Looking ahead. wellards.co.uk January 2010. Expect significant NHS change to continue through 2010/11 This year’s general election may only slightly deflect the direction of travel Higher quality, productivity and efficiency gains will remain important drivers
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Opportunities from change
New directions in England
NHS 2010 -15: from good to great
'This five-year plan maps out how the journey of improvement in our NHS will continue in a new financial era… The pre-Budget report has confirmed future funding increases which will be locked into frontline budgets... But savings will have to be made in every part of the NHS... Our vision will require significant transformation in the way in which care is delivered in the future... '
NHS 2010-15: from good to great, December 2009
'We are at a critical juncture in the history of the NHS. After a decade of investment and reform that has helped drive real improvements for our patients, the NHS, along with other public services, is about to enter perhaps the toughest financial climate it has ever known…
'NHS 2010-2015: from good to great sets out a five-year strategy and 2010/11 is the first year of this new strategy... This operating framework sets out a number of new and powerful shifts in national policies and levers to support this strategy... The NHS operating framework for 2010/11 also challenges all NHS organisations to reduce overheads and management costs…'
Foreword by Sir David Nicholson, December 2009
Operating framework for 2010/11
Operating framework for 2010/11
'It would be a grave mistake to underestimate the challenge ahead. The politicians may want to talk about protecting the NHS, but the reality is that even with some protection there will have to be very tough choices… We may see the vultures circling again, questioning whether we can sustain a free comprehensive system funded out of general taxation’
Niall Dickson, chief executive, King's Fund, commenting on a joint report with the Institute for Fiscal Studies: How cold will it be? Prospects for NHS funding: 2011-17
‘The heath service is about to enter a new era. After years of unprecedented growth, it faces the prospect of unprecedented austerity... Windmill 2009 provided little confidence that the cushion of recent significant funding increases by the health sector has put it into a strong position to weather the coming storm…'
Windmill 2009: the storm scenario, December 2009
After seven years of plenty
NHS Confederation, Dealing with the downturn,
Targets and levers
Structures and customers
'The corpse of PBC is not for resuscitation… The uptake of the policy has not been what the government had hoped for. We’re struggling to make it systematic... and it's not really taking off out there… Clinicians should have some degree of control over the purse strings in order to renovate and improve clinical care'
David Colin-Thome, Wellards Conference, October 2009
Diagram from the commissioning framework documentA good understanding of this is vital to 'speaking the payer language'
'All NHS organisations will have to register the services they provide… and demonstrate that they are meeting the standards required. If it is shown that an organisation is not providing safe and effective care, as a result of not implementing NICE guidance or complying with technology appraisals, the CQC will take the appropriate action proportionate to the risk posed to people who use the services...'
How to use NICE guidance to commission, December 2009 (p19)
NICE and the CQC
NICE and the NHS Constitution
'PCT boards should be able to report organisations failing to 'have regard to' the NHS Constitution to the relevant regulator… SHAs could use the NHS Constitution to mobilise 'an army of agitators', taking their local NHS to task about whether their rights are being met and putting their results on NHS Choices... '
NHS Constitution state of readiness group final report, November 2009
The quality landscape
Old versus new world
NSF: national service framework CQC: Care Quality Commission
'Some payers are still wary and cautious of pharma and remain deeply suspicious of its motives… In the eyes of payers, partnership can no longer mean ''prescribe my products''…The industry will need to demonstrate its commitment to improving health outcomes through investing in more than just medicines... '
Carsten Edwards and Sarah Giles
Pharmaceutical Marketing, September 2009 (pp24-6)
Pharmaceutical Marketing, September 2009 (p26)
Dr Richard Barker, Pharmaceutical Marketing, November 2009 (p19)
The view from A T Kearney
'The industry has now reached not one but three interconnected tipping points, concerning what it sells, to whom and how it must be organised. The first relates to the move from therapies to service models… For payers, the availability of marginally more effective but much more expensive treatments is far from compelling. What would be more compelling for payers is a service model that can be proven to result in fewer admissions... It would be even more compelling if this could be demonstrated in the payer's specific care system and target population – positioning a therapy in this context would dramatically increase its value…'
Pharmaceuticals out of balance, July 2009
Climate change – the ice age cometh
'While the NHS barricades itself against the imminent cold front, should we be inside taking the initiative and working on solutions?... To many in the NHS, the industry is part of the problem… Costs will have to be extracted from the health service and prescribing budgets will be a target for early quick efficiencies… Companies will have to change… Coverage and frequency models that are predominantly product-specific will have to morph into innovative, holistic approaches that encompass whole system changes across treatment pathways…'
Adam Knights, managing director, 15Healthcare
Pharmaceutical Marketing, November 2009 (p13)