Slide 1 - One East Midlands

							                Towards Excellence:
Driving up Quality Across the East Midlands

             Health and Social Care Conference
                              25 February 2010




                                                 1
                  Main Themes


• Why has the NHS been so poor at engaging the
  third sector?

• What is changing?

• The quality and productivity challenge
            ‘Failure’ of Commissioning

NHS has ‘commissioned’ for two decades, but …

• Commissioners’ capability has been limited
• Few levers, not well used
• Inadequate regulatory regime – bail out of NHS providers
• Low investment in developing commissioners
• Highly variable & fragmented practice
• Lack of legitimacy (linked to ‘voice’ & patient /public engagement)
• Very limited range of providers
                          An unfair playing field

• Lack of awareness amongst commissioners of the Third Sector
• Inconsistency of procurement and regulatory practices
• Great variation in when/whether to use grants or contracts
• Burden of disproportionate procurement practices – pre-qualification
  requirements, guarantees/bonds
• Poor funding practice: lack of full cost recovery > ‘subsidy’
• Poor funding practice: short-termism = barrier to investment
• Burden of disproportionate monitoring

‘Working with the Third Sector’ National Audit Office June 2005
An unfair playing field
The Commissioning Framework
for Health and Well-being
                      Assuring high quality
                    providers for all services

Obstacle:         Providers are sometimes unwilling or unable to
                  provide new and innovative services
Solution:
•   Commissioning focused on outcomes
•   Wider range of providers
•   Develop effective, strong partnerships with providers
•   Transparent and fair procurement
•   More innovative provision, tailored to the needs of individuals (engage
    providers in needs assessments)
•   Intelligent decommissioning
             Quality & Productivity Challenge
• The population has increased 24% over the 60 years of the NHS
• More people now over pension age than under 16
• By 2031 the 75+ population will double to 8.2 million
• Half of babies born today will live to be 100
• Men and women live 10 years longer than in 1948
• Time lived with a limiting illness or disability has increased by over
  two years in past decade
• Alzheimer’s and other forms of dementia will double in a generation
• Demographic change will cost the NHS £1.1–1.4 bn extra each year


 Source: The Human Factor, NESTA, 2009
                                                                           8
                           The scale of the challenge

Growth in Allocations                                       Trajectory of rising costs

             8


             8                                                                                   £1.4 bn
             7                                                                                   challenge
             7
£ Billions




             6
                                                                                                  Flat
             6                                                                                    cash
             5
                                                                                                  scenario

             5


             4
                 2006/07   2007/08   2008/09   2009/10   2010/11   2011/12   2012/13   2013/14




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                            Our Aim

• The aim of the Towards Excellence programme is to
  drive up the quality of healthcare across the East
  Midlands, and ensure we have the resources to meet the
  challenges of:

   –   Demographic change
   –   Increasing costs of drugs and technology
   –   Rising demand
   –   Growing expectations




                                                           10
                    Responding to the Challenge
                        - levels of working

National

Regional

County health system

                            Co-Production
PCT / Provider               Subsidiarity
                           Clinical Leadership
                           System Alignment
Organisation
Team / Individual

                                                  11
        12 National Priorities Confirmed
Priority                                      Lead
Primary Care Contracting                      Dame Barbara Hakin
Technology / Digital Vision                   Peter Spilsbury
Procurement                                   Phillipa Slinger
Supporting staff productivity                 Lorraine Foley (NHSI)
Back Office Efficiency                        Tony Spotswood
Drugs – Prescribing                           Peter Rowe
Clinical Support Rationalisation              Dr Ian Barnes
Right Care                                    Sir Muir Gray
- Decommissioning
- Threshold, referral/conversion management
- Patient decision support

Safe Care                                     Maxine Power (DH)
Pathway - Long Term Conditions – Overall      Sir John Oldham (DH)
Pathway - Acute - Urgent & Emergency Care     Sir John Oldham (DH)
Pathway - End of Life                         Sophia Christie (BENPCT)




                                                                         12
                          East Midlands Priorities
                             Clinical Priorities

1    Transformation of the Urgent Care System                                £45 - 85m

2    Delivery of upper quartile performance in planned care                  £7 – 17m

3    VTE prevention                                                          £3 - 6m

4    Long term conditions management - best practice pathways                £67 - 68m
     Initial Priorities: Falls and Dementia

5    End of Life care – best practice                                        £10 - 26m

6    Large scale prevention programmes                                       £25 - 62m

7    Reduction in caesarean section rates                                    £1 – 4m

8    Reducing out-of-area placements for people with learning disabilities   £1 - 21m

9    Significant reduction in prescribing and drug procurement costs         £31m

    Potential opportunity                                                    £189 – 321m
                                                                                           13
                           Non-Clinical Priorities

1   Workforce productivity                                          £169 -176m

2   Rationalise back-office functions and supply chain management   £25m

3   Major improvement in productivity of Pathology services         £20 - 40m

4   Introduce standard thresholds for surgery                       £6 - 69m

5   Estates optimisation                                            £72 – 112m

6   Reduce Variation and Maximise Capacity                          £3 - 27m

7   Reduce costs of primary care contracting (LES, DES)             £34 - 37m

8   Reduce costs of Continuing Care                                 £27m


    Potential opportunity                                            £355 – 512m




                                                                                   14
                 Quality Observatory

• East Midlands QO was launched on 1 December
• It will provide the main mechanism to measure and track
  quality improvements
• Access to the data on the website is currently restricted
• It will gradually be opened to all




                                                              15
16
                    Our Next Steps

• Establish priority work streams, with high quality
  leadership
• Set up PMO
• Develop detailed plan for each initiative
• Develop county health system assurance plans
• Closer alignment with local government / social care
• Produce SHA Delivery Plan
• Widespread communication and engagement


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