NHS Next Stage Review

1. NHS Next Stage Review Professor the Lord Darzi KBE Parliamentary Under-Secretary of State

2. Why do we need a Review?… • Objectively the NHS is better than ever • Subjectively there has been confusion and frustration in the NHS, especially among NHS staff – why?

3. Journey so far • Ten years ago the NHS was in relatively poor health: • Investment had varied hampering planning • Access was poorer, with long waiting times • Capacity problems led to an annual winter crisis • My own experience illustrates the improvements since then: • More staff on the team • Shorter waits for patients needing operations • Higher quality care that is more personalised • Across the country: • Tens of thousands more doctors, nurses and others • Hundreds of new or refurbished facilities and lots of new kit • Care still provided according to clinical need not ability to pay

4. … based on a fresh approach to change • Reactive in nature • Designed to meet Targets • Clinicians often not engaged in process • Clinical leadership not essential • Targets become the goal • Difficult to sustain clinical improvement over time & across organisation • Proactive in nature • Evidence-based foundation • Clinicians actively engaged in process • Clinical leadership critical to success • Best and safest care is the goal, indicators as markers of success • Sustainable improvement over time and across organisation

5. Clinical Case for Change • Major inequalities in health and wellbeing across the country • Variation in care across the country • NHS lags behind other countries on treatment outcomes • Care could be more convenient and easier to access for many • Care needs to keep pace with the expectations of citizens • Disease patterns evolve & the population is ageing • New technology and treatments

6. Major inequalities in people’s health • Life expectancy varies across the country • Lowest life expectancies are concentrated in parts of London, Midlands, Yorkshire, North West and North East • Partly due to unhealthy behaviours and societal factors, but… 6

7. Variation in care across the country Fewer GPs and worse care in areas with greatest need (Areas with the fewest GPs have poorer quality and outcome (QOF) scores) 7

8. Disease patterns are • changing, so is the population • People with long term conditions – e.g. diabetes, asthma, heart disease - use health services more – 58% of all GP appointments, 77% of inpatient bed days • Population is ageing – by 2029 there will be 50% more 75 to 89 year olds • Long term conditions are set to increase as the population ages • And currently only a small a proportion of patients receive optimal long term conditions care

9. NHS Next Stage Review - process 9 • Communications Local National • Clinical Pathway groups • in each SHA: • Maternity & New-Born Care • Staying Healthy • Children’s Health Care • Acute Care • Long-Term Care • Planned Care • Mental-Health Care • End-Of-Life Care • National Themes to include: • Quality and Safety • Clinical leadership • Education & training • Innovation • NHS constitution • Local accountability • 21st Century NHS • Local visions for health and healthcare that meet local circumstances and needs, supported by national principles, minimum standards and enablers Engagement of patients, staff and public

10. Staying healthy Population-level interventions

11. Acute pathway A telephone triage service is required to support services Ambulance 999 for emergencies Paramedic Health and urgent care centres Single number for all urgent case services Access to healthcare records Up-to-date information on all local services Appointment with most relevant team- social care, LTC, GP Advice andinformation

12. Planned care DH estimates that much outpatient activity could be conducted in the local care setting 64% of total outpatients could be removed or devolved from hospital outpatients, leaving only 36% in the traditional outpatients setting

13. Long-term conditions NHS next stage review will put community-based care at the centre • Acute Hospital • Emergency care • Inpatient care • Specialist outpatients • Specialist diagnostics Outpatient appointments(new and follow-up) Shift ~60% Increased direct access to diagnostics,e.g. MRI Routine diagnostics Shift 100% of x-ray and ultrasound • Outreach outpatients • Specialists for long-term conditions: • doctor • nurse • therapist

14. Long-term conditions Create a web of care with the individual at the centre

15. Delivery models Health Centres - GP, community and some currently hospital-based care in the local setting Community services General practice services Most outpatient appointments (including antenatal and postnatal care) Minorprocedures Diagnostics – point-of-care pathology and radiology Urgent care Interactive health information services including healthy living classes Proactive management of long-term conditions Other health professionals e.g. optician, dentist Pharmacy

16. Direction of travel 1965  1990  1998  2005  Organisational Unit Individual GPs Larger GP Units 10 Health Services nGMS / CHS PCTs +/- ?Integrated Trusts (NB Kaiser) Mechanism of Delivery The Red Book GP Commissg GP Fundholdg TPP/Multifund Practice Contracts (PMS) Various NHS and Private Providers Service Focus Individual Patients Specific Target Groups >75 years etc Practice Populations Populations & Communities of Interest Choice

17. Current IS involvement • Through Independent Sector partnerships, the following services are already being delivered: • 23 independent sector treatment centres (Wave 1) • 10 walk-in centres (6 with a commuter focus) • Mobile ophthalmology services • Mobile MRI scanning services • Chlamydia screening services • 5 ISTC schemes are operational (Phase 2) Huge opportunities for capable providers to deliver these services

18. Patient Choice Since January 2006 - Patients have a choice of 4 or more local hospitals, and 139 other hospitals through the Extended Choice Network From April 2008 - Patients able to chose services from any hospital nationally, which has the capacity to treat them and meets NHS standards In the run up to April 2008 • Roll out choice video on Life Channel in more than 2,000 surgeries • Roll out a national training programme for librarians in all 3,088 public and mobile libraries and in UK Online centres • Expand our work with the third sector (Princess Royal Trust for Carers, Arthritis Care and Age Concern) and other voluntary sector groups to raise awareness The NHS Choices information service creating better access to information about health services (Hospitals and GP Practices)

19. System Management is… “The actions and behaviours to make a local health system the best it can be” • Tasks of system managers: • Building the system • Ensuring strategic coherence • Maintaining system effectiveness • Values of system management: • transparency, • objectivity, • proportionality, • non-discrimination, • subsidiarity, • consistency, • no double jeopardy The patient’s chosen provider Right therapy Right time When needed High quality and safe • Commissioning • Procurement & Contracting • Choice offer • Promotion • Payment • Failure, Support and Intervention • Transactions • Market management • Market development Technical aspects:

20. Principles and rules for co-operation and competition …..to drive up service quality, deliver better value and reduce inequalities Commissioning, competition and choice are powerful levers….. • Examples of key principles • Commissioners should commission services from providers who are best placed to deliver the needs of their populations • Commissioning and procurement should be transparent and non-discriminatory • Commissioners and providers should foster patient choice and ensure that patients have accurate and reliable information to exercise more choice and control over their healthcare

21. FESC (Framework for Procuring External Support for Commissioners) Collaborative procurement Ad hoc local procurement (full process) Commissioning business services Private Sector Support Public sector/NHS Support Other national procurements Skills pooling Localsolution from FESC SHA-led services Internal Support Joint arrangements with local authority Recruitment of specialist staff External consultancy (for training or general support) An additional tool for the PCT toolbox PCT Commissioning Function SHARE BUY LEARN 21

22. NHS into the 21st century “It is not the strongest of the species that survives, not the most intelligent, but the one most responsive to change.” Charles Darwin