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Main Themes

Towards Excellence : Driving up Quality Across the East Midlands Health and Social Care Conference 25 February 2010. Why has the NHS been so poor at engaging the third sector? What is changing? The quality and productivity challenge. Main Themes. ‘Failure’ of Commissioning.

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Main Themes

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  1. Towards Excellence:Driving up Quality Across the East MidlandsHealth and Social Care Conference 25 February 2010

  2. Why has the NHS been so poor at engaging the third sector? What is changing? The quality and productivity challenge Main Themes

  3. ‘Failure’ of Commissioning NHShas ‘commissioned’ fortwo decades, but … • Commissioners’ capability has been limited • Few levers, not well used • Inadequate regulatory regime – bail out of NHS providers • Low investment in developing commissioners • Highly variable & fragmented practice • Lack of legitimacy (linked to ‘voice’ & patient /public engagement) • Very limited range of providers

  4. An unfair playing field • Lack of awareness amongst commissioners of the Third Sector • Inconsistency of procurement and regulatory practices • Great variation in when/whether to use grants or contracts • Burden of disproportionate procurement practices – pre-qualification requirements, guarantees/bonds • Poor funding practice: lack of full cost recovery > ‘subsidy’ • Poor funding practice: short-termism = barrier to investment • Burden of disproportionate monitoring ‘Working with the Third Sector’ National Audit Office June 2005

  5. An unfair playing field

  6. The Commissioning Framework for Health and Well-being

  7. Assuring high quality providers for all services Obstacle: Providers are sometimes unwilling or unable to provide new and innovative services • Solution: • Commissioning focused on outcomes • Wider range of providers • Develop effective, strong partnerships with providers • Transparent and fair procurement • More innovative provision, tailored to the needs of individuals (engage providers in needs assessments) • Intelligent decommissioning

  8. The population has increased 24% over the 60 years of the NHS More people now over pension age than under 16 By 2031 the 75+ population will double to 8.2 million Half of babies born today will live to be 100 Men and women live 10 years longer than in 1948 Time lived with a limiting illness or disability has increased by over two years in past decade Alzheimer’s and other forms of dementia will double in a generation Demographic change will cost the NHS £1.1–1.4 bn extra each year Quality & Productivity Challenge Source: The Human Factor, NESTA, 2009

  9. The scale of the challenge Growth in Allocations Trajectory of rising costs £1.4 bn challenge Flat cash scenario

  10. Our Aim • The aim of the Towards Excellence programme is to drive up the quality of healthcare across the East Midlands, and ensure we have the resources to meet the challenges of: • Demographic change • Increasing costs of drugs and technology • Rising demand • Growing expectations

  11. Responding to the Challenge - levels of working National Regional County health system Co-Production PCT / Provider Subsidiarity Clinical Leadership System Alignment Organisation Team / Individual

  12. 12 National Priorities Confirmed

  13. East Midlands PrioritiesClinical Priorities 1 Transformation of the Urgent Care System £45 - 85m 2 Delivery of upper quartile performance in planned care £7 – 17m 3 VTE prevention £3 - 6m 4 Long term conditions management - best practice pathways £67 - 68m Initial Priorities: Falls and Dementia 5 End of Life care – best practice £10 - 26m 6 Large scale prevention programmes £25 - 62m 7 Reduction in caesarean section rates £1 – 4m 8 8 Reducing out-of-area placements for people with learning disabilities £1 - 21m 9 Significant reduction in prescribing and drug procurement costs £31m Potential opportunity £189 – 321m

  14. Non-Clinical Priorities 1 Workforce productivity £169 -176m 2 Rationalise back-office functions and supply chain management £25m 3 Major improvement in productivity of Pathology services £20 - 40m 4 Introduce standard thresholds for surgery £6 - 69m 5 Estates optimisation £72 – 112m 6 Reduce Variation and Maximise Capacity £3 - 27m 7 Reduce costs of primary care contracting (LES, DES) £34 - 37m 8 Reduce costs of Continuing Care £27m Potential opportunity £355 – 512m

  15. Quality Observatory • East Midlands QO was launched on 1 December • It will provide the main mechanism to measure and track quality improvements • Access to the data on the website is currently restricted • It will gradually be opened to all

  16. Our Next Steps • Establish priority work streams, with high quality leadership • Set up PMO • Develop detailed plan for each initiative • Develop county health system assurance plans • Closer alignment with local government / social care • Produce SHA Delivery Plan • Widespread communication and engagement

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