Transforming the NHS from within

Transforming the NHS from within Ed Smith, CBE, Deputy Chairman, NHS England Kings Fund 13 th November 2014

Our Collective 5 year forward view NHS - Recognise progress and sheer hard work by 000,000 s of people DEMAND CARE/QUALITY EFFICIENCY/FUNDING

Source: Commonwealth Fund, October 2014

The NHS have achieved a lot Currently ranked #1 healthcare system in the world More than 2/3 UK public believe the NHS works well Cancer survival is at its highest ever Operation waiting lists are down - many from 18 months to 18 weeks Early deaths from heart disease are down over 40% 160,000 more nurses, doctors and other clinicians Single Sex Wards implemented 4

Our Collective 5 year forward view NHS - Recognise progress and sheer hard work by 000,000 s of people NHS - Agree where we are and need to be DEMAND CARE/QUALITY EFFICIENCY/FUNDING

Agree where we are and need to be AS IS TO BE HEALTH & WELLBEING GAP CARE & QUALITY GAP FUNDING & EFFICIENCY GAP

Our Collective 5 year forward view NHS - Recognise progress and sheer hard work by 000,000 s of people NHS - Agree where we are and need to be NHS - Prosecute the prevention agenda DEMAND CARE/QUALITY EFFICIENCY/FUNDING

Bending the curve on demand 1/5 adults still smoke 1/3 of people drink too much alcohol 1/3 of men and 1/2 of women don t get enough exercise More than 2/3 of adults are overweight or obese By the time they re in year six, nearly 1/5 of children are obese The NHS can no longer continue to be the healer of last resort 1. Targeted prevention-70% of the NHS Budget is spent on long term conditions 2. Incentivising healthier consumer behaviour 3. Local democratic leadership on public health 4. Support to help people stay in employment 5. Workplace health with the NHS leading by example 6. A broad coalition of actors to deliver upstream action and prevent future burden of disease

Our Collective 5 year forward view NHS - Recognise progress and sheer hard work by 000,000 s of people NHS - Agree where we are and need to be NHS - Prosecute the prevention agenda NHS - Tight, loose, loose, loose! NHS - Porous Boundaries - clear outcomes DEMAND CARE/QUALITY EFFICIENCY/FUNDING

Porous boundaries Whole of government NHS bodies Care providers Communities Citizens

Successfully implementing new care models is core to improving quality and sustainability in future Implementing new care models Enhanced primary care to provide a wider selection of services available close to home Expert generalists taking responsibility for the totality of an individual s care for a small group of complex patients Multi-specialty care hubs that bring together senior clinicians (generalist and specialists) in a single community- based location Networked care where there is an evidence based for quality volume benefits (e.g. Urgent and Emergency Care, Maternity, Specialised services) requires new delivery models Multispecialty groups that employ GPs, consultants, nurses, pharmacists and other roles to deliver out-of-hospital care Viable smaller hospitals; care homes inreach support Vertically integrated hospitals, with new business models, increasingly dissolving the boundary between primary & secondary care; one variant being an Accountable care organisation accountable for achieving a set of outcomes for a defined population at an agreed cost Specialised centres of excellence acting as lead providers, responsible for integrating pathways and developing networks

Implementing new care models To deliver new care models we need a new type of partnership between national bodies and local leaders Working with local communities and leaders, NHS national bodies will jointly develop: Detailed prototyping of new care models A shared methodology for assessing the characteristics of health economies National and regional expertise and support for implementation at pace National flexibilities in current regulatory, funding and pricing regimes A new investment model to help pump-prime and fast-track the new care models 16

Tight, loose, loose, loose!! Trust Disciplined and persistent execution Instinctively collaborative and co-producing A transparency reflex Embrace the doers - its where the energy needs to be Information & insight driven - digitally enabled

5YFV Theory of Transformation 3 main execution axis

Technology Impact on 5YFV Solutions Diagnostics Analytics Remote monitoring Collaboration Challenges Cross-silo collaboration Pace (keep up with Digital Consumer) Security Behaviours/culture (workforce + patient) Agile delivery Realising the benefits of IT spend

Trust a wicked issue Trust declines REFLEX Regulation increases REFLEX Real trust declines REFLEX A downward spiral of compliance over integrity Regulation increases

The Rules, Instincts, Behaviours Model Rules Culture Instincts Behaviours

Final thoughts Leaders at all levels have an obligation and duty to:- Treat People as the answer not the problem Treat People as they would wish to be treated Treat People with dignity and respect Treat People as inherently trustworthy Treat People as People - not cogs in a machine And in doing so implementation will have the power of the People LLBWA

Thank you for listening