data about the utilisation of their patients of any of the urgent or emergency care facilities locally, so that they have the opportunity to manage patients proactively (Urgent Care Clinical Dashboard). This is the system we are now bringing about. NHS111 and the directory of services are being rolled out.
The Urgent Care Clinical Dashboard, designed by NHS Bolton, is now available for all clinical commissioning groups. The workstream’s recommendations for providing consistency of offer across the country in urgent and emergency care were shaped by what drives patients in their use of any element of urgent and emergency care, and what resonates with them, alongside professional input on clinical governance and safety.
This iterative process resulted in proposals that were independently evaluated, and received support from all the major stakeholder organisations.
Information and intellectual property assets in relation to this workstream will be used to support the development of a proposed future programme of work in the NHS Commissioning Board’s patient safety directorate where relevant and appropriate.
Any future action from 1 April 2013, including funding and resources, mechanisms for discharging any programmes of work and the detail of the individual future programmes will be matter for the NHS CB to decide.