Cutting bureaucracy and improving efficiency

The health White Paper, Equity and Excellence: liberating the NHS, re-iterates the government's commitment to increase health spending in real terms in each year of this parliament, while recognising that this represents a challenge to the NHS (which has received increases in funding of an average of 4 per cent per year since its inception).

The existing Quality, Innovation, Productivity and Prevention programme (QIPP) will continue 'with even greater urgency' but leadership of the programme is to be devolved to local authorities and GP consortia as soon as possible.

Management costs will be cut by 45 per cent and proposals to abolish some arms-length bodies have been published (see Review of arms length bodies to cut bureaucracy). Primary care trusts and strategic health authorities are to be abolished and the Department of Health is to cut its budgets for centrally managed programmes.

Providers will be free of central management, and the system of economic regulation overseen by Monitor will 'drive efficiency'. Monitor will have powers to set efficient or maximum prices for NHS-funded services 'where necessary' and will have the power to apply competition law to both publicly and privately funded health and social care.

The government will not bail out failing commissioners, nor will it provide additional funding for failing providers. GP consortia will be required to take part in risk-pooling arrangements and providers of essential services may also be required to do so, to ensure that should a provider become financially unsustainable Monitor will be able to keep services running without recourse to the Department of Health.

Further commentary and analysis from the Fund

We've produced a number of resources on the topics covered in this section of the White Paper, and have listed some of the key pieces of commentary and analysis below:

Funding and finance resources

This project and the resulting publication, Improving NHS productivity: more with the same not more of the same, provides NHS leaders with analysis and advice on the scale of the financial challenge facing the health service. (Project and publication, 2010)

What questions will the coalition government's White Paper need to answer if it is to lessen the deficit in funding for health care? (Blog, July 2010)

As expected, the government's first budget set out a combination of spending cuts and tax increases, so how will these affect the NHS? (Blog, June 2010)

Although key decisions about public expenditure on health and social care are unlikely to be made until the Spending Review in the autumn, the June Emergency Budget still contains some key changes for health care. (Press release, June 2010)

The key to unlocking NHS efficiencies and therefore living with constrained resources is influencing the practice of front-line clinicians as they take decisions on a daily basis about patient care. (Blog, April 2010)

In our series of key election questions we asked if Labour had achieved its spending commitment, and just where has the money gone? (Article, April 2010)

How will the NHS respond as the period of unprecedented investment ends? We developed an analysis of what will be required if health and social care systems are to respond effectively to the major challenges that lie ahead. (Publication, December 2009)

Looking first at the historical funding for the NHS, The King's Fund and the Institute for Fiscal Studies set out three plausible future funding scenarios and their consequences. (Publication, July 2009)

Leadership and management resources

The scale of the challenge facing NHS leaders in pushing through the major reforms outlined in the recent health White Paper, against the backdrop of current financial constraints, is unprecedented. (Blog, August 2010)

The Inquiry into the Quality of General Practice is commissioning research on clinical leadership for its final report in November 2010. (Project, 2010)

It is vital that the NHS continues to invest in its leaders to engage frontline clinical staff in improving care quality and efficiency. Read our full response to the revised Operating Framework. (Press release, June 2010)

Real change and improvement can only be delivered by front-line staff, but they need leaders who have the skills and capacity to manage such change. (Blog, June 2010)

Whether the financial squeeze is upon us already, or a few years away, honest conversations with staff and the public will be needed. (Blog, May 2010)

As part of our election content we looked at key health questions, setting out the facts behind the rhetoric. The number of managers in the NHS remains a particularly contentious issue. (Article, April 2010)