Transcript The NHS in a time of austerity

The NHS in a time of austerity
James Gubb, Civitas
www.civitas.org.uk/nhs
Image Source: HSJ
Public finances
Source: IFS, HM Treasury
Fiscal tightening
Source: IFS, HM Treasury
Real cuts in funding
Source: IFS
Shortfall in NHS funding
Source: IFS, King’s Fund
Slow uptake not fully engaged
Source: King’s Fund
NHS productivity
Driving value
Microcosm of inefficiencies
1. Use of resources
0
Isle of Wight Healthcare PCT
County Durham PCT
Gateshead PCT
Westminster PCT
Lincolnshire Teaching PCT
East Lancashire PCT
Barking and Dagenham PCT
Blackburn with Darwen Teaching PCT
Oxfordshire PCT
Warrington PCT
Salford Teaching PCT
Derbyshire County PCT
Hastings and Rother PCT
South Birmingham PCT
Derby City PCT
Tower Hamlets PCT
East Sussex Downs and Weald PCT
Somerset PCT
Dorset PCT
Southwark PCT
Newcastle PCT
Bedfordshire PCT
Portsmouth City Teaching PCT
Shropshire County PCT
Nottingham City PCT
Bournemouth and Poole Teaching PCT
Heywood, Middleton and Rochdale PCT
Leicestershire County and Rutland PCT
Hammersmith and Fulham PCT
Peterborough PCT
Knowsley PCT
Redcar and Cleveland PCT
Berkshire West PCT
Haringey Teaching PCT
Lambeth PCT
Buckinghamshire PCT
Berkshire East Teaching PCT
North Somerset PCT
Bromley PCT
Lewisham PCT
Norfolk PCT
Rotherham PCT
Devon PCT
Croydon PCT
Coventry Teaching PCT
Cumbria PCT
Sutton and Merton PCT
Hillingdon PCT
Solihull Care Trust
West Hertfordshire PCT
Trafford PCT
Waltham Forest PCT
Liverpool PCT
City and Hackney Teaching PCT
North Yorkshire and York PCT
Ealing PCT
Leeds PCT
Gloucestershire PCT
Central and Eastern Cheshire PCT
Herefordshire PCT
Sheffield PCT
West Essex PCT
Wirral PCT
Stockton-on-Tees Teaching PCT
Bassetlaw PCT
Wandsworth PCT
Milton Keynes PCT
Heart of Birmingham Teaching PCT
Birmingham East and North PCT
Wolverhampton City PCT
Bradford and Airedale Teaching PCT
Richmond and Twickenham PCT
West Cheshire PCT
East and North Hertfordshire PCT
Telford and Wrekin PCT
South East Essex PCT
Microcosm of inefficiencies
2. Patient safety
Unintended consequences of treatment, cost/100,000 population
2500000
2000000
1500000
1000000
500000
Unintended consequences of treatment
Source: DH, Programme Budget data
Microcosm of inefficiencies
3. Finished Consultant Episodes
Source: Bloor, K, Freemantle, N, Maynard, A, Gender and variation in activity rates of hospital consultants, J R Soc Med, DOI: 10.1258/jrsm.2007.070424
Solutions
1. Pluralism
Source: Christensen, Bohmer, Kenagy (HBR, 2000)
“Revolutions in business generally come from new entrants. That is why
so many of today’s market leaders – Microsoft and Google, Vodafone
and Easyjet – are companies that did not exist a generation ago. These
companies could not have succeeded if governments had been
committed to the continued leadership of IBM and AOL, AT&T and British
Airways.”
- John Kay, Financial Times
Solutions
2. Cultural change
• “For many years, it has become increasingly clear
that paper safety, the ability to tick boxes to satisfy
the government and regulators, has usurped patient
safety as the priority in the NHS”.
– Aidan Halligan, former deputy CMO
• “We should perhaps be spending more time developing
professional and corporate commitment than directly trying
to improve quality: programmes or projects quickly run out
of energy; being professional is a lifelong vocation and the
very fuel of giving service.”
- Paul Bate, UCL
Solutions
3. Measurement and accountability
• Clinical outcomes should be measured as a composite of the
most effective procedure, done correctly, safely, and with
minimum discomfort for the patient.
• Patient experience. Providers need to understand what really
matters to patients and improve these elements. A key part of
this is compassionate care and a hospitable experience.
• Benchmarking of cost and value. What you don’t measure
you don’t understand.
ARE PCTs UP FOR IT... Or do
we need to countenance more
radical system reform?
The NHS in a time of austerity
James Gubb, Civitas
www.civitas.org.uk/nhs
Image Source: HSJ