Capacity, Diversity & Choice

1. Capacity, Diversity & Choice

2. What is all this for? “To improve the patient experience by providing fast, fair, convenient high quality services which respond to their needs.”

3. Fast, Fair, Convenient High Quality Services:How the elements of system reform fit together S Y S T E M R E F O R M Increase Capacity DTCs More day surgery Systematic use of independent sector and Europe Financial Framework Price tariff Contracts based on volume and quality “Payment by results” NHS Bank Patient Choice Booked appointments More information Workforce Agenda for change Consultant contract GMS contract Strengthened devolution NHS Foundation Trusts 3 year planning and allocations Diversity DTCs Independent providers NHS Foundation Trusts Service redesign Standards NSFs NICE Strengthened accountability CHAI Franchising PCT prospectuses

4. How the system worked 2001 DH Driven top-down from DH centrally CHI Inspection Health authorities performance management accountability PCG/Ts NHS Trusts Finance CHI Patients Patients are “owned” by the system

5. How the system will work: 2006 The patient will have more choice and control over their care. The system has to be designed to be responsive to this Patients NHS Providers Trusts PCTs Non NHS Providers Foundation Trusts Independent Providers PCT Commissioners The PCT role in contracting with these providers will be vital Strategic Health Authorities CHAI Inspection Regulation and CHAI inspection DH Performance management accountability Standards Inspection Finance

6. Three Main Elements to Focus on Today Capacity Patient Experience DiversityChoice

7. 1. Capacity Need to deliver key maximum waiting time targets: • 4 hours in Accident & Emergency (2004) • 3 months outpatient consultation (2005) • 6 months for treatment (2005) NB: Challenging milestones (12 months for treatment by March 2003)

8. Capacity (contd) Key Issues: • Much existing capacity used sub-optimally: • NHS run “too hot” (95-98% occupancy) • Poor streaming of workload • Independent sector capacity/Europe seen as last resort  ad hoc use • Capacity gaps (and performance) skewed geographically and by specialty (orthopaedics) • Workforce = limiting factor • Lead times (can’t afford traditional solutions)

9. Capacity (contd) Solutions: • Rapid expansion in day surgery (375,000 FCEs) • Diagnosis & Treatment Centres (250,000 FCEs) • Incremental NHS growth (175,000 FCEs) • Redesign & Modernisation (‘productivity’) • Systematic use of independent sector and Europe (50,000 FCEs) • ‘Blitz’ orthopaedics (DTCs, workforce, accelerated orthopaedic improvement programme 30+ Trusts)

10. Capacity (contd) Diagnosis & Treatment Centres: • Delivers scheduled care in an environment which is not affected by emergencies • Focus on high volume, low variation elective cases • Streamlined patient pathways • 100% booking • Size (1,500 - 9,000 FCEs; average 4,000) • Rapid spread (9 open in 2002; 50 by 2004)

11. 2. Diversity of Provision Policy goal to increase diversity to: • Provide additional capacity • Conduct for innovation • Catalyst for increased productivity and working practices in NHS • Challenge UK independent sector • Facilitate Choice

12. NHS Foundation Trusts Overarching objectives • Plurality • Devolution • Freedom • Incentive

13. NHS Foundation Trusts Freedoms • Wider agenda to provide freedoms for all NHS Trusts • Earned Autonomy for 3* Trusts • Additional freedoms for NHS Foundation Trusts

14. NHS Foundation Trusts Incentives Local entrepreneurialism and innovation to deliver better services for patients encouraged by • Financial flows and payment by results • links to freedoms agenda

15. NHS Foundation Trusts: Accountability mechanisms Registered as a holder of an FT licence and regulated against it Governance structure and Constitution Inspection by CHAI against nationally agreed Standards Commissioning via legally binding contracts

16. NHS Foundation Trusts • Won’t be subject to performance management by StHAs • Will be held to account for delivering outputs agreed with PCTs through legally binding contracts • As NHS FTs not subject to SofS Direction, they are fully responsible for outcomes achieved • Will require clarity and transparency in NHS FT and PCT relationship

17. Agreeing Contracts with NHS FTs Some issues to consider: • Range of services to be provided • Volumes • Penalty and incentive clauses • Service development programmes • Specialist packages of care for specific complex cases • Information requirements and timeliness and data sharing • Standards of quality and safety • Risk sharing and risk management provisions

18. 3. Choice 2 versions: (a) 2002-2004 (‘Managed Choice’)  Choice of hospital after 6 months wait on list (3 or 4 choices, including Europe)  Cardiac and London Choice pilots (help manage demand/capacity)  Website (consultant/waits) (b) 2005> (‘Full Choice’)  Choice at the point of referral

19. Key Issues • Identify the elements of this programme that are most likely to apply locally - e.g. is there a potential Foundation Trust, a new DTC being developed or an overseas establishment scheme being set up? • What will the impact of these developments be? • How can we get the most benefit from these developments in conjunction with the financial flows reforms?