Derek Feeley: Scotland - why quality is the best response to the financial challenge

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Derek Feeley, Chief Executive at NHS Scotland, gives an overview of health care in Scotland, including the economic, demographic and population health challenges.

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  • Quality Strategy launched May 2010 Quality Alliance Board to challenge and ensure implementation to achieve aim of being a world leader Commitment to prioritise, align and ensure a coherent programme of local and national work underpinning Quality Strategy Ambitions Quality Outcomes and related measures, with national targets embedded Quality Strategy launched May 2010 Quality Alliance Board to challenge and ensure implementation to achieve aim of being a world leader Commitment to prioritise, align and ensure a coherent programme of local and national work underpinning Quality Strategy Ambitions Quality Outcomes and related measures, with national targets embedded Quality Strategy launched May 2010 Quality Alliance Board to challenge and ensure implementation to achieve aim of being a world leader Commitment to prioritise, align and ensure a coherent programme of local and national work underpinning Quality Strategy Ambitions Quality Outcomes and related measures, with national targets embedded
  • Smoothed the seasonal effect . Fit regression line: shows a marked acceleration over the most recent two year period. Why is this ? We cant say for certain – but one explanation is the cumulative additive effect of the many many small changes and improvements made across a nation. Made by you and the people you work with The so called aggregation of marginal gains The sum is greater than the whole- there is probably a synergistic effect beyond the simple addition or cumulation- achieving a critical mass. Fits with our thinking- focus on processes – and outcomes will follow – often after a delay or lag
  • Derek Feeley: Scotland - why quality is the best response to the financial challenge

    1. 1. The King’s Fund 2012 Annual Conference Derek FeeleyDirector General Health and Social Care and Chief Executive of NHS Scotland
    2. 2. NHS Scotland • c. 5.1 million population • Devolved (since 1999) • 14 Regional Boards • Integrated system ( e.g. no purchaser/ provider split) • Integration of health and social care underway • Tax funded/ cash limited • Equal access on basis of need • Free at the point of care
    3. 3. Health Budget Real Terms Summary overall Overall 00-01 01-02 02-03 03-04 04-05 05-06 06-07 07-08 08-09 09-10 10-11 11-12 12-13 13-14 14-15 Increase Increase £m £m £m £m £m £m £bn £bn £bn £bn £bn £bn £bn £bn £bn £bn % Health Budget (Cash) 5.521 6.162 6.474 7.227 8.048 8.790 9.531 10.215 10.642 11.058 11.182 11.369 11.583 11.803 11.946 6.425 116.4% Health Budget (Real at 2000-01 prices) 5.521 6.047 6.198 6.769 7.322 7.818 8.255 8.632 8.754 8.962 8.812 8.751 8.682 8.631 8.522 3.001 54.4% Health Budget Cash and Real Terms Summary 2000-01 to 2014-15 12 11 10 Budget 9 Cash £bn Real 8 7 6 5 00- 01- 02- 03- 04- 05- 06- 07- 08- 09- 10- 11- 12- 13- 14- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 Financial YearNote: This presentation provides a high level position based onpublished budget figures. It should be noted that budgets betweenyears are not directly comparable due to transfers between portfoliosand other budgetary and accounting adjustments (e.g. HM Treasurycost of capital removal)
    4. 4. Health spend – 4 nations Identifiable Expenditure per capita on Health, UK and countries, £2,5002,000 England1,500 Scotland Wales Northern Ireland1,000 UK identifiable expenditure 500 0 2007-08 2008-09 2009-10 2010-11 2011-12 Source: HM Treasury Oct 2012
    5. 5. Health spend – Scotland and English regions Identifiable spend per capita on health, Scotland and English Regions, £ Identifiable Expenditure per head2,500 on health, £ 2011-12 North East London 2,102 North West North East 2,0952,000 Yorkshire and North West 2,029 the Humber East Midlands Yorkshire and the Humber 1,9051,500 West Midlands West Midlands 1,865 East South West 1,771 London East Midlands 1,7281,000 South East East 1,711 South West South East 1,702 Scotland England 1,874, Scotland 2,091, 500 Source: HM Treasury, Oct 2012 0 2007-08 2008-09 2009-10 2010-11 2011-12Source: HM Treasury Oct 2012
    6. 6. 4 key challenges• Economic• Demographic• Population health• Changing expectations
    7. 7. Triple Aim The triple aim Health of the Population IntegrationExperience of Best Value Care for Money
    8. 8. 3 quality ambitions• Mutually beneficial partnerships between patients, their families and those delivering healthcare services. Partnerships which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making.• No avoidable injury or harm from the healthcare they receive, and that they are cared for in an appropriate, clean and safe environment at all times.• The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, with no wasteful or harmful variation.
    9. 9. HSMR Ja n- M ar 0.80 0.85 0.90 0.95 1.00 1.05 A 20 pr -J 0 un 8 Ju 2 l-S 00 ep 8 O 2 ct 1.03 -D 008 ec Ja n- 200 M 8 ar A 20 pr -J 0 un 9 Ju 2 l-S 00 ep 9 O 20 ct -D 0 ec 9 Ja n- 200 M 9 ar A 20 pr 1 10.6% -J un 0 Ju 2 l-S 01 ep 0 O 2 ct redu -D 010 c ec Ja n- 201 M 0 ar A 20 tion pr HSMR: Scotland -J 1 un 1 Ju 2 Jan. ’08  Mar. ‘12 l-S 01 ep 1 O 2 ct 6640 less than expected deaths -D 011Ja ec n- 20 M 11 ar 20 12 p 0.89
    10. 10. Hospital Standardised Mortality Ratios (Seasonally Adjusted) Scotland: Oct-Dec 2002 to Jan-Mar 2012 1.2 1.1 1.0Smoothed SMR 0.9 1.4% 0.8 average yearly average yearly reduction reduction 0.7 4.2% (Oct 2002 to Jan 2010) (Apr 2010 to Mar 2012) 0.6 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 Quarters
    11. 11. Implications for costs – what do we know? • Poor quality is costly • Costs and benefits are spread over time and between stakeholders • The context matters • Better data would help
    12. 12. Quality and cost - it’s complicated….Too bad all the people who know how to run the country are busy driving cabs and cutting hair. -- George Burns
    13. 13. Why quality?• Waste, harm and variation• Poor quality costs more• Clinical engagement• Thrive or survive?• Route to longer term sustainability• What is the alternative?
    14. 14. The alternative?
    15. 15. Or this…..?
    16. 16. Ja 0 1 2 0.5 1.5 2.5 n- 08Ap r- 0 8 Ju l-0 8O 1.15 ct -0 8Ja n- 09Ap r- 0 9 Ju l-0 9O ct -0 9Ja n- 10Ap r- 1 0 Ju l-1 0O ct -1 0 (per thousand patient days)Ja n- 11Ap r- 1 1 90% reduction Ju l-1 1O ct -1 1 0.12 Harm - General ward C.Difficile rate
    17. 17. Cost of infection
    18. 18. Cost of infection (Pennsylvania)
    19. 19. Tackling variation –high cost, high volume services
    20. 20. Bedday rate for patients aged 75+, emergency admissions 6500Bedday rate per 1000 aged 75+ 6000 Borders Lothian 5500 ~550 beds Board average 5000 Highland Ayrshire & Arran 4500 Tayside Re-shaping Care Prog/LTC Prog 4000 0 6 0 7 0 8 0 9 1 0 1 1 M ar- M ar- M ar- M ar- M ar- M ar- Sept-11 Year ending Prepared by Peter Knight JIT June12
    21. 21. Sustainability - quality and efficiency
    22. 22. Improving quality and reducing costs Our choice Surviving – the 3% Thriving – the 97%
    23. 23. The future - getting to the third curve Co-production & assetsPerformance Improvement Performance Time
    24. 24. "Quality is never an accident; it isalways the result of high intention, sincere effort, intelligent directionand skillful execution; it represents the wise choice of many alternatives.” 1941, William A. Foster

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