main themes
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Towards Excellence : Driving up Quality Across the East Midlands Health and Social Care Conference 25 February 2010. Why has the NHS been so poor at engaging the third sector? What is changing? The quality and productivity challenge. Main Themes. ‘Failure’ of Commissioning. - PowerPoint PPT PresentationTRANSCRIPT
Towards Excellence:Driving up Quality Across the East Midlands
Health and Social Care Conference
25 February 2010
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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
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£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
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National
Regional
County health system
OrganisationTeam / Individual
Co-Production
Subsidiarity
Clinical Leadership
System Alignment
Responding to the Challenge - levels of working
PCT / Provider
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12 National Priorities Confirmed
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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
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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
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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
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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
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