The Future of Health and Care

NHS Confederation Perspective

16th April 2015

Dr. Johnny MarshallDirector of Policy

ADDAS SPRINGCONFERENCE

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21st Century Challenges

Rising demand

Increasing need

Financial constraints

Carbon resource constraints

http://www.anewdirection.org.uk/blog/three-21st-century-challenges-for-museum-learning

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Projections of GDP Share of Health in OECD Countries

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Embrace data and information to transform health and care

Innovate healthcare delivery

Build the healthy cities and countries of the future

World Economic Forum

Sustainable Health Systems Visions, Strategies, Critical Uncertainties and Scenarios

A report from the World Economic Forum 2013

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Paradigm Shift

New cultures and systems around wellness and

population health, rather than simply

integration of old.

“It is better to beg forgiveness

than seek permission.”

Grace Murray Hopper

“System leadership requires leaders to move away from thinking from an organisational perspective; instead decisions need to be taken on the basis of pursuing improvements in the health and wellbeing of the local population”

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Doctor

Teach

er

Judge

Clerg

y

Police

Civil s

erva

nt

Trade

Union o

ffici

al

Busines

s le

ader

Govmnt M

inis

ter

Journ

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Politic

ian

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

90% 86% 80%71% 66%

55%39%

32%19% 22% 16%

IPSOS MORI 2014 – “Trust me, I’m a doctor!”

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Case study: Kingston HWB

Local GPs and councillors had been dissatisfiedwith mental health services for some time, and usedthe HWB to articulate the changes they wanted tosee.

After consulting users, the HWB drew up acommissioning mandate for mental health services,which declared: “The way we plan and oversee localhealth and social care services is changing.”

The HWB went on to confront long-standing difficultissues: for example, it became responsible for jointlycommissioning substance abuse services, revisingthe service specification and awarding the contract tonew providers

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The mandate became very powerful, Attempts to resist change proved futile in the face of it.

Former NHS Kingston CCG chief officer DavidSmith (now chief executive of NHS Oxfordshire CCG) said :

That showed the real power of GPs and councillors signed up to the same agenda.

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Demonstrate political leadership by encouraging discussions at all

levels about the future of health and care services to focus on

getting the best outcomes for people with limited money.

Align payment mechanisms that

support more integrated and

outcomes focussed care

Develop future workforce to work

within the emerging integrated

models of care.

Making integrated health and social care a reality...

Enable shared accountability by introducing a

simpler, unified health, public health and social

care Outcomes framework

Make health and wellbeing boards the focus for joined-up commissioning of primary, secondary and social care.

Improve data sharing.

A national sector-led programme to support

health and social care organisations to adopt

participation and self-management

approaches for all who would benefit. Extra transitional funds to move to new models of care and longer term financial

settlements to provide up-front investment

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Structure

Culture

0% 10% 20% 30% 40% 50% 60% 70%

41%

49%

59%

51%

Agree Disagree

Is the structure and culture of your Health and Wellbeing Board conducive to improving the health and wellbeing of your population?

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Are the structure and culture of HWB conducive to improving the health and wellbeing of your local population?

It is on the way to being conducive. We are all still young as organisations and governance structures

Very staid and embedded in council culture

The HWB are led more by the LA's than the NHS

The CCG is not treated as an equal partner, the partnership being local authority dominated.

[The HWB] has a built in LA majority, so if any issues ever come to a vote the LA will be assured it will win

A decent H&WBB with some good members, but nowhere near ready to take responsibility for the NHS locally

It is difficult to have a feeling of localism for all areas that the board covers

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The Future of Health and Care Challenge

“…. we need to battle for supremacy over outcomes not each other …..”

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