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Sunday 25th August 2019

The Quarter: How is the NHS doing?

6th January 2012

The Quarter is an update on progress within the NHS released by David Flory, Deputy NHS Chief Executive. 

The publication gives an account of how the NHS is performing at national level against the requirements and indicators set out in the NHS Operating Framework.

The update for Quarter 2 2011/12 has now been released and holds some promising figures around QIPP savings and gives an indication on the priorities moving forwards where achievements have so far not reached expectations.

The update gives forecast figures for the savings the Quality, Productivity, Innovation and Prevention Programme (QIPP) should generate broken down by sector. It also showed the actual savings realised this quarter by these groups.

Categories of planned QIPP savings in 2011/12

 QIPP Category

 Q2 Forecast 2011/2012 Annual Savings £m

 Q2 2011/2012 YTD Savings £m

 Acute Services



 Ambulance services



 Community services



 Continuing healthcare



 Mental health and learning disability services



 Non-NHS healthcare (inc reablement)






 Primary care, dental, pharmacy, ophthalmic services



 Specialised commissioning






 Grand total



The figures show that savings must be achieved from across all sectors of healthcare, but perhaps unsurprisingly, hospitals have the biggest challenge facing them with a need to achieve savings of almost £3bn for 2011/12.

The Department of Health have commented that the £2.5bn saved in the first half of the year means that they are on track to reach their targets. The latter half of this year however, the NHS are forecast to save £3.4bn, in a time when the usual seasonal pressures will be placed on them.


The report gave figures based on performance against benchmarks in a number of areas. These figures included updates on MRSA infections, referral to treatment times, A&E admission and cancer care.


The report published figures that MRSA infections were 33 percent lower than the same quarter last year, with C. difficile infections 16 percent lower.

Referral to treatment times

Referral to treatment times have not improved but were maintained.  In September 2011 90.7 percent of admitted patients and 97.2 percent of nonadmitted patients completed their RTT pathway within a maximum of 18 weeks.


Arrival to admission for A&E attendances have also not improved but were maintained with 97.3% of patients seen within 4 hours, this being above the 95% target.


Cancer care has also not improved but was maintained. At a national level, the requirements for waiting times for diagnosed and suspected cancer patients were met, but in there has been an increase in the local variation for some measures.

The QIPP programmes aims to save £20bn by 2014/15 but crucial is that although savings need to be achieved, this cannot be at the expense of the quality of care provided by the NHS.


The NHS Chief Executive’s Innovation Report, Innovation Health and Wealth, Accelerating Adoption and Diffusion in the NHS  sets out a delivery agenda based on eight key themes:

  • We should reduce variation in the NHS, and drive greater compliance with National Institute for Health and Clinical Excellence (NICE) guidance; 
  • Working with industry we should develop and publish better innovation uptake metrics, and more accessible evidence and information about new ideas; 
  • We should establish a more systematic delivery mechanism for diffusion and collaboration within the NHS by building strong cross boundary networks; 
  • We should align organisational, financial and personal incentives and investment to reward and encourage innovation; 
  • We should improve arrangements for procurement in the NHS to drive up quality and value, and to make the NHS a better place to do business; 
  • We should bring about a major shift in culture within the NHS, and develop our people by hardwiring innovation into training and education for managers and clinicians; 
  • We should strengthen leadership in innovation at all levels of the NHS, set clearer priorities for innovation, and sharpen local accountability; and 
  • We should identify and mandate the adoption of high impact innovations in the NHS.

The report goes on to detail the programmes and initiatives that will commence over the next year and beyond with the aim to spread innovation throughout the NHS. These include; 

  • launch Whole Systems Demonstrator and Three Million Lives, 
  • launch an uptake programme for use of Oesophageal Doppler Monitoring (ODM) or similar fluid management technology, 
  • launch the Department of Health Procurement Strategy, 
  • Introduce NICE Compliance, 
  • strengthen advice on decommissioning in NICE Guidance, 
  • publish details of Academy Health Science Network (AHSN) designation process, 
  • hold international healthcare summit with UK Trade and Investment.


Emergency Readmissions

The Operating Framework 2011/12 stipulated that hospitals will not be reimbursed for emergency readmissions within 30 days of discharge. This was to ensure that hospitals have good discharge arrangements in place to avoid emergency readmissions.  In Q1, 33 percent of all emergency readmissions were not paid for under this new policy. This percentage increased to 62% for readmissions following elective admissions.
Approximately £107.5 million was saved in Q1 by not paying for readmissions. 86% of this was reinvested by the time the survey had been completed. More than one third of the money saved by not paying for readmissions was directed into specified services including home reablement, intermediate care and community health services, once again highlighting the ongoing commitment to moving care closer to home. The long term ambition is to redesign pathways so that patients are treated in the most appropriate settings, which is expected to result in fewer unplanned emergency admissions.

Elective activity

The report showed that that at the end of Q2 there was a slowdown in referrals from GPs.  The growth in elective activity continues to be lower than the last two years. The report suggest that this is because the NHS is beginning to treat more people in the most appropriate setting and preventing unnecessary admission.

  • GP referrals made were 3.6 percent lower than the same period last year. 
  • Other referrals for a first outpatient appointment were 2.6 percent higher than the same period last year. 
  • The reduction in GP referrals made is reflected in the rate of GP written referrals seen which were 4 percent lower than the same period last year. 
  • All first outpatient attendances were 1.6 percent lower than the same period last year. 
  • Elective activity (admissions) was 2.1 percent above the same period last year7


Health Visitors

In 2010 the Government committed to increasing the number of Health Visitors. In Q2 the number of Health Visitors has declined, however the government is committed to significantly increasing the number of Health Visitors that can offer families core programmes of evidence based preventable health care.


Breastfeeding is known to protect the health of babies and mothers and reduces risk of illness. The report notes that there is a clear case for investing in services to support breastfeeding as part of a local child health strategy. As it is known that mothers from lower income groups are less likely to breastfeed, this strategy is particularly important for low income groups.


The long term and serious impact that smoking can have on a person’s health are well known, so successful smoking cessation programmes are a crucial step in the move to a healthier society. Figures show an encouraging 13 percent increase in the number of people having successfully quit smoking at their four week follow up when compared to the figures from the same time last year.


Screening programmes result in earlier diagnosis of serious illnesses such as cancer. Early detection greatly increases the chance of better outcomes for the patient. The report highlighted that they are committed to meeting their targets for the various screening programmes such as Venous Thromboembolism (VTE) risk assessment,  Breast screening, Cervical screening and Bowel Screening, Diabetic Retinopathy and Immunisation programmes.


The current government has shown in many of their initiatives that they want people to take more responsibility for their health. This includes taking responsibility for their online medical records. The government have pledged that everyone should have access to their GP medical records online by 2015, though more details on long term goals of this pledge are due in the Information Strategy for Health and Social Care Paper due in April. Medical information is currently online in some areas for patients to view via HealthSpace. This medical information is from the patients Summary Care Record (SCR) which holds the minimal amount of medical information, such as allergies, which is required to support safe care if the patient admits to A&E or any other unscheduled care provider who may otherwise not have access to their medical history.

During Q2 there was an average of 805 views per week of Summary Care Records, usually by GP out of hours services. The report suggests that access to the SCR increased the level of confidence in clinical decision making and had an impact on prescribing decisions. A number of acute services reported that the SCR contributed to medicines reconciliation for emergency admissions.

Over 8.5 million patients now have a SCR, but report indicates that this is below the level that they had expected. It is stated that there needs to be ‘significant effort’ to ensure the commitment to provide patients with a Summary Care Record is met.

Overall the report highlights a lot to be pleased about - standards are mostly improving and new initiatives are paving the way for a more streamlined and efficient service-  but it also throws into sharp relief the great challenges the NHS has to face. There are huge savings to be made across the NHS, but with advancement in technology and medicine, there is also the ever increasing pressure to improve quality of services to meet the rising expectations of the public. With a population that is growing, living longer and living with more illnesses, the option to do nothing is not an option. Savings need to be made and QIPP is leading the way.

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