Update NHS England Nov 2013 Structure 1. Where do we want to be? - - PowerPoint PPT Presentation

Strategy Development Update

NHS England Nov 2013

Structure

• 1. Where do we want to be?
• 2. Where are we now?
• 3. How do we get there?

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Where do we want to be?

• Vision
• Legal/policy context
• Case for change

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Mandate commitment “to ensure the NHS becomes dramatically better at involving patients and their carers, and empowering them to manage and make decisions about their own care and treatment”

The NHS Mandate, 2012

Vision

• Authentic patient partnership – in their own care
• Services provided 'with' rather than 'to' or 'for' people
• Proactive, holistic, preventative and people-centred
• Collaborative endeavour with active patient involvement and

effective self-management support

• Transforming the relationship between patients and

clinicians

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Case for change?

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2 4 6 8 10 12 14 16 18 2000 2008 2016 Number with long-term conditions (millions) One LTC Two LTCs Three+ LTCs

Sources: ONS population projections and General Household Survey

Source: Department of Health analysis of ONS projections and GHS

Estimate for changes in co-morbidity patterns over the next decade, England

Rise of multiple LTCs vs increasing medical

• specialisation. Personalisation essential

What business are we really in?

• 15m with LTCs
• Massive rise in

population with multiple LTCs

• 50% GP

sessions

• 77% bed days
• 70% spend
• Mostly self

manage, 5800 waking hours pa

Recognising role/value of individuals/carers

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“Patient involvement is crucial to the delivery of appropriate, meaningful and safe healthcare…The goal is to achieve a pervasive culture that welcomes authentic patient partnership – in their own care”

. Berwick Report, 2013

Silent mis-diagnosis

• The problem of the silent misdiagnosis is

widespread.

• Several studies show that patients choose

different treatments after they become better informed.

• Wide gaps between what patients want and what

doctors think patients want.

• Finally, there are dramatic geographic variations

in care that can only partially be explained by causes other than the silent misdiagnosis.

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Stark financial position

• 4% rise in activity pa. Pay for activity (PbR) not patient
• capacity. Need honest debate.
• ‘Call to Action’ - £30 billion shortfall.

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Health Spending 1949-50 to 2010-11

Traditional NHS models will need to be radically rethought

• Need to transform health care from a system that is largely reactive to
• ne that is proactive, preventative and patient-centred and focuses on

supporting patients to self manage.

• Acute focused, episodic single disease models will not work alone. Need

personalised care planning to support & manage multiple LTCs.

• Active role for patients as PARTNERS, encouraged to become more

knowledgeable about their condition(s) and more actively involved in decisions about their care.

• Drawing on the asset value of individuals and communities – who have

multiple resources that can be mobilised to help people live healthier and more fulfilled lives.

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Passive Vs participative model of care

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Passive model Participative model

Acute – Poorly informed patients and paternalistic treatment Acute – Informed patients & shared decision making Primary care - Single disease treated

• reactively. 10 minute consultation

Primary Care - Personalised proactive care planned for multiple LTCs. Greater self management. Mental Health – treat and manage symptoms of disease. Dependency Mental Health – holistic support focused on wider personal goals. Greater self and peer support. Information one size fits all. Not a commissioned service Information and support services built into commissioning The consultation – single patient meets professional face to face Consultation in groups, peer support, expert patients, Skype Disjointed services for people with multiple morbidity. No care planning. Integrated services and personalised care planning

Where are we now?

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Where are we now?

• Where is the NHS now in terms of patient participation?
• What is the evidence base in terms of shared decision

making, support for self-management, personalised care planning (and personal health budgets)?

• What are the future trends (including technology and

personalised medicine) and public health/life course perspectives?

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Where are we now?

• What are patient/public enablers/barriers towards

participation (attitudes/ability)?

• What are workforce enablers/barriers to

participation (attitudes/ability)?

• Analysis of metrics, incentives and commissioning
• Analysis of existing work programmes

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How do we get there?

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Whole system approach

• Evidence of effectiveness and positive impacts on resource

use and costs but gaps remains

• Key challenges in terms of implementation – need whole

system approach

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House of Care

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House of Care Model

• Centre of the house – person-centred,

coordinated care

• Left wall – engaged, informed individuals &

carers

• Right wall – health & care professionals

committed to partnership working

• Foundations – commissioning, metrics,

incentives

• Roof – organisational & clinical processes

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Next steps……

• Pull together and edit draft (currently 110 pages!) and

identify draft priorities for action and research (Dec 13)

• Share thinking with key internal and external

stakeholders (with purpose to review and build partnerships) (Jan/Feb 14)

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