The Psychiatrist – saviour of the cash strapped NHS? Akmal Makhdum & Hashim Reza
Psychiatrist - Saviour of the Cash Trapped NHS - Akmal Makhdum and Hashim Reza
Nov 15, 2014
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The Psychiatrist – saviour of the cash strapped NHS?
Akmal Makhdum & Hashim Reza
May you live in interesting times
NHS 1997-2010
NSH Plan National Service Frameworks National Institute of Clinical Excellence Healthcare Commission National Patient Surveys National Staff Surveys Foundation Trusts QIPP / QSIP / CQUIN
NHS 1997-2010 – what changed? Waiting times Deaths from cancer & CV disease Health care associated infections National standards of care for major diseases Information on performance Smoking rates
Mental Health Services 1997-2010 Suicide Prevention Toolkit Assertive Community Treatment Crisis Resolution & Home Treatment Early Intervention in Psychosis Payment by Results HoNOS PbR / Care Packages Programme /
MH Clustering
A high performing NHS
Access Safety Clinical effectiveness Patient experience Equity Efficiency Accountability Health promotion Management of long-term conditions
NHS 1997-2010
£35 billion £110+ billion
Could this last forever?!
Liberating the NHS and an Information Revolution
The White Paper ‘Liberating the NHS’, published on the 12th July, outlined government plans for a new direction for the NHS, including an ‘information revolution’ and greater patient choice and control.
Vision for an information revolution
People have access to their health records and the information they
need to make informed choices about their health and care.
“No decision about me, without me”
Liberating NHS information will help drive better care, improving
outcomes , innovation and the better use of resources.
What does this mean for clinicians
• Patient access to the whole of their records electronically• Initially in primary care but later all records
• More patient and public facing information about health and care options
• Information derived from care records to be harnessed• To assess care quality – and to help improve it• To find and disseminate best practice• To highlight areas of poor performance or waste
Care records your records form the primary source of data
Creating intelligence as data is analysed and interpreted
The Information revolution
The InformationRevolution
Creating intelligence as data is analysed and interpreted
Care records your records form the primary source of data
The Information revolution
1.4
Leading to patient-centred care
Improving service quality and outcomes for you
Giving you greater ownership & control over your care
Encouraging clinicians and care professionals to respond to your needs and capture data at the point of care
Enabling you to make properly informed choices
Leading to easily understandable Information published by a range of organisations to meet your needs
Improving data quality as data is exposed to professional scrutiny and the quality of data improves
Leading to greater transparency through routine publication of core data
The main source for aggregate data for secondary uses such as research
Enabling more direct communication between you & your professional
Allowing you to share information from your record with others
Promoting benchmarking of outcomes by clinicians
Promoting benchmarking of outcomes by clinicians
Creating intelligence as data is analysed and interpreted
Care records your records form the primary source of data
The Information revolution
1.5
Leading to patient-centred care
Giving you greater ownership & control over your care
Encouraging clinicians and care professionals to respond to your needs and capture data at the point of care
Enabling you to make properly informed choices
Leading to easily understandable Information published by a range of organisations to meet your needs
Improving data quality as data is exposed to professional scrutiny and the quality of data improves
Leading to greater transparency through routine publication of core data
The main source for aggregate data for secondary uses such as research
Enabling more direct communication between you & your professional
Allowing you to share information from your record with others
Promoting benchmarking of outcomes by clinicians
Improving service quality and outcomes for you
Improving service quality and outcomes for you
Creating intelligence as data is analysed and interpreted
Care records your records form the primary source of data
The Information revolution
2.4
Giving you greater ownership & control over your care
Encouraging clinicians and care professionals to respond to your needs and capture data at the point of care
Enabling you to make properly informed choices
Enabling more direct communication between you & your professional
Allowing you to share information from your record with others
Promoting benchmarking of outcomes by clinicians
Improving service quality and outcomes for you
Leading to patient-centred care
The main source for aggregate data for secondary uses such as research
Leading to greater transparency through routine publication of core data
Improving data quality as data is exposed to professional scrutiny and the quality of data improves
Leading to easily understandable Information published by a range of organisations to meet your needs
Leading to easily understandable Information published by a range of organisations to meet your needs
Moving away from targets to outcomes
• New frameworks for measuring NHS, social care and public health outcomes create new opportunities for improvement and accountability*
• We will consider how outcomes information may be mandated in Quality Accounts
• We are undertaking a fundamental review of data collections in health and social care. There will be a public consultation on this in 2011
• This will introduce a new focus on patient and service-user generated information such as patient reported outcomes measures (PROMS), patient and service user experience, ratings and real-time feedback
• Information must support GPs to take commissioning decisions and local authorities to integrate health and social care
*Transparency in Outcomes – a framework for the NHS’ consultation launched 19 July
InformationInformation
What is meant by ‘Information’?
InformationInformation
Patient RecordsPatient
RecordsPatient
RecordsPatient
RecordsPatient
RecordsPatient
Records
Patient RecordsPatient
RecordsPatient
RecordsPatient
Records
Patient RecordsPatient
Records
GP HospitalCommunity
Linkage then interoperability
Patient access
Initially Subsequently
InformationInformation
Patient RecordsPatient
Records
Patient access
Coding
Standards
Governance
Security
Internal External
AuditAudit
Quality assuranceQuality assurance
Capacity planningCapacity planning
FinanceFinance
ResearchResearch
RevalidationRevalidation
Public healthPublic health
CommissioningCommissioning
ImprovementImprovement RegulationRegulation
InformationInformation
Patient RecordsPatient
Records
Patient access
Condition informationCondition
information
Treatment informationTreatment information
Organisation information
Organisation information
Individual team/ clinician
information
Individual team/ clinician
information
Patient RecordsPatient Records
Patient access
Condition informationCondition
information
Treatment informationTreatment information
Organisation information
Organisation information
Individual team/ clinician
information
Individual team/ clinician
information
Medical jargon
Trustworthiness
Routes of access
Timeliness
Interpretation
Conflicting information
Transparency
Information for autonomy, accountability and democratic legitimacy
• A ‘presumption of openness’ when publishing data is crucial for accountability
• Wider availability of data will allow ‘information intermediaries’ to cater for people with a range of needs (including people who do not themselves presently use computers)
• We are identifying national data sets for early release
• We attach great importance to ensuring trust in published data
Jul 2010 Oct 2011 Jan Apr Jul Oct 2012 Jan Apr
Provisional overall timeline: July 2010 - June 2012 K
ey m
ilest
on
es
Overall White Paper Published
Health Bill
Publichealth White Paper
NHS Boardbegins. in shadow form
NHS Board and economic regulator take up full powers
New public health service operational
2012/132011/12
Report on funding of long-term care and support
White Paper on social care reform (during 2011)
Shadow health and wellbeing partnerships begin
Publications on social care, choice, information, education and data returns
Spending Review released
New Spending Review period begins
2011/12 allocations
11/12 QIPP/ operational planning complete
2012/13 allocations
12/13 QIPP/ operational planning complete
First GP Consortia start work in shadow form (from 2011/12)
Finance and efficiency Autonomy and accountabilityPolicy and legislation
Additional White Paper Consultations
Local health and wellbeing boards and HealthWatch established
Choice extended to long-term conditions and diagnostics (from 2011)
Choice of consultant-led team; expansion of PROMs
Free choice of GP practiceExtension of
choice in mental health (ongoing)
A patient-led NHS
Outcomes Framework fully implemented
Outcomes Framework comes into use
Further publication on Outcomes Framework
Initial consultation on Outcomes Framework
Improving healthcare outcomes
Jul 2010 Aug Sep Oct Nov Dec Jan Feb Mar
Early engagement and action timeline: July 2010 – Mar 2011
Planning, performance and QIPP
First submission QIPP and Reform plan and QIPP tertial review at SHA level
QIPP and Reform plan and QIPP tertial review at SHA level
White Paper consultation processes
NHS Chief Executive visits every region
National stakeholder engagement
Regional and local stakeholder engagement
Development of QIPP plans to include reform
New commissioner / provider leads and bridging functions in place at DH and in SHAs
DH planning with Monitor and CCP for creation of Economic Regulator
Identification of likely first GP commissioning consortia
Development process for first GP commissioning consortia
Capability development for GP commissioning consortia (ongoing)
Engagement and consultation
Policy design and implementation
Work to drive and accelerate the Foundation Trust pipeline
Fact and Facade
Information Revolution another NPfIT?! Liberating – from jobs?! Demand to reduce £20 billion AND coalition promise: “no clinical services will be
cut” … “may be cut” … “will have to be cut” … “these are the cuts!”
The Process
Monitoring Monitoring Monitoring
Monitoring
Where you are? What are you doing? How are you doing it? How much of it are you doing?
Big Brother is watching you!
Unique Selling Product
What is your NHS Trust selling? Your Expertise Your Credentials Your Experience
Do you know that they know?
The new drivers
Current changes: What ideology? What place for ideology? What attachment NHS staff can have / afford? Stock market – the new god that failed
Time for psychiatrists to reconsider their options
Local options
PBC Specialist commissioning Local types of specialist commissioning What out of county expenditure on each? What are your local PBC priorities?
Enter the saviour!
Meet the commissioner(s) Identify needs of specialist commissioning in
your area
Think outside the box!
Create a consortium Create a social enterprise Employee-Employer partnership Develop new businesses
None of these options possiblewithout YOUR clinical
leadership
Think of business within … … and business without NHS
Your unique value
Practice based experience Experience based evidence Basis for a new model of delivery
How will you market the new model?
Marketing the new model
Your organisation Others
Yourself, your ideasCoherently expressed in
business jargon
Survival skills
Seen a bid? Written a bid? What about a business plan?
Do nothing!
Salary freeze – already here Job cuts – proposed & planned
When is your turn?
May you come to the attention of powerful people
May you find what you are looking for
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