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Planned Care : Getting a Grip

Planned Care : Getting a Grip. How can we deliver the same quality of care while making savings?. CHANGES IN THE NHS. To see a video produced by The Kings Fund which was watched in the workshop, please click on this link: https://www.youtube.com/watch?v=8CSp6HsQVtw . AGENDA.

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Planned Care : Getting a Grip

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  1. Planned Care : Getting a Grip How can we deliver the same quality of care while making savings?

  2. CHANGES IN THE NHS To see a video produced by The Kings Fund which was watched in the workshop, please click on this link: https://www.youtube.com/watch?v=8CSp6HsQVtw

  3. AGENDA • Welcome and introductions (10) • Setting the context: (15) • Why Planned Care matters? • The financial and demographic picture in North Somerset • What do we intend to do? • How can you get involved? • Introduction to group activity (10) • Break • Group activity: A Vision for Planned Care (30) • Next Steps (10) • CLOSING

  4. Setting the context • The NHS has been asked to find savings of £20bn by 2015 to cope with rising demands. • In North Somerset, we need to find £11m of savings over the next 2 years. …We are dealing with £15 to £20bn (in reduced costs), you don’t save that by not providing biscuits at a board meeting Gerry O’Dwyer Royal College of Nurses Nursing Times 2009

  5. What is Planned Care? Planned care covers all services provided for adults, 18 years or over, which are planned (scheduled), including all primary care, community and hospital services. This does not include emergency (unscheduled) care.

  6. Planned Care: Getting a Grip THE LOCAL CONTEXT

  7. North Somerset Total Spending • Key messages • Total Spend £252m • Nearly 90% of acute spend is with local acute providers • Fastest growing areas of spend are acute • Medical Emergency admissions • A&E • Elective Orthopaedics • NICE • Diagnostic scopes Accounts for 59% of all spending

  8. How does this compare? 0.37% of NHSE budget • A cataract operation on one eye costs the NHS about £900. • A hip replacement costs the CCG more than £5,000.

  9. Local Information • North Somerset population 202,566 (2011 census) • 214,068 are officially registered with a GP • 97% White Ethnic • Two thirds live in Weston-super-Mare, Clevedon, Nailsea and Portishead. • One in five are over age 65 • 88,200 households of which 29% are single owner occupied • We have Lower Super Output Areas in the most and least deprived 1% Nationally

  10. Planned Care: Getting a Grip THE CASE FOR CHANGE

  11. The need for change in North Somerset • Our acute hospital spend is increasing at a faster rate than our funding and faster than our growth in population. • Our acute hospital spend is increasing relative to our neighbours or our peers. • Our acute spend is increasing in the areas that we are trying to reduce. • Non acute spend is beginning to accelerate. • Not only is our spend higher than our allocation it is now higher than our target allocation. • We have signed up to deliver changes in service delivery that will save £11m over the next 2 years. • These savings are still largely embryonic.

  12. Acute hospital spend is increasing faster than our funding and faster than our growth in population This is our key cost driver • GROWTH IN SPENDING • 2012/13 - 2013/14 • The problem is getting worse • In 2013/14 growth in acute hospital spend is £8m (6%) • In 2012/13, our unfunded growth in acute spend was £5m (4%) • This is well above what we would expect for overall population growth of 0.6%. • Even allowing for our aging population we would expect the impact of demographic change to be around £2.5m Non-acute spend is broadly flat Note: Based on M11 Contract Performance

  13. Focus Areas • Trauma & Orthopaedics/ Musculo-Skeletal • Ophthalmology • Urology • Dermatology • Diabetes and other general medicine • Diagnostics

  14. Our spend is not only higher than our actual allocation it is now higher than our target allocation ---- In 2013/14, we find ourselves with a gap of 7% between spending and our funding. We are in the process of understanding the change. In 2012/13, the financial picture shifted into a less favourable position In 2011/2012, our expenditure met our funding allocation NORTH SOMERSET NEEDS BIG IDEAS AND BIG CHANGE

  15. Planned Care: Getting a Grip HOW WE INTEND TO GET A GRIP

  16. A real time example • Dermatology: Keeping more of the work in GP practices • 1636 referrals into Acute (April- December 2013) • Advice and Guidance • Tele-dermatology • Redesign the pathway and enable the pathway with Map of Medicine • Explore developing GPs with special interest in dermatology and specialist nurses • Ensuring appropriateness of referrals and prescribing

  17. Dermatology Present Future Effective pathway Reduction in number of inappropriate referrals Greater skill and confidence in primary care Improve speed of access to specialist treatments Reduced variation in standards of care Improved prescribing • Pathways not clear • High numbers of referrals into acute and growing waiting list • Variation in skills and confidence of doctors to treat • High demand on primary care appointments • Shortage of dermatologists nationally

  18. THE CHALLENGES ARE SIGNIFICANTOur elective T&O hospital spend is increasing relative to our neighbours and our peers Key Messages: Trauma & Orthopaedics spend accounts for around £18m ( 20% ) of hospital spend on outpatients/admissions There has been a sharp increase in more complex high cost procedures locally which is not mirrored nationally

  19. Key Messages • We have a big challenge but we are getting a grip • We are NOT going to reduce costs by slashing quality • The first year as a CCG was a period of stabilisation but there is a renewed focus and energy • We are seeking innovative solutions to old problems

  20. FINAL THOUGHT • If every GP took out one referral a week, we would save a £1m. • The challenges are not intractable • The solutions are within reach

  21. PLANNED CARE: GETTING A GRIP HOW CAN YOU HELP Us?

  22. Next Steps • Exercise to gather reaction and feedback • 3 questions • 10 minutes timed discussion on each • Facilitator at each table

  23. 1. North Somerset is embarking on an ambitious programme to reduce unnecessary acute activity by introducing greater efficiencies in clinical pathways, improving the quality of referrals and engaging active patient citizenship. 2. Planned Care Programme Board 3. You are here!

  24. Questions • What, in your understanding,  were the top 3 issues the Planned Care presentation? • How can we engage patients and the public in transforming Planned Care in North Somerset? • Is there a role for you/your organisation in this agenda? What can you contribute and how would you like to be involved?

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