ACHIEVING HIGH QUALITY, FINANCIALLY SUSTAINABLE HEALTHCARE

1. ACHIEVING HIGH QUALITY, FINANCIALLYSUSTAINABLE HEALTHCARE

2. Why are you here? Achieving financially sustainable healthcare now and in future is likely to change how and where people access services This means that NHSScotland needs to consistently deliver: high quality care at a lower cost against rising expectations and demand. This session will investigate and develop current thinking and practice around the critical links between improving quality and delivering on efficiency

3. Who will you hear from? Chair: Simon Belfer, Director of Finance, NHS National Services Scotland Session Lead: Professor Cam Donaldson Yunus Professor of Social Business & Health, Glasgow Caledonian University, author of ‘Credit Crunch Healthcare’ Sally Campbell - Managing Director of Cheshire HR Service Discussion and audience voting Wrap up Introduction Challenge delegates on their thinking around ‘traditional’ delivery of efficiencies and how this can impact on improving quality. Describe the journey to delivering best value in HR services.

4. Three session aims Explore the links between quality and efficiency Opportunity to share innovative ideas and suggestions to influence this work Able to contribute to the national work being undertaken to support NHS Boards in this area

5. 2020 Vision for Health and Care in Scotland Our vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting. We will have a healthcare system where we have integrated health and social care, a focus on prevention, anticipation and supported self-management. When hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.

6. The challenge inside the 2020 vision Over the next few years, demand and the circumstances for delivery will be radically different We will need to continue to provide high quality health and care services, meeting what the people of Scotland expect We will be measured by securing the best possible outcomes for people from the care and support they receive.

7. Examples of the challenges Healthcare inflation Reducing health inequality: Despite efforts to address, we have made very little progress. Ageing population: By 2033 the number of over 75 is likely to have increased by almost 60% Continuing shift towards long-term and multiple conditions, with complex needs By 2033, demography could grow spend on health and social care by over 70% Dementia: Estimates will rise from 71,000 to 127,000 sufferers in the next 20 years Tremendous financial costs to the NHS and social services Health and cost impact on carers - more likely to take prescribed medication, visit GP with higher levels of stress and physical symptoms

8. Public Service Reform – Christie response decisively shifting towards prevention integrating more public services locally, driven by better partnership, collaboration and effective local delivery investing in the people who deliver services through enhanced workforce development and effective leadership focussing on better performance, through more transparency, innovation and use of digital technology.

9. Professor Cam DonaldsonYunusChair in Social Business & HealthGlasgow Caledonian University

10. Collaborating for Quality Achieving high-quality, financially-sustainable health care Cam Donaldson Scottish Exhibition and Conference Centre, Glasgow 11-12th June 2013

11. Celebrating the NHS, London Olympics opening ceremony

12. Otherwise known as ‘leftie...crap’!

14. Two main directions follow • Health care reform to enhance incentives for efficiency: • user charges • ‘internal markets’ • remuneration • integration • The need for economic evaluation of health care: • assessments of cost effectiveness and cost benefit (a challenge to physicians) • systematising evaluation thinking (a challenge to managers)

15. Two main directions follow • Health care reform to enhance incentives for efficiency: • user charges • ‘internal markets’ • remuneration • integration • The need for economic evaluation of health care: • assessments of cost effectiveness and cost benefit (a challenge to physicians) • systematising evaluation thinking (a challenge to managers)

16. The focus of ‘Triple Aim’ • Patient experience (quality) • Population health • Cost (Value and financial responsibility)

17. Important antecedents • Rational collective action • Integration

18. My triple aim at Triple Aim • Is integration sufficient?

19. Platitudes of health care reform • Reforms all over the world state that the ‘new’ system will: • adopt ‘a balance of care’ approach • be about ‘effectiveness and efficiency’ • adopt ‘an evidence-based approach’ • ‘involve communities and other stakeholders’. • But no-one ever says how!!! i.e. what’s the process?

20. My triple aim at Triple Aim • Is integration sufficient? • Are we recognising and managing scarcity?

21. Managing scarcity: the clinical challenge • Any decision to change the way care is delivered will impact on HEALTH OUTCOMES. This will: • improve A • remain unchanged B • decrease C

22. Managing scarcity: the clinical challenge • Any decision to change the way care is delivered will impact on COST. This will: • decrease 1 • remain unchanged 2 • increase 3

23. “Allocation of funds and facilities are nearly always based on the opinion of consultants but, more and more, requests for additional facilities will have to be based on detailed arguments with ‘hard evidence’ as to the gain to be expected from the patient’s angle and the cost. Few could possibly object to this.” Who said this?

24. “Allocation of funds and facilities are nearly always based on the opinion of consultants but, more and more, requests for additional facilities will have to be based on detailed arguments with ‘hard evidence’ as to the gain to be expected from the patient’s angle and the cost. Few could possibly object to this.” Cochrane AL. Effectiveness and Efficiency: random reflections on health services. Nuffield Provincial Hospitals Trust, London, 1972.

25. Deciding whether it’s worth it:A challenge to clinicians HEALTH OUTCOMES A B C   1 COS T  = × 2 × × 3  = recommend change to new treatment X = recommend status quo = judgement required

26. An economics-based framework for needs assessment: the management challenge An economic approach addresses need from the perspective of resources: 1. What resources are available in total? 2. In what ways are these resources currently spent? 3. What are the main candidates for more resources and what would be their effectiveness and cost? 4. Are there any areas of care which could be provided to the same level of effectiveness but with less resources, so releasing those resources to fund candidates from (3)? 5. Are there areas of care which, despite being effective, should have less resources because a proposal from 3. is more effective (for £s spent)? Can be applied at ‘micro’ or ‘macro’ levels

27. Shameless promotion: part II

28. But it’s not new Who said this? “If I had a plan, it would be simply to take the poorest and least organised hospital in London and, putting myself there, to see what I could do – not touching the Fund for years, until experience had shown how the Fund might best be available.”

29. A novel idea! “If I had a plan, it would be simply to take the poorest and least organised hospital in London and, putting myself there, to see what I could do – not touching the Fund for years, until experience had shown how the Fund might best be available.” Florence Nightingale (1857)

30. My triple aim at Triple Aim • Is integration sufficient? • Are we recognising and managing scarcity? • Where does ‘population health’ fit?

31. Lessons We need to work towards: • maintaining publicly financed systems • thinking more about explicit evaluation and priority setting at all levels of the system • dealing with chronic disease management: • integration plus priority setting? • working ‘with’ rather than ‘on’: • people as well as systems • engaging the public: • what is socially relevant? • rethinking the notion of the ‘clinician-scientist’.

32. Sally CampbellManaging Director of Cheshire HR Service

33. Developing a new model of HR Services

34. Cheshire HR Service - Overview • Established in 2006, experienced in supporting NHS organisations in various sectors of healthcare • Hosted by East Cheshire NHS Trust as an ‘arms-length’ division with an operating framework to provide increased autonomy • Provider of a full range of business focused HR and L&D services • We offer customers a wealth of experience and knowledge of working with the complexities of the changing healthcare environment • Our mission ‘to deliver excellence in people management’

35. Cheshire HR Service - Timeline 2013 2006

36. The HR Challenge

37. Our Key Drivers • Small shared HR Service already existed • Changes to commissioning structure – new organisations forming • Introduction of Electronic Staff Record (ESR) across NHS • Different payroll arrangements • Absence of coherent HR strategy/lack of strategic HR input • Cumbersome and outdated HR processes, inadequate technology • Poor levels of satisfaction with HR • Increased measurement and monitoring of HR indicators

38. Transforming HR Services • Shared HR Service • Harmonised and centralised HR services • Single point of contact for HR customers • Single employee access portal and data entry • Enhanced Technology platforms • Enhanced HR reporting • Results • Cost reduction • Customer focused HR delivery • Strategic staff re-focused on strategic delivery • Separate HR Departments • Multiple sites • Multiple Processes and Procedures • Multiple contact points • Disparate, outdated technology platforms • Manual and duplicate data entry • Strategic staff performing administrative tasks • Results • Costly, disparate HR functions. • No performance metrics • No customer service focus

39. Our vision for a model service Customer retained HR activities Centres of expertise Process improvement automisation, Self-service /HR Service Centre

40. Our Services Business Partnering

41. 2009 - 2011

42. Services underpinned by Systems Support

43. Multiple Systems Multiple Systems Remove complexity Standardise Processes Remove complexity Standardise Processes Implement Common System Remove Complexity Establish new organisation Remove complexity Standardise Processes Implement Common System Centralise transaction processing Non-Standard Complex Processes Establish new organisation Remove complexity Standardise Processes Implement Common System Centralise transaction processing Implement e-enabled common system Migrate to Virtual transaction processing Multiple Locations Multiple Locations Multiple Systems Multiple Systems Non-Standard Simple Processes Non-Standard Simple Processes Transactional Efficiencies Baseline Transactional Efficiencies Baseline Multiple Systems Multiple Locations Common Systems Multiple Locations Standard Simple Processes Transactional Efficiencies 20% Transactional Efficiencies 20% Standard Simple Processes Common Systems Multiple Locations Standard Simple Processes Multiple Locations Transactional Efficiencies 40% Single/ Few Locations Transactional Efficiencies 50% e-enabled system Standard Simple Processes Transactional Efficiencies 60% Virtual Locations Transactional Efficiencies 75% Increasing process maturity

44. Challenges • Diversity of cultures from multiple organisations and ownership of HR • Allocation of resources • Geography/location • Managing Change • Business Continuity • Developing technology against competing demands • Achieving change in behaviours – customer/business focus • Developing internally – capability to “let go” and become commissioning partners

45. Was it worth it? • Supported organisations in making savings year on year • Increased customer satisfaction – organisation, manager, staff • Technology benefits for HR and customers – modern, fast, efficient, compliant • Improved job satisfaction in HR (above the best national average score) • Skill Mix/Career Development - Right people undertaking right tasks • Increased confidence and capability of managers

46. What did we learn? Internal HR

47. Discussion and audience participation

48. So Just How Effective Are We?

49. Question 1 Who are the greatest band of all time? • Pink Floyd • Beatles • Abba • Chas & Dave

50. Question 2 How easy or difficult would it be for your organisation to introduce ‘an economics-based framework for needs assessment’ into its management processes? (please enter a number from 1-4, where 1=very easy and 4=very difficult)