«Vers un système de santé national britannique centré sur le patient»

Transcription

1 «Vers un système de santé national britannique centré sur le patient» 16 Fevrier, 2011 Dr Wendy Thomson, CBE Université McGill

2 Public services and the NHS in Context The need for reform Redesigning the whole system Choice, contestibility, national standards and incentives Results so far Conditions for success

3 The Need for Reform The post code lottery : A national service actually delivering extreme variation in services Major inequity in health outcomes Accessibility: long waits for hospital outpatient and inpatient appointments Very weak demand management Accountability: Professions exercising national power through threat of labour shortages and challenge to change in practices Hospital consultants employed by public and many by private hospitals General practitioners employed as small businesses Affordability Perceived problem of sustainability and affordability

4 A redesigned health system 1. Developing demand:- More patient choice and a much stronger voice for local commissioning of health services 2. Developing supply:- More diverse providers, more freedom to innovate more challenge to existing NHS to improve services 3. New transactional forms:- Money following the patients, rewarding the best and most efficient and giving the others a real incentive to improve 4. A national framework of delivery, regulation and decision-making which guarantees quality, fairness, equity and value for money

5 A system designed to align population needs, performance, incentives and safety

6 Developing a system for demand More patient choice o Patient choice for GPs, surgery and diagnostics o Using patient choice and payment by results to drive down waiting times Local Commissioning of health services o National money, commissions locally (80% of NHS budget) o Primary Care Trusts: understand local needs, commission best quality + value services o More responsibility to come for GP s (practice based commissioning)

7 Developing a System for supply Based on principle of contestability Single payer but many suppliers Encourages innovation and service quality New types of health care providers NHS Foundation Trusts now 129 with more to come More freedom for all NHS hospitals as emphasis shifts from Whitehall-led to patient-led improvements Developing new providers within GP services Independent Sector Treatment Centres international competition for small amounts of new capacity Shorter waiting times and more choice for NHS patients reconfiguring private health care

8 A system of Incentives Money follows the patients - rewarding the best and most efficient - incentivising improvement o Hospitals are Paid by Results (PbR on HRG), not an annual grant o Tariffs set as proxy for price, local weighting. o Covers 90% of NHS inpatients, day cases, and outpatient transactions o Greater transparency: reveals high costs and inefficiencies; incentive for better value for money o Incentive to hospitals to improve services, cost control and productivity, and to move some secondary to primary care. o Electronic patient records transforms quality, safety, speed

9 A System of Incentives ) Patient-level information & costing systems (PLICS) service-level economics reporting an understanding of service variations and their causes Encourages clinical ownership of resource decisions Provides information to enable improved HRG classification Improves funding policy and evidence-based analysis in discussions with commissioners.

10 A national framework of delivery, regulation and decision-making To ensure quality, fairness, equity & value for money National targets on outputs and outcomes National Service Frameworks for the main disease patterns NIHCE National Institute for Health and Clinical Effectiveness- an organisation to agree the cost effectiveness of drugs and technologies Distribution of national finance on a health needs formulae to localities Care Commission & Monitor - national inspection and regulation Modernised approach to public health

11 Organising framework

12 Reduction in waiting times

13 Reduction in over 13-week outpatient waits and 26-week in-patient waits

14 Circulatory disease mortality rate

15 Hours spent in A & E From July September 2010 in 150 NHS Organisations in England % of patients who spent less than 4 hours in A & E # of NHS Organisations Average: 97.02% Range: 85.91% %

16 Emergency wait times over 48 hours

17 Patient choice

18 National choice

19 Patient choice

20 Patient choice

21 How do NHS Trusts Score?

22 NHS Constitution NHS/Rightsandpledges/NHSC onstitution/documents/nhs_ Constitution_interactive_9Mar 09.pdf epage.aspx

23 Since the Coalition government Equity and excellence: liberating the NHS Continuity comprehensive service, available to all, free at the point of use and based on clinical need, not the ability to pay Protect NHS funding, with annual increases (modest)..and change 20 billion of efficiency savings by 2015 Eliminating Primary Care Trusts & Strategic Health Authorities Creation of GP-led commissioning Creation of an NHS Commissioning Board

24 Conditions of successful reform Political & managerial leadership Engaged clinicians Data and Analytic Capacity Systems designed for adaptation Continuity of approach to reform