- NHS trusts support the Getting it right first time (GIRFT) programme and, overall, their experiences and early engagement with the central and regional teams have been positive.
- Trusts value the GIRFT programme for its clear emphasis on quality improvement, clinical engagement and better outcomes for patients. An open and constructive dialogue will be an important cultural determinant of the programme’s credibility with clinicians.
- Trusts welcome that the GIRFT programme is a data driven collaboration between trusts and the national level. Clinical engagement is most effective when data and analysis have been presented as the beginning of a conversation with clinicians, rather than as the 'final word' on performance.
- Refining datasets to capture the most important and meaningful metrics will be important, particularly in clinical specialties where current datasets are insufficiently granular to support nuanced debate about unwarranted variation. Specialties with less developed datasets, especially mental health, will require significant co-production with trusts before analysis can offer meaningful insight.
- However, we need to recognise that data is only the starting point in a complex process to eliminate unwarranted clinical variation. Trusts report that while the GIRFT data is a good starting point for the conversation, more work is required to actually identify why the variation exists; establish what is warranted and what is unwarranted, agree how to tackle this, deliver the changes to clinical practice required and unlock the savings originally identified.
- The GIRFT programme aims to save around £1.4bn per year by 2020/21, which equals just over a quarter of the financial gap facing the NHS by 2020/21. However, caution is required when using headline financial savings. National bodies must set savings targets that are realistic and which take in to account the complex factors affecting the pace by which trusts can eliminate unwarranted variation. While trusts are fully committed to implementing the programme, our view is that the sector will struggle to deliver all the savings identified within the expected timescales due to the complexity of the change process required and multiple dependencies linked to this.
- The NHS continues to deliver productivity improvements that significantly outperform historic trends and the wider economy; the GIRFT programme must act as an enabler for those efforts and compliment the existing productivity efforts that are underway.
- Trusts wish to avoid at all costs the GIRFT data and approach being used as a regulatory tool. Any punitive use of GIRFT will undermine the objective and judgement free approach which has underpinned the programme to date. Our view is that regulatory levers would do little to increase the scale and pace of savings delivered, and at the same time would erode the clinical buy in required for this work to succeed.