Ben Richardson - Driving change in the NHS - what are the solutions?
Scaling up how we meet thedifferent needs of older peopleHow can we learn from what works and better care for olderpeople in a time of constrained resources?Ben RichardsonMcKinsey & Company
Needs of high risk patients are intenseSOURCE: McKinsey team analysis, NHS NWL data; HES 2010/11, FIMS, Q research/NHS Information centre, PSSEX;NHS Reference CostsTotal / averageVeryhighHighModerateLow riskVery low378,020322,609142,77341,6754,7571041863543271883005002,4008,70039,600~890,000 1,230 1168Average cost percapita per annum, £Totalspend, £mPopulation2010/11 data, 4 LondonCCGs1 Includes elective admissions, outpatient, and A&E 2 Includes community health & primary careThere is a 40X variationin spend (and needs)between average andhighest risk patientsHealth spendSocial care spend130xdifferencein cost!
Elderly are massively weighted to highestrisk groups compared to rest of population44%26%37%Very Low RiskLow RiskMedium RiskHigh RiskVery HighRiskElderly0%27%40%8%Non-elderly16%3% 0%3%highrisk48%veryhighandhighrisk
Clear impact delivered by leading modelsjustifies investment even in tough times0 200 400 600 800CareMoreChen MedUSAdmissions Rate/10000 1000200030004000CareMoreUSTorbayUKBed days Rate/1000
Success stories have commonthemes of what they doDelivery matched toneedsSegmentationPatient/user partnershipAccountability andgovernanceClinical leadershipInformation and IT Payment mechanism
Why we don’t manage to deliver what hasbeen proven to work elsewhereYou dowhat?!That won’t workhereWe aren’t paidto do thatUnfortunately, we don’t have ITsystems thatcan do thatWe don’thave timeI don’tknow howI don’t knowanyone whodoes it likethat
Potential ways to encourage rapid spreadof proven models– Mandate integrated data sets everywhere withtransparent reporting in UK– Create new payment mechanism to createincentives and let system respond– Create at scale innovation with pool of £100m for10 leading experiments, with clear set ofrequirements– Commission directly a new model of care– Spur chains to roll out proven formats withprequalification– Wait and hope that someone else fixes it…..