CD Forum, 7 March 2008, St Thomas’s, London Stephanie Somerville; Member of Darzi Team NHS Next Stage Review

2 Big ambitions for the Review… Proactively predict & prevent Sickness Reactively diagnose & treat Health Patients Public Staff Evidence-based change Superbugs Cuts High quality and personal Empowered Disengaged Disempowered Motivated

NHS Next Stage Review 3 Global trends are changing healthcare and the Next Stage Review will lay out how the NHS will respond, in line with the PM’s speech (7/1/08) NHS core purpose and values NHS focused on Quality Fair Personal Safe Effective Local vision for best models of care What the NHS is about How the NHS will be Making it real locally Securing it nationally What we are here to do An NHS system that enables local visions and is secured by a Constitution ‘Consumer’ expectations Long-term conditions Progress of technology Challenge & Opportunity Challenge for insurance-based systems – adverse selection Opportunity for a National Health Service Eight Clinical Working Groups Per SHA

NHS Next Stage Review 4 2,000 clinicians and others involved 74 clinical pathway groups nationwide An international clinical summit in November Hundreds of policy submissions and questionnaire responses Scale of engagement in the Review The Review is underpinned by the largest locally-led engagement in the history of the service There are clinical pathway groups in nine regions across the country Staying healthy Maternity & newborn Children’s health Planned care Mental health LTCs Acute care End-of-life care SHA strategic vision documents PCT commissioning strategies National ‘enabling’ report

NHS Next Stage Review 5 Long term conditions – emerging thinking All people with LTC or multiple conditions to have named key worker Everyone should have a care plan which includes info or what good care like and what people can expect Greater continuity of care and co-ordination across health and social care National standard of care including less info about what good looks like – and info for users and carers Commissioners need to define what good quality care looks like/ build a market place for providers/ act on sub quality care More incentives for high quality care – but stretch incentives Greater role and recognition for carers particularly in the spreading of best practice info. Users should become commissioners

NHS Next Stage Review 6 End of Life Care – emerging thinking …. Commissiong framework based on the end of life care pathway developed across sectors - quantified reduction in hospital deaths Quality standards established Comprehensive assessment of needs Electronically based advance care planning in all sectors of care – preferences and choices identified and shared with staff – accessible 24/7 Fully integrated services with 24/7 access to a specialist palliative care underpinned by single point of access Support for carers & single care co-ordinator Training and education of the workforce in End of Life care Challenge “live for ever” mindset through social marketing, public education

NHS Next Stage Review 7 Implications for what we do at national level… Local clinical staff need to own the visions and advocate them Public perception requires delivery to be seen to be led and advocated by local clinicians Benefits for patients/users depend on local delivery of the visions by local clinicians National report must be about enabling locally-led change not imposing it or doing it

NHS Next Stage Review 8 Eight national workstreams looking at enablers. We are also developing the ‘narrative’… Eight national workstreams Quality framework Innovation Leadership Workforce Information Systems & incentives Primary & community care services NHS constitution Narrative… Where we were 10 years ago; where we are now; where we’re going in the next 10 years There is a compelling long-term case for a tax-funded, free-at-the point-of-need, national health service in the 21 st century Reform in three stages – capacity building, system reform, and now transformation: Focus on prevention as well as cure Improving quality as the primary, unifying goal Enabling frontline leadership 1 2 3

NHS Next Stage Review 9 How do we make high quality care the primary, unifying goal of the NHS? There are eight national workstreams Quality Innovation Leadership Workforce Information Systems & Incentives Primary & Community Care NHS Constitution Some issues for us to consider Should we set system level quality improvement goals? Should we rationalise standard setting and knowledge management? Should performance be judged on the basis of quality? Should funding flows reward quality and penalise poor quality? Do we need a high profile quality campaign (lives saved)?

NHS Next Stage Review 10 Questions for discussion today… Are the recommendations ambitious enough? What would be your recommendations to clinical pathway groups? Are these the questions we need to address on quality?