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Jennings Annual Conference 24.11.09

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Mark Jennings, Director of Health Care Improvement at The King's Fund, discusses the impact of the economic downturn on health care.

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Jennings Annual Conference 24.11.09

  1. 1. Quality in a Cold Climate: The Opportunities Mark Jennings Director of Health Care Improvement 24th November 2009 ©The King’s Fund 2009
  2. 2. + Quality NHS Plan Efficient care is quality care (2000 - 2011) (2011 on) •Growth •a new paradigm •‘Quality costs’ •Continuous •Productivity falls improvement + _ Siege Efficiency (2011 on) Cost Control •Fragmented system (1980s and 90s) •Wrong decisions •Slash and burn •Lower quality and •‘Efficient’ but lower efficiency quality _ ©The King’s Fund 2009
  3. 3. A New Health Care Paradigm Health care can only considered to be high quality if it is also efficiently delivered. ©The King’s Fund 2009
  4. 4. Why do you rob banks? "because that's where the money is." Will Sutton ©The King’s Fund 2009
  5. 5. Where is the money? Clinical reconfiguration? Moving care outside hospital? Estates rationalisation? Health and social care integration? Organisational restructuring? Improving what we already do? Variation in care and care delivery ©The King’s Fund 2009
  6. 6. Why look at variation? Improve cost Improve quality Improve effectiveness Improve patient experience ©The King’s Fund 2009
  7. 7. Natural variation Artificial variation Inevitable Created by the way characteristic of any the system is healthcare system managed Variation in patient Variation in the way characteristics the care is provided ©The King’s Fund 2009
  8. 8. Natural variation Artificial variation demographic differences: staff skills and skill mix – sex – age individual practice – socio-ecomonic status scheduling of staff and – race and ethnicity appointments time of year staff absence: type and severity of illness – planned absence – unplanned absence Patient & public expectations ward rounds geography availability of buildings availability of technology past spending patterns ©The King’s Fund 2009
  9. 9. Wennberg “Variations in Care are often idiosyncratic and unscientific with local medical opinion and local supply of resources appearing more important than science in determining how medical care is delivered” [J.Wennberg, BMJ, October 2002] ©The King’s Fund 2009
  10. 10. Unjustified variations in health care cause….. Increased cost Reduced quality ©The King’s Fund 2009
  11. 11. Variations in: What we do How we do it ©The King’s Fund 2009
  12. 12. ©The King’s Fund 2009
  13. 13. Inpatients Percentage of patients admitted on the day of operation 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Acute hospital trusts [Source: NHS Better Care, Better Value Indicators] ©The King’s Fund 2009
  14. 14. Outpatients 20.00 18.00 16.00 14.00 DNA Rate (%) 12.00 10.00 7.10% 8.00 6.00 4.00 2.00 0.00 0.00 0.50 1.00 1.90 1.50 2.00 2.50 3.00 3.50 4.00 Follow Up to New Ratio Follow Up/New Ratio to DNA% - Q1 2008/2009 [Source: NHS Better Care, Better Value Indicators] ©The King’s Fund 2009
  15. 15. ©The King’s Fund 2009
  16. 16. Programme budgets - Cancer ©The King’s Fund 2009
  17. 17. Thresholds Control chart for Standardised Admissions Ratios - Tonsillectomy 250 Standardised Admission Ratios 200 150 95% confidence limits 100 50 0 0 100 200 300 400 500 Expected number of cases [Source: NHS Better Care, Better Value Indicators] ©The King’s Fund 2009
  18. 18. Day surgery Day case rates for laparoscopic cholecystectomny [Source: NHS Institute Focus on HVC update 2008] ©The King’s Fund 2009
  19. 19. Prescribing [Source: NHS Better Care, Better Value Indicators] ©The King’s Fund 2009
  20. 20. Reactions to variation data The data is wrong The data is right, but it’s not a real problem The data is right, it’s a real problem but it’s not my problem The data is right, it’s a real problem ,and it’s my problem …………………but I don’t need to do anything about it Adapted from Jarman / Berwick ©The King’s Fund 2009
  21. 21. Push and Pull….. Push Pull ©The King’s Fund 2009
  22. 22. Thank you Mark Jennings Director of Health Care Improvement M.Jennings@kingsfund.org.uk +44 (0)777 1996410 ©The King’s Fund 2009

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