big picture thinking

Seeing the Bigger PictureThe NHS in transition

Charlotte Leggatt

MDN Northern Region Facilitator

Aims of the session

• Why does the NHS need to change?– A world picture– Economic Change– Societal Change– Demographic Change

What are the reforms proposed

What skills will Managers need

A World Picture

• Many Countries (western and third world) are tackling the difficulties of health inequality

• Scotland is not on its own – everyone is attempting to balance the financing, organisation and delivery of services against the deeply held moral imperatives to maintain and improve on equity of services

THE USA – a topical issue!!

• Most expensive form of healthcare

• Single major reason for bankruptcy in the USA

• Obama – Healthcare for all

• Focusing on value, ratio of quality to cost

• Improving healthcare

The USA – How do they intend to do it

• Increase use of technology

• Research & incentives to improve medical decision making

• Reduce tabacco use and tackle obesity

• Reform the payment of providers to ensure efficiency

The Global Economy

• Less than anticipated uplift• Higher than anticipated Pay Award• Significantly increased energy costs• Agreed developments from some years ago• Many Health Boards have underlying financial

deficits

Financial pressures 2008/2009:

• £1618 per head of population Scotland is average health expenditure

• Lowest is £1583• Highest is £1889• This is affected by deprivation and rurality• Known further 10% cut in public services• Public policy economists suggest 20% may

be more realistic

A Changing Society

• Technological Advances - unrelenting• Expectations – 24/7 society• Growth of consumerism• Educated society – means we challenge everything• Competition • Modern Industry needs Innovation and Creativity• Management vs Leadership

Demographics

• A shrinking and ageing population = critical policy challenges for Scottish Executive

• Age rate is rising – births are falling– 2002 800,000 over 75s– 30% rise will mean that by 2042 1.3 million– 2002 800,000 under 15s– 30% fall wil mean by 2042 620,000

Demographics – what does this really mean for society

• Population is declining faster than any other EU country– Economic, social and cultural challenges– Greater demands for NHS services– The “grey electorate” will note vote for those

not representing their direct interests– Has an impact on earnings, employment,

mobility, savings, consumption and housing

Demographics – impact on health services

• Most people use services in the last few years of life

• Living longer places a greater demand on services

• Labour marker shortages

• Less taxation = less funding

Long Term Conditions

• LTC are growing at a faster rate in Scotland than many of our counterparts

• 80% of GP appointments are for chronic disease

• 60% of hospital in patients are for those with chronic disease

• Chronic disease increases with age

Long Term Conditions

• COPD to rise by a predicted 33%• Diabetes – 1 patient every 40 minutes in the

UK being diagnosed• Depression – WHO believes 2nd major

chronic disease in the next 20 yrs.• Enoch Powell in his more unpopular years

said “any health service faces the problem of infinite demand meeting finite resources”

Or put another wayCapacity and demand are out of

kilter

Kerr Report 2005 “..the next twenty years will see an ageing

population, a continuing shift in the pattern of disease towards long term conditions and a growing number of older people with multiple conditions and complex needs. These changes in themselves will make the current model of health care delivery unsustainable”

Better Health Better Care

• Sustainable services close to home

• A shift in the balance of care from the hospital to community settings

• Proactive rather than reactive care

• Community Health Partnerships to act as the bridge between primary and secondary care, working in partnership with LA.

General Practice and Heat Targets

• These are the Government’s priorities for Health Care in Scotland (devolved function)– Health Improvement– Efficiency and Governance– Access– Treatment

Heat Targets

• Access– Ensure that anyone contacting their GP surgery

has guaranteed access to a GP, nurse or other health care professional within 48 hours

– The maximum wait from urgent referral to treatment for all cancers is 2 months

– No patient will wait longer than 15 weeks from GP referral to first outpatient appointment from 21st March 2009 (18WRTT by 2011)

Heat Targets

• Efficiency and Governance cont’d– To increase the % of new GP outpatient

referrals into consultant led secondary care services that are triaged on line for clinical priority and appropriate service to 90% from Dec 2010

Heat Targets

• Efficiency and Governance– Achieve a sickness absence rate of 4% from

March 2009– To operate within their agreed revenue resource

limit; operate within their capital resource limit; meet their cash requirement

– To meet efficiency targets– Universal utilisation of CHI

Heat Targets

• Treatment– Reduce the proportion of over 65s who are

admitted as an emergency inpatient two or more times in a single year by 20%

– Reduce admissions for patients with COPD, Asthma, Diabetes and CHD

– Reduce the annual rate of antidepressants– Reduce the number of re-admissions for those

with psychiatric problems

18 Week RTT Service Re-Design & Transformation

One of the most significant reforms in the history of the NHS and it will

transform service delivery

Specific Measure for 18RTT

“A whole journey waiting time target of 18 weeks from general practitioner referral to treatment …..

by December 2011”

Cabinet Secretary for Health & Wellbeing – Official Report 26th June 2007

Real opportunity for radical change

CATALYSTS FOR

CHANGE

18 weeksreferral to treatment

Financialpressures

Aging population

European workingtime directive

Shorter waiting times

Mental health Long term conditions

18 Weeks RTT: High Level Themes

Improve Referral Management &

Access to Diagnostics(Pathways)

Redesign of Pathways

(ENT, Ortho, Diabetes)

Corporate Enabling Activities

Actively Manage Follow Ups

Actively Manage Admissions and

Discharges

Theatres &Treat Day Surgery

as the Norm

Define, Measure, Monitor and Performance

Manage

Management of Waiting Lists / Appointments

18 Weeks RTTService Re-Design and

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Contracted=£39m Non-Contracted=£164.3m

2008/09 Practice Direct Impact (£203.4m)

Whole System Re-design

Hospital Care = £££

The changingrole of the GP

Collaborative Working

Social CareCommunity Nursing

Patient Expectations

Non health related issues

Extended role of Primary Care

Whole System Re-design in practice

• Recognising the need for change

• Excellent Project Management

• Collaborative and partnership working

• Understanding the role of all concerned

• Using all areas appropriately

• Involving only those appropriate in service re-design (inputs and outputs).

What skills will Managers Need

• The ability to manage change• The ability to manage projects• Leadership (Visionary) Skills• Interpersonal (People) Skills• The ability to make tough decisions• The ability to make the organisation more

efficient• The ability to manage performance/capability• The ability to manage risk

On a personal level, from one to another

• The art of self preservation

• Self belief

• Self confidence

• The ability to keep moving forward when you would rather not be there

• The ability to self motivate because who else is going to do it for you

If you remember nothing else…..

• On Leadership - “I suppose leadership at one time meant muscles, but today it means getting along with people” Ghandi

• On Change Management – “Keep your fears to yourself but share your inspiration with others” Robert Louis Stevenson

On self belief

• “For me life is continously being hungry. The meaning of life is not simply to exist, to service, but to move ahead, to go up, to achieve, to conquer”

• Any guesses???

He also said this – his mantra

• “I want to be the best built man in the world. I will go to America and be in movies. I will marry a beautiful woman, be happy and will one day be a very important man in America”