Enhancing Healthcare Services through Capacity Growth and Direct NHS Opportunities

1. DHF Presentations 2004 to 2008 +44(0)1423 506 848 +44(0)789 907 4881 Kent House 42 Duchy Rd Harrogate HG1 2ER www.directhealthfirst.com

2. 15% eventually from IS buy NHS 2004 elective over 6m pa Likely to grow

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

4. Entry Hurdles • UK visas • UK work permits • NCSC • CHI • Professional bodies • Clinical registration bodies • Other government initiatives

5. Pharmacological spend as % of total health spend

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

7. Admissions per 1000 patients

8. Average LOS

9. Hospital Beds per 1000 population

10. Bed Occupancy

11. Attractions & Resentments DHF

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

13. Wait Times DHF

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

16. ISTCs OCTs [2000-2005] 7/27 43/46 NHS TCs NHS Capacity through Systems Redesign & other ways DHF

17. Aims • Government wanted to encourage entrants who are: • competent, • provide VFM and are • sustainable

18. PPP PFI Capacity Growth Services FM

19. Sick or well model: • In business parks and shopping malls. • Range of procedures away from hospital site. • Age range. • Investigations. • Contraindication and risk factors. • Length of stay.

20. Procedure v Patient Year

22. 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

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

24. Early (2002) Capacity Predictions FFCEs

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

26. Differences • Equipment & Facilities • Buildings & Layouts • Turnkey & Systems • Health from Sickness Model (Pt walking) • Changing Expectations (Drs pushing) • Procedure innovation (i.e. blood conservation) • Indicators • Competencies VS. Apprenticeships

27. 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

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

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

30. New Opportunities: Direct to NHS • Acute Capacity for NHS • Endoscopy • Day surgery • Short stay surgery

31. Opportunities: Direct to NHS • Diagnostics • radio diagnostics, • Histopathology • Haematology • Chemical pathology • Physiological measurements

32. Opportunities: Direct • Other capacity for NHS • LTC (diabetes) • Primary Care (e.g. CWICs) • Chlamydia etc • Mental Health • LD • Care of Elderly

33. Opportunities: Indirectly to NHS • Chambers • Surgeons • Physicians • Other clinicians/Health/Well being • As a provider, • as a FM

34. Investment and capacity • Volumes needed 12 months ago • Volumes needed now • Waiting list • Waiting for OP • Waiting over 4 weeks • Affordability (impact on other services)

35. 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

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

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

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

39. The process of NIT procurement • No 10, DH, CD, NIT • OJEU • PQQ • Criteria • ITT • Fixing the deals • STBOP

40. First two Phases of NIT procurement • Wave 1 (despite delays, was fast by usual standards) • Electives 200 000 (Daventry celebrates 1 year) • GSUP 1 • MRI • Wave 2 • Electives (250 000) • Diagnostics (radio, pact, physiological, endoscopy) • LTC (diabetes) • Primary Care (e.g. CWICs) • Chlamydia etc • Renewals and handovers

41. Perceptions of quality risk • National govt. • Local Govt. • Providers (new territories) • Investors (due diligence) • Professions (mixed interests) • Media • Public

42. Opportunities • Acute Capacity for NHS • Other capacity for NHS • Diagnostics (radio, pact, physiological, endoscopy) • LTC (diabetes) • Primary Care (e.g. CWICs) • Chlamydia etc • Mental Health • LD • Care of Elderly • Chambers • Surgeons • Physicians • Other clinical/Health/Well being • Sa a provider, as a FM

43. Two’s company, • Virtuous contract £ Payer Provider Happiness Service Client

44. Three’s a crowd • Two third party payers Govt £ £ control £ Payer Provider happiness services Client

45. Inpatient versus Day Surgery: US Number of Procedures (thousands) Source: SMG Marketing

46. Freestanding Ambulatory Surgery Centresin the United States

47. Types of Surgery Centres in the U.S. • Hospital owned • Joint Venture (Hospital & Physicians) • Physician Owned • Management Companies with or without physician ownership