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Reflections on Health Care Reform
Ann Lloyd CBE
CMPO Policy Seminar: Public Service ReformMarch 2009
One country – the United Kingdom
defence, police, borders national economy foreign affairs – including international health
Four countries – Wales, England, Scotland, Northern Ireland
health, industry and transport education housing etc.
3 million people most in the south east Mid-Wales thinly populated ‘The Valleys’
old mining towns poor infrastructure poor health
What is Wales like?
3. TOWNSEND AND WANLESS
Townsend index
Most DeprivedNext DeprivedMedianNext AffluentMost Affluent
Townsend index of deprivation for Wales 2001
Source: Derived from Census 2001
Health is worse in some places
Source: CACI information solutions
Wales’s future health?
How can people use health services in Wales?
hospital - highly specialised care for less common problems
hospital - mainstream care
primary and community care care
Social care
There are several major types of service
Primary and community care -
local services everywhere
about 6 visits a year
c. 2,000 GPs in 500 practices - c. 9% alone
c. 700 local pharmacies
c. 1,000 dentists
c. 600 opticians
community nurses, midwives, therapy staff, social workers
HOSPITAL
16 large acute hospitals a cancer hospital mental health hospitals 50+ small hospitals all-Wales ambulance service
ACCIDENT & EMERGENCY DEPARTMENT
hospital care -
1 after seeing GP
2 ambulance
3 walk in
Welsh Government
22 Local Health Boards
10 NHS trusts
GPs, etc.
Find what is wrong and find a response Provide careDecides policy
trusts
GPs, etc.
22 Local Health Boards
private organisationsvoluntary
organisations
10 NHS trusts
The system NOW
Welsh Government
- health …….. relatively poor…………….. - insupportable burden on the acute sector and its workforce……………….- Wales does not get as much out of its health spending as it should.…………..- ………….. change difficult…………. - too few examples of successfully engaging the public in a change agenda.
2003 Welsh Wanless Report on Health and Social Care
Our challenge
a new balance
before hospital/ not in hospital
hospital after hospital/ support in community
x
Statutory local stratgies
Health Challenge Wales
Public Health Strategic Framework
Specific strategies e.g.-food, fitness, housing, environment
1. Improving health and wellbeing
Finance strategy
Performance improvement
Quality Improvement
Strategy
Improving Planning/ Commissioning
Clinical/ Professional Engagement
Public Engagement
Workforce redesign
Information
4. Improving systems and processes
National Service Frameworks (NSFs)
DECS emergency services
Project 2009
Chronic Conditions
Care pathways
Healthcare Standards
2. Changing the pattern of services
Acute Services Review/service reconfiguration
Community Services Framework
Designed for Life
Fulfilled Lives, Supportive Communities
Making the Connections
Sustainability Duty
Equality Duties
Welsh Language Action Plan
3. Improving care pathways Local Service Boards
trusts
GPs, etc.
22 Local Health Boards
private organisationsvoluntary
organisations
10 NHS trusts
We are changing the system in 2009
Welsh Government
Replace by fewer organisations
££
£££
GPs, etc.
trusts
GPs, etc. 7 NEW Local Health Boards – not 22
private organisationsvoluntary
organisations
The NEW system 2009
Welsh Government
2 NHS trusts – not 10
£
£
£ £