Meeting the efficiency challenge NHS Providers Chairs and Chief Executives Network David Prior, Parliamentary Under-Secretary of State for NHS Productivity 8 December 2015 1
The Commonwealth Fund ranked the NHS top of its comparison of international health systems 2
Health spending in the UK is the lowest in the G7 and below the OECD average Total health spending as a share of GDP United States Switzerland Netherlands Sweden Germany France Denmark Japan Canada Belgium Austria New Zealand Greece Portugal OECD average Norway Italy Slovenia Iceland Finland United Kingdom Slovak Republic Israel Hungary Chile Czech Republic Korea Poland Mexico Estonia Turkey Total health spending per capita, 2013 USA $8,713 Netherlands $5,131 Germany $4,819 France $4,124 UK $3,235 0 2 4 6 8 10 12 14 16 18 Total health spending (% of GDP), 2013 or nearest year Source: OECD 2015 3
The NHS operates with lean levels of beds and clinicians 9 8 7 6 5 4 3 2 1 0 Hospital beds per 1,000 population 40 35 30 25 20 15 10 5 0 MRI scanners per million population Source: OECD 2015 (data for 2013 or nearest year) 4
Much of health policy since 2000 has driven resources into acute hospitals 120 bn revenue 100 80 60 40 54% 82% Growth in consultant numbers 2000-2014 20 0 1999/00 2000/01 2001/02 2002/03 2003/4 2004/5 2005/6 2006/7 2007/8 2008/9 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 Growth in activity 2000-2015 (finished consultant episodes) 22% Growth in GP numbers 2000-2014 NHS spending Primary care spending Source: DH Figures not adjusted for inflation. NHS spending figures adjusted for accounting changes. 2002 2004 2004 2004/5 2008 A&E four hour target Foundation Trusts New GP contract Payment by Results Elective waiting times targets Sources: Hospital Episode Statistics, NHS Hospital & Community Health Service (HCHS) monthly workforce statistics 5
There are compelling reasons to do things differently The NHS is a 1940s system operating in a 21st century world The NHS Plan (2000) there is broad consensus on what [the] future needs to be. It is a future that dissolves the classic divide, set almost in stone since 1948, between family doctors and hospitals, between physical and mental health, between health and social care, between prevention and treatment [ ] One organised to support people with multiple health conditions, not just single diseases. A future that sees far more care delivered locally but with some services in specialist centres where that clearly produces better results. The NHS Five Year Forward View (2014) 6
High agency and substantive staffing growth have led to falling productivity 11/12 12/13 13/14 14/15 YTD Cost-weighted activity 0.4% 1.1% 2.3% 3.1% 1.6% All workforce labour input -1.7% 0.6% 2.6% 4.1% 3.7% Of which substantive -1.2% 0.1% 1.3% 2.2% 2.0% Of which agency -13.3% 11.0% 25.2% 30.2% 23.4% All workforce productivity 2.1% 0.5% -0.3% -1.0% -2.0% Source: DH data Average productivity growth 1995-2010: 0.4% per year (ONS) 7
The Carter programme will help providers identify savings opportunities 8
Professor Tim Evans will provide leadership on clinical productivity Source: Future Hospital, Royal College of Physicians 2013 9
The Hospital of the Future & the Future Hospital Commission Source: Future Hospital, Royal College of Physicians 2013 10
Professor Tim Briggs will lead on clinical quality and efficiency 200-300 million Annual savings if the lowest infection rates for total hip and knee replacements of some hospitals were achieved throughout the NHS 11
GETTING IT RIGHT FIRST TIME Improving the Quality of Orthopaedic Care within the National Health Variation in Practice Huge and widespread Service in England National average Range Cost of post surgery total hip replacement... 1,021 531 to 2,083 Deep Infection Rates for total hip/knee replacement 0.2% - 5% ODEP 10A Acetabular use is 20.2% 0% to 100% Knee Arthroscopy washout/total knee replacement in one year Return to theatres #neck of femur fractures in 30 days is 2.37% Huge variation 0% to 7% 12
GETTING IT RIGHT FIRST TIME Improving the Quality of Orthopaedic Care within the National Health Knees 12 month surgeon profile (184 Hospitals) Service in England Category Total Operations Total Surgeons Average* National Average Nos of surgeons conducting <6 (%) Nos of surgeons conducting <11 (%) Total Knee 57,756 1,152 50 48 99 (8%) 178 (15%) Patello-Femoral Replacement Unicondylar Knee Replacement Knee Revision 1,551 275 6 3 239 (87%) 267 (97%) 5,176 484 11 10 280 (58%) 372(77%) 5,529 687 8 6 410 (60%) 562 (82%) Source: NHS Choices website, 2012 data. Note: Not all consultants have consented to releasing this data. If this is the case for the Trust, then the values above may under-represent the true values for the Trust. A full listing of the consultants who have not consented, and their reasons for doing so can be found at the NHS Choices website. * To create totals those with a note of <5 are counted as 5, this may impact on the average number per surgeon, the notes section will be used to identify when this has occurred. 13
Meeting the efficiency challenge NHS Providers Chairs and Chief Executives Network David Prior, Parliamentary Under-Secretary of State for NHS Productivity 8 December 2015 14