What can England teach us about changing healthcare? Final version of the presentation

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This is the presentation that Steve Fairman and Helen Bevan made at the Institute for Healthcare Improvement 25th Annual National Forum on Quality Improvement, 10th December 2013

Text of What can England teach us about changing healthcare? Final version of the presentation

  • 1. A16/B16What can England teach us about changing healthcare? Helen Bevan @HelenBevanSteve Fairman@SteveFairman1 Crystal Ballroom, Salon A-C @HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS

2. Why might this be useful? This isnt how to do it the best way to do it or we are perfect Understanding some factors and levers that help or hinder transformational change of a large health system Strategy at system level versus frontline reality Case study of discontinuous innovation@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 3. The English NHS: facts and figures Provides comprehensive healthcare to 51 million people Funded by direct tax Its free at the point of delivery Virtually EVERYONE uses it @HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 4. at h Wta ri B@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHSlo ins ve 5. @HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 6. The NHS is highly valued by the public we love it!Source: Ipsos Mori 2013@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 7. If there was one thing that the British people took from the [World War II] experience, it was a health service free at the point of use...... And no government of any stripe has dared to try to take it away from us since..... Andrew MarrHistory of Modern Britain@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 8. The British people have the NHS in place of fear Aneurin Bevan Founder of the NHS@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 9. @HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 10. The NHS belongs to the people It is there to improve our health and well-being, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives. It works at the limits of science bringing the highest levels of human knowledge and skill to save lives and improve health. It touches our lives at times of basic human need, when care and compassion are what matter most@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 11. Patients have a legal right to: Access to health services Nationally approved treatments, drugs and programmes Respect, consent and confidentiality Informed choice Involvement in their healthcare and in the NHS Complain and to have that complaint redressed @HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 12. Populations served by British health systems(as a % of total population of Great Britain)ENGLANDSCOTLAND84% 51,446,000 peopleSource: The Times August 20098% 5,169,000 peopleWALES@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS5% 2,993,000 peopleNORTHERN IRELAND3% 1,775,000 people 13. @HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 14. @HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 15. @HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 16. What do we know about how our NHS is performing?Some great news!16@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 17. 17 NHS | Presentation to [XXXX Company] | [Type Date]@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 18. 18 NHS | Presentation to [XXXX Company] | [Type Date]@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 19. 19 NHS | Presentation to [XXXX Company] | [Type Date]@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 20. What do we know about how our NHS is performing?Some less great news!20@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 21. 21 NHS | Presentation to [XXXX Company] | [Type Date]@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 22. 22 NHS | Presentation to [XXXX Company] | [Type Date]@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 23. 23 NHS | Presentation to [XXXX Company] | [Type Date]@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 24. 24 NHS | Presentation to [XXXX Company] | [Type Date]@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 25. Challenges facing the NHS todayFuture pressures Improving outcomes against the NHS Outcomes Framework Ageing population and rising birth rate Significant inequalities in health and life expectancy Increasing burden of disease e.g. by 2035 46% expected to be obese with 550,000 extra cases of diabetes NHS performance on certain diseases lags behind the rest of Europe Patient and public expectations rising Burden of long term conditions increasing Flat real financial settlements expected (i.e. only in line with general price inflation) Demands on hospitals, emergency admissions and readmissions rising Costs expected to keep increasing with new and more technology Patient experience is too variable NHS productivity difficult to increase grew only 0.4% between 1995 and 2010 Unacceptable safety failures25 @HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 26. We could adopt this view26@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 27. Be ambitious you cant take two steps over a gap David Lloyd George 28. The role of NHS England To allocate resources (63.4bn in 2013/14) to clinical commissioning groups (CCGs) To support CCGs to commission services on behalf of their patients (according to evidence-based quality standards) To have direct responsibility (and a 24.7bn budget in 2013/14) for commissioning services: primary care (11.1bn); military and prison health services; high secure psychiatric services; and specialised services (12.0bn). 28@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 29. The role of NHS England (2) To create the conditions for value for taxpayers and turn their money into good clinical outcomes through strong and well-directed commissioners To ensure that everything that NHS England does: contributes to continually improving outcomes; has been clinically-led; promotes equality and supports a reduction in health inequalities; is informed by the needs, views and wishes of patients and the public; and promotes innovation and puts research into practice. 29@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 30. What do you mean, you dont have real authority, you only have influence?30@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 31. The history of the NHS in a triangle QUALITY STANDARDSTENSIONMONEY 31@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHSENTITLEMENT 32. NHS England and transformational change All our work on the Case for Change, the Call to Action and further work to come, must be: Based on clinical arguments about improving outcomes Underpinned by a sound evidence base An integral part of every local plan Something that appeals to both the head and the heart 32@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 33. The NHS Change Modelwww.nhschangemodel.nhs.uk @HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 34. What do we need to do? 1. 2. 3. 4. 5. 6. 7. 8.Understand the scale of the issue Work with patients and be transparent Shift public expectations Shift from the current clinical model (Primary/Community/Secondary.Integrated) Be relentless on efficiency Get the incentives right Find, understand and implement best practice Encourage innovation34@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 35. 1. Understand the scale of the issue35@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 36. The Gap36@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 37. Why do we have a growing financial challenge? Because the equationDemographics + Patient/Public Expectations + Quality Money doesnt work unless we have transformational change to the current way of delivering health care @HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 38. The Dependency Ratio is rising alarmingly38@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 39. 2. Work with patients and be transparent AND3. Shift public expectations39@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 40. A Call to Action @HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 41. Preserving the values that underpin a universal health service, free at the point of use, will mean fundamental changes to how we deliver and use health care services. This is NOT about: Privatising the NHS Charging for services Restricting access 42. What are the engagement themes? 43. Current challenges We know there is more to do and recommendations for improvement already exist 44. What the people we serve want. My goals/outcomesCommunicationPerson centred coordinated care EmergenciesTransitionsMy care is planned with people who work together to understand me and my carer(s), put me in control, co-ordinate and deliver services to achieve my best outcomesCare planningInformationDecision-making 45. 8 high impact interventions Early diagnosis Primary care referrals and prescribing Self-help: patient-carer communities Telehealth/telecare Case management and coordinated care Mental health Dementia pathway Palliative care 45 46. 4. Shift from the current clinical model46@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 47. Why working across organisational boundaries is importantThe core area for effective integrated care 48. 5. Be relentless on efficiency49@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 49. The Magic BoxClinical DevelopmentCostDriftCutsReduced hospitalisation Standardisation Technology / innovation Time saving Reducing clinical error Waste reductionImproved quality With thanks to Jim Easton @HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 50. 6. Get the incentives right51@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 51. Commissioning 52. 7. Find, understand and implement best practice AND8. Encourage innovation53@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 53. The Academic Health Science Networks54@HelenBevan @SteveFairman1 #IHI25Forum #EnglishNHS 54. Core objectives for Aims of NHS EnglandAcademic Health Science Networks1. Focuson the needs of patients and local populations 2. Build a culture of partnership and collaboration 3. Speed up adoption of innovation into practice to improve clinical outcomes and patient expe