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The NHS Operating Framework is set in a background where financial efficiency is paramount and is driven locally through Cost Improvement Programmes (CIPs). The historic environment for NHS financial efficiency has been a ‘top-slicing’ of budget approach. In order to withstand future financial challenges and achieve expected reductions and efficiency gains the traditional approach has to be wider, with more depth and one that brings about transformational changes to the way services are delivered in order to optimise effectiveness and productivity.

Transformational change requires careful consideration to the impact of quality and safety to ensure no disadvantage to users of our services or to the staff that provide those services. The need to fully consider quality as part of CIP planning is evidenced by the Mid Staffordshire NHS Trust Report which shows financial efficiencies driven without recognition of quality standards or application of robust quality assessment can have disastrous effects.



The quality assessment of CIPs is not new to the NHS. In 2010 Monitor described a best practice approach to the assurance processes (see appendix 1) by means of Quality and Safety Impact Assessment (QSIA). The guidance was supplemented by the National Quality Board (NQB) in 2012 outlining expected management procedures for the assessment of quality impact of CIPs.

The following process takes account of this guidance and has developed its main principles to reflect the recommended best practice. Principles include:

  • QSIA process will be Board Executive led by the Medical Director and Chief Nurse to ensure integrity of the process
  • clearer articulation of the risks and impact to quality using a risk assessment matrix
  • risk stratification
  • inclusion of measurements on quality relating to proposed changes (quality metrics and metrics to provide assurance within the performance framework)
  • CIP’s prohibited from operational initiation until approved by the QSIA Approval Panel (unless alternative Executive permission obtained)


Policy Details

Download: PDF version
Compiled by: Assistant Director of Productivity and Efficiency
Ratified by: Quality Governance Committee
Date Ratified: November 2016
Date Issued: November 2016
Review Date: June 2018
Target Audience: All staff
Contact name: Assistant Director of Productivity and Efficiency
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