NHS Next Stage Review

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NHS Next Stage Review
Professor the Lord Darzi KBE Parliamentary
Under-Secretary of State
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Why do we need a Review?

• Objectively the NHS is better than ever
• Subjectively there has been confusion and
  frustration in the NHS, especially among NHS
  staff why?

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Journey so far

• Ten years ago the NHS was in relatively poor
  health
• Investment had varied hampering planning
• Access was poorer, with long waiting times
• Capacity problems led to an annual winter crisis
• My own experience illustrates the improvements
  since then
• More staff on the team
• Shorter waits for patients needing operations
• Higher quality care that is more personalised
• Across the country
• Tens of thousands more doctors, nurses and others
• Hundreds of new or refurbished facilities and
  lots of new kit
• Care still provided according to clinical need
  not ability to pay

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based on a fresh approach to change

• Reactive in nature
• Designed to meet Targets
• Clinicians often not engaged in process
• Clinical leadership not essential
• Targets become the goal
• Difficult to sustain clinical improvement over
  time across organisation

• Proactive in nature
• Evidence-based foundation
• Clinicians actively engaged in process
• Clinical leadership critical to success
• Best and safest care is the goal, indicators as
  markers of success
• Sustainable improvement over time and across
  organisation

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Clinical Case for Change

• Major inequalities in health and wellbeing across
  the country
• Variation in care across the country
• NHS lags behind other countries on treatment
  outcomes
• Care could be more convenient and easier to
  access for many
• Care needs to keep pace with the expectations of
  citizens
• Disease patterns evolve the population is
  ageing
• New technology and treatments

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Major inequalities in peoples health

• Life expectancy varies across the country
• Lowest life expectancies are concentrated in
  parts of London, Midlands, Yorkshire, North West
  and North East
• Partly due to unhealthy behaviours and societal
  factors, but

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Variation in care across the country
Fewer GPs and worse care in areas with greatest
need (Areas with the fewest GPs have poorer
quality and outcome (QOF) scores)
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• Disease patterns are
• changing, so is the population
• People with long term conditions e.g. diabetes,
  asthma, heart disease - use health services more
  58 of all GP appointments, 77 of inpatient
  bed days
• Population is ageing by 2029 there will be 50
  more 75 to 89 year olds
• Long term conditions are set to increase as the
  population ages
• And currently only a small a proportion of
  patients receive optimal long term conditions
  care

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NHS Next Stage Review - process
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• Communications

Local
National

• Clinical Pathway groups
• in each SHA
• Maternity New-Born Care
• Staying Healthy
• Childrens Health Care
• Acute Care
• Long-Term Care
• Planned Care
• Mental-Health Care
• End-Of-Life Care

• National Themes to include
• Quality and Safety
• Clinical leadership
• Education training
• Innovation
• NHS constitution
• Local accountability

• 21st Century NHS
• Local visions for health and healthcare that meet
  local circumstances and needs, supported by
  national principles, minimum standards and
  enablers

Engagement of patients, staff and public
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Staying healthy
Population-level interventions
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Acute pathway
A telephone triage service is required to support
services
Ambulance
999 for emergencies
Paramedic
Health and urgent care centres
Single number for all urgent case services Access
to healthcare records Up-to-date information on
all local services
Appointment with most relevant team- social
care, LTC, GP
Advice andinformation
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Planned care
DH estimates that much outpatient activity could
be conducted in the local care setting
64 of total outpatients could be removed or
devolved from hospital outpatients, leaving only
36 in the traditional outpatients setting
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Long-term conditions
NHS next stage review will put community-based
care at the centre

• Acute Hospital
• Emergency care
• Inpatient care
• Specialist outpatients
• Specialist diagnostics

Increased direct access to diagnostics,e.g. MRI
Outpatient appointments(new and follow-up) Shift
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Routine diagnostics Shift 100 of x-ray and
ultrasound

• Outreach outpatients
• Specialists for long-term conditions
• doctor
• nurse
• therapist

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Long-term conditions
Create a web of care with the individual at the
centre
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Delivery models
Health Centres - GP, community and some currently
hospital-based care in the local setting
Community services
General practice services
Most outpatient appointments (including antenatal
and postnatal care)
Minorprocedures
Diagnostics point-of-care pathology and
radiology
Urgent care
Interactive health information services including
healthy living classes
Proactive management of long-term conditions
Other health professionals e.g. optician, dentist
Pharmacy
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Direction of travel
Organisational Unit
Individual GPs
PCTs /- ?Integrated Trusts (NB Kaiser)
10 Health Services nGMS / CHS
Larger GP Units
Mechanism of Delivery
The Red Book
Various NHS and Private Providers
Practice Contracts (PMS)
GP Commissg GP Fundholdg TPP/Multifund
Service Focus
Populations Communities of Interest Choice
Practice Populations
Specific Target Groups gt75 years etc
Individual Patients
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Current IS involvement

• Through Independent Sector partnerships, the
  following services are already being delivered
• 23 independent sector treatment centres (Wave 1)
• 10 walk-in centres (6 with a commuter focus)
• Mobile ophthalmology services
• Mobile MRI scanning services
• Chlamydia screening services
• 5 ISTC schemes are operational (Phase 2)

Huge opportunities for capable providers to
deliver these services
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Patient Choice
Since January 2006 - Patients have a choice of 4
or more local hospitals, and 139 other hospitals
through the Extended Choice Network From April
2008 - Patients able to chose services from any
hospital nationally, which has the capacity to
treat them and meets NHS standards

• In the run up to April 2008
• Roll out choice video on Life Channel in more
  than 2,000 surgeries
• Roll out a national training programme for
  librarians in all 3,088 public and mobile
  libraries and in UK Online centres
• Expand our work with the third sector (Princess
  Royal Trust for Carers, Arthritis Care and Age
  Concern) and other voluntary sector groups to
  raise awareness

The NHS Choices information service creating
better access to information about health
services (Hospitals and GP Practices)
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System Management is

• The actions and behaviours to make a local
  health system the best it can be

• Tasks of system managers
• Building the system
• Ensuring strategic coherence
• Maintaining system effectiveness

• Values of system management
• transparency,
• objectivity,
• proportionality,
• non-discrimination,
• subsidiarity,
• consistency,
• no double jeopardy

The patients chosen provider Right therapy Right
time When needed High quality and safe

• Commissioning
• Procurement Contracting
• Choice offer
• Promotion
• Payment
• Failure, Support and Intervention
• Transactions
• Market management
• Market development

Technical aspects
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Principles and rules for co-operation and
competition
..to drive up service quality, deliver better
value and reduce inequalities
Commissioning, competition and choice are
powerful levers..

• Examples of key principles
• Commissioners should commission services from
  providers who are best placed to deliver the
  needs of their populations
• Commissioning and procurement should be
  transparent and non-discriminatory
• Commissioners and providers should foster patient
  choice and ensure that patients have accurate and
  reliable information to exercise more choice and
  control over their healthcare

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FESC (Framework for Procuring External Support
for Commissioners)
An additional tool for the PCT toolbox
PCT Commissioning Function
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NHS into the 21st century
It is not the strongest of the species that
survives, not the most intelligent, but the one
most responsive to change. Charles
Darwin