Download - Main Themes
Towards Excellence:Driving up Quality Across the East Midlands
Health and Social Care Conference
25 February 2010
1
Main Themes
• Why has the NHS been so poor at engaging the third sector?
• What is changing?
• The quality and productivity challenge
‘Failure’ of Commissioning
NHS has ‘commissioned’ for two decades, but …
• Commissioners’ capability has been limited
• Few levers, not well used
• Inadequate regulatory regime – bail out of NHS providers
• Low investment in developing commissioners
• Highly variable & fragmented practice
• Lack of legitimacy (linked to ‘voice’ & patient /public engagement)
• Very limited range of providers
An unfair playing field
• Lack of awareness amongst commissioners of the Third Sector
• Inconsistency of procurement and regulatory practices
• Great variation in when/whether to use grants or contracts
• Burden of disproportionate procurement practices – pre-qualification requirements, guarantees/bonds
• Poor funding practice: lack of full cost recovery > ‘subsidy’
• Poor funding practice: short-termism = barrier to investment
• Burden of disproportionate monitoring
‘Working with the Third Sector’ National Audit Office June 2005
An unfair playing field
The Commissioning Framework for Health and Well-being
Assuring high quality providers for all services
Obstacle: Providers are sometimes unwilling or unable to provide new and innovative services
Solution:
• Commissioning focused on outcomes
• Wider range of providers
• Develop effective, strong partnerships with providers
• Transparent and fair procurement
• More innovative provision, tailored to the needs of individuals (engage providers in needs assessments)
• Intelligent decommissioning
Quality & Productivity Challenge
• The population has increased 24% over the 60 years of the NHS
• More people now over pension age than under 16
• By 2031 the 75+ population will double to 8.2 million
• Half of babies born today will live to be 100
• Men and women live 10 years longer than in 1948
• Time lived with a limiting illness or disability has increased by over two years in past decade
• Alzheimer’s and other forms of dementia will double in a generation
• Demographic change will cost the NHS £1.1–1.4 bn extra each year
Source: The Human Factor, NESTA, 2009
8
9
£1.4 bn challenge
Flat cash scenario
The scale of the challenge
Growth in Allocations Trajectory of rising costs
Our Aim
• The aim of the Towards Excellence programme is to drive up the quality of healthcare across the East Midlands, and ensure we have the resources to meet the challenges of:
– Demographic change– Increasing costs of drugs and technology– Rising demand– Growing expectations
10
National
Regional
County health system
OrganisationTeam / Individual
Co-Production
Subsidiarity
Clinical Leadership
System Alignment
Responding to the Challenge - levels of working
PCT / Provider
11
12 National Priorities Confirmed
12
Priority Lead Primary Care Contracting Dame Barbara Hakin Technology / Digital Vision Peter Spilsbury Procurement Phillipa SlingerSupporting staff productivity Lorraine Foley (NHSI) Back Office Efficiency Tony SpotswoodDrugs – Prescribing Peter RoweClinical Support Rationalisation Dr Ian Barnes Right Care- Decommissioning- Threshold, referral/conversion management- Patient decision support
Sir Muir Gray
Safe Care Maxine Power (DH) Pathway - Long Term Conditions – Overall Sir John Oldham (DH) Pathway - Acute - Urgent & Emergency Care Sir John Oldham (DH) Pathway - End of Life Sophia Christie (BENPCT)
East Midlands PrioritiesClinical Priorities
£189 – 321mPotential opportunity
Transformation of the Urgent Care System £45 - 85m1
Delivery of upper quartile performance in planned care £7 – 17m2
VTE prevention £3 - 6m3
Long term conditions management - best practice pathways £67 - 68m4
End of Life care – best practice £10 - 26m5
Large scale prevention programmes £25 - 62m6
Reduction in caesarean section rates £1 – 4m7
Reducing out-of-area placements for people with learning disabilities £1 - 21m8
Significant reduction in prescribing and drug procurement costs £31m9
8
13
Initial Priorities: Falls and Dementia
Non-Clinical Priorities
£355 – 512mPotential opportunity
Workforce productivity £169 -176m1
Rationalise back-office functions and supply chain management £25m2
Major improvement in productivity of Pathology services £20 - 40m3
Introduce standard thresholds for surgery £6 - 69m4
Estates optimisation £72 – 112m5
Reduce Variation and Maximise Capacity £3 - 27m6
Reduce costs of primary care contracting (LES, DES) £34 - 37m7
Reduce costs of Continuing Care £27m8
14
Quality Observatory
• East Midlands QO was launched on 1 December
• It will provide the main mechanism to measure and track quality improvements
• Access to the data on the website is currently restricted
• It will gradually be opened to all
15
16
Our Next Steps
• Establish priority work streams, with high quality leadership
• Set up PMO
• Develop detailed plan for each initiative
• Develop county health system assurance plans
• Closer alignment with local government / social care
• Produce SHA Delivery Plan
• Widespread communication and engagement
17