The NHS

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The NHS - Effective Commissioning
Rt. Hon. Stephen Dorrell MP
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Commissioning

• Established in 1991
• Abolished in 1997
• Reinvented in 2004
• Still to be made effective

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What is Commissioning?Three key processes

• Decide priorities
• Focus resource on priorities
• Measure performance

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Decide PrioritiesUnderstand the needs of patients

• Long term conditions
• Mental health
• Ageing population

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Decide PrioritiesLong Term Conditions

• 17.5m people in Britain have a long term medical
  condition
• Around 45 of those patients have more than one
  condition
• These patients account for 2/3rds of medical
  emergency admissions

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Decide PrioritiesMental Health

• One third of patients consulting a GP have a
  mental health problem (Social Exclusion Unit,
  2004)
• 13 of NHS budget is spent on mental health
  services
• 2.75 million people of working age consult a GP
  for a mental disorder (Psychiatric Morbidity
  Survey)

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Decide PrioritiesAgeing Population

• Three quarters of people over 75 have a long term
  illness
• (GMS Contract data, 2005)

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Decide PrioritiesAddress Health Inequalities

• Public health measures well established
• Committed to strengthened public health function
• Inadequate links between population measures and
  patient experiences

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Decide PrioritiesAddress Health Inequalities -
Tale of Two Cities
Source Community Health Profiles, 2006
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Decide PrioritiesPromote Best Practice

• Understand practice developments elsewhere
• Measure local performance against best practice
• Take action when standards dont measure up

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Decide PrioritiesPromote Best Practice - A Case
Study

• In Malmo in Sweden, patients suffering a heart
  attack are admitted immediately to a coronary
  intervention unit and undergo immediate
  angioplasty.
• Hospital stay averages 3 days and the incidence
  of heart failure has plummeted in the local
  community.

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Decide PrioritiesPrevention is better than cure

• In the UK
• 22 of adults smoke
• 1 in 4 adults and children are obese
• Half of all children eat no fruit or vegetables
  in a week
• 65 of adults and 50 of children do not take the
  recommended amount of exercise

Source Oxford Health Alliance
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Decide PrioritiesPrevention is better than cure

• If the three risk factors, smoking, poor diet and
  lack of exercise were completely eliminated
• 80 of early deaths from heart disease
• 40 of early deaths from cancers would be
  prevented

Source Oxford Health Alliance
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Decide PrioritiesPredicted benefits of effective
commissioning
Source Wanless 2000/ Kings Fund 2006
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Focus Resource on PrioritiesEfficiency is falling

• Money has been spent before reform

Source Kings Fund/ DOH 2006
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Focus Resource on PrioritiesDespite rhetoric
about priority services

• 27 of our health spending is in the community
  compared to 33 in our European neighbours
  (Source OECD compendium, 2005)
• Consultants have risen by 64 GPs have risen by
  15.3 (Source Information Centre, 1995 2005)

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Focus Resource on PrioritiesEngage with the
professions

• Concentrate on disease not process
• Enlist professional support
• Healthcare should be commissioned with and by
  the professions not against the professions

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Focus Resource on PrioritiesEngage with primary
care

• Closer to patients
• Local accountability

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Focus Resource on PrioritiesEvidence for local
budgets

• Fundholding
• Shorter waiting times by 8
• Reduced elective hospital admissions by 3.3
• Reduced prescribing costs
• Total Purchasing Pilots
• 69 of TP pilots reduced occupied bed days
• 13 reduced admissions

Source Kings Fund
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Focus Resource on PrioritiesEngage with
independent sector

• Private skills
• Social enterprises
• Charities

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Measure PerformanceFocus on real priorities

• NHS debate is too focused on targets
• Commissioning should focus on patient outcomes
• Patient reported experience
• Clinical outcomes
• What gets measured gets managed

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Measure PerformancePatient reported experience

• Ever been asked about your care?

How patients viewed their physical health after a
coronary artery bypass graft (CABG) SF- 36
(Source Bupa 2006)
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Measure PerformancePatient reported experience
(contd)

• Ever been asked about your care?

Source Nuffield Hospitals
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Measure PerformanceClinical outcomes

• A dialogue with professions to establish better
  measures of clinical outcomes

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