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Where are we going? A glimpse of services in 2010

Where are we going? A glimpse of services in 2010. Dr David Dawson Director of Organisational and Clinical Development Trent Strategic Health Authority. Overview. Key Messages This is really about business change This is really complex This is real. Aim to Cover

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Where are we going? A glimpse of services in 2010

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  1. Where are we going? A glimpse of services in 2010 Dr David Dawson Director of Organisational and Clinical Development Trent Strategic Health Authority

  2. Overview Key Messages This is really about business change This is really complex This is real Aim to Cover • One view of the system reform agenda • Implications • The role of SHAs

  3. Pan-European Problems Health care spending growing faster than GDP Huge variation in quality outcomes Customers are changing; more proactive Evidence based growing; response lagging

  4. FOUR KEY AREAS OF GOVERNMENT REFORM Changes to the financial system “payment by results” and a fixed price tariff Introduction of a commissioning function – in some cases at the level of individual consumers – to create a market place in healthcare Improved quality, improved efficiency of healthcare provision New freedoms for state run provider organisations Opening up of market place to private sector providers

  5. Creating a Patient-Led NHS • New Service Models • Greater choice • Better commissioning • Networks • Health promotion and improvement • A Changed Culture • Impact on patients and empowered staff • Shared values and codes of conduct • Support to frontline staff and clinical leadership • Continuous learning • New model of managing change • Clearer leadership at all levels • Better Support • Trust and PCT development • Integrated incentives • Integrated IT and HR infrastructure • Better risk mitigation

  6. Changing Organisations by 2010 Providers: • “All-rounder” hospitals will not survive • Survival dependent upon clear market tested strategy and alliances/networks • Mergers are inevitable Commissioners: • Driving improvement from customer perspective • Increase in capability and capacity • Managing demand and managing costs

  7. Changing Organisations by 2010 Primary Care and Community services • Larger primary care units and alternative providers • Differentiated services • Vertical integration • Commissioning separated from provision Professionals • Population perspective • Gradations in service (stepped care) • Quality assurance of self- and nurse led-care • More flexible use of staff

  8. Advantages Choice/convenience Competition Income guarantees Quality explicit Risks Fragmentation Duplication Discontinuous care Confusion Organisational risk

  9. Functions of SHAs • Co-ordination • Building Capacity • Performance Improvement

  10. Role of the SHA • Strategic planning • Population-based needs assessment • Alternative providers and models of care • Contestability • Building capacity • Leadership programmes • Devolved resources • Organisational development • Strategic HR • Mitigating risk • Vision and values • Stepped care pathways • Quality Assurance • Supporting and aligning infrastructure • Cultural and leadership change • (Simple) rules of engagement Enable organisations and LHCs to do it themselves

  11. So What Might This Really Mean? Some Current Actions in Trent

  12. Strategic Planning • Dr Foster analysis of Spearhead PCTs • Public Health network development • Developing commissioners • Kaiser Permanante work in Lincolnshire • SHA-wide work with United Health Europe • APMS providers • LTC Oversight Board

  13. Oversight Board • Composition • Locally owned • All sectors • PCT CE Chair • Vision • Build on best-practice and local patient surveys • Trent-wide solutions • Delivery • Across the whole LHC • Agreed frameworks • Systematic application • Evaluation • Independent • Service-driven • Link to new MA (and NILSI?)

  14. Building capacity • Leadership • Targeted support (Talent Management, TMDI, ‘York’ multidisciplinary programme) – aimed at strategic priorities • Local personal development (via TIN) • Centre for Health Improvement and Leadership in Lincoln (CHILL) • Devolved resources • Service improvement – Transformation teams • Workforce development • IM&T • Organisational Development • Linked to leadership framework • Opportunities of new service models • The Improvement Network (TIN)

  15. Mitigating risk Now • SHA-wide approach • Aligning service improvement/NPfIT and workforce development • Network development • Knowledge management Further work • Values • Quality assurance • Using data and information • Care pathways • Clinical/managerial ‘conversations’ • Rules of engagement

  16. ‘David will …. tell us how chronic disease management programmes will fit with the existing services such as cardiac rehabilitation, specialist cardiac nursing services and primary care CHD clinics.’ That is for you to decide. An SHA should only ensure you have the capacity and capability to do it.

  17. ‘Never doubt that only a small group of thoughtful, committed citizens can change the world. Indeed it is the only thing that ever has.’ ‘Even though the ship may go down the journey goes on.’ Margaret Mead

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