NHS trusts continue to deliver productivity improvements that significantly outperform the historic NHS trend and the wider economy. As the early feedback in this briefing shows, NHS providers remain committed to addressing unwarranted variation in care where it can be identified. While we are yet to enter the implementation phase in the majority of the clinical specialties addressed by the GIRFT programme, it is positive that the programme’s clinical engagement has thus far been experienced by trusts as respectful and constructive. As a programme focused on supporting clinicians and trusts to tackle complex challenges, this is essential.
Despite the additional revenue funding announced in the November 2017 budget, there remains a fundamental mismatch between the funding available to providers and the costs they incur delivering high-quality care. The GIRFT programme is forecast to generate £1.5bn in efficiency savings annually by 2020/21, making a key contribution to the aggregate provider efficiency challenge, however this alone will fall significantly short from closing the financial gap.
Given the scale of savings the GIRFT programme is expected to help realise, careful monitoring of its progress is required, particularly as it progresses into the clinical specialties that have limited or poor quality data available. It would be wrong to undermine the potential of the GIRFT programme by placing unrealistic financial expectations on the clinicians and trusts, or by holding trust finances ‘hostage to fortune’ on GIRFT outcomes.
Finally, clinical quality improvement must remain the focal point and driver of the GIRFT programme. Clinical engagement is most effectively engaged when data and analysis are presented as the beginning of a conversation with clinicians, rather than as the 'final word' on performance.
Trusts felt that the GIRFT programme’s data and analysis should not be used as a regulatory lever. Using the data to make regulatory judgment on trusts, when it does not present a clear and consistent picture across the provider sector, could undermine the programme’s positive impact as a galvanising force for clinical quality improvement.
NHS Providers will monitor the progress of the GIRFT programme and will continue to facilitate dialogue between the central team and trusts. This will be particularly important as the programme turns its attention to specialties where it is less clear cut what is unwarranted and warranted variation, such as in non-acute services such as community and mental health services. We welcome ongoing feedback and engagement from trusts as the programme develops.