Making it Happen A Regional Perspective Steve Fairman Director
of Improvement & Efficiency South Central SHA Kings Fund, 17
January 2011
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Population of 4 million -9 PCTs -7 Foundation Trusts -8 NHS
Trusts and 2 potential NHS Trusts -2900 GPs -547 Practices
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South Central overview High life expectancy Low deprivation
(some pockets) Population growing and ageing Complex system /
borders Politically high profile
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South Central overview (2) Current spend 6.1bn; population 4.2m
Funding gap is 1.4bn by 2014/15 55% provider efficiency 45% pathway
changes
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South Central context Funded at 1,416 per head v. England
average 1,612; G&A bed ratio of 2.54 per 1,000 v. England
average 3.18 NEL hospital admissions 0% growth and EL hospital
admissions 2.4% reduction
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Where are we now? We understand the size of the challenge and
that doing more of the same is not enough we must do more for the
same We are making good progress we are already in implementation
We have some good delivery mechanisms in place We have a good
regional focus We are moving into organisational transition
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QIPP how are you going to cut the cake Hint: A hip replacement
costs 7599
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The essential elements of effective Regional leadership of QIPP
Understanding YOU dont actually make any of the changes that
deliver on QIPP savings A profile with local leaders Very well
organised Programme Management and Governance arrangements
Standardisation Integration with normal processes
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Key risks and barriers to QIPP delivery at a Regional level
1.Gaining front-line engagement on QIPP 2.Organisations look
internally for savings (or growth!) 3.No record of change on the
scale required 4.Priorities not always properly aligned with the
challenge 5.Management / leadership capability 6.Organisational
sustainability
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2011/12 (year 1) m % of 4 year total Demand pressure on 2011/12
base ( millions) i.e. pressure on commissioners if tariff
efficiency fully achieved 24239 Pressure of tariff efficiency
demand on providers 16724 Size of challenge (sum of demand and pay
and price pressures) 40931 The South Central QIPP Challenge
(Draft)
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Key risks and barriers to QIPP delivery at a Regional level (2)
and a new one leadership and delivery through, and beyond,
organisational transition
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What have we done at a regional level to mitigate the effects
of these? A relentless focus on quality Maximise safety Drive out
unwarranted variation Developing people Tailored our leadership
programmes Mobilised our Clinical Leadership Network Working with
the new commissioners Building ownership Developed a communications
strategy Been open and honest about the scale of change
necessary
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What have we done at a regional level to mitigate the effects
of these? (2) Focused effort and resource around the 5 clinical
programme areas that evidence shows us will really make a
difference: Planned Care e.g. enhanced recovery programme Acute
Care e.g. improved stroke care pathway Long Term Conditions e.g.
COPD management End of Life Care e.g. choice of place of death
Maternity & Newborn Care e.g. cut caesarean sections
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What have we done at a regional level to mitigate the effects
of these? (3) Facilitated joint work between local organisations on
other system-wide initiatives Integrated Supply Chain Estates
rationalisation Pathology services Medicines Use and Procurement
The productives
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Conclusions 1.Regional leadership of the QIPP agenda is
essential but can easily be ineffective 2.You must build an
understanding of the scale and nature of change needed 3.You must
build a movement for change 4.Clinicians must be at the forefront
5.You must be organised 6.You must be resilient!
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You cant solve a problem by using the same thinking that
created it Albert Einstein