The Psychiatrist – saviour of
the cash strapped NHS?
Akmal Makhdum & Hashim Reza
May you live in interesting
times
NHS 1997-2010
 NSH Plan
 National Service Frameworks
 National Institute of Clinical Excellence
 Healthcare Commission...
NHS 1997-2010 – what changed?
 Waiting times
 Deaths from cancer & CV disease
 Health care associated infections
 Nati...
Mental Health Services 1997-2010
 Suicide Prevention Toolkit
 Assertive Community Treatment
 Crisis Resolution & Home T...
A high performing NHS
 Access
 Safety
 Clinical effectiveness
 Patient experience
 Equity
 Efficiency
 Accountabili...
NHS 1997-2010
£35 billion £110+ billion
Could this last forever?!
Liberating the NHS and an Information Revolution
The White Paper ‘Liberating the NHS’, published on the 12th July,
outline...
What does this mean for clinicians
• Patient access to the whole of their records electronically
• Initially in primary ca...
Care records
your records
form the
primary
source of data
Creating
intelligence
as data is
analysed
and
interpreted
The
In...
Creating
intelligence
as data is
analysed
and
interpreted
Care records
your records
form the
primary
source of data
The
In...
Creating
intelligence
as data is
analysed
and
interpreted
Care records
your records
form the
primary
source of data
The
In...
Creating
intelligence
as data is
analysed
and
interpreted
Care records
your records
form the
primary
source of data
The
In...
Moving away from targets to outcomes
• New frameworks for measuring NHS, social care and public health
outcomes create new...
InformationInformation
What is meant by ‘Information’?
InformationInformation
Patient
Records
Patient
Records
Patient
Records
Patient
Records
Patient
Records
Patient
Records
Pat...
InformationInformation
Patient
Records
Patient
Records
Patient
access
Coding
Standards
Governance
Security
Internal Extern...
InformationInformation
Patient
Records
Patient
Records
Patient
access
Condition
information
Condition
information
Treatmen...
Patient RecordsPatient Records
Patient
access
Condition
information
Condition
information
Treatment
information
Treatment
...
Information for autonomy, accountability and
democratic legitimacy
• A ‘presumption of openness’ when publishing data is c...
Jul 2010 Oct 2011 Jan Apr Jul Oct 2012 Jan Apr
Provisional overall timeline: July 2010 - June 2012Keymilestones
Overall
Wh...
Jul 2010 Aug Sep Oct Nov Dec Jan Feb Mar
Early engagement and action timeline: July 2010 – Mar 2011
Planning, performance ...
Fact and Facade
 Information Revolution another NPfIT?!
 Liberating – from jobs?!
 Demand to reduce £20 billion AND
 c...
The Process
 Monitoring
 Monitoring
 Monitoring
Monitoring
 Where you are?
 What are you doing?
 How are you doing it?
 How much of it are you doing?
Big Brother is w...
Unique Selling Product
What is your NHS Trust selling?
 Your Expertise
 Your Credentials
 Your Experience
Do you know t...
The new drivers
Current changes:
 What ideology?
 What place for ideology?
 What attachment NHS staff can have / afford...
Local options
 PBC
 Specialist commissioning
 Local types of specialist commissioning
 What out of county expenditure ...
Enter the saviour!
 Meet the commissioner(s)
 Identify needs of specialist commissioning in
your area
Think outside the box!
 Create a consortium
 Create a social enterprise
 Employee-Employer partnership
 Develop new bu...
 Think of business within …
 … and business without NHS
Your unique value
 Practice based experience
 Experience based evidence
 Basis for a new model of delivery
How will you...
Marketing the new model
 Your organisation
 Others
Yourself, your ideas
Coherently expressed in business jargon
Survival skills
 Seen a bid?
 Written a bid?
 What about a business plan?
Do nothing!
 Salary freeze – already here
 Job cuts – proposed & planned
When is your turn?
May you come to the
attention of powerful people
May you find what you are
looking for
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Psychiatrist - Saviour of the Cash Trapped NHS - Akmal Makhdum and Hashim Reza

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  • 68.9 billion in 2002-03
    63.2 billion in 2001-02
  • Psychiatrist - Saviour of the Cash Trapped NHS - Akmal Makhdum and Hashim Reza

    1. 1. The Psychiatrist – saviour of the cash strapped NHS? Akmal Makhdum & Hashim Reza
    2. 2. May you live in interesting times
    3. 3. NHS 1997-2010  NSH Plan  National Service Frameworks  National Institute of Clinical Excellence  Healthcare Commission  National Patient Surveys  National Staff Surveys  Foundation Trusts  QIPP / QSIP / CQUIN
    4. 4. NHS 1997-2010 – what changed?  Waiting times  Deaths from cancer & CV disease  Health care associated infections  National standards of care for major diseases  Information on performance  Smoking rates
    5. 5. Mental Health Services 1997-2010  Suicide Prevention Toolkit  Assertive Community Treatment  Crisis Resolution & Home Treatment  Early Intervention in Psychosis  Payment by Results  HoNOS PbR / Care Packages Programme / MH Clustering
    6. 6. A high performing NHS  Access  Safety  Clinical effectiveness  Patient experience  Equity  Efficiency  Accountability  Health promotion  Management of long-term conditions
    7. 7. NHS 1997-2010 £35 billion £110+ billion Could this last forever?!
    8. 8. Liberating the NHS and an Information Revolution The White Paper ‘Liberating the NHS’, published on the 12th July, outlined government plans for a new direction for the NHS, including an ‘information revolution’ and greater patient choice and control. Vision for an information revolution People have access to their health records and the information they need to make informed choices about their health and care. “No decision about me, without me” Liberating NHS information will help drive better care, improving outcomes , innovation and the better use of resources.
    9. 9. What does this mean for clinicians • Patient access to the whole of their records electronically • Initially in primary care but later all records • More patient and public facing information about health and care options • Information derived from care records to be harnessed • To assess care quality – and to help improve it • To find and disseminate best practice • To highlight areas of poor performance or waste
    10. 10. Care records your records form the primary source of data Creating intelligence as data is analysed and interpreted The Information revolution The Information Revolution
    11. 11. Creating intelligence as data is analysed and interpreted Care records your records form the primary source of data The Information revolution 1.4 Leading to patient-centred care Improving service quality and outcomes for you Giving you greater ownership & control over your care Encouraging clinicians and care professionals to respond to your needs and capture data at the point of care Enabling you to make properly informed choices Leading to easily understandable Information published by a range of organisations to meet your needs Improving data quality as data is exposed to professional scrutiny and the quality of data improves Leading to greater transparency through routine publication of core data The main source for aggregate data for secondary uses such as research Enabling more direct communication between you & your professional Allowing you to share information from your record with others Promoting benchmarking of outcomes by clinicians Promoting benchmarking of outcomes by clinicians
    12. 12. Creating intelligence as data is analysed and interpreted Care records your records form the primary source of data The Information revolution 1.5 Leading to patient-centred care Giving you greater ownership & control over your care Encouraging clinicians and care professionals to respond to your needs and capture data at the point of care Enabling you to make properly informed choices Leading to easily understandable Information published by a range of organisations to meet your needs Improving data quality as data is exposed to professional scrutiny and the quality of data improves Leading to greater transparency through routine publication of core data The main source for aggregate data for secondary uses such as research Enabling more direct communication between you & your professional Allowing you to share information from your record with others Promoting benchmarking of outcomes by clinicians Improving service quality and outcomes for you Improving service quality and outcomes for you
    13. 13. Creating intelligence as data is analysed and interpreted Care records your records form the primary source of data The Information revolution 2.4 Giving you greater ownership & control over your care Encouraging clinicians and care professionals to respond to your needs and capture data at the point of care Enabling you to make properly informed choices Enabling more direct communication between you & your professional Allowing you to share information from your record with others Promoting benchmarking of outcomes by clinicians Improving service quality and outcomes for you Leading to patient-centred care The main source for aggregate data for secondary uses such as research Leading to greater transparency through routine publication of core data Improving data quality as data is exposed to professional scrutiny and the quality of data improves Leading to easily understandable Information published by a range of organisations to meet your needs Leading to easily understandable Information published by a range of organisations to meet your needs
    14. 14. Moving away from targets to outcomes • New frameworks for measuring NHS, social care and public health outcomes create new opportunities for improvement and accountability* • We will consider how outcomes information may be mandated in Quality Accounts • We are undertaking a fundamental review of data collections in health and social care. There will be a public consultation on this in 2011 • This will introduce a new focus on patient and service-user generated information such as patient reported outcomes measures (PROMS), patient and service user experience, ratings and real-time feedback • Information must support GPs to take commissioning decisions and local authorities to integrate health and social care *Transparency in Outcomes – a framework for the NHS’ consultation launched 19 July
    15. 15. InformationInformation What is meant by ‘Information’?
    16. 16. InformationInformation Patient Records Patient Records Patient Records Patient Records Patient Records Patient Records Patient Records Patient Records Patient Records Patient Records Patient Records Patient Records GP HospitalCommunity Linkage then interoperability Patient access Initially Subsequently
    17. 17. InformationInformation Patient Records Patient Records Patient access Coding Standards Governance Security Internal External AuditAudit Quality assuranceQuality assurance Capacity planningCapacity planning FinanceFinance ResearchResearch RevalidationRevalidation Public healthPublic health CommissioningCommissioning ImprovementImprovement RegulationRegulation
    18. 18. InformationInformation Patient Records Patient Records Patient access Condition information Condition information Treatment information Treatment information Organisation information Organisation information Individual team/ clinician information Individual team/ clinician information
    19. 19. Patient RecordsPatient Records Patient access Condition information Condition information Treatment information Treatment information Organisation information Organisation information Individual team/ clinician information Individual team/ clinician information Medical jargon Trustworthiness Routes of access Timeliness Interpretation Conflicting information Transparency
    20. 20. Information for autonomy, accountability and democratic legitimacy • A ‘presumption of openness’ when publishing data is crucial for accountability • Wider availability of data will allow ‘information intermediaries’ to cater for people with a range of needs (including people who do not themselves presently use computers) • We are identifying national data sets for early release • We attach great importance to ensuring trust in published data
    21. 21. Jul 2010 Oct 2011 Jan Apr Jul Oct 2012 Jan Apr Provisional overall timeline: July 2010 - June 2012Keymilestones Overall White Paper Published Health Bill Public health White Paper NHS Board begins. in shadow form NHS Board and economic regulator take up full powers New public health service operational 2012/132011/12 Report on funding of long- term care and support White Paper on social care reform (during 2011) Shadow health and wellbeing partnerships begin Publications on social care, choice, information, education and data returns Spending Review released New Spending Review period begins 2011/12 allocations 11/12 QIPP/ operational planning complete 2012/13 allocations 12/13 QIPP/ operational planning complete First GP Consortia start work in shadow form (from 2011/12) Finance and efficiency Autonomy and accountabilityPolicy and legislation Additional White Paper Consultations Local health and wellbeing boards and HealthWatch established Choice extended to long-term conditions and diagnostics (from 2011) Choice of consultant-led team; expansion of PROMs Free choice of GP practiceExtension of choice in mental health (ongoing) A patient-led NHS Outcomes Framework fully implemented Outcomes Framework comes into use Further publication on Outcomes Framework Initial consultation on Outcomes Framework Improving healthcare outcomes
    22. 22. Jul 2010 Aug Sep Oct Nov Dec Jan Feb Mar Early engagement and action timeline: July 2010 – Mar 2011 Planning, performance and QIPP First submission QIPP and Reform plan and QIPP tertial review at SHA level QIPP and Reform plan and QIPP tertial review at SHA level White Paper consultation processes NHS Chief Executive visits every region National stakeholder engagement Regional and local stakeholder engagement Development of QIPP plans to include reform New commissioner / provider leads and bridging functions in place at DH and in SHAs DH planning with Monitor and CCP for creation of Economic Regulator Identification of likely first GP commissioning consortia Development process for first GP commissioning consortia Capability development for GP commissioning consortia (ongoing) Engagement and consultation Policy design and implementation Work to drive and accelerate the Foundation Trust pipeline
    23. 23. Fact and Facade  Information Revolution another NPfIT?!  Liberating – from jobs?!  Demand to reduce £20 billion AND  coalition promise: “no clinical services will be cut” …  “may be cut” …  “will have to be cut” …  “these are the cuts!”
    24. 24. The Process  Monitoring  Monitoring  Monitoring
    25. 25. Monitoring  Where you are?  What are you doing?  How are you doing it?  How much of it are you doing? Big Brother is watching you!
    26. 26. Unique Selling Product What is your NHS Trust selling?  Your Expertise  Your Credentials  Your Experience Do you know that they know?
    27. 27. The new drivers Current changes:  What ideology?  What place for ideology?  What attachment NHS staff can have / afford?  Stock market – the new god that failed Time for psychiatrists to reconsider their options
    28. 28. Local options  PBC  Specialist commissioning  Local types of specialist commissioning  What out of county expenditure on each?  What are your local PBC priorities?
    29. 29. Enter the saviour!  Meet the commissioner(s)  Identify needs of specialist commissioning in your area
    30. 30. Think outside the box!  Create a consortium  Create a social enterprise  Employee-Employer partnership  Develop new businesses None of these options possible without YOUR clinical leadership
    31. 31.  Think of business within …  … and business without NHS
    32. 32. Your unique value  Practice based experience  Experience based evidence  Basis for a new model of delivery How will you market the new model?
    33. 33. Marketing the new model  Your organisation  Others Yourself, your ideas Coherently expressed in business jargon
    34. 34. Survival skills  Seen a bid?  Written a bid?  What about a business plan?
    35. 35. Do nothing!  Salary freeze – already here  Job cuts – proposed & planned When is your turn?
    36. 36. May you come to the attention of powerful people
    37. 37. May you find what you are looking for

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