Delivering the NHS Mandate Priorities for Patient Participation 30th September, 2014Patricia MuramatsuSenior Strategy AdvisorT:@pmuramatsu

NHS | Presentation to [XXXX Company] | [Type Date]

Structure of presentationThe Challenge. Why is this so important? The moral case. Finance. The changing business of health. The NHS Mandate. What has NHS England been asked to do?Evidence based thinking Do we know what works?Developing a shared vision Developing a systems approach to delivery

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Moral case. When your life is defined by NHS participation in care can transform your lifeFrustrated, articulate man, Robert, with treatment resistant schizophrenia miles from home. Wanted flat, a job and friends for years. Care cost 100k per year for 7 years. No plan. No voice.Middle aged woman, Mary, with personality disorder, in poor out of area private provision. Shared bathroom between 10 on ward with others including men. Terrible life. No plan.Woman with arthritis and chronic pain, Angela, never having had information or support to manage condition. Snippets of reactive care.

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Finance Challenge. Unsustainable care model. Efficiency not enoughFace decade without any increase in spending, unprecedented in NHS history, set against rising demand (4% pressure pa)

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Health Spending 1949-50 to 2010-11Source: IFS, HMT

Chart1

11.5397997415

12.0694681604

11.5786806306

11.0985610853

11.1104637661

11.3499092196

11.6231086644

11.9530869574

12.2980953072

12.7938653201

13.7563537137

14.8995790556

15.486169747

15.7362572641

16.6201421205

17.4421788546

18.5408154519

19.5061541724

20.6093799926

21.1607456011

21.4960589249

22.6331199319

23.7036772318

25.1137844567

27.716748358

30.3324814339

31.1703798153

31.877711216

31.3128182038

32.1218567276

32.8300412392

34.2888692402

35.4795231107

36.0560349569

36.8900141072

37.2546891233

37.7889372497

39.8207742443

41.4001703757

42.6499465554

43.5675741063

45.0371390227

48.0649264549

51.6502176628

53.8300075405

55.5869941357

56.5075509589

56.6982396483

58.014009509

60.3682400103

62.7746781781

67.8240707105

73.3413388607

82.4236894982

88.1635818296

93.4649331048

101.4253013446

103.7962885166

110.4193529658

115.8213327747

124.2288144578

124.2036144578

Real (bn)

Real Spending (bn)

IFS - real spending

REAL billion (10-11 prices)

Total Managed ExpenditureCurrent SpendingPublic Sector net investmentDepreciationSocial SecurityNHSEducationDefence (excl. Non cash costs)Defence (incl. Non cash costs)Public Order & SafetyTransportPS Net Debt Interest PaymentsPS Gross Debt Interest Payments'Other' spendingGDPTME less social security less gross debt interestGDP growthNHS growthGDPNHSNHS/GDPNHS/TME

1945-46

1946-47

1947-48

1948-49128.9109.95.511.818.510.817.2342.293.2NHSEducation & WelfareOther

1949-50134.5112.57.112.018.211.510.217.4353.599.03.3%8.6%1949-509%14%78%

1950-51143.8113.89.712.618.112.19.517.3364.3108.43.1%4.6%8.4%1950-518%13%79%

1951-52149.0117.016.113.318.411.610.317.6371.8113.02.0%-4.1%7.8%1951-528%12%80%

1952-53154.2119.917.513.820.811.111.717.9375.5115.51.0%-4.1%7.2%1952-537%13%79%

1953-54151.3121.220.013.421.311.110.635.111.118.2390.2111.73.9%0.1%7.3%1953-547%21%72%

1954-55152.7123.316.213.920.711.311.233.39.818.1405.7113.94.0%2.2%7.4%1954-557%21%72%

1955-56149.1119.514.614.319.911.611.831.010.419.1412.4110.11.7%2.4%7.8%1955-568%21%71%

1956-57152.2123.014.514.821.212.012.930.49.318.1416.6112.81.0%2.8%7.9%1956-578%22%70%

1957-58152.4122.713.815.021.612.313.928.69.518.7421.1112.11.1%2.9%8.1%1957-588%23%69%

1958-59157.6126.514.315.325.412.814.627.111.319.1423.2113.20.5%4.0%8.1%1958-598%25%67%

1959-60165.1133.515.615.326.713.815.627.516.819.9447.8118.55.8%7.5%8.3%1959-608%26%66%

1960-61179.5142.416.116.326.914.916.828.418.521.7472.0130.95.4%8.3%8.3%1960-618%24%67%

1961-62185.4149.420.216.529.215.518.329.319.522.8481.3133.42.0%3.9%8.4%1961-628%26%66%

1962-63192.4151.018.916.930.415.720.229.918.422.2489.6139.81.7%1.6%8.2%1962-638%26%66%

1963-64204.4157.224.117.933.416.621.830.519.323.4517.8147.65.8%5.6%8.1%1963-648%27%65%

1964-65207.6159.328.018.333.517.423.030.619.123.6539.0150.54.1%4.9%8.4%1964-658%27%64%

1965-66225.1171.128.618.737.718.524.630.818.924.0550.7163.42.2%6.3%8.2%1965-668%28%64%

1966-67231.9178.233.318.838.919.526.031.319.624.8560.3168.21.7%5.2%8.4%1966-678%28%64%

1967-68257.8194.442.321.143.020.627.332.622.327.4577.2187.43.0%5.7%8.0%1967-688%27%65%

1968-69259.4198.939.021.546.621.228.631.022.728.2598.2184.63.6%2.7%8.2%1968-698%29%63%

1969-70258.8200.137.021.747.721.529.528.522.728.5608.7182.61.8%1.6%8.3%1969-708%30%62%

1970-71267.2204.838.823.547.022.630.828.621.527.2624.7193.12.6%5.3%8.5%1970-718%29%62%

1971-72272.3214.033.524.949.923.732.629.321.027.1641.0195.32.6%4.7%8.7%1971-729%30%61%

1972-73280.8223.132.925.953.725.135.330.220.626.6671.9200.54.8%5.9%8.9%1972-739%32%59%

1973-74310.2245.236.228.855.027.738.532.224.032.5699.7222.74.1%10.4%8.9%1973-749%30%61%

1974-75339.3270.239.630.357.030.339.832.426.634.5698.3247.8-0.2%9.4%8.9%1974-759%29%63%

1975-76344.8275.538.430.361.631.242.032.225.733.9693.9249.4-0.6%2.8%9.0%1975-769%30%61%

1976-77346.7283.431.631.665.031.941.233.229.038.0713.7243.72.9%2.3%9.2%1976-779%31%60%

1977-78332.7279.521.631.669.531.340.832.328.736.5730.6226.82.4%-1.8%9.4%1977-789%33%57%

1978-79339.1287.719.032.474.132.140.733.511.212.429.537.8105.5752.7227.13.0%2.6%9.5%1978-799%34%57%

1979-80345.5294.917.732.977.032.840.235.511.813.131.940.3103.1774.5228.22.9%2.2%9.5%1979-8010%34%57%

1980-81351.3303.814.133.478.934.341.036.712.512.832.440.6102.6746.8231.8-3.6%4.4%9.8%1980-8110%34%56%

1981-82358.2317.47.433.488.635.541.437.313.113.134.443.594.7750.2226.10.5%3.5%9.9%1981-8210%36%54%

1982-83369.5325.112.032.394.836.141.439.813.913.532.642.497.3767.1232.32.3%1.6%9.8%1982-8310%37%53%

1983-84382.4335.414.632.298.836.941.941.014.612.932.141.2104.2799.1242.44.2%2.3%9.6%1983-8410%37%54%

1984-85387.8344.412.930.8101.237.341.142.615.515.534.343.1100.4816.3243.52.1%1.0%9.6%1984-8510%37%54%

1985-86382.3344.29.928.2105.237.840.742.215.214.933.845.092.5849.4232.24.1%1.4%9.9%1985-8610%38%52%

1986-87384.2350.06.028.3108.539.843.641.416.014.229.942.590.8881.3233.23.8%5.4%10.4%1986-8710%40%50%

1987-88385.7353.55.526.7107.441.444.640.217.013.531.441.390.2927.5236.95.2%4.0%10.7%1987-8811%39%50%

1988-89375.8345.63.326.8102.242.645.538.217.712.429.139.687.9965.7234.04.1%3.0%11.3%1988-8911%39%49%

1989-90386.7348.212.126.3102.443.647.638.618.913.425.838.496.2987.6245.92.3%2.2%11.3%1989-9011%39%50%

1990-91387.9350.613.324.0105.445.047.937.520.014.223.334.894.6983.5247.7-0.4%3.4%11.6%1990-9112%40%49%

1991-92409.2371.517.420.3126.948.150.437.321.214.819.729.490.8977.7253.0-0.6%6.7%11.7%1991-9212%43%45%

1992-93428.2390.218.119.8137.051.751.837.222.516.921.729.689.5979.5261.60.2%7.5%12.1%1992-9312%44%44%

1993-94434.7400.814.319.6144.853.852.735.722.815.224.831.484.91010.8258.63.2%4.2%12.4%1993-9412%45%42%

1994-95447.5413.214.719.8146.355.654.234.923.317.228.735.087.31052.3266.24.1%3.3%12.4%1994-9512%45%43%

1995-96452.6418.914.718.9146.256.553.832.723.315.932.238.892.01082.6267.72.9%1.7%12.5%1995-9612%44%43%

1996-97442.9417.87.617.4146.056.753.031.023.013.333.139.386.81111.3257.62.7%0.3%12.8%1996-9713%45%42%

1997-98440.7417.36.616.7144.758.052.829.723.411.933.840.586.41152.4255.53.7%2.3%13.2%1997-9813%45%42%

1998-99444.0419.98.016.2142.760.453.532.824.110.432.139.288.01191.7262.13.4%4.1%13.6%1998-9914%44%42%

1999-00451.5428.07.216.3138.662.855.433.024.210.427.533.299.81240.1279.74.1%4.0%13.9%1999-0014%43%43%

2000-01471.3448.36.616.3140.067.859.533.326.411.726.134.2106.51282.2297.13.4%8.0%14.4%2000-0114%42%43%

2001-02495.7464.015.116.6149.973.364.932.229.314.322.328.5109.51307.3317.32.0%8.1%14.8%2001-0215%43%42%

2002-03518.4484.316.917.2150.682.467.233.230.018.220.726.3116.31340.9341.52.6%12.4%15.9%2002-0316%42%42%

2003-04544.8508.718.617.4156.288.272.834.431.519.521.727.3120.51382.1361.33.1%7.0%16.2%2003-0416%42%42%

2004-05572.6531.023.917.7159.093.575.634.633.118.621.929.0136.21411.3384.62.1%6.0%16.3%2004-0516%41%43%

2005-06598.7553.526.818.4162.5101.479.535.333.419.423.030.7144.01453.4405.43.0%8.5%16.9%2005-0617%40%43%

2006-07607.9560.728.518.8163.2103.880.535.433.622.025.032.3144.41488.7412.52.4%2.3%17.1%2006-0717%40%43%

2007-08625.2575.130.919.1169.5110.483.836.134.022.024.634.3144.81528.1421.42.6%6.4%17.7%2007-0818%41%42%

2008-09657.8589.848.519.5178.9115.886.338.335.121.724.433.7157.31497.9445.2-2.0%4.9%17.6%2008-0918%40%42%

2009-10688.7618.050.420.3193.4124.290.939.336.023.827.832.7153.31442.3462.6-3.7%7.3%18.0%2009-1018%41%41%

2010-11696.8637.338.920.6194.5124.289.438.539.744.21474.0458.12.2%-0.0%17.8%2010-1118%41%41%

2011-12686.8639.027.221.21510.32.5%0.0%1510.3129.17175903618.6%

2012-13682.1637.423.021.61554.12.9%0.0%1554.1134.33862939768.6%

2013-14675.1634.518.621.91598.82.9%0.0%1598.8139.71217457358.7%

2014-15671.4630.618.822.11641.52.7%0.0%1641.5145.30066155648.9%

2015-16671.5630.618.522.31686.12.7%1686.1151.11268801879.0%

2016-17GDPNHS1731.6157.15719553949.1%

2017-18AAGR2.4%4.0%1778.3163.4434833619.2%

2018-19forecast2.7%4.00%1826.3169.98122269559.3%

2019-201875.7176.78047160339.4%

2020-211926.3183.85169046749.5%

2021-221978.3191.20575808619.7%

2022-232031.7198.85398840959.8%

2023-242086.6206.80814794599.9%

2024-252142.9215.080473863810.0%

2025-262200.8223.683692818310.2%

2026-272260.2232.63104053110.3%

2027-282321.2241.936282152310.4%

2028-292383.9251.613733438410.6%

2029-302448.3261.678282775910.7%

2030-312514.4272.14541408710.8%

2582.3283.031230650411.0%

Rowena Crawford:TME less spending on social security, NHS, education, defence, public order, transport and debt interest

IFS - %GDP

Percentage of national income (% GDP)

Total Managed ExpenditureCurrent SpendingPublic Sector net investmentDepreciationSocial SecurityNHSEducationDefence (excl. Non cash costs)Defence (incl. Non cash costs)Public Order & SafetyTransportPS Net Debt Interest PaymentsPS Gross debt interest payments'Other' spendingTME less social security less gross debt interest

1945-46..............................

1946-47..............................

1947-48..............................

1948-4937.732.11.63.45.4............3.25.0..27.2

1949-5038.031.82.03.45.13.3..........2.94.9..28.0

1950-5139.531.22.73.45.03.3..........2.64.8..29.8

1951-5240.131.54.33.65.03.1..........2.84.7..30.4

1952-5341.131.94.73.75.53.0..........3.14.8..30.8

1953-5438.831.15.13.45.52.82.79.0......2.84.7..28.6

1954-5537.630.44.03.45.12.82.88.2......2.44.5..28.1

1955-5636.229.03.53.54.82.82.97.5......2.54.6..26.7

1956-5736.529.53.53.65.12.93.17.3......2.24.3..27.1

1957-5836.229.13.33.65.12.93.36.8......2.34.4..26.6

1958-5937.229.93.43.66.03.03.46.4......2.74.5..26.7

1959-6036.929.83.53.46.03.13.56.1......3.84.4..26.5

1960-6138.030.23.43.55.73.23.66.0......3.94.6..27.7

1961-6238.531.04.23.46.13.23.86.1......4.04.7..27.7

1962-6339.330.83.93.56.23.24.16.1......3.84.5..28.6

1963-6439.530.44.73.56.43.24.25.9......3.74.5..28.5

1964-6538.529.65.23.46.23.24.35.7......3.54.4..27.9

1965-6640.931.15.23.46.83.44.55.6......3.44.4..29.7

1966-6741.431.85.93.46.93.54.65.6......3.54.4..30.0

1967-6844.733.77.33.77.43.64.75.7......3.94.7..32.5

1968-6943.433.36.53.67.83.54.85.2......3.84.7..30.9

1969-7042.532.96.13.67.83.54.84.7......3.74.7..30.0

1970-7142.832.86.23.87.53.64.94.6......3.44.3..30.9

1971-7242.533.45.23.97.83.75.14.6......3.34.2..30.5

1972-7341.833.24.93.98.03.75.34.5......3.14.0..29.8

1973-7444.335.05.24.17.94.05.54.6......3.44.7..31.8

1974-7548.638.75.74.38.24.35.74.6......3.84.9..35.5

1975-7649.739.75.54.48.94.56.04.6......3.74.9..35.9

1976-7748.639.74.44.49.14.55.84.7......4.15.3..34.1

1977-7845.538.33.04.39.54.35.64.4......3.95.0..31.0

1978-7945.138.22.54.39.84.35.44.5..1.51.63.95.014.030.2

1979-8044.638.12.34.29.94.25.24.6..1.51.74.15.213.329.5

1980-8147.040.71.94.510.64.65.54.9..1.71.74.35.413.731.0

1981-8247.742.31.04.511.84.75.55.0..1.81.74.65.812.630.1

1982-8348.242.41.64.212.44.75.45.2..1.81.84.25.512.730.3

1983-8447.842.01.84.012.44.65.25.1..1.81.64.05.213.030.3

1984-8547.542.21.63.812.44.65.05.2..1.91.94.25.312.329.8

1985-8645.040.51.23.312.44.44.85.0..1.81.84.05.310.927.3

1986-8743.639.70.73.212.34.54.94.7..1.81.63.44.810.326.5

1987-8841.638.10.62.911.64.54.84.3..1.81.53.44.59.725.5

1988-8938.935.80.32.810.64.44.74.0..1.81.33.04.19.124.2

1989-9039.235.31.22.710.44.44.83.9..1.91.42.63.99.724.9

1990-9139.435.61.42.410.74.64.93.8..2.01.42.43.59.625.2

1991-9241.938.01.82.113.04.95.23.8..2.21.52.03.09.325.9

1992-9343.739.81.82.014.05.35.33.8..2.31.72.23.09.126.7

1993-9443.039.71.41.914.35.35.23.5..2.31.52.53.18.425.6

1994-9542.539.31.41.913.95.35.13.3..2.21.62.73.38.325.3

1995-9641.838.71.41.713.55.25.03.0..2.21.53.03.68.524.7

1996-9739.937.60.71.613.15.14.82.8..2.11.23.03.57.823.2

1997-9838.236.20.61.412.65.04.62.6..2.01.02.93.57.522.2

1998-9937.335.20.71.412.05.14.5..2.82.00.92.73.37.422.0

1999-0036.434.50.61.311.25.14.5..2.71.90.82.22.78.022.6

2000-0136.835.00.51.310.95.34.6..2.62.10.92.02.78.323.2

2001-0237.935.51.21.311.55.65.0..2.52.21.11.72.28.424.3

2002-0338.736.11.31.311.26.15.0..2.52.21.41.52.08.725.5

2003-0439.436.81.31.311.36.45.3..2.52.31.41.62.08.726.1

2004-0540.637.61.71.311.36.65.4..2.52.31.31.62.19.727.2

2005-0641.238.11.81.311.27.05.5..2.42.31.31.62.19.927.9

2006-0740.837.71.91.311.07.05.4..2.42.31.51.72.29.727.7

2007-0840.937.62.01.311.17.25.5..2.42.21.41.62.29.527.6

2008-0943.939.43.21.311.97.75.8..2.62.31.51.62.310.529.7

2009-1047.842.83.51.413.48.66.3..2.72.51.61.92.310.632.1

2010-1147.343.22.61.413.28.46.1..2.6....2.73.0..31.1

2011-1245.542.31.81.4

2012-1343.941.01.51.4

2013-1442.239.71.21.4

2014-1540.938.41.11.3

2015-1639.837.41.11.3

Chart - Forecast Gap

101.42530134462005-062005-06

103.79628851662006-072006-07

110.41935296582007-082007-08

115.82133277472008-092008-09

124.22881445782009-102009-10

124.20361445782010-112010-11

2011-12124.20361445784.9902201485

2012-13124.203614457810.1809360493

2013-14124.203614457815.5802031682

2014-15124.203614457821.196400621

2015-16126.68768674724.5541718885

2016-17129.221440481928.0969737638

2017-18131.805869291631.8332428173

2018-19134.441986677435.7717746306

2019-20137.130826410939.9217386221

2020-21139.873442939244.292693476

Historic

SR assumption

Gap

Chart - % GDP

4.57917624091990-91

4.916200521991-92

5.27320650371992-93

5.32563271471993-94

5.28239237651994-95

5.21962720941995-96

5.10183605481996-97

5.0339817911997-98

5.06568995781998-99

5.06214765021999-00

5.28952201662000-01

5.61021524222001-02

6.1468489072002-03

6.37883584672003-04

6.62249858252004-05

6.9783184932005-06

6.97206948162006-07

7.22604335592007-08

7.73208731222008-09

8.61334261132009-10

8.42629677462010-11

8.60986867378.2773052796

8.74589229728.0833059371

8.84089645987.8554965375

8.94562614027.6415335968

9.06041008187.5894491419

9.17666684977.537719693

9.29441534217.4863428305

9.41367469987.435316151

9.53446430927.3846372678

9.65680380537.3343038103

Historic

SR assumption

Chart - Projection

3.62291405891970-7122.63311993191970-71

3.69772582241971-7223.70367723181971-72

3.73788022481972-7325.11378445671972-73

3.96107786531973-7427.7167483581973-74

4.34392001571974-7530.33248143391974-75

4.49180479431975-7631.17037981531975-76

4.46637506771976-7731.8777112161976-77

4.2859997171977-7831.31281820381977-78

4.26769320931978-7932.12185672761978-79

4.23898567021979-8032.83004123921979-80

4.59174680151980-8134.28886924021980-81

4.72937343381981-8235.47952311071981-82

4.70008162521982-8336.05603495691982-83

4.61634536391983-8436.89001410721983-84

4.56411493071984-8537.25468912331984-85

4.44912168651985-8637.78893724971985-86

4.51824281851986-8739.82077424431986-87

4.46368396491987-8841.40017037571987-88

4.41636223841988-8942.64994655541988-89

4.41158549711989-9043.56757410631989-90

4.57917624091990-9145.03713902271990-91

4.916200521991-9248.06492645491991-92

5.27320650371992-9351.65021766281992-93

5.32563271471993-9453.83000754051993-94

5.28239237651994-9555.58699413571994-95

5.21962720941995-9656.50755095891995-96

5.10183605481996-9756.69823964831996-97

5.0339817911997-9858.0140095091997-98

5.06568995781998-9960.36824001031998-99

5.06214765021999-0062.77467817811999-00

5.28952201662000-0167.82407071052000-01

5.61021524222001-0273.34133886072001-02

6.1468489072002-0382.42368949822002-03

6.37883584672003-0488.16358182962003-04

6.62249858252004-0593.46493310482004-05

6.9783184932005-06101.42530134462005-06

6.97206948162006-07103.79628851662006-07

7.22604335592007-08110.41935296582007-08

7.73208731222008-09115.82133277472008-09

8.61334261132009-10124.22881445782009-10

8.42629677468.4262967746124.20361445782010-11

2011-128.60986867372011-12129.1938346063

2012-138.74589229722012-13134.3845505071

2013-148.84089645982013-14139.783817626

2014-158.94562614022014-15145.4000150788

2015-169.06041008182015-16151.2418586354

2016-179.17666684972016-17157.3184142457

2017-189.29441534212017-18163.6391121088

2018-199.41367469982018-19170.213761308

2019-209.53446430922019-20177.0525650331

2020-219.65680380532020-21184.1661364152

2021-229.78071307522021-22191.565514997

2022-239.90621226112022-23199.262183865

2023-2410.03332176382023-24207.2680874701

2024-2510.16206224562024-25215.5956501641

2025-2610.29245463422025-26224.2577954815

2026-2710.42452012552026-27233.2679661947

2027-2810.55828018772027-28242.6401451766

2028-2910.69375656442028-29252.3888771001

2029-3010.8309712782029-30262.5292910104

2030-3110.96994663372030-31273.0771238032

2031-3211.11070522282031-32284.0487446472

2032-3311.25326992642032-33295.4611803873

2033-3411.39766391942033-34307.3321419683

2034-3511.54391067382034-35319.680051921

2035-3611.69203396312035-36332.5240729515

2036-3711.84205786562036-37345.8841376801

2037-3811.99400676862037-38359.780979575

2038-3912.14790537232038-39374.2361651277

2039-4012.3037786942039-40389.272127323

2040-4112.46165207182040-41404.9122004519

2041-4212.62155116892041-42421.1806563248

2042-4312.78350197822042-43438.1027419381

2043-4412.94753082552043-44455.7047186556

2044-4513.11366437492044-45474.0139029632

2045-4613.28192963242045-46493.0587088616

2046-4713.45235395052046-47512.8686919613

2047-4813.62496503282047-48533.4745953508

2048-4913.79979093842048-49554.908397306

2049-5013.97686008622049-50577.2033609178

% GDP (Historic)

% GDP (Projection)

Real Spending (Historic)

Real Spending (Projection)

Calculation

NHS spendingNHS spending

Real (bn)% GDPReal growthReal (bn)% GDPReal growth

1949-5011.53.3

1950-5112.13.34.6%

1951-5211.63.1-4.1%

1952-5311.13.0-4.1%

1953-5411.12.80.1%

1954-5511.32.82.2%

1955-5611.62.82.4%

1956-5712.02.92.8%

1957-5812.32.92.9%

1958-5912.83.04.0%

1959-6013.83.17.5%

1960-6114.93.28.3%

1961-6215.53.23.9%

1962-6315.73.21.6%

1963-6416.63.25.6%

1964-6517.43.24.9%

1965-6618.53.46.3%

1966-6719.53.55.2%

1967-6820.63.65.7%

1968-6921.23.52.7%

1969-7021.53.51.6%% GDP (Historic)% GDP (Projection)Real Spending (Historic)Real Spending (Projection)

1970-7122.63.65.3%1970-713.622.6

1971-7223.73.74.7%1971-723.723.7

1972-7325.13.75.9%1972-733.725.1

1973-7427.74.010.4%1973-744.027.7

1974-7530.34.39.4%1974-754.330.3

1975-7631.24.52.8%1975-764.531.2

1976-7731.94.52.3%1976-774.531.9

1977-7831.34.3-1.8%1977-784.331.3

1978-7932.14.32.6%1978-794.332.1

1979-8032.84.22.2%1979-804.232.8

1980-8134.34.64.4%1980-814.634.3

1981-8235.54.73.5%1981-824.735.5

1982-8336.14.71.6%1982-834.736.1

1983-8436.94.62.3%1983-844.636.9

1984-8537.34.61.0%1984-854.637.3

1985-8637.84.41.4%1985-864.437.8

1986-8739.84.55.4%1986-874.539.8

1987-8841.44.54.0%1987-884.541.4

1988-8942.64.43.0%% GDP1988-894.442.6

1989-9043.64.42.2%HistoricSR assumption1989-904.443.6

1990-9145.04.63.4%1990-914.61990-914.645.0

1991-9248.14.96.7%1991-924.91991-924.948.1

1992-9351.75.37.5%1992-935.31992-935.351.7

1993-9453.85.34.2%1993-945.31993-945.353.8

1994-9555.65.33.3%1994-955.31994-955.355.6

1995-9656.55.21.7%1995-965.21995-965.256.5

1996-9756.75.10.3%1996-975.11996-975.156.7

1997-9858.05.02.3%1997-985.01997-985.058.0

1998-9960.45.14.1%1998-995.11998-995.160.4

1999-0062.85.14.0%1999-005.11999-005.162.8

2000-0167.85.38.0%2000-015.32000-015.367.8

2001-0273.35.68.1%2001-025.62001-025.673.3

2002-0382.46.112.4%2002-036.12002-036.182.4

2003-0488.26.47.0%NHS spending2003-046.42003-046.488.2NHS SpendingGDPGDP growth

2004-0593.56.66.0%HistoricSR assumptionGapProjection2004-056.62004-056.693.5

2005-06101.47.08.5%2005-061012005-067.02005-067.0101.4

2006-07103.87.02.3%2006-071042006-077.02006-077.0103.8

2007-08110.47.26.4%2007-08110NHS Spending2007-087.22007-087.2110.4

2008-09115.87.74.9%2008-09116Average GrowthSR Assumptions2008-097.72008-097.7115.8

2009-10124.28.67.3%2009-101244.0%2009-108.62009-108.6124.2

2010-11124.28.4-0.0%2010-111242010-118.42010-118.48.4124.21241474

2011-122011-12124.251294.0%0%2011-128.68.32011-128.6129.2129.193834606315011.80%

2012-132012-13124.2101344.0%0%2012-138.78.12012-138.7134.4134.384550507115372.40%

2013-142013-14124.2161404.0%0%2013-148.87.92013-148.8139.8139.78381762615812.90%

2014-152014-15124.2211454.0%0%2014-158.97.62014-158.9145.4145.400015078816252.80%

2015-162015-16126.7251514.0%2%2015-169.17.62015-169.1151.2151.241858635416692.70%

2016-172016-17129.2281574.0%2%2016-179.27.52016-179.2157.3157.318414245717142.70%

2017-182017-18131.8321644.0%2%2017-189.37.52017-189.3163.6163.639112108817612.70%

2018-192018-19134.4361704.0%2%2018-199.47.42018-199.4170.2170.21376130818082.70%

2019-202019-20137.1401774.0%2%2019-209.57.42019-209.5177.1177.052565033118572.70%

2020-21139.9441844.0%2%2020-219.77.32020-219.7184.2184.166136415219072.70%

2021-229.8191.6191.56551499719592.70%

2022-239.9199.3199.26218386520112.70%

2023-2410.0207.3207.268087470120662.70%

2024-2510.2215.6215.595650164121222.70%

2025-2610.3224.3224.257795481521792.70%

2026-2710.4233.3233.267966194722382.70%

2027-2810.6242.6242.640145176622982.70%

2028-2910.7252.4252.388877100123602.70%

2029-3010.8262.5262.529291010424242.70%

2030-3111.0273.1273.077123803224892.70%

2031-3211.1284.0284.048744647225572.70%

2032-3311.3295.5295.461180387326262.70%

2033-3411.4307.3307.332141968326962.70%

2034-3511.5319.7319.68005192127692.70%

2035-3611.7332.5332.524072951528442.70%

2036-3711.8345.9345.884137680129212.70%

2037-3812.0359.8359.78097957530002.70%

2038-3912.1374.2374.236165127730812.70%

2039-4012.3389.3389.27212732331642.70%

2040-4112.5404.9404.912200451932492.70%

2041-4212.6421.2421.180656324833372.70%

2042-4312.8438.1438.102741938134272.70%

2043-4412.9455.7455.704718655635202.70%

2044-4513.1474.0474.013902963236152.70%

2045-4613.3493.1493.058708861637122.70%

2046-4713.5512.9512.868691961338122.70%

2047-4813.6533.5533.474595350839152.70%

2048-4913.8554.9554.90839730640212.70%

2049-5014.0577.2577.203360917841302.70%

Sheet2

10 year growthAverage annual growthAnnual growth

1949-5011.519%1.92%4.59%4.59%

1950-5112.1-4.07%-4.07%

1951-5211.6-4.15%-4.15%

1952-5311.10.11%0.11%

1953-5411.12.16%2.16%

1954-5511.32.41%2.41%

1955-5611.62.84%2.84%

1956-5712.02.89%2.89%

1957-5812.34.03%4.03%

1958-5912.87.52%7.52%

1959-6013.856%5.63%8.31%8.31%

1960-6114.93.94%3.94%

1961-6215.51.61%1.61%

1962-6315.75.62%5.62%

1963-6416.64.95%4.95%

1964-6517.46.30%6.30%

1965-6618.55.21%5.21%

1966-6719.55.66%5.66%

1967-6820.62.68%2.68%

1968-6921.21.58%1.58%

1969-7021.553%5.27%5.29%5.29%

1970-7122.64.73%4.73%

1971-7223.75.95%5.95%

1972-7325.110.36%10.36%

1973-7427.79.44%9.44%

1974-7530.32.76%2.76%

1975-7631.22.27%2.27%

1976-7731.9-1.77%-1.77%

1977-7831.32.58%2.58%

1978-7932.12.20%2.20%

1979-8032.833%3.27%4.44%4.44%

1980-8134.33.47%3.47%

1981-8235.51.62%1.62%

1982-8336.12.31%2.31%

1983-8436.90.99%0.99%

1984-8537.31.43%1.43%

1985-8637.85.38%5.38%

1986-8739.83.97%3.97%

1987-8841.43.02%3.02%

1988-8942.62.15%2.15%

1989-9043.644%4.41%3.37%3.37%

1990-9145.06.72%6.72%

1991-9248.17.46%7.46%

1992-9351.74.22%4.22%

1993-9453.83.26%3.26%

1994-9555.61.66%1.66%

1995-9656.50.34%0.34%

1996-9756.72.32%2.32%

1997-9858.04.06%4.06%

1998-9960.43.99%3.99%

1999-0062.898%9.79%8.04%8.04%

Average to 20003.57%

2000-0167.88.13%8.13%

2001-0273.312.38%12.38%

2002-0382.46.96%6.96%

2003-0488.26.01%6.01%

2004-0593.58.52%8.52%

2005-06101.42.34%2.34%

2006-07103.86.38%6.38%

2007-08110.44.89%4.89%

2008-09115.87.26%7.26%

2009-10124.2-0.02%-0.02%

2010-11124.24.01%4.01%

Average:1949-50 to 2009-104.01%4.02%

Average 1949-50 to 1999-004.00%

Average 2000-01 to 2010-116.00%

Sheet3

*Source: Department of Health analysis of ONS projections and GHSEstimate for changes in co-morbidity patterns over the next decade, EnglandOld model passive patient, one disease vs. rise of multiple LTCsWhat business are we really in?15m with LTCsMassive rise in population with a co-morbidity Most GP sessions LTCs77% bed days70% spendMostly self manage, 5800 waking hours pa

NHS | Presentation to [XXXX Company] | [Type Date]

Traditional NHS models will need to be radically rethought.

Financial case. Efficiency will not be enough. We need new sources of value, increasing the outputs/outcomes, not just more efficient staff.

In retail we have seen a revolution in the co-production of value by consumers (here patients) to create new value.

Model of care must change. Acute focused, episodic single disease models will not work. We need active patients, self-managing multiple long term conditions and supporting each other. We will need proactive, personalised care planning to support & manage multiple morbidities.

People as ACTIVE PARTNERS in control of their care

*

Customer participation has created new forms of value and transformed customer service in other sectors

Patients as co-producersnot just consumers

SOURCE: Financial Fraud Action UK Consumer applications offered with digital bankingOnline banking a consumer success story Launched in the US in 1994 and in the UK in 1998 Now >22M adult users (>50% of computer users)Access to recordsOnline banking offers access to personal bank account applications in a secure environmentHealthcare equivalent: access to the medical recordAbility to transact Customers pay bills and receive paymentsHealthcare equivalent: ability to receive test results

Ability to book appointmentsOnline banks offer real time facilities to book meetings and calls with advisers Healthcare equivalent: ability to email your doctor*Public Sector coproduction recycling People now sort own waste, producers not just consumerTransformed economic model and great for environment

NHS | Presentation to [XXXX Company] | [Type Date]

The NHS Mandate objective on patient participation in careThe NHS Mandate Objective:To ensure the NHS becomes dramatically better at involving patients empowering them to manage and make decisions about their own care and treatment. by 2015 more people managing own health everyone with LTCs including MH, offered a personalised care plan patients who could benefit have the option to hold a personal health budget information to make fully informed decisions.Shared decision making, self-management, PHBs, information and personalised care planning all linked*

Evidence of what works better outcomes, particularly high needsInformation as a supported service Targeted information and support. Risk stratification, health literacy and activation key to lifestyle change. Built into professional models. Shared decision making (literature focused on PDAs)Stronger on experience of care than outcomes, some reduction in use of services (surgery)Information and decision aids necessary, not sufficientPersonalised care planning and Personal Health BudgetsCost effective, improve QoL, best for high needs with supportSelf Care and Self Management SupportImpact of behaviours, QoL, symptoms and resources.

*

*Passive information less effective than proactive supportSource: Health Foundation 2011 Helping People Help Themselves

Economic evidence NESTA report 4.4 bn saving*NESTA People Powered Health report showed it could reduce the cost of healthcare by 7% or 4.4 bn in England. Reduced A&E attendances, inpatient admissions and outpatient

Business case scenarioTotal benefit (m)Percentage of average CCG budget (%)Benefit per patient ()Scenario 1: Median of all studies5920322Scenario 2: Minimum reported impact12464Scenario 3: Highest level of evidence217113

The Shared Vision building on the important work of others*SOURCE: adapted from NESTA slide

The Shared Vision building on the important work of others*SOURCE: inspired and adapted by NESTA People Powered Health

Existing model of careParticipative modelPatients passive recipient of carePatients co-produce their carePassive information without supportTargeted information with supportSingle disease treated reactivelyPersonalised proactive care plannedNHS shapes lives to meet its needs NHS supports people to achieve their goalShort GP consultation on single issueGP targeted care planning for multiple LTCs Dependency on professionalsgroup consultation, peer support, expert patientsReactive acute careIntegrated teams, case management

This is a huge challenge counter cultural 65+ years% who felt as involved in inpatient care as they would like*

NHS England to support commissioning system *Individuals identified and assessedPersonalised / integrated Care Plans Agreed with PHB offerCommissioned packages & support servicesEvaluate/metrics outcomes, involvement, costInformation as a service (Pro-active coaching, edu, trainers to PDAs, Info prescriptions, to online courses, care recordsRisk stratification, CHC, LTC, end of life careProfessional training in SDM, integrated care teams, advocacy, peer networksUniversal online & phone offer. Leadership culture, training

Duty to involve commissioners to develop locally tailored options Duty in 2012 Act on commissioners to promote patient involvement in their treatment and care. Options include:personalised care planning with appropriate supportpatient decision aids and information prescriptions;training in shared decision making & personalisation;support for patients with self-care, including coaching;patient peer support networks;expert patient programmes/patient leaders/health literacy;community health champions/volunteer health trainers;social prescribing;

*

Patient and public voiceNational support for the NHS*

A new customer service platform will launch in November 2013.

This will mark a watershed in the adoption of digital technology in healthcare. It will provide a multi-channel point of access to information and services in the NHS. It will be the biggest online service of its kindUniversal offer New platformPutting the consumer digital revolution at the heart of the NHS*

The 311 movement: a model for the NHS? American cities transformed their commissioning efficiency through use of multi-channel platforms based around the 311 non-emergency helpline. They encouraged mass citizen feedback. New York receives 90,000 calls and texts a day.

There is now clear evidence that crowdsourcing municipal commissioning reduced costs , improved quality and has transformed citizen relationshipsCustomer service & participation

its worked in the US and we have pioneersOnline record access: transforming the customer experience

Margaret Rickson, 83, from Hyde in Greater Manchester trained herself to use a computer in order to order prescriptions online. This has changed her life. More than 50m visits to the GP may not be needed if patients went online as they do*

What are our priorities?Integrated Personal Commissioning Personal Health BudgetsThe PAM learning set Realising the Value of Patients Transforming Participation in CKDC4CCTools, guidance, evidence to support commissioners (CSU field force, work with children and young people, Person centred care group)Digital care planning *

How can you help develop & deliver the vision?Do you agree with the developing vision?How can we make it work?How to we deliver at large scale?Where to put effort and resources for best effect, including on shared decision making, self-management, PHBs, information as a service and personalised care planning?Do we focus on those with highest needs?What can you do to help?

Let me know including by tweeting today @pmuramatsuThank you!*

Cite examples of current work and thinking throughout ****xVA-ZZI901-2011mmdd-VMSx***Realising the value of individuals and communities in their own health and careTransforming Particiaption *Mention some of our programmes C4CCIPCRealising the value of patients transforming particiaption in CKD*