Printable version E-mail this to a friend

New guide to help NHS deliver savings and improve care

A new briefing looks at the evidence from Cost Improvement Plans (CIPs) across the NHS to identify important lessons and provide examples of how NHS trusts and foundation trusts can use CIPs to deliver lasting benefits for their patients and service users. CIP is the term widely used in NHS to describe schemes to make efficiency savings and improvements in productivity.

The joint report by Monitor and the Audit Commission found a significant variation in the approach and success of CIPs across different organisations. The evidence suggests that a successful CIP is not simply a scheme that saves money; it includes a long-term plan to improve patient care, satisfaction and safety. Some of the more straightforward CIP schemes, such as vacancy freezes and a cut in use of agency staff for example, have already been carried out in most organisations. Now a more strategic approach is needed.

The briefing looks at the key stages of planning and implementing a CIP, with real case studies in each section. It highlights the important role that clinical leaders play in ensuring CIPs are given a high priority within the organisation. Their role is also crucial to providing assurance that potential risks to the quality of services have been identified. In some cases this may require a change of culture, as CIPs are traditionally seen as lying with the management team. The report argues that without clinical engagement trusts will struggle deliver the full value of CIPs.

Commenting on the guide, Chair of Monitor, David Bennett, said:

"The aim for the NHS is to save money by reducing inefficiency and to invest the savings in improving services for patients. This won’t happen without strong leadership. It’s the board’s responsibility to ensure the organisation is committed to achieving cost savings by changing the way services are delivered and improving processes, rather than by implementing cost cutting measures that have a negative impact on the quality of care patients receive. To really succeed, boards must put clinical staff at the heart of the process.

"Delivering efficiency improvements is likely to remain one of the key challenges facing foundation trusts – and the rest of the NHS – for the foreseeable future. The financial challenges facing the economy as a whole mean that all trusts need to make sure that they are making every pound go as far as possible so that patients receive the quality care they deserve."

Managing Director for Health at the Audit Commission Andy McKeon says:

"Health organisations are used to making efficiency savings, but the increase in NHS funds over the last decade reduced the pressure. Now trusts are facing a real-terms freeze on resources, alongside continuing demands for better services, new technologies and improved quality.

"CIPs are not just about money, but about achieving sustainable high quality service delivery. Our research shows that success varies greatly from trust to trust, and no single approach works for all. We have found common factors in the higher performing trusts which have enabled them so far to deliver savings without reducing quality or patient safety. This isn’t easy and there are difficult choices ahead, but it is critical everybody adopts the proven techniques described here. Our guide is also designed to help trusts test how well they measure up."


  1. For further information please contact Michael Moruzzi: or 020 7340 2438
  2. Monitor was established in January 2004. It is independent of government and accountable to Parliament. Monitor’s functions and powers are set out in the National Health Service Act 2006.
  3. The Audit Commission is a public corporation set up in 1983 to protect the public purse. The Commission appoints auditors to councils, NHS bodies (excluding NHS Foundation trusts), police authorities and other local public services in England, and oversees their work. The auditors we appoint are either Audit Commission employees (our in-house Audit Practice) or one of the private audit firms. Our Audit Practice also audits NHS foundation trusts under separate arrangements. We also help public bodies manage the financial challenges they face by providing authoritative, unbiased, evidence-based analysis and advice.

The State of Cybersecurity in 2023