- 1 - Investing in your health Building a better NHS for people in Bedfordshire & Hertfordshire PROPOSED MONITORING ARRANGEMENTS 20th June 2005

- 2 - Investing in your health Building a better NHS for people in Bedfordshire & Hertfordshire Five key questions 1.Is the NHS doing what it said it would do? 2.Is the timetable being adhered to? 3.Are the changes having the predicted impact? 4.What is the public understanding of the changes? Plus 5.What else is going on and to what extent (if any) do local plans need to be modified?

- 3 - Investing in your health Building a better NHS for people in Bedfordshire & Hertfordshire Three general issues 1.Difficulty in separating out specific impact of IIYH from impact of general changes in health and healthcare. 2.Balance between hard and soft measures. 3.Appropriateness of the level of detail.

- 4 - Investing in your health Building a better NHS for people in Bedfordshire & Hertfordshire What we said we would do More local services Expanded primary care and 15 (?) Community DTCs Expanded intermediate care facilities Expansion of elective care facilities and separation from emergency care Different approach now between Hertfordshire & Bedfordshire Concentration of hospital based services onto fewer sites 4 major acute hospitals but 6 A&E departments remaining Development of specialist services Cancer centre within Beds and Herts Distributed model of supra DGH services Development of postgraduate medical school Proposal : Annual report and presentation

- 5 - Investing in your health Building a better NHS for people in Bedfordshire & Hertfordshire Timetable Transitional plan Key milestones for: DTCs Development of intermediate care Elective treatment centres Business case process for 2 major hospitals Proposal : Annual report and presentation Summary Gantt chart

- 6 - Investing in your health Building a better NHS for people in Bedfordshire & Hertfordshire Predicted impact (1) Shift in expenditure % revenue expenditure in acute, primary and other NHS care More care locally % fces delivered within Beds & Herts % fces delivered in non-acute hospitals % diagnostic tests delivered in non-acute hospitals emergency bed days (also efficiency measure) travel time assessment (emergency care) Quality of care standardised mortality rates readmission rates post operative infection rates (MRSA) specific services and/or conditions? (e.g. cancer, cardiac) PCT and Trust surveys on patient satisfaction

- 7 - Investing in your health Building a better NHS for people in Bedfordshire & Hertfordshire Predicted impact (2) Separation of elective from emergency care access times transfers patient satisfaction Population’s health wide range of indicators More attractive place to work vacancy rates staff surveys Proposal : Annual report and presentation Web based population health

- 8 - Investing in your health Building a better NHS for people in Bedfordshire & Hertfordshire Public understanding Do people know about IIYH and the proposed changes? Are the changes having a beneficial impact? Do behaviour changes reflect changes to model of care? How are the changes being communicated? Proposal : Three-yearly major survey (MORI) with annual updates

- 9 - Investing in your health Building a better NHS for people in Bedfordshire & Hertfordshire External events and comparisons Changes in government policy and national context, e.g. plurality, payment by results, choice, NHS funding Changes in local organisations and local context, e.g. structural changes, financial performance, Harefield Legal and procedural issues, e.g. judicial reviews, business cases Beds & Herts compared to England average Combined impact on IIYH Proposal : Annual report and presentation