Vision without action is a daydream; Action without vision is a nightmare Vision to Action Prof. Robert Harris Director of Strategy - NHS England
65 years ago, the NHS began Founding Context Founded in 1948 The population of Britain was 47 million Food rationing was still in place A quarter of homes had no electricity Life expectancy for men was 66 2
Current Context Today and every day the NHS saves lives and helps people stay well and live well for longer. The NHS treats 1,000,000 people every 36 hours Between 1990 and 2010, life expectancy in England increased by 4.2 years 88% of patients in the UK described the quality of care they received as excellent or very good
The NHS continues to be highly valued by the public. Source: Ipsos Mori 2013
Current challenges We know there is more to do and recommendations for improvement already exist
Demographic pressures: we are living longer, but living with more LTCs Nearly two-thirds of people admitted to hospital are over 65 years old There are more than 2 million unplanned admissions per year for people over 65 The greatest growth is expected in the number of people aged 85 or older the most intensive users of health and social care
Demographic pressures: Long term conditions Those with more than one long-term condition have the greatest needs and absorb more healthcare resources; for example, patients with a single long-term condition cost about 3,000 per year whilst those with three or more conditions cost nearly 8,000 per year These multi morbid, high-cost patients are projected to grow from 1.9 million in 2008 to 2.9 million in 2018 If predictions are correct, and 46% of men and 40% of women are obese by 2035, the result is likely to be 550,000 additional cases of diabetes, and 400,000 additional cases of stroke and heart disease.
There is an estimated financial challenge of 8.4 billion in 2015/16 but 30 Historical billion Funding pressures by 20/21 on the NHS in England Real terms freeze through to 2020/21 Funding b 140 135 130 125 120 115 110 105 100 95 90 85 2013/14 14/15 15/16 8.4b 16/17 17/18 18/19 19/20 20/21 30b FY 13/14 FY 14/15 FY 15/16 FY 16/17 FY 17/18 FY 18/19 FY 19/20 FY 20/21 bns bns bns bns bns bns bns bns Total Projected Costs 94.4 99.48 106.8 112.0 117.5 123.7 130.3 137.4 Projected Resource 94.4 96.5 98.3 100.0 101.7 103.7 105.8 107.9 Surplus / (Shortfall) (0.0) (3.0) (8.4) (12.0) (15.8) (20.0) (24.5) (29.5) SOURCE: NHS England
Reasons to focus on patient need and identify population segments Patient Segments Cost Breakdown Multiple complex conditions 5% 45% A&E over-utilisation, high care variation Single chronic disease/ At risk of a major procedure 20% 40% Infections, complications, readmissions Healthy, minor Health issues If any 75% 15% Multiple complex conditions
The UK healthcare system will undergo waves of innovation, transforming care delivery Early effects already impacting the UK, continuing over the next decade Future waves Wave 0 BASIC SAFETY AND EFFICIENCY Wave 1 PATIENT-CENTRED CARE Wave 2 CONSUMER ENGAGEMENT Wave 3 SCIENCE OF PREVENTION Baseline established for: Quality Safety Primary Care and Hospital efficiency Integrated, team-based delivery Shift to prevention and wellness Transformed outcomes and value for money, partly through selective partnerships New non-traditional healthcare players Intent to improve accessibility and wellness Extensive use of partnerships Widespread genomics sequencing Likely to change entirely health systems
Organise Care Around patient Medical Conditions: Migraine Care in Germany Existing Model: Organise by Specialty & Discrete Service New Model: Organise into Integrated Practice Units Imaging Centres Affiliated Imaging Unit Outpatient Psychologists Outpatients Neurologists Outpatient Physical Therapists Primary Care Physicians West German Headache Centre: Neurologists Psychologists Physical Therapists Day Hospital Essen Univ Hospital Inpatient Unit Primary Care Inpatient Treatment & Detox Centres Affiliated Network of Neurologists
NHS England needs to focus on system levers it can use to drive change Examples of WHAT type of value system players could release Examples of HOW NHS England can help the system create value Acute productivity gain Integrated care gain Shift to the most efficient care setting Reduced input costs Promote self management Create the right incentives Free up managerial capacity by reducing bureaucratic burden Build capability to implement change Ensure the right organisational structure Flex rules
Drivers of Change Citizen Expectations Demographics Technology & Innovation Patients of the Future Prevention Agenda Healthy / infrequent user Low/Moderate single LTC Multiple/ Complex conditions 1 2 3 4 NHS England Strategic Characteristics Empowered patients: codesigning the service /managing their condition Wider primary care, provided at scale A modern model of integrated care Access to the highest quality urgent and emergency care Consequences People and carers are active participants in their own care Most care provided outside hospital setting Flexible workforce, trained for people and disease not organs or site Economic Pressures High expectations of Quality 5 A step-change in the productivity of elective care Year of Care / Pathway Budgets Outcome Standards Units of need and provision across complex boundaries 6 Specialised services concentrated in Centres of Clinical Excellence Community pooled resources risk/reward sharing commonplace
Major Value Creating Opportunities in NHS Reduce process variation that lowers efficiency & raises inventory without improving outcomes Eliminate low or non value added services or tests - sometimes driven by outdated / low confidence protocols Rationalise the oversupply in administrative and scheduling units Improve utilisation of expensive physicians, staff, clinical space, and facilities by reducing duplication and service fragmentation Make far greater use of generalists to manage complex care patient needs Reduce the provision of routine or uncomplicated services in highly resourced places Reduce cycle times across the care cycle Empower citizens to make choices about their own care provision
The Future: Move the money; change behaviours The future does not just pose challenges, it also presents opportunities A health service, not just an illness service we must get better at preventing disease. Giving patients greater control over their health Developing effective preventative approaches, giving service users greater control over their health Harnessing transformational technologies Exploiting the full potential of transparent data Moving away from a one-size fits all model of care
Preserve the magic Preserving the values that underpin a universal health service, free at the point of use, will mean fundamental changes to how we deliver and use health care services. This is NOT about: Privatising the NHS Charging for services Restricting access