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Big picture thinking
Big picture thinking
Big picture thinking
Big picture thinking
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Big picture thinking
Big picture thinking
Big picture thinking
Big picture thinking
Big picture thinking
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Big picture thinking

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NHS Scotland 2009

NHS Scotland 2009

Published in: Business, Health & Medicine
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  • 1. Seeing the Bigger Picture The NHS in transition Charlotte Leggatt MDN Northern Region Facilitator
  • 2. Aims of the session
    • Why does the NHS need to change?
      • A world picture
      • Economic Change
      • Societal Change
      • Demographic Change
      • What are the reforms proposed
      • What skills will Managers need
  • 3. A World Picture
    • Many Countries (western and third world) are tackling the difficulties of health inequality
    • Scotland is not on its own – everyone is attempting to balance the financing, organisation and delivery of services against the deeply held moral imperatives to maintain and improve on equity of services
  • 4. THE USA – a topical issue!!
    • Most expensive form of healthcare
    • Single major reason for bankruptcy in the USA
    • Obama – Healthcare for all
    • Focusing on value, ratio of quality to cost
    • Improving healthcare
  • 5. The USA – How do they intend to do it
    • Increase use of technology
    • Research & incentives to improve medical decision making
    • Reduce tabacco use and tackle obesity
    • Reform the payment of providers to ensure efficiency
  • 6. The Global Economy
  • 7.
    • Less than anticipated uplift
    • Higher than anticipated Pay Award
    • Significantly increased energy costs
    • Agreed developments from some years ago
    • Many Health Boards have underlying financial deficits
    • Financial pressures 2008/2009:
  • 8.
    • £1618 per head of population Scotland is average health expenditure
    • Lowest is £1583
    • Highest is £1889
    • This is affected by deprivation and rurality
    • Known further 10% cut in public services
    • Public policy economists suggest 20% may be more realistic
  • 9. A Changing Society
    • Technological Advances - unrelenting
    • Expectations – 24/7 society
    • Growth of consumerism
    • Educated society – means we challenge everything
    • Competition
    • Modern Industry needs Innovation and Creativity
    • Management vs Leadership
  • 10. Demographics
    • A shrinking and ageing population = critical policy challenges for Scottish Executive
    • Age rate is rising – births are falling
      • 2002 800,000 over 75s
      • 30% rise will mean that by 2042 1.3 million
      • 2002 800,000 under 15s
      • 30% fall wil mean by 2042 620,000
  • 11. Demographics – what does this really mean for society
    • Population is declining faster than any other EU country
      • Economic, social and cultural challenges
      • Greater demands for NHS services
      • The “grey electorate” will note vote for those not representing their direct interests
      • Has an impact on earnings, employment, mobility, savings, consumption and housing
  • 12. Demographics – impact on health services
    • Most people use services in the last few years of life
    • Living longer places a greater demand on services
    • Labour marker shortages
    • Less taxation = less funding
  • 13. Long Term Conditions
    • LTC are growing at a faster rate in Scotland than many of our counterparts
    • 80% of GP appointments are for chronic disease
    • 60% of hospital in patients are for those with chronic disease
    • Chronic disease increases with age
  • 14. Long Term Conditions
    • COPD to rise by a predicted 33%
    • Diabetes – 1 patient every 40 minutes in the UK being diagnosed
    • Depression – WHO believes 2 nd major chronic disease in the next 20 yrs.
    • Enoch Powell in his more unpopular years said “any health service faces the problem of infinite demand meeting finite resources”
  • 15. Or put another way Capacity and demand are out of kilter
  • 16. Kerr Report 2005
    • “ ..the next twenty years will see an ageing population, a continuing shift in the pattern of disease towards long term conditions and a growing number of older people with multiple conditions and complex needs. These changes in themselves will make the current model of health care delivery unsustainable”
  • 17. Better Health Better Care
    • Sustainable services close to home
    • A shift in the balance of care from the hospital to community settings
    • Proactive rather than reactive care
    • Community Health Partnerships to act as the bridge between primary and secondary care, working in partnership with LA.
  • 18. General Practice and Heat Targets
    • These are the Government’s priorities for Health Care in Scotland (devolved function)
      • Health Improvement
      • Efficiency and Governance
      • Access
      • Treatment
  • 19. Heat Targets
    • Access
      • Ensure that anyone contacting their GP surgery has guaranteed access to a GP, nurse or other health care professional within 48 hours
      • The maximum wait from urgent referral to treatment for all cancers is 2 months
      • No patient will wait longer than 15 weeks from GP referral to first outpatient appointment from 21 st March 2009 (18WRTT by 2011)
  • 20. Heat Targets
    • Efficiency and Governance cont’d
      • To increase the % of new GP outpatient referrals into consultant led secondary care services that are triaged on line for clinical priority and appropriate service to 90% from Dec 2010
  • 21. Heat Targets
    • Efficiency and Governance
      • Achieve a sickness absence rate of 4% from March 2009
      • To operate within their agreed revenue resource limit; operate within their capital resource limit; meet their cash requirement
      • To meet efficiency targets
      • Universal utilisation of CHI
  • 22. Heat Targets
    • Treatment
      • Reduce the proportion of over 65s who are admitted as an emergency inpatient two or more times in a single year by 20%
      • Reduce admissions for patients with COPD, Asthma, Diabetes and CHD
      • Reduce the annual rate of antidepressants
      • Reduce the number of re-admissions for those with psychiatric problems
  • 23. 18 Week RTT Service Re-Design & Transformation
      • One of the most significant reforms in the history of the NHS and it will transform service delivery
  • 24. Specific Measure for 18RTT
    • “ A whole journey waiting time target of 18 weeks from general practitioner referral to treatment ….. by December 2011”
    • Cabinet Secretary for Health & Wellbeing – Official Report 26 th June 2007
  • 25. Real opportunity for radical change CATALYSTS FOR CHANGE 18 weeks referral to treatment Financial pressures Aging population European working time directive Shorter waiting times Mental health Long term conditions
  • 26. 18 Weeks RTT: High Level Themes Improve Referral Management & Access to Diagnostics (Pathways) Redesign of Pathways (ENT, Ortho, Diabetes) Corporate Enabling Activities Actively Manage Follow Ups Actively Manage Admissions and Discharges Theatres & Treat Day Surgery as the Norm Define, Measure, Monitor and Performance Manage Management of Waiting Lists / Appointments 18 Weeks RTT Service Re-Design and Transformation 2008-2011
  • 27. 2008/09 Practice Direct Impact (£203.4m)
  • 28. Whole System Re-design Hospital Care = £££ The changing role of the GP Collaborative Working Social Care Community Nursing Patient Expectations Non health related issues Extended role of Primary Care
  • 29. Whole System Re-design in practice
    • Recognising the need for change
    • Excellent Project Management
    • Collaborative and partnership working
    • Understanding the role of all concerned
    • Using all areas appropriately
    • Involving only those appropriate in service re-design (inputs and outputs).
  • 30. What skills will Managers Need
    • The ability to manage change
    • The ability to manage projects
    • Leadership (Visionary) Skills
    • Interpersonal (People) Skills
    • The ability to make tough decisions
    • The ability to make the organisation more efficient
    • The ability to manage performance/capability
    • The ability to manage risk
  • 31. On a personal level, from one to another
    • The art of self preservation
    • Self belief
    • Self confidence
    • The ability to keep moving forward when you would rather not be there
    • The ability to self motivate because who else is going to do it for you
  • 32. If you remember nothing else…..
    • On Leadership - “I suppose leadership at one time meant muscles, but today it means getting along with people” Ghandi
    • On Change Management – “Keep your fears to yourself but share your inspiration with others” Robert Louis Stevenson
  • 33. On self belief
    • “ For me life is continously being hungry. The meaning of life is not simply to exist, to service, but to move ahead, to go up, to achieve, to conquer”
    • Any guesses???
  • 34. He also said this – his mantra
    • “ I want to be the best built man in the world. I will go to America and be in movies. I will marry a beautiful woman, be happy and will one day be a very important man in America”

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