Quality in a cold climate The NHS challenge

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Quality in a cold climate The NHS challenge

• PCT Prescribing Advisors Annual Conference
  University of Keele 17 June 2009
• Niall Dickson
• Chief Executive, The Kings Fund

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The NHS state we are in

• State of the NHS
• The financial state we are in
• Conservative Party health policy
• The real policy challenges
• Obstacles and solutions

3
The 2008 health check

• Over the past two years, in almost every part of
  the country, we have seen the number of trusts
  rated good' or excellent' expanding and the
  number rated fair' or weak' shrinking.
• Self payers spending on non-cosmetic surgery such
  as knee and hips fell by nearly 30m to 345m
  since mid 1990s Laing's Healthcare Market Review
  2008-2009 edition
• Improved quality and use of money
• Waits for cancer treatment, ambulances, 18 week
  target successful

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Our Future Health Secured

• Unprecedented investment 2002/7 50
• Pay absorbed 43 of new money
• Little robust evidence of benefit from extra pay
• Shorter waits, more elective ops (7)
• Many more A and E attendances (33)
• Looking forward affordable care only
• - if individuals are more engaged
• - if system promotes self care
• - if productivity increases

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Financial climate (Health spending rates since
1971) Source HM Treasury
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Post CSR the climate from 2011

• Tax funded all political parties appear
  committed
• In effect growth will be zero or less
• Demand will continue to rise demography alone
  accounts for c 1 increased cost pa
• Unless services are redesigned services will
  struggle to cope

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Post CSR the climate from 2011

• Social care under pressure
• Quality Value
• Cost
• Hard decisions needed
• Avoid short-termism
• Freezing posts
• Delaying care
• Quality services can cost less

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2011-14

• Government predicts 0.7 real growth but
  that excludes debt repayment
• IFS-based projection -2.3 pa, sharing the pain
  across all spending departments
• NHS Optimistic 1 pa, effectively a real
  cut/standstill given baseline pressures
• Requires dramatic cuts in other departments
  budgets/tax rises. (e.g. Lansleys 10)
• 
  IFS / The
  Kings Fund 2009

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NHS Funding v Fully Engaged
INDEX 2006/7 100
Growing funding gap?
NHS real spend based on IFS
projections
IFS 2009

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The Tories are coming
?

• Volatility of the electorate
• Can the political class fall any lower in
  public esteem?
• Volatility of the economy
• Personalisation of politics
• The Scottish factor
• Extinct volcanoes

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Common ground conceded

• Tax-funded
• We do not differ with the government over
  funding for the NHS.
• Fully-funded
• .. the NHS has been underfunded in the past
  .. it needs sustained investment..
• Vision improve and sustain
• So no encouragement of middle class flight -
  tax relief and patient passports seen as a
  mistake

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Real differences?

• Independent Board ?
• A new approach to public health ?
• Reform of regulation ?
• Local accountability ?
• End of national targets ?
• Moratorium on reconfiguration ?
• Pace of change commitment to reform ?

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The policy challenge issues

• Rising costs
• Configuration of services/estate and outmoded
  models of care
• Low productivity and variable quality
• Poor levers for public health
• Weak and non aligned incentives for quality,
  efficiency and productivity
• Professional disengagement
• Public disengagement and potential hostility to
  reform
• Political timidity

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The policy challenge solutions

• Reconfigure services
• - concentrate some, disperse and integrate
  others
• Cost review programmes
• Medicines management/Length of stay/day surgery
  rates/variations in medical practice
• Service Line Reporting, involve clinicians
• Improve management of LTCs
• Manage relationships
• Align incentives for quality and productivity
• Freeze pay (70 of NHS costs)
• Redefine NHS offer?

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The policy challenge in summary

• Clear priorities
• Formal cost reduction programme
• Secure clinical leadership, build relationships
  with local NHS, patient groups, local authorities
• Benchmark, understand and tackle variations in
  spending and quality
• Redesign services and pathways
• Optimise technology
• Divest estate focus on services not buildings

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Thank you

• www.kingsfund.org.uk