Reflections on Health Care Reform

Ann Lloyd CBE

CMPO Policy Seminar: Public Service ReformMarch 2009

One country – the United Kingdom

defence, police, borders national economy foreign affairs – including international health

Four countries – Wales, England, Scotland, Northern Ireland

health, industry and transport education housing etc.

3 million people most in the south east Mid-Wales thinly populated ‘The Valleys’

old mining towns poor infrastructure poor health

What is Wales like?

3. TOWNSEND AND WANLESS

Townsend index

Most DeprivedNext DeprivedMedianNext AffluentMost Affluent

Townsend index of deprivation for Wales 2001

Source: Derived from Census 2001

Health is worse in some places

Source: CACI information solutions

Wales’s future health?

How can people use health services in Wales?

hospital - highly specialised care for less common problems

hospital - mainstream care

primary and community care care

Social care

There are several major types of service

Primary and community care -

local services everywhere

about 6 visits a year

c. 2,000 GPs in 500 practices - c. 9% alone

c. 700 local pharmacies

c. 1,000 dentists

c. 600 opticians

community nurses, midwives, therapy staff, social workers

HOSPITAL

16 large acute hospitals a cancer hospital mental health hospitals 50+ small hospitals all-Wales ambulance service

ACCIDENT & EMERGENCY DEPARTMENT

hospital care -

1 after seeing GP

2 ambulance

3 walk in

Welsh Government

22 Local Health Boards

10 NHS trusts

GPs, etc.

Find what is wrong and find a response Provide careDecides policy

trusts

GPs, etc.

22 Local Health Boards

private organisationsvoluntary

organisations

10 NHS trusts

The system NOW

Welsh Government

- health …….. relatively poor…………….. - insupportable burden on the acute sector and its workforce……………….- Wales does not get as much out of its health spending as it should.…………..- ………….. change difficult…………. - too few examples of successfully engaging the public in a change agenda.

2003 Welsh Wanless Report on Health and Social Care

Our challenge

a new balance

before hospital/ not in hospital

hospital after hospital/ support in community

x

Statutory local stratgies

Health Challenge Wales

Public Health Strategic Framework

Specific strategies e.g.-food, fitness, housing, environment

1. Improving health and wellbeing

Finance strategy

Performance improvement

Quality Improvement

Strategy

Improving Planning/ Commissioning

Clinical/ Professional Engagement

Public Engagement

Workforce redesign

Information

4. Improving systems and processes

National Service Frameworks (NSFs)

DECS emergency services

Project 2009

Chronic Conditions

Care pathways

Healthcare Standards

2. Changing the pattern of services

Acute Services Review/service reconfiguration

Community Services Framework

Designed for Life

Fulfilled Lives, Supportive Communities

Making the Connections

Sustainability Duty

Equality Duties

Welsh Language Action Plan

3. Improving care pathways Local Service Boards

trusts

GPs, etc.

22 Local Health Boards

private organisationsvoluntary

organisations

10 NHS trusts

We are changing the system in 2009

Welsh Government

Replace by fewer organisations

££

£££

GPs, etc.

trusts

GPs, etc. 7 NEW Local Health Boards – not 22

private organisationsvoluntary

organisations

The NEW system 2009

Welsh Government

2 NHS trusts – not 10

£

£

£ £