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Challenges in SWIan BiggsArea Director BGSW
10 April 2014
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Guiding Principles
Walk in the shoes of the people we serve:
Think like a patient. Act like a taxpayer
NHS | Presentation to SW Senate NHS England | 10-04-143
Financial
Political Social
Clinical
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Challenge status quo
• Viable local hospitals that don’t all have to be huge.
• Mental and physical health, unified.
• Employers actively engaged in health of employees.
• Faster uptake of digital technologies.
• The critical role of the Third Sector, and the innovation value of new providers.
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Challenges: changing demography• Older population (over 65s)
• Increased demand: Between 1999 and 2008 the number of GP consultations per patient rose from 4.1 annually to 5.5 annually.
• Increased survival with long term conditions leading to increased complexity and comorbidity
• Recruitment challenges to key clinical roles
NHS | Presentation to SW Senate NHS England | 10-04-145
National SW
2011 16.4% 19.7%
2021 18.7% 22.8%
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Challenges: Older people & frailty
• ‘Everyone Counts: Planning for Patients’ frailty as a priority.
Long lengths of stay. High readmission rates. High rate of long-term care after discharge.
• Variations in practice: NHS England guidance (DCIoS)
Four key components: identify those who are frail, assess, personalise care planning, keyworkers.
• Variations in access to services e.g. transport, specialised services, sensory impairment, rurality
• Changing carer population: shrinking carer population, older, socioeconomic geographical motility.
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Frailty and older people: Questions
• How do we know the experience of frail, elderly patients?.
• How do we balance clinical effectiveness with easy timely access to services?
• How do we work together across health and social care?
• How do we keep people at home and reduce admissions?
• How do we measure outcomes resulting from service change?
• How do we improve quality, especially in SW with rural and ageing population?
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Challenges: Dementia
• 1 in 3 people aged over 65 will suffer from dementia
• Approx 25% of hospital beds are occupied by people with dementia. Stay in hospital longer. More readmissions. More likely to die.
• The national cost £19 billion per year. By 2030 this cost is expected to treble to over £50 billion per year.
• Currently less than ½ of people living with dementia in England receive a formal diagnosis.
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Challenges: No health without mental health
• Single largest cause of disability
• Wide economic costs (£105.2 bn)
• People with severe mental illnesses die on average 20 years earlier than the general population.
• Associated with other long term conditions
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Challenges: LTCs, complexity and comorbidity
• Increasing comorbidity: 2/3 of older people currently live with more than one LTC.
• LTC’s account for 50% of all GP appointments, 70% of all hospital admissions and 70% of spend on health and social care.
• Variations in preferred place of care in last year of life.
• More complexity means one size does not fit all
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Questions: Complexity and comorbidity• How do we ensure personalised care planning
and patient choice?
• How do we tackle fragmentation between organisations / services?
• How do we empower patients to self-manage and access services in a timely way 24/7?
• How do we anticipate need of our population both clinically and strategically?
• How do we balance the need to improve quality and reduce spend with increased demand?
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Questions…Specialised services
• How do we ensure patients experience joined up care throughout the pathway?
• How can we solve complex issues, hub and spoke models?
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Simon Stephens’ inaugural speech
‘It’s time to get serious about patient power, prevention and community partnerships……So it’s time to chart a new
course. One that combines hard-headed realism about the here-and-now with a sense of shared purpose and – dare I
say it – even optimism about the future.’
..’
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