Department of Health operating framework to quicken efficiency work

The NHS will face major challenges next year, with the government stating that the health service needs to take bold, long term measures to secure sustainable change and increase innovation, which it described as the "forgotten element" of its efficiency programme. In the recently published operating framework for 2012-13 , the Department of Health (DH) outlines four key themes for all NHS organisations in England next year: • Putting patients at the centre of decision making in preparing for an outcomes approach to service delivery, whilst improving dignity and service to patients and meeting essential standards of care. • Completion of the last year of transition to the new system, building the capacity of emerging clinical commissioning groups (CCGs) and supporting the establishment of health and wellbeing boards so that they push improvement across the NHS. • Increasing the pace on delivery of the quality, innovation, productivity and prevention (QIPP) challenge. • Maintaining a strong grip on service and financial performance, including ensuring that the NHS Constitution right to treatment within 18 weeks is met. "The NHS is moving to a system where quality and outcomes drive everything we do. Our model of delivery needs to be overhauled and 2012-13 is the year to make that change happen," says the document. "The NHS outcomes framework will act as a catalyst for driving quality improvements and outcome measurement throughout the NHS. It defines and supports a focus on clinical outcomes, including the reduction of health inequalities, to drive a change in culture, behaviour and the way we deliver clinical services." It also outlines a series of finance and business rules that aim to ensure that clinical commissioners do not inherit debt from their predecessors. Among these will be the way tariff is delivered. The framework highlights payments by results (PbR) and says that guidance and accompanying code of conduct will describe one system and one set of rules for England that are mandatory. The document says: "Where commissioners and providers find the rules prevent them doing the best for patients, then local variation is permitted. However, variations which in effect enable the continuation of poor-quality, inefficient models of care or restrict patient choice are not valid." The document also says that in response to concerns about the cherry picking of patients, commissioners will be required to adjust the tariff price if the type of patients that a provider treats results in it incurring lower costs than the average of the tariff category. "The national efficiency requirement for 2012-13 is 4%. This will be offset by pay and price inflation. The tariff price adjuster will be a reduction of at least 1.5%, and this will also be applied to non-tariff services. This will be confirmed in the 2012-13 PbR guidance following allocations," says the document. This article is published by Guardian Professional. Join the Guardian Healthcare Network to receive regular emails on NHS innovation.