Improving Healthcare in a Constrained Financial Environment Dr Kathy McLean Medical Director

Context The NHS has enjoyed a decade of growth and expansion We have seen real improvements: More patients treated than ever before Reduced waiting times Better outcomes for cancer and heart patients, and others The focus on improving quality culminated in 2008 in regional and county clinical visions We have been working to implement these visions and want to continue with greater urgency

The NHS faces increasing pressures Quarter more over 85s by 2015 The cost of new drugs is increasing Diseases of modern lifestyles Rising consumer expectations

The Challenge From April 2011 we expect that funding increases will be negligible. At the same time: Prices will increase by 2.9% per year Demand for activity will increase by 3.1% per year By 2014 we will face a funding gap of around £1.3 billion The NHS must respond by becoming much more efficient. We will need to do things differently to get more value from the resources we have

How do we respond? There is much evidence that we can reduce costs by focusing on improving quality: Eliminating waste Avoiding duplication Performing at the levels of the best

What are we doing about this? We have identified 8 areas where the biggest gains can be made Making urgent care systems work effectively Supporting people with long term conditions Preventing ill-health (large scale) Improving primary care Delivering high quality planned care Making services safer Streamlining non-clinical services Improving mental health and well-being

Work has been progressing at all levels National Regional County health system PCT / Provider Organisation Team / Individual

Focus on tackling variation Huge variation in the rate of emergency admissions for COPD within the East Midlands LCR: 155 admissions per 100,000 population Leicester City: 275 admissions per 100,000 population

Tackling variation % NOF fracture patients operated on within 24-48h of admission (Q4 2008/09) Regional control limits National control limits Trust Score 3SD Confidence Limits Mean Peer Min-Max 98% Target Legend

Tackling variation Years of Life Lost per 10,000 population 2006-2008 – Bronchitis, Emphysema & COPD PCT VALUE NATIONAL RANK (1 Best) BASSETLAW 13.47 95 / 152 DERBY CITY 11.81 77 / 152 DERBYS 11.71 75 / 152 LCR 7.60 21 / 152 LEICS CITY 14.73 110 / 152 LINCS 14.59 107 / 152 NORTHANTS 10.22 53 / 152 NOTT CITY 18.39 140 / 152 NOTTS 12.12 83 / 152 NHS EAST MIDLANDS 12.09 6 / 10

How should we move forward? We have developed a regional delivery plan: Driven by lead clinicians Sponsored by chief executives leading individual work streams Underpinned by metrics for quality improvement as well as financial savings We need to engage GPs – as future commissioners – more directly in achieving the required improvements

For Discussion In light of the proposed White Paper reforms: Are we doing the right things in the right way? How do you want to be involved? How can we best engage you in key change projects?