Mark Adams

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Providing for the Future
Mark Adams Chief Executive Netcare UK 21 March
2007
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CONTENTS

• Introducing Netcare
• Background to Reforms
• Challenges for the Future
• Case Studies

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Introducing Netcare

• Netcare South Africa
• Established in 1996
• Listed on JSE
• 62 hospitals
• 800,000 patients p.a.
• 56 Medicross centres
• GP services, dental, optical
• Netcare 911
• Ambulance service
• National Renal Care
• Ampath Pathology
• HIV Care

Netcares strategy to expand internationally
coincided with UK government aim to contract with
overseas providers to bring in teams from
overseas to drive down waiting lists
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Netcare in the UK

• Established in the UK in 2001
• Provide specialised clinical services under
  contract to the NHS
• 2001 to date
• Waiting list initiatives
• London
• Morecombe Bay
• Portsmouth
• Southport
• ISTC Wave One contracts
• Mobile cataract units
• Greater Manchester Surgical Centre
• CWICs
• ISTC Phase 2
• CL CATS
• Manchester CATS
• Diagnostics London and East
• Stracathro

• Public Private partnership award winner

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From Beveridge to Blair

• post war, baby boomers
• big government - small citizen
• comprehensive health welfare
• rising expectations and costs
• PMI private hospitals

• balance between a caring state and individual
  responsibility
• more pragmatism over cost
• consumer protection
• Pru health launched

Safety Net
Individual/Private
Collective/Public

• economic slump
• unions v business
• rampant inflation, 3 day week
• massive govt borrowing
• cultural revolution
• NHS paybeds dispute
• first 6 week plan (1979)

• reduction of state role
• greed culture
• pensions and PMI growth
• contracting out
• waiting lists at 1.3m
• BUPA hospitals
• growth of private dentistry

Services
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NHS in crisis when Labour came to power
UK healthcare in 1997

• Waiting lists over 1 million with 5 waiting over
  12 months
• Expenditure c 45bn p.a.
• Health expenditure per capita lower than most EU
  and OECD countries
• Health expenditure as of GDP lower than EU and
  OECD countries
• UK health outcomes poor
• 30 of NHS estate pre-dates 1948
• Fewer doctors and other healthcare professionals
  per head of population
• Low investment in health care technologies
• Poor morale amongst staff and staff shortages

New model and increased funding required
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Government policy since 1997 NHS remains free
at point of need

• Main Reforms
• Foundation Trusts (devolved decision making)
• Plurality of providers (introduction of
  independent sector)
• PCTs as commissioners (restructuring of PCTs)
• Practiced based commission (indicative
  commissioning budgets)
• Payment by results (Money follows the patient and
  providers are reward for the activity they
  undertake)
• Public and patient choice (choice of elective
  provider)
• New regulatory regime (Monitor, Healthcare
  Commission)
• Modernising Primary Care (GP access, long term
  conditions support, prevention, and integrating
  service with social care)

• Desired Outcome from Initiatives
• Reduce waiting times (18 weeks maximum wait from
  GP consultation)
• More choice to patients
• Deliver value for money by introducing market
  forces
• Create a sustainable independent sector market
• Reduce secondary care costs (using commissioning
  to drive prevention and disease management
  activities)
• Increased capacity in difficult areas
• Stimulate innovation and improvement within the
  NHS

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Independent Sector Involvement in UK Healthcare
Objectives of IS involvement
IS provision the challenges

• Centrally procured activities not necessarily
  what local population need
• Services must integrate with local NHS activities
• Suspicion from some quarters
• Multiple stakeholders SHAs, PCTs, Trusts, GPs,
  patients etc
• Must support SHAs and PCTs strategic objectives
• Substantial bid costs
• Additionality no NHS staff
• High profile / media interest

• Additional capacity
• Reduced waiting times
• Choice and contestability
• Plurality of providers
• Affordable innovative service models
• Improve productivity and VfM in NHS services
• Customer focus

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Activity continues to rise
Waiting lists / times down but activity continues
to rise
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Drivers of change
Demographics long term conditions
Consumer expectations
AMBITIOUS TARGETS eg 18 week
Medical advances
Financial pressures
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Ongoing demand drivers

• Demographics over 60s account for gt50 of costs
  and their population is increasingly
  significantly
• Medical advances reduced lengths of stay but
  more things can be treated, expenditure on drugs
  has more than doubled in the last 10 years
• Consumer expectation -increasing availability
  increases demand
• Long term conditions over 5m suffer from asthma
  and nearly 25 of population now obese

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New and intense future pressures

• Spending growth beyond 2008 likely to be below
  current NHS inflation
• Spend growth 2002 2008 approx 7 p.a. real
• Likely envelope beyond 2008 below 3 real
• Pay and prices inflation around 6 p.a
• Implies activity growth around zero, possibly
  negative, vs around 2 to 3 currently to meet
  demand
• Obstacles to further significant increases
• Public resistance to further tax rises
• Competing demands (schools funding aspiration,
  climate change, policing)
• The gap is supposed to be covered by NHS
  productivity increase but 2 target probably
  not being met

NHS expenditure 2008 and beyond
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Addressing the breadth and depth of NHS services
The NHS in 2015 - scope

• Rapidly evolving view of
• what the NHS does
• how it does it

• Different structures for provision
• National policy
• Quasi-independence (Bank of England model)
• NICE
• Local flexibility
• Mix of provision district generals, foundation
  trusts, IS
• PCT as commissioners
• Different scope of service
• Lifestyle treatments means tested
• Different culture
• Patient centred
• Accountable
• Commercial, marketing competence

• Royal Colleges

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Market Forces in Secondary care
Addressing the breadth and depth of NHS services
Brand Reputation Accessibility Environment Qualit
y Patient experience VfM
FOUNDATION TRUSTS
ISTCs
POLYCLINICS
PRIVATE HOSPITALS
Volume of Patients
Financial Performance
ACUTE TRUSTS
COMMUNITY HOSPITALS
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Does a modern NHS need marketing?
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Media representation
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Marketing techniques

• Developing relationships
• Brand building among key influencers
• Maximising appropriate patient referrals in to
  Netcare services
• Identifying new business opportunities
• Patient information

• Expensive advertising campaigns
• Hard sell
• Negative campaigning
• Scare tactics

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Supermarket Analogy
1970s
Supermarkets, on the High Street, 9am 5pm
Monday to Saturday
Brand development
Large choice Real VfM
High Quality Premium Price
Large choice Good value
Large out of town stores New specialist offerings
butchers counter, bakery, delicatessen Extended
opening hours
Smaller stores, Community based
Sainsburys
Local
Home delivery
New Competitors MS Food Lidl / Aldi
2007
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Supermarket Analogy
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Market Forces in Secondary care
Addressing the breadth and depth of NHS services
Brand Reputation Accessibility Environment Qualit
y Patient experience VfM
FOUNDATION TRUSTS
ISTCs
POLYCLINICS
PRIVATE HOSPITALS
Volume of Patients
Financial Performance
ACUTE TRUSTS
COMMUNITY HOSPITALS
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Critical Success Factors

• Partnership approach
• Open communication
• Agreed objectives
• Regular performance reviews
• Local engagement
• Multiple stakeholders
• Listening to local needs
• Communication
• Best clinical practice
• Consistent clinical pathway
• Pre-op infection screening
• Pain management and early mobilisation

• Innovation and efficiency
• Essential to demonstrate vfm
• Theatre utilisation
• Limited choice of prosthesis
• Supply chain partnerships
• SMS reminders
• Customer focus
• Staff who put the patient first
• Written and spoken information, DVDs and patient
  booklets
• Patient satisfaction surveys

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Provision of care the Netcare model
Clinical Approach
Customer Focus

• Staff who put the patient first
• Safe and clean environment
• Seen on time
• Written and spoken information
• Information on DVDs and patient booklets
• Patient satisfaction surveys
• Rapid response to complaints and concerns
• Telephone reminders and follow up

• Consistent clinical pathway
• One stop assessment
• Short length of stay
• Preoperative infection screening
• Minimum blood loss
• Pain management and early mobilisation
• Only relevant follow up
• Peer review and Clinical Advisory Board

• Good clinical outcomes
• Satisfied patients and families

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Customer Satisfaction
Everyone was so lovely and understanding at the
centre, I know that they have operated on
hundreds of knees but I felt very special and
certainly not just an operation number.  Since I
have returned home I have been able to take up
bowling again and although I still feel the odd
ache and pain I can just ring up my surgeon and
have a consultation. Alan Holmes, patient at the
Greater Manchester Surgical Centre.
An asset to the company. Nothing was too much
trouble, and always pleasant smiles from all.
Well done.
I have never come across another hospital that
thrives on cleanliness and makes patients feel so
relaxed. I found that patients come first.
My stay was excellent. Everyone was so lovely
and understanding at the centre.
It was a fantastic service.  The staff were
professional and polite, with a very pleasant
manner.   The operation was an absolute success,
with no complications, and I cant believe my
sight is so good. Ann Robinson, Morecombe,
Lancashire, our 20,000th ophthalmic patient
This was the most enjoyable experience of
healthcare I have ever received. It was
outstanding and should be what other places
aspire to be.
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Case Study - Mobile Cataract Units

• Innovative solution
• Bringing care almost to the patients doorstep
• Rotate between different locations, undertaking
  pre-operative assessments, surgery and
  post-operative care
• Single specialty allows high volume throughput
• Highly efficient
• 30 FTEs
• 95 uptake, 24,000 procedures completed
• Clinical outcomes presented to European Society
  for Cataract Refractive Surgeons

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Case Study - Mobile Cataract Units
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Case Study - Greater Manchester Surgical Centre
(GMSC)

• Refurbished NHS unit in Trafford
• Day surgery, inpatient and outpatient procedures
• 48 beds, 3 laminar flow theatres, rehab
  department, clinical support services
• Theatre utilisation
• Opening hours
• Labour management
• Productivity management
• Innovative pain management allows speedy
  rehabilitation and shorter length of stay

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Case Study - Stracthro

• Working in collaboration with NHS Scotland and
  Tayside, Grampian and Fife Health Boards on the
  first ISTC in Scotland
• Supporting rural communities to access healthcare
  closer to home
• Utilising NHS theatres, evening and weekends
• RMO Cover
• Recruiting 68 FTEs
• Supporting the local economy

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Case Study - Stracthro
Before Opening
After Opening
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Case Study - PPU

• BMI operate 9 PPUs on NHS sites
• Benefits
• Profit for re-investment
• Attract top consultants
• Brand profile
• National local marketing
• Purchase services from Trust
• Patient focus
• Relationships with insurers

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• Discussion