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SÅ KAN VI FÅ EN BÄTTRE VÅRD 10 January 2004 Nick Jones, Head of Strategy
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  1. SÅ KAN VI FÅ EN BÄTTRE VÅRD10 January 2004 Nick Jones, Head of Strategy

  2. Content • Who I am and what I do! • Healthcare Commission – what it is • Context, our place in the England healthcare system • Performance rating the National Health Service (NHS) • Moving to a ‘richer’ and more complex picture • Using information more intelligently

  3. The Healthcare Commission • Formally, the Commission for Healthcare Audit and Inspection • Health and Social Care (Community Health and Standards) Act 2003 • Established in April 2004 • Independent of government but funded by government (c. £70m or 900,000,000 SEK) • About 650 staff (mainly in London)

  4. Healthcare Commission - Main duties • Assess the management, provision and quality of NHS healthcare • Review the performance of each NHS trust (organisation – c. 600) • Publish information about the state of healthcare • Consider complaints about NHS organisations • Promote coordination of reviews by others • Regulate the independent sector • Carry out investigations of serious failures

  5. Healthcare Commission – Main goals Promote improvement in health and healthcare • Best possible information about health and healthcare • A fair and thorough complaints system • Proportionate and coordinated assessment regime • Similar approach irrespective of provider • Setting world class inspectorate standards

  6. Context • Spending • System reform • Positive quality results • Quality infrastructure

  7. 1. Spending (1) Health expenditure per capita 2000 • USA $4,540 • Germany $2,780 • Canada $2,580 • France $2,387 • Sweden $2,270 • UK $1,813

  8. 1. Spending (2) Physicians per 1000 population • Italy 5.5 Germany 3.5 Sweden 2.7 UK 1.6

  9. 1. Spending (3) • Second term Labour Government • 43% rise in expenditure over 5 years • 7.4% ‘real’ increases per year to 2007/08 • £65.4bn in 2002/03 £105.6bn by 2007/08 • GDP: Now 7.7% 2005/06 8.7% 2007/08 9.2 • Per person (England • 1997 - £680 • 2003 - £1345

  10. 2. System Reform • Increased funding essential – part of multi-dimensional approach • a) Support for providers • b) Hierarchical challenge • c) Localist challenge

  11. a) Support for providers • Increasing the supply of health professionals • Modernising the infrastructure • Supported learning and improvement

  12. b) Hierarchical challenge • National standards and targets • Inspection and regulation • Published performance information • Direct intervention – freedom or sanctions

  13. c) Localism - Shifting the balance of power • Active purchasing • Patient choice • Aligned provider incentives • New entrants and pluralism • Local democratic accountability

  14. 3. Positive Quality results (1) Since 2000 • 30,000 extra nurses • 3,000 extra consultants • 500 extra general practitioners • 3,500 extra health professionals

  15. 3. Positive Quality results (2) Since 1997 • Deaths from heart disease down 14% • Deaths from cancer down 6.5% • 8,000 waiting more than 15 months for operation: Now 0 • 95% wait no more than 4 hours for A&E • In 2002 94.4% patients with breast cancer received first treatment within 1 month • 26 week outpatient wait 2001 92,500 2002 716 • 1,325 surgeries refurbished

  16. Quality infrastructure • National Institute for Clinical Excellence (1999) • Modernisation Agency (2000) • National Patient Safety Agency (2001) • National Clinical Assessment Authority (2001) • General Medical Council (1858) • Royal Colleges (RC Surgeons 1540) • Commission for Health Improvement (1999-2004)

  17. Healthcare Commission - Main duties • Assess the management, provision and quality of NHS healthcare • Review the performance of each NHS trust (organisation – c. 600) • Publish information about the state of healthcare • Consider complaints about NHS organisations • Promote coordination of reviews by others • Regulate the independent sector • Carry out investigations of serious failures

  18. ‘Star’ (NHS Performance) Ratings • Accessible and easy to understand information about the overall performance of local health services • Report on the main targets set by Government for the NHS • Not a comprehensive picture but lead to a single ‘star’ being awarded to every NHS organisation

  19. How does it work? • 3*: Highest level of performance • 2*: Mostly high levels of performance, but not consistent • 1*: Some cause for concern about particular areas • Zero*: Poorest levels of performance

  20. Targets - include • Outpatients waiting • Total time in A&E • All cancers: 2 weeks • Financial management • Elective admission • Ambulance waiting times • Access to GP • Smoking quitters • Assertive mental health outreach services

  21. Balanced by additional (40 or 50) indicators on • Clinical focus e.g. emergency re-admissions, infection control,audit participation • Patient focus e.g. survey results, cancelled operations, diagnosis to treatment times • Capacity and capability e.g. staff survey; doctor’s hours For more see:http://www.healthcarecommission.org.uk/InformationForServiceProviders/PerformanceRatings/fs/en

  22. Results for 200304 3 Stars: 143 2 Stars: 290 1 Star: 122 0 Star: 35

  23. Dangers of targets • Tunnel vision • Gaming • Adverse risk selection • Perverse behaviour Be careful about selected measures and be careful in interpreting the results. • But…………….

  24. Key target: Impact? % patients waiting for hospital admission > 12 months Source: National Health Service hospital waiting lists by region: Regional Trends 35, 36, 37 & 38

  25. Key target: Impact? % patients waiting for hospital admission > 12 months Source: National Health Service hospital waiting lists by region: Regional Trends 35, 36, 37 & 38

  26. Key target: Impact? % patients waiting for hospital admission > 12 months Source: National Health Service hospital waiting lists by region: Regional Trends 35, 36, 37 & 38

  27. Key target: Impact? % patients waiting for hospital admission > 12 months Source: National Health Service hospital waiting lists by region: Regional Trends 35, 36, 37 & 38

  28. The Healthcare Commission aims to promote improvement in health and healthcare Our assessments will emphasise the steps to improvement, rather than criticism of the past Purpose of our assessments

  29. Principles for a new approach Assessments that are relevant to patients, public and providers • No unnecessary burden • build on organisation’s own responsibilities • intelligent use of information • partnership with other agencies inspecting, regulating & auditing healthcare: the ‘concordat’ • focus inspection where it is most valuable Fair judgements, reported clearly to each of our audiences

  30. Core standards Core standards Getting the basics right Existing targets Use of resources Other regulatory findings Developmental standards Progress against developmental standards Making & sustaining progress National targets Local targets Our assessments Annual review

  31. Developmental standards Making & sustaining progress Making & sustaining progressImprovement reviews An in-depth review, focusing on: • An aspect of the patient pathway… • a service, across organisations • a population group, e.g. children • a condition, such as diabetes • A domain of the developmental standards • Leadership and organisational capacity Reviews will often be carried out in partnership with other agencies.

  32. Developmental standards Making & sustaining progress Improvement reviewsProgramme for 2005/06 Primary care Mental health Ambulance Specialist Acute

  33. Developmental standards Making & sustaining progress Improvement reviewsPiloting in 2005/06 Primary care Mental health Ambulance Specialist Acute

  34. Core standards Getting the basics right Reporting the Annual Reviewthe dashboard – part one

  35. Developmental standards Making & sustaining progress Reporting the Annual Reviewthe dashboard – continued

  36. Timeline July 2004 November 2004 Spring 2005 2005/2006 DH published Standards for Better Health Start of 12 week consultation across England on our proposals for new systems of assessment • Report back on the results of consultation: • Summary on website • Event participants receive a copy Phased implementation

  37. Vision for Intelligent Information Assessment Investigations Email Surveys Complaints Clinical Audit Relationship Management Services Support for Business Processes Patients & Carers Registration & Enforcement Healthcare Commission People Public Partners and Audiences Healthcare Orgs Assessment Benchmarking Information Channels Information Alerting Information Search Healthcare Providers Government & Regulators Resource and Schedule Management Intermediary Services CONCORDAT Information Cabinet Data and Knowledge Management Documents Sources Interview Recordings Structured Data Information Centre Information Governance

  38. IIMS Key Components • Consolidate all of our information, evidence, intelligence into one single integrated central repository – the information cabinet; • Work in partnership with information partners to collect and manage information which is relevant to performance and quality (measure what matters); • Support all of our internal business processes in the regions and our central office; and • Inform and drive improvement through the creative dissemination of the information we use to inform our judgements to all our audiences.

  39. Relationship Managed by: St. Elsewhere Hospital Tel: 01256 473 202 Website: http://www.northhampshire.nhs.uk Local Presence Manager: Fred Smith Assessment Manager: Linda Patel Paul Targett Chairman Nancy Wolstenholme Chief Executive Local PVH Manager: Fred Smith Media Contact: Jo Bind Assessment Score Card Planned Events Leadership and Capacity to Improve? Overall View September 2006 National Priorities Met? 5th 10:00 HC – Investigation Meeting Financial management and value for money? Local Targets Met? 10th TBC NPSA – Safety Review Results from Other HC reviews October 2006 Core Standards Met? 5th HC – AHP Results Review Progress on developmental standards Findings from other Regulators 20th 16:00 Previous Assessments DoH – PCT Structure Review Concordat Activity Relevant Documents: CSCI – Investigation underway NAO – Funding Review Monitor – Reviewing Foundation case Investigations • Meeting Minutes • Associated Reports 2006 2005 2004 2 (Major Concern) 1 0 Activity Top 3 Email by person Recent Media News Tom Smith (Complaints) Jo Hunter (Media Rels) Alf Do (Investigations) 10 Jul 2006 – CEO Departs Complaints Basingstoke Gazette Jo Springer has today announced that after a long career she is looking forward to the golf. Year Received Under-Review Active HC People 2006 2005 2004 80 33 20 10 5 3 5 Aug 2006 – Staff Shortages Hit Tom Smith (Complaints) Jo Hunter (Media Rels) Alf Do (Investigations) Lisa Right (Assessment) Helen Long said today that services in A&E would not be hit by recent shortages in nursing staff ….. HSJ Relationship Management Dashboard

  40. Thank you Nick Jonesnick.jones@healthcarecommission.org.ukwww.healthcarecommission.org.uk