Professor Christine Beasley, CBE Partnership Development Director Modernisation Agency

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Professor Christine Beasley, CBEPartnership
Development DirectorModernisation Agency

• The Role of the
• Modernisation Agency in
• Modernising the Healthcare
• System

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Outline

• Brief Background to the NHS in England
• The work of the Modernisation Agency
• The Future of the Improvement System

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The History of the NHS

• NHS created 5 July 1948
• 1988 1997 Internal Market established - most
  significant cultural shift since inception
• Creation of independent organisations
• Collaboration, partnership, whole systems
  working
• Plurality of provision, patient choice
• Foundation Trusts

13 year old Sylvia Diggory 5 July 1948
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Current Structure

• Department of Health
• Sets overall policy on all health issues
• Responsible for provision of health services
  through the NHS
• Strategic Health Authorities
• Local headquarters of the NHS
• Responsible for performance managing the NHS
  Locally
• Primary Care Trust
• Responsible for commissioning of
  healthcare on behalf
• of their resident population
• Providing community services
• NHS Trusts
• Responsible for provision of healthcare

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NHS Facts and Figures

• In 2003 - 04
• 56 billion (96 billion) budget
• 1.3 million staff
• 28 Strategic Health Authorities
• 304 Primary Care Trusts
• 275 Hospital and Mental Health Trusts

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NHS Facts and Figures

• In a typical week
• Over 6 million people will visit their GP
• Nearly 1.5 million people will receive help
  in their home
• Over 800,000 people will be treated in NHS
  hospital outpatient clinics
• Over 10,000 babies will be delivered by the
  NHS
• NHS ambulances will make over 50,000
  emergency journeys
• NHS surgeons will perform around 1,200 hip
  operations, 30,000 heart operations and 1,050
  kidney operations

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The Old NHS

• Low levels of investment, staff shortages, poor
  accommodation
• Lack of good information and IT
• Little information or choice
• Small number of isolated quality projects
• Few staff with improvement skills

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The Challenge
The challenge is to maintain an NHS based on the
values of equity and social justice, but to
provide the flexibility, convenience and choice
demanded by 21st Century consumers
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NHS Core Principles

• The NHS will
• Provide a universal service for all based on
  clinical need, not ability to pay
• Provide a comprehensive range of services
• Shape its services around the needs and
  preferences of individual patients, their
  families and their carers
• Respond to different needs of different
  populations
• Work continuously to improve quality services and
  to minimise errors
• Support and value its staff
• Public funds for healthcare will be devoted
  solely to NHS patients
• Work together with others to ensure a seamless
  service for patients
• Help keep people healthy and work to reduce
  health inequalities
• Respect the confidentiality of individual
  patients and provide open access to information
  about services, treatment and performance

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The NHS Plan

• Published July 2000, set out a radical 10 year
  action plan
• Sets out measures to put patients and people at
  the heart of the health service
• Programme of increased funding (6.3) over 5
  years to 2004
• More power and information for patients
• More hospitals and beds
• More doctors and nurses
• Less waiting
• Cleaner, better food and facilities
• Improved care for older people
• Tougher standards for NHS organisations and
  rewards for the best

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The Mission of the Agency
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Definition

• Modernisation is the transformation of the
  delivery of care through the implementation of
  the NHS Plan

...the most ambitious healthcare improvement
programme anywhere in the world involving
fundamental change at every level in the largest
employer in Europe David Fillingham, MA
Director
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Perfect Healthcare

• No delays
• No waste
• No feelings of helplessness
• No needless pain
• No needless death
• (Professor Don Berwick and the
• IHI Pursuing Perfection Programme)

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A System for Improvement

• National standards and targets Top
• Significant new Investment Down
• Primary Care Trust Commissioning Bottom
• Greater Choice and Patient Power Up
• Service Redesign and Middle
• Organisational Development Out

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"Middle out creating an improvement
movement

• NHS Modernisation Agency
• Collaboratives, networks and communities of
  interest
• Investment in learning and development
• 150,000 NHS staff engaged

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Approaches

• Finding and applying leading edge practice
  improvement methodologies
• Engaging frontline staff - harnessing their
  energy to improve services
• Facilitating the exchange of ideas
• Teaching improvement techniques creating
  headroom for experimentation
• Supporting poor performers
• Policy development and implementation

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How the Agency works
NHSLEADERSHIPCENTRE
LEADERSHIP
NEW WAYS OF WORKING
WORKFORCE
CLINICALGOVERNANCESUPPORT TEAM
CLINICAL GOVERNANCE
INNOVATION KNOWLEDGE GROUP
INNOVATION IMPROVEMENT KNOWLEDGE
TECHNOLOGYIN HEALTHGROUP
HEALTH TECHNOLOGIES AND IT
PARTNERSHIPWORKING
PARTNERSHIPS DIRECTORATE
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No Delays
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Redesign of Emergency Care

• See and Treat
• New Job Roles
• Improving flow through hospitals
• Alternatives - Walk-in-Centres, NHS Direct
• Diagnostics
• Emergency Services Collaborative - (200
  hospitals, 800 project teams, 3000 staff)

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No Waste
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70 fewer medical outliers Sept 2002 August 2003
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No Needless Death
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No feelings of helplessness
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Improved mental health access

• 140 project teams from each of NIMHEs 8
  Development Centres
• 50 improvement in access times
• 50 booking initiatives
• Reduction in Did Not Attend Rates (DNAs) from 38
  to 14 (average)

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Ten High Impact Change for Service Redesign

• 1. Treat day surgery (rather than in-patient
  surgery) as the norm for elective
• surgery
• 2. Improve patient flow across the NHS system by
  improving access to key diagnostic tests
• 3. Manage variation in patient discharge thereby
  reducing length of stay
• 4. Manage variation in the patient admission
  process
• 5. Avoid unnecessary follow-ups for patients,
  providing necessary follow-ups in the right care
  setting
• 6. Increase the reliability of therapeutic
  interventions through a "care bundle" approach
• 7. Apply a systematic approach to care for people
  with chronic conditions
• 8. Improve patient access by reducing the number
  of queues
• 9. Optimise patient flow through service
  bottlenecks using process templates
• 10. Redesign and extend roles in line
  with efficient patient pathways to attract
• and retain an effective
  workforce

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Lessons and Next Steps

• Improvement projects alone dont lead to
  transformation
• Leadership at every level is critical
• System wide improvement requires action on many
  levels (Top Down, Bottom Up and Middle Out!)
• Public health and chronic disease management are
  the next great challenges
• Improvement activity unleashes enthusiasm,
  creativity and hope

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What can we do.5 Simple Rules

• See things through Patients eyes
• Find a better way of doing things
• Look at the whole picture
• Give front line staff the time and the tools to
  tackle the problems
• Take small steps as well as big leaps