Does improving quality save money?

The health service has been set the goal of saving £15 billion to £20 billion through efficiency savings from 2011 to 2014. The challenge to the NHS is how to make these savings while keeping quality as its organising principle. The Quality, Innovation, Productivity and Prevention (QIPP) initiative was developed to prepare the NHS to deliver high quality care in a tighter economic climate – the aim being to “do more for less”. However, the question arises: does improving quality save money? Janet Williamson, the national director for NHS improvement, examined this question at a recent conference, entitled: “A practical guide to delivering High Quality Care for All through QIPP”.1 She pointed out that, although the idea that improving quality will deliver cost savings is an appealing proposition, actually making this happen on the frontline presents a major challenge. She explained that there is plenty of evidence that poor quality healthcare and adverse events are costly for the NHS – particularly in relation to longer hospital stays, infection rates and litigation cases. Unfortunately, there is limited documented evidence of where service and clinical changes have led to identified savings, or where quality improvements have led to lower cost. Although individual case studies have been costed, there are few examples of where these have been extrapolated into achieving major changes. “Only by joining examples of quality improvements together, and by changing the whole system, can we truly make a difference,” said Janet Williamson, pointing out that there is a tendency to focus on the symptom – such as adverse events for example – and not the cause.

Savings

However, significant opportunities for savings have been identified, including: