Challenges in SW Ian Biggs Area Director BGSW 10 April 2014

Guiding Principles Walk in the shoes of the people we serve: Think like a patient. Act like a taxpayer NHS | Presentation to SW Senate NHS England | Financial Political Social Clinical

Challenge status quo Viable local hospitals that don’t all have to be huge. Mental and physical health, unified. Employers actively engaged in health of employees. Faster uptake of digital technologies. The critical role of the Third Sector, and the innovation value of new providers. NHS | Presentation to SW Senate NHS England |

Challenges: changing demography Older population (over 65s) Increased demand: Between 1999 and 2008 the number of GP consultations per patient rose from 4.1 annually to 5.5 annually. Increased survival with long term conditions leading to increased complexity and comorbidity Recruitment challenges to key clinical roles NHS | Presentation to SW Senate NHS England | NationalSW %19.7% %22.8%

Challenges: Older people & frailty ‘Everyone Counts: Planning for Patients’ frailty as a priority. Long lengths of stay. High readmission rates. High rate of long-term care after discharge. Variations in practice: NHS England guidance (DCIoS) Four key components: identify those who are frail, assess, personalise care planning, keyworkers. Variations in access to services e.g. transport, specialised services, sensory impairment, rurality Changing carer population: shrinking carer population, older, socioeconomic geographical motility. NHS | Presentation to SW Senate NHS England |

Frailty and older people: Questions How do we know the experience of frail, elderly patients?. How do we balance clinical effectiveness with easy timely access to services? How do we work together across health and social care? How do we keep people at home and reduce admissions? How do we measure outcomes resulting from service change? How do we improve quality, especially in SW with rural and ageing population? NHS | Presentation to SW Senate NHS England |

Challenges: Dementia 1 in 3 people aged over 65 will suffer from dementia Approx 25% of hospital beds are occupied by people with dementia. Stay in hospital longer. More readmissions. More likely to die. The national cost £19 billion per year. By 2030 this cost is expected to treble to over £50 billion per year. Currently less than ½ of people living with dementia in England receive a formal diagnosis. NHS | Presentation to SW Senate NHS England |

Challenges: No health without mental health Single largest cause of disability Wide economic costs (£105.2 bn) People with severe mental illnesses die on average 20 years earlier than the general population. Associated with other long term conditions NHS | Presentation to SW Senate NHS England |

Challenges: LTCs, complexity and comorbidity Increasing comorbidity: 2/3 of older people currently live with more than one LTC. LTC’s account for 50% of all GP appointments, 70% of all hospital admissions and 70% of spend on health and social care. Variations in preferred place of care in last year of life. More complexity means one size does not fit all NHS | Presentation to SW Senate NHS England |

Questions: Complexity and comorbidity How do we ensure personalised care planning and patient choice? How do we tackle fragmentation between organisations / services? How do we empower patients to self-manage and access services in a timely way 24/7? How do we anticipate need of our population both clinically and strategically? How do we balance the need to improve quality and reduce spend with increased demand? NHS | Presentation to SW Senate NHS England |

Questions…Specialised services How do we ensure patients experience joined up care throughout the pathway? How can we solve complex issues, hub and spoke models? NHS | Presentation to SW Senate NHS England |

Simon Stephens’ inaugural speech ‘It’s time to get serious about patient power, prevention and community partnerships……So it’s time to chart a new course. One that combines hard-headed realism about the here-and-now with a sense of shared purpose and – dare I say it – even optimism about the future.’..’ NHS | Presentation to SW Senate NHS England |