CD Forum, 7 March 2008, St Thomas’s, London Stephanie Somerville; Member of Darzi Team

1. NHS Next Stage Review CD Forum, 7 March 2008, St Thomas’s, London Stephanie Somerville; Member of Darzi Team

2. Big ambitions for the Review… • Sickness • Health Patients • Reactively diagnose & treat • Proactively predict & prevent • Superbugs • High quality and personal Public • Cuts • Evidence-based change • Disengaged • Motivated Staff • Disempowered • Empowered

3. Global trends are changing healthcare and the Next Stage Review will lay out how the NHS will respond, in line with the PM’s speech (7/1/08) What we are here to do NHS core purpose and values • ‘Consumer’ expectations What the NHS is about • Long-term conditions NHS focused on Quality • Progress of technology How the NHS will be Effective Personal Fair Safe Challenge & Opportunity Local vision for best models of care Making it real locally Eight Clinical Working Groups Per SHA Challenge for insurance-based systems – adverse selection An NHSsystem that enables local visions and is secured by a Constitution Securing it nationally Opportunity for a National Health Service

4. SHA strategic vision documents The Review is underpinned by the largest locally-led engagement in the history of the service PCT commissioning strategies There are clinical pathway groups in nine regions across the country • Staying healthy • Maternity & newborn • Children’s health • Planned care • Mental health • LTCs • Acute care • End-of-life care National ‘enabling’ report Scale of engagement in the Review • 2,000 clinicians and others involved • 74 clinical pathway groups nationwide • An international clinical summit in November • Hundreds of policy submissions and questionnaire responses

5. Long term conditions – emerging thinking • All people with LTC or multiple conditions to have named key worker • Everyone should have a care plan which includes info or what good care like and what people can expect • Greater continuity of care and co-ordination across health and social care • National standard of care including less info about what good looks like – and info for users and carers • Commissioners need to define what good quality care looks like/ build a market place for providers/ act on sub quality care • More incentives for high quality care – but stretch incentives • Greater role and recognition for carers particularly in the spreading of best practice info. • Users should become commissioners

6. End of Life Care – emerging thinking …. • Commissiong framework based on the end of life care pathway developed across sectors - quantified reduction in hospital deaths • Quality standards established • Comprehensive assessment of needs • Electronically based advance care planning in all sectors of care – preferences and choices identified and shared with staff – accessible 24/7 • Fully integrated services with 24/7 access to a specialist palliative care underpinned by single point of access • Support for carers & single care co-ordinator • Training and education of the workforce in End of Life care • Challenge “live for ever” mindset through social marketing, public education

7. Implications for what we do at national level… Benefits for patients/users depend on local delivery of the visions by local clinicians 1 National report must be about enabling locally-led change not imposing it or doing it Public perception requires delivery to be seen to be led and advocated by local clinicians 2 Local clinical staff need to own the visions and advocate them 3

8. Eight national workstreams looking at enablers. We are also developing the ‘narrative’… Eight national workstreams Narrative… • Where we were 10 years ago; where we are now; where we’re going in the next 10 years • There is a compelling long-term case for a tax-funded, free-at-the point-of-need, national health service in the 21st century • Reform in three stages – capacity building, system reform, and now transformation: • Focus on prevention as well as cure • Improving quality as the primary, unifying goal • Enabling frontline leadership Quality framework Innovation Leadership Workforce Information Systems & incentives Primary & community care services NHS constitution 1 2 3

9. How do we make high quality care the primary, unifying goal of the NHS? Some issues for us to consider There are eight national workstreams Should we set system level quality improvement goals? Should we rationalise standard setting and knowledge management? Should performance be judged on the basis of quality? Should funding flows reward quality and penalise poor quality? Do we need a high profile quality campaign (lives saved)? Quality Innovation Leadership Workforce Information Systems & Incentives Primary & Community Care NHS Constitution

10. Questions for discussion today… Are the recommendations ambitious enough? What would be your recommendations to clinical pathway groups? Are these the questions we need to address on quality?