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DHF

DHF. Presentations between 2004 an d2009. +44(0)1423 506 848 +44(0)789 907 4881. Kent House 42 Duchy Rd Harrogate HG1 2ER. www.directhealthfirst.com. Diffusion of MRI Units, 2000. Source: OECD Health Data, 2003. Cost of Waiting for Elective Surgery (OECD, Working Paper no.6, 2003).

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DHF

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  1. DHF Presentations between 2004 an d2009 +44(0)1423 506 848 +44(0)789 907 4881 Kent House 42 Duchy Rd Harrogate HG1 2ER www.directhealthfirst.com

  2. Diffusion of MRI Units, 2000 • Source: OECD Health Data, 2003

  3. Cost of Waiting for Elective Surgery(OECD, Working Paper no.6, 2003) • Deterioration in condition, death at the extreme • Loss of utility from delay • Rise in the cost of total treatment • Example: • A study of patients waiting for varicose vein surgery in the UK found ‘considerable deterioration’ in their condition while waiting for surgery (Sarin et al, 1993)

  4. Opportunity Costs • 856.8 work days lost each year in the UK due to sickness, • Statutory Sick Pay & Incapacity Benefit: In England, 5-10% of the patients on elective waiting lists are on sick leave from work • 1,047,890 people waiting for NHS in-patient treatment, June 2000. • Out-patient treatment (hospital tests, specialist consultations) 13 week wait lists for 308,760 people (of which 128,532 were waiting over 26 weeks).

  5. What is day surgery? • Ambulatory care. • Out-patient care. • Short-stay. • Minimally invasive surgery. • Diagnostic procedures. • Minor injuries. • Non-surgical interventions.

  6. Prices and Costs e.g. ENT (figures available in 2002) • HRG code C22 • Septoplasty • £366/ £905/ £2302 • HRG code C24 • Bilateral dissection tonsillectomy • £250/ £853/ £4676

  7. (50%) possible as day cases: • Lasar prostatectomy • Trans cervical resection endometrium (TCRE) • Eyelid surgery inc tarsoplasty, blepharoplasty • Hallux valgus ("bunion") operations • Arthroscopic menisectomy • Scope’ shoulder surgery (subacromial decomp) • Subcutaneous mastectomy • Rhinoplasty • Dentoalveolar surgery • Tympanoplasty

  8. (50%) possible as day cases: • Laparoscopic cholecystectomy • interval appendicectomy • Laparoscopic herniorrhaphy • Thoracoscopic sympathectomy • Submandibular gland excision • Partial thyroidectomy • Superficial parotidectomy • Breast cancer wide axillary clearance • Haemorrhoidectomy • Urethrotomy • Bladder neck incision

  9. Possible as day cases: • Tonsillectomy in children • Correction squint • Bat ears/minor plastic procedures • SMR • Reduction nasal fractures • Cataract extraction • Laparoscopy  sterilisation • Termination pregnancy • TUR/laser/diathermy/limited resection bladder Ts • Pilonidal sinus excision and closure

  10. Waste from unplanned admissions

  11. Pharmacological spend as % of total health spend

  12. OTC and non-prescription drugs as % of total drugs

  13. Admissions per 1000 patients

  14. Average LOS

  15. Hospital Beds per 1000 population

  16. Bed Occupancy

  17. “if you’re a fit young man who needs a knee operation, you don’t want to go into a general hospital and lie next to somebody who has a bed-sore and MRSA” Hospital Doctor (09-09-2004) NHS Improvement Plan: Part Three, Treatment Centres are not a threat DHF

  18. ASC’s CASE COSTING DECIDES WHETHER OR NOT YOU DO A PROCEDURE COST/CASE (BY CPT or DRG, SPECIALTY,CONSULTANT) SUPPLY MANAGER IT SYSTEM SUPPORT DETAILED INVENTORY SYSTEM EDUCATE STAFF AND CONSULTANTS HAVE TO CONTINUALLY WORK TO DRIVE DOWN COSTS NHS TC’s NO WAY TO CASE COST NEVER BEEN A NEED NO SYSTEM IN PLACE Case Costing DHF

  19. Govt’s Target • 18 weeks to include • OP • Dx • WL DHF

  20. Wait Times DHF

  21. Drivers • Waiting times, lists & capacity • Choice, Access and Quality • Contestability, Plurality and VFM DHF

  22. PPP PFI Capacity Growth Services FM

  23. Performance Management & KPIs • KPIs • SUIs • Outcome measures DHF

  24. Procedure v Patient Year

  25. CSS v CPS • The CSS contains everything that should help us specify our procurement safely for the NHS • The CPS only contains that which we consider essential to the ITT and which will deliver a VFM bid

  26. Input and process specifications • So the sponsor can integrate ISTC care with the rest of the health economy. • e.g. what is expected from the NHS may differ between one cholecystectomy package (with a very limited follow up) and another.

  27. Input and process specifications • Ministers will find it hard to defend untoward events in the absence of process specifications or standards • Provider can easily offer a strong argument that he was not at fault for a poor outcome (by citing biological variability)

  28. Input and process specifications • Some procedures require specific data for national registers and these have to be specified • e.g. NCEPOD • Cataract National Dataset • e.g. National Joint Registry

  29. Outcomes The difficulty with outcome(s) is that the results should be attributable to the treatment

  30. Measures • KPIs • 25 ISTCs • NHS TCs • Outcome Measures • NHS TCs • ISTCs

  31. Outline • Current NHS organisation • Aspects of the NHS • Fears of the NHS • Opportunities in the NHS • Politics of the NHS

  32. History • Churches & Charities • Poor Houses and other reforms to 1911 • Lloyd George and the panel • 1942 to 1948 : The NHS • 1968 to 1989 reforms • Mrs Thatcher & Waiting times 1992 April • Mr Blair & Plurality

  33. Waiting Lists • 1992 24 months (+ 6months) • 2002-2004…9 Months for treatment • 2002… 900K (to 150K) • 2008 … 18 weeks total

  34. Early (2002) Capacity Predictions FFCEs

  35. PM’s Target • 18 weeksto include • O.P 4/52, • Diagnostics 4/52 • treatment 8weeks……?

  36. Differences... • Spot Prices • Speciality to Procedure Information, Refining Procedures’ Descriptions (severity, co morbidity, and case mix) • Patient Care Pathways • Clinical Engagement in real costings & interfaces • Financial Flows anticipated

  37. Fears: commoditisation of health Contract Failure & VFM Delivery Failure : Impact on - NHS viability - Private Practice: volume -prioritisation Poor Quality

  38. Fear of Overcapacity • PCTs (allowing lists to go up again) • Acute Trusts • SHAs • DH • Risk to NHS estate and base • Challenge to National strategy

  39. Fear of clinical incompatibility

  40. Credentialing • GMC • People • Specialist Register • Training • Buildings, equipment, consumables • Facilities • HCC • Organisation • systems, information, registration

  41. Status of US Industry:Shift from Inpatient to Outpatient 35000 30000 25000 20000 Annual Number of Surgeries (in Thousands) 15000 10000 5000 0 2000 1984 1986 1988 1990 1992 1994 1996 1998 Total Hospital Inpatient Surgeries Total Outpatient Surgeries

  42. ISTC ProgrammeTCs Patient Flow Diagram New Provider Assessments (Outpatients) (£A) + - diagnostics Diagnostics (direct access) OP Consultation OP Follow-up D B C A New Provider Surgery (FCEs) (£S) EssentialOP follow- up as required + diagnostics - Discharge to NHS - GP - Intermediate Care - Subsequent necessary care GP Consultation with Patient Pre-opAssessment Surgery& Recovery Acute Inpatient Follow-up ? E NHS OP Consultation (and waiting list)

  43. VFM • Growcapacity • Delivered quickly • TCs • Improve access • Maintain quality

  44. In their buildings • On or Off NHS property • NHS Trusts& PCTs • With or without their staff • Near orfar away

  45. refurbished • Movable • Buildings • (modular) • leased

  46. Joint Service Reviews • actions agreed at previous meetings • routine data, identification of any problem areas, and agreed actions • ad hoc reports and the results of any investigations, identification of problem areas, and agreed actions • figures for the ISTCs concerned, compared with other ISTCs; • all findings from reviews of random case records • presentation by the provider to the sponsor of the results of their clinical audit

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