Developing the ‘U’ in ABMU:creating the new 21st Century

health economy

Professor Andrew DaviesChairman

Abertawe Bro Morgannwg University Health Board

ABMU Health BoardOne of seven health boards in Wales. Wales’ health policy and structures increasingly different from

England: • internal market abolished; • no Clinical Commissioning Groups (CCGs)

ABMU a very ‘big beast’! • Fully integrated Health Board covering acute/tertiary, primary

care, community services and public health • £1.3 billion annual budget• 16,5000 employees• Serving population of over 500,000 (Local authority areas of

Swansea, Neath Port Talbot & Bridgend)

NHS England• April 1st 2013 major change in NHS England• Primary Care Trusts and Regional Health Authorities abolished• Clinical Commissioning Groups (CCGs) set up• CCGs - clinically led groups including all GP groups in their

geographical area to give GPs and other clinicians the power to influence commissioning decisions.

• CCGs commission:* Elective hospital care* Rehabilitation care* Urgent and emergency care* Most community health services* Mental health and learning disability services

The challengesDemographic - especially those of an ageing society• The ‘Silver Tsunami’ here now!• 65% of hospital admissions over 65• Median age of patients in many wards 85+• Increasing acuity and complexity of older patients• Rapidly widening health inequalities, e.g. life chances• Chronic conditions e.g. diabetes

Financial - especially at time of austerity• Wales - 3rd year of flat cash settlement• Health & social care - over 40% of Welsh Government budget

Wales• We admit more people into hospital (Wales 11,471 per

100,000, England 9,994 per 100,000)*• They stay longer (Wales 6.3 days - England 4.3 days)*• More likely to die in hospital (63% in ABMU - 54.8% UK

average)*• Marie Curie Cancer Care - £280 per person is average

extra daily cost of end-of-life care in hospital compared to care in community.**

* NAO report July** Marie Curie Cancer Care End-of-Llfe Care Atlas

Managing complexity

• Patients: increasingly elderly and frail, increasing acuity, with complex chronic conditions/co-morbidity

• Health setting increasingly complex - 61 specialisms/sub-specialisms recognised by Royal Colleges (Norway only 30!)

• ‘Health’ is not just about what happens in NHS - integrated health & social care involves local authorities, third/voluntary sector In ABMU ‘Western Bay Partnership’ - 3 local authorities

• ……and of course Higher Education. • Memorandum of Understanding between ABMU & Swansea

UniversityBut patient and their carers must be at centre of services - ‘producer interest’ dominates - culture change needed

The NHSThe NHS can be very insular!• Driven by Finance, not always by Quality and Safety (e.g. Mid Staffs

& Francis Report)• ‘Hit the target but miss the point’ - ”The proper objective of a

health service is patient health outcome, not the volume of patients treated, relative to the total cost". (Professor Michael Porter)

Need to urgently develop capacity for:

• Strategic thinking - “Everything is urgent but there is no urgency!”

• Rigorous analysis - need for access to robust data

• Long-term planning and commissioning

• Clear focus on delivery of quality, patient-centred services

Swansea and medical training

Summer of 1999 I met with with Professor Julian Hopkin and others to

discuss a Clinical School at Swansea.

As Leader of the House tabled motion in the National Assembly that led

to creation of Swansea Clinical School,

Why so passionate about this in 1999?

• Doctors are more likely to practice where they train;

• Raise the quality of clinicians by attracting specialists to practice in Swansea;

• Raise the research profile of the university and help drive multi-disciplinary research and develop;

• Big growth areas in employment and wealth generation are life and health sciences, including health informatics.

University must be at heart of ABMU’s thinking and delivery

Huge range of existing activity• College of Medicine, with innovative 4-year Graduate-entry

course• Institute of Life Science 1 & 2, with funding for ILS 3

announced • College of Human & Health Sciences with nurse and paramedic

training• Colleges of Science and Engineering• Centre for Nano Health with links to Texas as part of the UK-

Texas Collaborative• Health Informatics SAIL: Dr Ronan Lyons and David Ford; MRC

and Welsh Government funded CIPHER; Farr Institute for Health Informatics

… and more

But not just ‘health’ • Centre for Innovative Ageing/OPAN and Professor Judith Phillips.

Again a centre with international standard research.• Professor Harold Thimbleby - Computer Science and Psychology:

“If preventable death in Western hospitals was treated as an illness, it would be the sixth biggest killer, ahead of diabetes, obesity, and road deaths.

• Sports Science in College of Engineering. Professor Gareth Stratton. internationally rated research into children’s physical activity

• University links with elite sports -The Swans & Ospreys • The Humanities: £1million Wellcome Trust research programme

‘Disability and Industrial Society: 1780 - 1948• Swansea University very good at (i) applied and (ii) multi-

disciplinary research

The Intelligent City

• The ‘Intelligent city’ integrates the physical, institutional and digital spaces of a metropolitan area

• A developed knowledge-intensive activities or clusters of such activities

• An embedded social co-operation allowing knowledge and know-how to be acquired and adapted;

• A developed communication infrastructure, digital spaces and knowledge/innovation management

• A proven ability to innovate, manage and resolve problems that appear for the first time, since the capacity to innovate and to manage uncertainty are the critical factors for measuring intelligence.

The Creative, Learning City

• Richard Florida’s ‘Creative City’ - metropolitan regions with high concentrations of technology workers, artists, musicians, exhibit a higher level of economic development

• Increasing evidence that educational levels and density of knowledge workers crucial in determining a city or region’s dynamism

• Edward Glaeser - successful cities need diversity and competition and investing in people’s skills is crucial factor: “The real city is made of flesh, not concrete.”

• The University central to this

Swansea - A Healthy City

• The Zagreb Declaration for Healthy Cities (2008) • A holistic approach in developing sustainable, cohesive and

healthy communities. • “Where people live affects their health and chances of

leading flourishing lives. Communities and neighbourhoods that ensure access to basic goods, that are socially cohesive, that are designed to promote good physical and psychological wellbeing, and that are protective of the natural environment are essential for health equity.” ‘Closing the gap in a generation’, (World Health Organisation)

• The University a key partner