The document discusses the challenges facing the UK National Health Service (NHS) and the proposed reforms to address these challenges. It notes that healthcare systems around the world are struggling to balance costs and access to services. The NHS reforms aim to shift more services to community settings, better manage long-term conditions, and reduce wait times from 18 weeks for treatment. Health managers will need skills in change management, leadership, efficiency, and performance management to successfully implement the reforms.

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”