Surviving the economic climate


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Surviving the economic climate

  1. 1. Coping with NHS Cuts A Consultant's Survival Guide Dr Sabyasachi Bhaumik Medical Director – Leicestershire Partnership Trust Chair – Faculty of LD, RCPsych
  2. 2. Overview <ul><li>Setting the scene </li></ul><ul><ul><li>Current scenario </li></ul></ul><ul><ul><li>Shape of things to come </li></ul></ul><ul><li>How to survive and possibly grow </li></ul><ul><li>Discussion – examples of innovative practice </li></ul>
  3. 3. Current scenario <ul><li>Perspective of mental health services in the overall NHS context </li></ul><ul><li>Growth factors </li></ul><ul><li>Barriers to growth </li></ul><ul><li>Implications of zero growth budget </li></ul>
  4. 4. Current economic climate <ul><li>£20 billion savings over next 5 years </li></ul><ul><li>30% or more in first 2 years </li></ul><ul><li>Emergency budget on 22 nd June </li></ul><ul><li>Public debt – increasing by £3 billion per week </li></ul><ul><li>Cost - £77000 per head </li></ul><ul><li>Local health economies – total place </li></ul><ul><li>PCTs (commissioners) perspective </li></ul><ul><li>Acute care trusts perspective </li></ul><ul><li>Mental health trusts perspective </li></ul>
  5. 6. Shape of things to come <ul><li>Commissioning process </li></ul><ul><li>PCTs / PBCs </li></ul><ul><li>Provider services </li></ul><ul><li>PbR in mental health </li></ul><ul><li>Next Stage Review </li></ul><ul><li>Local health economies including shared services </li></ul>
  6. 7. How to survive & possibly grow! <ul><li>Review everything you do </li></ul><ul><ul><li>Individual level </li></ul></ul><ul><ul><li>Service level </li></ul></ul><ul><ul><li>Regional level </li></ul></ul><ul><ul><li>National level </li></ul></ul>
  7. 8. What to review <ul><li>Activity – NWW </li></ul><ul><li>Quality – Outcomes </li></ul><ul><li>Cost effectiveness </li></ul><ul><li>Always be aware of your competitors </li></ul>
  8. 9. Individual level (1) <ul><li>Review what you are doing. Review your job plan. Does your practice line up with your specialties’ and Trust’s vision and objectives? </li></ul><ul><li>Record activity figures. </li></ul><ul><li>Audit your clinical practice and show evidence of providing quality services – 360 degree appraisal etc. </li></ul>
  9. 10. Individual level (2) <ul><li>New ways of working for consultant psychiatrists. </li></ul><ul><li>Think innovatively and reduce wastage and duplication in your work – Lean thinking. Apply this for your management responsibilities too – attend fewer meetings and only those relevant to you. </li></ul><ul><li>Delegate work and set small, measurable and agreed targets for projects. Use meetings to discuss outcomes rather than discuss issues. </li></ul>
  10. 11. Individual level (3) <ul><li>Review your specialist skills and volunteer to use those skills to develop a service or acquire specialist skills to provide a better service. Develop your specialist skills in line with local population needs and commissioning intent. Develop a niche area so that regional services may also depend on you. </li></ul><ul><li>Keep up to date with CPD, appraisal, revalidation etc. </li></ul><ul><li>Keep up to date with not only clinical evidence but also with the changing political scenarios, policies etc – read HSJ. </li></ul>
  11. 12. Service level (1) <ul><li>Review your service and set a vision with objectives </li></ul><ul><li>Concentrate on what the service does well and develop it further </li></ul><ul><li>Handover things that the service does not provide well </li></ul><ul><li>Engage other services for things they could do better (Together we grow stronger) </li></ul><ul><li>Invest in care pathways based on stepped care model. </li></ul>
  12. 13. Service level (2) <ul><li>Care pathways </li></ul><ul><li>Framework for leaner system </li></ul><ul><li>Built on a platform of good relationship </li></ul><ul><li>Collaborative working is must </li></ul><ul><ul><li>Multi agency </li></ul></ul><ul><ul><li>User / carer </li></ul></ul><ul><li>Dynamic interaction with evidence base </li></ul><ul><li>Clinical Network should underpin the pathways. </li></ul>
  13. 14. Leaner working - system Self care Primary Care Community Psychiatry IP Specialist services
  14. 15. Self Care Health Promotion Self guided care for Long term conditions Sign posting Building bridges with GPs Mental Health services in Primary care (IAPT etc) Primary care Secondary care Care pathways based on stepped care model Workforce development New ways of working Skills development in Primary care IP / Specialized Reaching out to community Early intervention to shorten the stay Skills development in lower tier Voluntary sector
  15. 16. Service level (3) <ul><li>Plan your workforce by reviewing their skills mix in line with care pathways and provide training accordingly. Workforce planning should be with a long term plan and not reactionary. </li></ul><ul><li>Invest in IT systems that are user friendly, relevant and compatible with other systems used by other providers for easy sharing of information. </li></ul><ul><li>Be innovative and develop services and teams which are virtual and needed for the local population and which is compatible with commissioning intent. </li></ul>
  16. 17. Service level (4) <ul><li>Develop shared services with acute trusts, primary care and 3rd sector to use resources more efficiently. </li></ul><ul><li>Decommissioning of services – have a discussion with commissioners about decommissioning of certain services outside the Trust like OAP’s. </li></ul><ul><li>Establish outcome measures to provide commissioners with evidence of the quality of the service you provide. </li></ul><ul><li>Aim for FT status </li></ul>
  17. 18. Service level (5) <ul><li>Learn from good practice in other regions and in the private sector. </li></ul><ul><li>Assessing the CPD and training needs of staff in the service and providing in house training in mass may reduce the amount of money spent on study leave. </li></ul><ul><li>Develop training packages and organise conferences with the support of local specialists in your Trust. </li></ul><ul><li>Rationalise and question the time spent in meetings by staff in the service. </li></ul>
  18. 19. Regional & National level <ul><li>Be actively involved with the respective Faculty of RCPsych to influence local decisions. </li></ul><ul><li>Be aware of national policies and strategic directions so that your are better prepared for changes. </li></ul><ul><li>Use market intelligence & business development schemes </li></ul><ul><li>Forge partnerships </li></ul>
  19. 20. Remember – Maintain quality whilst achieving efficiency <ul><li>What is quality? </li></ul><ul><ul><li>Professional perspective </li></ul></ul><ul><ul><li>User / carer perspective </li></ul></ul><ul><ul><li>Peer review </li></ul></ul><ul><ul><li>Dialogue with commissioners </li></ul></ul>
  20. 21. Leading beyond authority <ul><li>Horizon scanning – constantly gathering intelligence (always be one step ahead) </li></ul><ul><li>Influencing others – mutually beneficial trades </li></ul><ul><li>You have to loose small battles some times for a major victory </li></ul><ul><li>Keeping the bigger picture in mind all the time </li></ul><ul><li>Turning adversities in to opportunities if possible </li></ul>