industrial transformation in nhs scotland
DESCRIPTION
Presentation on productivity transformation to HFMA ScotlandTRANSCRIPT
Redefining Healthcare
in Challenging Times
Professor Matthew Swindells
Group Managing Director, Health
Tribal Group
07825 060102
Industrial transformation in
NHS Scotland
Preserving a publically funded health service
in an economic downturn
September 2009
Historic growth
REAL GROWTH
-6.0
-4.0
-2.0
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
19
90
-91
19
91
-92
19
92
-93
19
93
-94
19
94
-95
19
95
-96
19
96
-97
19
97
-98
19
98
-99
19
99
-00
20
00
-01
20
01
-02
20
02
-03
20
03
-04
% REAL GROWTH
40% real growth in 6 years
Equates to 5.5% per annum
60% real growth in 13 years
Equates to 3.6% per annum
-
1
2
3
4
5
10-11 11-12 12-13 13-14 14-15 15-16 16-17 17-18 18-19
£b
n
Projected Real Health DeficitAssume average real expenditure growth from 96/97 - 10/11: 3.6%
1% real funding growth
0% real funding growth
-1% real funding growth
5 yrs out: £0.7bn - £1.5bn deficit
Health: the scale of the challenge: 3.6%
Source: Scottish Parliamentary Questions, 7th Feb 2008, http://www.scottish.parliament.uk/business/pqa/wa-08/wa0208.htm
Triggering a quantum leap in performance
Exploit
known
technology
Challenge
business
models
Shift labour
resources
Redefine
consumer
contracts1997 2009
Performance
A catalytic
event
A catalytic
event
Money Capacity AccessMoney Capacity Access Productivity
On almost every measure the productivity of the
UK NHS system is either flat or improving only
marginally
Risks of inaction
Growing financial pressure
Hospitals reduce
services and waiting
increases
Hard won gains of past 10 years at
risk
New transparency means fuller
public awareness
Loss of public confidence in the NHS as viable model
NHS becomes a
political football over
its future
Tribal’s Diagnostic Approach
• Demographic pressures
• Cost drivers – pay, drugs, technology
• Resource availability projection
• Gap identification
System economic analysis
• First contact clearance rates
• Avoidable hospital use
• Community service effectiveness
• Expenditure / needs alignment
System utilisation analysis
• Door to Door Efficiency
• Workforce productivity
• Diagnostic effectiveness
• Clinical Engagement
Provider productivity
analysis
Tribal’s transformation programme
Improve System Performance
• Manage Demand
• Care at first contact
• Complex and continuing care
• Health maintenance
Reposition Consumer Contract
• Target key groups
• Make greater use of intervention tools
• Adopt supportive technologies
Transform Provider Efficiency
• Operational effectiveness
• Structural Arrangement
• Service Strategy
Build Capacity and Capability
• Recruit key skills
• Training and Development
• Source world-wide best practice
• Acquire tools and methodologies
Will it be enough?
Acute performance
Medicine Management
Resource Allocation
Appropriate hospital usage
Health Maintenance Programmes
Wellbeing programmes
Primary Care
0.5 – 1% savings
Secondary care
still quantifying
John’s Hopkins
ACGs
1 – 2% savings
MCAP Utilisation Mgt
1 – 2% savings
Care / Disease
Management
2 – 3% savings
Health coaching /
risk reduction
3 – 4% savings
Savings
11% - 15.5%
Getting everyone to
the best performing
3.5% savings
Conclusion
The NHS in Scotland has a choice:
• Do what we always do – trim, cut, tweak and watch the service
deteriorate so the hard won gains of the last 10 year’s are
wasted
• Accept that the rate of recent funding growth makes it possible
that not every penny has been spent brilliantly; challenge the
status quo and reinvent the NHS as one that is both better and
better value for money