CCG Series: Expanding the ‘I’ in QIPP

Bexley CCG is commissioning for outcomes. In this CCG Series blog, chair Dr Howard Stoate says that allowing patients to decide what to aim for will allow providers to be more innovative

In Bexley we aim to put the patient and the public at the centre of everything we do. The government’s ‘The NHS belongs to the people: A call to action’, gives clinical commissioning groups in particular a platform to have an open, transparent debate with local people to discuss healthcare.

We must have a proper conversation – with patients at the centre – about how to maximise the efficiency, safety and quality of the health service, in a climate where we are not going to see an increase in resources. However, we are going to see an increase in demand with the ageing population's growing health needs.

We need to explain to people that services will need to change; hospitals will need to be reconfigured if only to make them more efficient and safe.

Take stroke services as an example. Medical evidence suggested that the most effective, safe and resourceful way for patients to receive care was to close stroke units in many London hospitals and send patients to highly specialised centres.

Patients were receiving mediocre care from small units dealing with strokes and outcomes were satisfactory. London now has eight Hyper Acute Stroke Units. This has led to an increase in survival rates, resulting in 400 lives saved since 2010, as well as delivering a 12% cost saving.

The reconfiguration did mean that difficult decisions had to be made. The public debate focused on where the stroke units were placed and which ones needed to close. London now has one of the best stroke services in the world.

We plan to have a series of debates in Bexley as we redesign cardiology, diabetes and musculo-skeletal services. We are one of four clinical commissioning groups in the country applying the prime contractor model to redesign our three largest Quality, Innovation, Productivity and Prevention (QIPP) schemes.

We are commissioning for outcomes. Working with our patients, we will decide what outcomes we want to achieve and how they, as well as quality and safety, are measured. How the provider delivers the outcome is up to them.

We think this is a really exciting approach, giving providers the opportunity to have a completely new look at how they do things and find new ways of doing it. It could deliver some really interesting pathways that no one has thought of before. Once the provider has developed an innovative idea for a pathway, we then need a further debate. We have already started the debate with local people by asking for their views on current diabetes, cardiology and musculo-skeletal physiotherapy services. We also have a patient council who oversee business cases and receive regular programme updates.

For us, it is about putting the ‘I’ in innovation. It’s about taking QIPP further and putting patients at the centre of redesign, not just focusing on the efficiencies. It’s about finding innovative ways of delivering outcomes and having an honest transparent debate along the way.