Slide 1

Making it Happen A Regional Perspective Steve Fairman Director of Improvement & Efficiency South Central SHA Kings Fund, 17 January 2011

Slide 2

Population of 4 million -9 PCTs -7 Foundation Trusts -8 NHS Trusts and 2 potential NHS Trusts -2900 GPs -547 Practices

Slide 3

South Central overview High life expectancy Low deprivation (some pockets) Population growing and ageing Complex system / borders Politically high profile

Slide 4

South Central overview (2) Current spend 6.1bn; population 4.2m Funding gap is 1.4bn by 2014/15 55% provider efficiency 45% pathway changes

Slide 5

South Central context Funded at 1,416 per head v. England average 1,612; G&A bed ratio of 2.54 per 1,000 v. England average 3.18 NEL hospital admissions 0% growth and EL hospital admissions 2.4% reduction

Slide 6

Slide 7

Slide 8

Where are we now? We understand the size of the challenge and that doing more of the same is not enough we must do more for the same We are making good progress we are already in implementation We have some good delivery mechanisms in place We have a good regional focus We are moving into organisational transition

Slide 9

QIPP how are you going to cut the cake Hint: A hip replacement costs 7599

Slide 10

Slide 11

The essential elements of effective Regional leadership of QIPP Understanding YOU dont actually make any of the changes that deliver on QIPP savings A profile with local leaders Very well organised Programme Management and Governance arrangements Standardisation Integration with normal processes

Slide 12

Key risks and barriers to QIPP delivery at a Regional level 1.Gaining front-line engagement on QIPP 2.Organisations look internally for savings (or growth!) 3.No record of change on the scale required 4.Priorities not always properly aligned with the challenge 5.Management / leadership capability 6.Organisational sustainability

Slide 13

2011/12 (year 1) m % of 4 year total Demand pressure on 2011/12 base ( millions) i.e. pressure on commissioners if tariff efficiency fully achieved 24239 Pressure of tariff efficiency demand on providers 16724 Size of challenge (sum of demand and pay and price pressures) 40931 The South Central QIPP Challenge (Draft)

Slide 14

Key risks and barriers to QIPP delivery at a Regional level (2) and a new one leadership and delivery through, and beyond, organisational transition

Slide 15

What have we done at a regional level to mitigate the effects of these? A relentless focus on quality Maximise safety Drive out unwarranted variation Developing people Tailored our leadership programmes Mobilised our Clinical Leadership Network Working with the new commissioners Building ownership Developed a communications strategy Been open and honest about the scale of change necessary

Slide 16

What have we done at a regional level to mitigate the effects of these? (2) Focused effort and resource around the 5 clinical programme areas that evidence shows us will really make a difference: Planned Care e.g. enhanced recovery programme Acute Care e.g. improved stroke care pathway Long Term Conditions e.g. COPD management End of Life Care e.g. choice of place of death Maternity & Newborn Care e.g. cut caesarean sections

Slide 17

What have we done at a regional level to mitigate the effects of these? (3) Facilitated joint work between local organisations on other system-wide initiatives Integrated Supply Chain Estates rationalisation Pathology services Medicines Use and Procurement The productives

Slide 18

Conclusions 1.Regional leadership of the QIPP agenda is essential but can easily be ineffective 2.You must build an understanding of the scale and nature of change needed 3.You must build a movement for change 4.Clinicians must be at the forefront 5.You must be organised 6.You must be resilient!

Slide 19

You cant solve a problem by using the same thinking that created it Albert Einstein