Directors of nursing will have to rubber stamp the safety of plans to make efficiency savings in hospitals and community services in future, under the latest operating instructions for the NHS.
The new rules follow government policy to increase clinical influence on the purchasing and provision of health services, introduced under the controversial Health and Social Care Act.
But they may also leave nursing directors at greater risk of being directly blamed for patient safety breaches proven to have resulted from stringent NHS cost cutting plans.
The NHS Commissioning Board today published its first set of planning guidance called Everyone Counts: Planning for Patients 2013-14. It will apply from April when the body takes over responsibility for the day-to-day running of the NHS from the Department of Health.
The document warns it is “essential” that the health service’s national efficiency drive – known as the quality, innovation, productively and prevention (QIPP) challenge – continues into a third financial year due to the limited growth in financial resources.
However, it states that while the NHS needs to improve its efficiency “at an increasingly faster rate” it is essential that there is “no trade-off with the quality of services provided”.
“It is the fundamental responsibility of the boards of provider organisations to ensure that any decisions to reduce costs do not have a negative impact on the quality of services,” the guidelines say.
“Any cost improvement programmes must be agreed by the medical and nursing directors of the provider as having been assured as clinically safe,” it states.
The stipulation that quality and safety must not suffer as a result of efficiency cuts comes barely a month ahead of the expected publication of the Francis report, which will reveal the findings of the public inquiry into Mid Staffordshire Foundation Trust.
The care failings at the foundation trust have previously been closely linked with managers placing too much focus on financial control at the expense of patient services.
The commissiong board’s guidance also instructs clinical leaders involved in the commissioning of NHS services to “make their own assessment” of cost improvement plans to satisfy themselves that services are “safe for patients with no reduction in quality”.
The requirement hands nursing and medical directors in the new clinical commissioning groups an influential role in ensuring safety is maintained and that service changes do not contravene guidelines from the National Institute for Health and Clinical Excellence.