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25
OPPORTUNITIES IN THE NHS – NOW AND THE NEXT FIVE YEARS Frances Pennell-Buck

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Page 1: Presentación NHS

OPPORTUNITIES IN THE NHS – NOW AND THE NEXT FIVE YEARS

Frances Pennell-Buck

Page 2: Presentación NHS

AGENDA

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• What is the National Health Service?

• Current situation in the NHS

• NHS England Five Year Forward View

• Innovation and opportunit ies in the NHS and beyond

Page 3: Presentación NHS

THE NHS IS A NATIONAL TREASURE

• Survey by Channel 4 – a TV stat ion (2012):

What makes you proud to be Brit ish:

1. Our history

2. The NHS

3. Our armed forces

4. Royalty

• NHS Constitut ion:

The NHS belongs to the people.

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Page 4: Presentación NHS

HISTORY OF THE NHS

• Founded in 1948 –

“Good healthcare should be available to all with access based on cl inical need, not the abil i ty to pay”

• Today’s Constitut ion of the NHS:

“The NHS belongs to the people. I t provides a comprehensive service, available to all , irrespective of gender, race, disabil i ty, age, sexual orientation, religion or belief, gender assignment, pregnancy and maternity, or marital civi l partnership status”

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Page 5: Presentación NHS

PRINCIPLES OF THE CONSTITUTION OF THE NHS

1. The NHS provides a comprehensive service available to all

2. Access to NHS services is based on clinical need, not on an individual’s abi l i ty to pay

3. The NHS aspires to the highest standards of excellence and professional ism

4. The NHS aspires to put patients at the heart of everything i t does

5. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population

6. The NHS is committed to providing best value for the taxpayer’s money and the most effective, fair and sustainable use of finite resources

7. The NHS is accountable to the public, communities and patients that i t serves

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Page 6: Presentación NHS

WHAT MAKES UP THE NHS?

“ The NHS is an integrated system of organisations and services bound together by the principles and values ref lected in the Constitut ion”

•NHS in Scotland, Wales and Northern Ireland

•NHS in England

•1.6 mil l ion employees (in top 5 of world’s largest workforces)

The NHS is the largest single publicly funded health provider in the world

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Page 7: Presentación NHS

BREAKDOWN OF “THE NHS”

NHS Scotland - £12bn – 5.3 m people159,748 employees14 NHS Boards

NHS England£115 bn – 53 million people1.3 million emps

NHS Northern Ireland£2 bn – 4.5 m people62,603 employeesHealth and Social Care Board5 Health and social care trusts5 local commissioning groups

NHS Wales£7bn – 3.5 m people7 Local health boards84,817 employees

2015-16

Page 8: Presentación NHS

MORE STATISTICS – NHS ENGLAND

• 247 Trusts – Hospitals, mental health, ambulance services

• 209 Clinical Commissioning Groups (CCGs)

• 8 Commissioning Support Units

• Registered professionals (January 2015)

– General practit ioners (family doctors) – 40,236

– Nurses – 351,446

– Ambulance staff – 18,576

– Hospital and Community Health Service medical and dental staff – 111,963

The NHS treats over 1 mil l ion patients every 36 hours 8

Page 9: Presentación NHS

THE RECENT TRANSITION IN THE NHS IN ENGLAND“The Health and Social Care Act 2010 wil l deliver more power to cl inicians, it wil l put patients at the heart of the NHS, and it wil l reduce the costs of bureaucracy. We now have an opportunity to secure clinical leadership to del iver improving quality and outcomes; better results for patients is our objective.”

Clinical leadership has never been greater:

75 Clinical Reference Groups

12 Clinical Senates

209 Clinical Commissioning Groups (CCGs)

15 Academic Health Science Networks (AHSNs)

Page 10: Presentación NHS

A new commissioning system

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Page 11: Presentación NHS

HOW DOES THE MONEY FLOW?

HM Treasury

Department of Health

Centrally Managed Projects and Services

Arms Length Body Funding

Public Health Spending

NHS England (£98.5 bn)

Nationally commissioned services

Clinical Commissioning Groups (£67 bn)

Locally commissioned services

Page 12: Presentación NHS

THE ROLE – AND BUDGETS – OF CLINICAL COMMISSIONING GROUPS (CCGS)

•Urgent and emergency care•Elective hospital care•Community health services•Maternity and newborn•Mental health and learning disabilities

CCGs have 65% of overall budget to “commission” (buy) services from providers for:

Page 13: Presentación NHS

CURRENT ROUTES TO THE NHS MARKET

Collaboration with existing supplier(s) – research projects/trials

Direct to NHS Trusts – hospitals, clinical commissioning groups, commissioning support units and NHS England for specialised areas

NHS Supply Chain – more for commodities/quick turnaround products

Collaborative Purchasing Agreements - eg London Procurement Programme

National Framework contracts – government-run esp for contracts under £10,000

Tenders - Official Journal (OJEU) for contracts over £113,000

Page 14: Presentación NHS

2015/16 NHS OUTCOMES FRAMEWORK

Domain 1 Preventing people from dying prematurely

Domain 2 Enhancing quali ty of l i fe for people with long-term condit ions

Domain 3 Helping people to recover from episodes of i l l health or fol lowing injury

Domain 4 Ensuring that people have a posit ive experience of care

Domain 5 Treating and caring for people in a safe environment; and protecting them

from avoidable harm.

68 indicators to measure performance at a national level

Page 15: Presentación NHS

CHALLENGES FACING THE NHS

• Ageing population

– Dementia

• Increase in long term conditions – account for 70% of health service budget

• Changes in expectations – “treat me NOW” – 22 million visits to A&E a year

• Technology transforming our ability to predict, diagnose and treat disease

• NHS hasn’t changed organisation of care since inception (boundaries between hospitals and primary care, health and social care)

Page 16: Presentación NHS

BIG PROBLEM!

Current model of care unsustainable –

MISMATCH BETWEEN RESOURCES AND PATIENT NEEDS OF NEARLY £30 BILLION A YEAR BY 2020/21

ACTION NEEDED TO:

– Reduce demand

– Increase efficiency

– Manage funding

Page 17: Presentación NHS

NHS ENGLAND - FIVE YEAR FORWARD VIEW

Opportunity to change future of healthcare:

•Radical upgrade in prevention and public health•Greater control of own care when patients need health services•Breaking down the barriers•More local control of health services

Page 18: Presentación NHS

GETTING SERIOUS ABOUT PREVENTION

Priorit ies:

•Tackle obesity

•Reduce smoking and harmful drinking

•Ensure children get the best start in life

•Reduce risk of dementia through tackling lifestyle risks

•Keeping people in employment (sickness absence costs £22 bn pa)

•Empowering patients to take control of their own health, especially long term conditions

Page 19: Presentación NHS

WHAT WILL THE FUTURE LOOK LIKE?

• Need to manage systems – networks of care – not just organisations

• Out of hospital care needs to be much greater

• Services to be integrated around the patient (mental health, physical health, social care)

Page 20: Presentación NHS

NEW CARE MODELS

• Multispeciality Community Providers (MCPs) – will become the focal point for wider range of care needed by their patients

• Primary and Acute Care Systems (PACS) – single organisations to provide GP and hospital services, together with mental health and community care services

• Urgent and emergency care networks

• Viable smaller hospitals

• Specialised care – eg stroke, cancer

• Modern maternity services

• Enhanced health in care homes

Page 21: Presentación NHS

INNOVATION IS KEY TO THE FUTURE OF THE NHS

Although 86% of adults use the internet, only 2% report using i t to contact their family doctor

•Comprehensive transparency of performance data

•NHS accredited health apps

•Interoperable electronic health records

•GP appointments and electronic prescribing to be available to all

•Patient data to be used in research (able to opt out)

•Increase use of technology eg smart phones by staff and patients

Page 22: Presentación NHS

HEALTH INNOVATION TO BE ACCELERATED

Despite history of innovation (vaccines, modern nursing, hip replacements, IVF, CT scanners, DNA double helix), not so good at adopting or implementing innovation. NHS England will:

•Support the work of the National Institute for Health Research (NIHR)

•Develop collection and use of health outcomes data

•Work with NICE to expand work on devices and equipment

•Combine different technologies to transform care delivery eg monitor elderly patients with heart disease to keep them at home

Digital health wil l play a big part in transformation of service delivery

Page 23: Presentación NHS

NHS – ATTITUDE TO INNOVATION

The NHS will become one of the best places in the world to test innovations that require staff, technology and funding all to align in a health system, with universal coverage serving a large and diverse population.

NHS England will:

•Develop a few “test bed” sites with the AHSNs

•Work with NIHR and the Department of Health to expand NHS operational research

•Get involved with the development of health and care “new town” developments

AHSNs wil l have a key role to adoption of innovation in NHS

Page 24: Presentación NHS

CONCLUSIONS

• The NHS is a national treasure – the majority of services remain free at the point of access.

• There is no single “NHS” but several hundred organisations brought together under a single set of values

• Just building up from the most radical transformation in its history but more needs to be done

• Facing critical factors, especially ever-increasing demand on its service

• Five Year Forward View sets out plan to address issues

• Innovation key to sustainability of the NHS

Page 25: Presentación NHS

THANK YOU

ANY QUESTIONS?Frances Pennell-Buck

[email protected]

Tel: +44(0)7711 191 828