Surviving the economic climate

Coping with NHS Cuts A Consultant's Survival Guide Dr Sabyasachi Bhaumik Medical Director – Leicestershire Partnership Trust Chair – Faculty of LD, RCPsych

Overview
Setting the scene
Current scenario
Shape of things to come
How to survive and possibly grow
Discussion – examples of innovative practice

Current scenario
Perspective of mental health services in the overall NHS context
Growth factors
Barriers to growth
Implications of zero growth budget

Current economic climate
£20 billion savings over next 5 years
30% or more in first 2 years
Emergency budget on 22 nd June
Public debt – increasing by £3 billion per week
Cost - £77000 per head
Local health economies – total place
PCTs (commissioners) perspective
Acute care trusts perspective
Mental health trusts perspective

Shape of things to come
Commissioning process
PCTs / PBCs
Provider services
PbR in mental health
Next Stage Review
Local health economies including shared services

How to survive & possibly grow!
Review everything you do
Individual level
Service level
Regional level
National level

What to review
Activity – NWW
Quality – Outcomes
Cost effectiveness
Always be aware of your competitors

Individual level (1)
Review what you are doing. Review your job plan. Does your practice line up with your specialties’ and Trust’s vision and objectives?
Record activity figures.
Audit your clinical practice and show evidence of providing quality services – 360 degree appraisal etc.

New ways of working for consultant psychiatrists.
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.
Delegate work and set small, measurable and agreed targets for projects. Use meetings to discuss outcomes rather than discuss issues.

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.
Keep up to date with CPD, appraisal, revalidation etc.
Keep up to date with not only clinical evidence but also with the changing political scenarios, policies etc – read HSJ.

Service level (1)
Review your service and set a vision with objectives
Concentrate on what the service does well and develop it further
Handover things that the service does not provide well
Engage other services for things they could do better (Together we grow stronger)
Invest in care pathways based on stepped care model.

Service level (2)
Care pathways
Framework for leaner system
Built on a platform of good relationship
Collaborative working is must
Multi agency
User / carer
Dynamic interaction with evidence base
Clinical Network should underpin the pathways.

Leaner working - system Self care Primary Care Community Psychiatry IP Specialist services

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

Service level (3)
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.
Invest in IT systems that are user friendly, relevant and compatible with other systems used by other providers for easy sharing of information.
Be innovative and develop services and teams which are virtual and needed for the local population and which is compatible with commissioning intent.

Service level (4)
Develop shared services with acute trusts, primary care and 3rd sector to use resources more efficiently.
Decommissioning of services – have a discussion with commissioners about decommissioning of certain services outside the Trust like OAP’s.
Establish outcome measures to provide commissioners with evidence of the quality of the service you provide.
Aim for FT status

Service level (5)
Learn from good practice in other regions and in the private sector.
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.
Develop training packages and organise conferences with the support of local specialists in your Trust.
Rationalise and question the time spent in meetings by staff in the service.

Regional & National level
Be actively involved with the respective Faculty of RCPsych to influence local decisions.
Be aware of national policies and strategic directions so that your are better prepared for changes.
Use market intelligence & business development schemes
Forge partnerships

Remember – Maintain quality whilst achieving efficiency
What is quality?
Professional perspective
User / carer perspective
Peer review
Dialogue with commissioners

Leading beyond authority
Horizon scanning – constantly gathering intelligence (always be one step ahead)
Influencing others – mutually beneficial trades
You have to loose small battles some times for a major victory
Keeping the bigger picture in mind all the time
Turning adversities in to opportunities if possible

Surviving the economic climate

by JP Rajendran on Aug 28, 2010

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