Guest Editorial February 2011

Bernard Crump 

February's guest editorial was written by Professor Bernard Crump, CEO of the NHS Institute for Innovation and Improvement.  Bernard presented on the topic of A blueprint for improving quality and cost, during the Expert on Call on 17th February 2011.  Follow this link to hear the recording of the session.


A blueprint for improving quality and cost

Bernard Crump studied Medicine at Birmingham University, qualifying in 1980. After 7 years in clinical practice and clinical research, he returned to the West Midlands to postgraduate training in Public Health Medicine. He spent a decade as Director of Public Health, in South Birmingham and in Leicestershire, where he was also Deputy Chief Executive. In 2002 he became CEO of Shropshire & Staffordshire Strategic Health Authority, a post which he occupied until being appointed the first CEO of the NHS Institute for Innovation and Improvement in July 2005. The NHS Institute has developed a wide range of programmes that are supporting the improvement of the NHS; the Productive Ward and the Productive Series; the No Delays Achiever and support for commissioners.

He has written and lectured on a wide range of topics in healthcare including aspects of population health, the role of clinicians in management, health and healthcare improvement, the use of metrics in encouraging improvement and the use of health economics in decision making. He is visiting professor at the University of Leicester and Honorary professor at the University of Warwick.

The current context

The NHS is facing a major productivity challenge. To some extent we have a had a period of a “phoney war”; whilst we have known that the future funding prospects for the growth in resources for the service are bound to be less positive than in the last decade, it is only with the allocations announced for April 2011 that the squeeze really starts to take effect. This comes at the same time as major reorganisation and a substantial reduction in running costs which are reducing the management attention necessary to improve quality whilst reducing costs.

National actions, including particularly pay restraint, will help with a proportion of the challenge but the majority of the action needs to take place locally. There are many examples of initiatives which have delivered cost and quality improvement, but these need to be replicated, upscaled and brigaded into major programmes if the optimal productivity increase is to be delivered and the necessary proportion of cash released from these endeavours. The alternative is all too familiar; a “slash and burn” approach as projected deficits emerge and a tendency to look to organisational protectionism when often the optimal solutions need a more collaborative approach.

Programmes already developed and successfully implemented in many organisations can provide a significant part of the answer; they don’t need to be invented from scratch. However, faithful and effective implementation is the key and our track record of doing this well is not strong.

Building on our experience of working with over 90% of NHS organisations this session offers a framework for people charged with leading such a programme.

What will I learn?

In this session Bernard will present the accumulated experience of the NHS Institute and organisations with which the Institute has worked which have been improving quality whilst reducing costs of healthcare.

The session will comprise:

  • A brief summary of the case for change; where does the £15-20Bn “Nicholson challenge” come from and what does it mean?
  • The evidence that quality can be improved whilst reducing cost
  • The NHS Institute experience of working with partners to achieve these objectives
  • The NHSI framework for tackling cost and quality
  • The “Anatomy and Physiology” of a programme or blueprint for Cost and Quality improvement which combines the technical aspects of improvement with the leadership and motivation necessary to devise and implement a successful programme.