1. THE REFORM AGENDA 2015–2025 Policy Update Masterclass Wednesday 25 th May 2016 Dr. Patricia Oakley Director, Practices made Perfect Ltd. Teaching and Research Fellow. Public Policy and Management. King’s College, London www.practices.co.uk

2. 16e17466aso1 *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk © Practices made Perfect Ltd 16e17466aso1 PUBLIC SERVICES IN THE 21ST CENTURY  More public services for the same/less money.  More technology, science and informatics to increase efficiency and efficacy.  More multi-agency working to develop shared understanding of problems and approaches to commissioning services and deploying staff.  Better educated and trained joint workforces to solve complex problems.  Better reconciliation of delivery now while developing for the future. © Practices made Perfect Ltd *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk

3. 16e17466aso1 *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk © Practices made Perfect Ltd 16e17466aso1 DEVELOPING THE NHS 2015-2025 The Dilnot Report and Elders’ Care The Bell Report and “UK Science Plc” The Trauma & Emergency Care Networks “The Place in the Middle” & 7 Day Services Staffing post-Francis & Clinical Education Reform © Practices made Perfect Ltd *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk

4. 16e17466aso1 *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk © Practices made Perfect Ltd THE NEXT 30 YEARS  Care of the Elderly – physically well and mobile, socially engaged and psychologically content.  Chronic Disease Management including Mental Health and Carer Support.  Specialist Surgical and Therapeutic Interventions.  New Science: Pharmaco-Therapeutics and Genetics, Molecular Imaging and Diagnostics.  Building technologies and flexible designs underpinned with real-time information e.g. Electronic Transfer of Prescriptions, Digital X-ray, Just-in-Time Training Programmes.

5. © Practices Made Perfect NEW SERVICE DESIGN PRINCIPLES GP Well-being Practices and Managed Care Centres (Cancer, Stroke/Cardio, Mental Health) Community Activity Centres and The Gym Re-enablement, Rehabilitation and Resettlement Centres “High Street” Screening and Diagnostic Centres (high science and technology) Single-people enabled Homes and Campuses Hospice @ Home Service Hospital @ Home Service Trauma Centres Urgent Care Centres Planned Care Centres Nursing and Care Homes Step-down/Convalescent Homes 16e17466aso1

6. *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk © Practices made Perfect Ltd SUPPORTING GETTING OLD AND MANAGING LONG-TERM CONDITIONS Build a fabric of dense social networks within which good quality health and social care interventions are delivered in a timely and sensitive way. The Goals of Integrated Care Programmes

7. 16e17466aso1 *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk © Practices made Perfect Ltd  Support for family, friends and community self-help groups.  Support for collectivising events and activities.  Support for patient-focused charities and enabling groups. Reducing Isolation What is the Role of the State? SUPPORTING GETTING OLD AND MANAGING LONG-TERM CONDITIONS

8. © Practices made Perfect Ltd *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk 16e17466aso1 ?Local Diagnostic Services? ?Local Imaging Services? ?Local Genomics Services? High Street Social Care Services Hospice and Hospital at Home Services Community Pharmacy and Medicines Services GP Surgeries and Out of Hours Services Community Nursing and Midwifery and Therapy Services ?Regional Diagnostic Services? ?Regional Imaging Services? ?Regional Genomics Centres and Predictive Analytics Services? ?The Home Tests? ?The Gym Tests? ?Point of Testing Services? Maternity & Neonatology Care Services (including children’s trauma service) (includes current A&E “minors” service) Regional Trauma Services Urgent Care Services Cancer, Cardiac, Stroke Care Services Mental Health Care Services (inpatients) Convalescent, Observation and Place of Safety Beds and Services. Minor Injuries and “Off-legs” Front Door Services. Planned Care and Rehabilitation Services. Outpatients and Long Term Care Support Programmes including Self-Care Workshops and Self-Help Networks Support Programmes. End of Life Services. Local Care Services (including mental health and planned care services) Genetics Services Social & Probation and Police Services (including children’s urgent care service) Paramedic/Blue Light Service Services THE PLACE IN THE MIDDLE

9. 16e17466aso1 *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk © Practices made Perfect Ltd 16e17466aso1 THE NELSON CENTRE A modern NHS facility providing integrated care for the local community © Practices made Perfect Ltd *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk

10. 16e17466aso1 *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk © Practices made Perfect Ltd 16e17466aso1 THE NELSON CENTRE – CRUCIBLE OF CHANGE  a happening place in the centre of a community;  a shared place of many players and professionals;  a vehicle to develop new ways of working;  a locus of major new investments;  a crucible of change in workforce deployment. © Practices made Perfect Ltd *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk

11. 16e17466aso1 *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk © Practices made Perfect Ltd 16e17466aso1 INTEGRATED CARE ORGANISATIONS  Improve quality of life of old and frail people and those with long-term conditions, including mental health problems – ‘ologies, pain and skin, mobility.  Improve quality of dying and death – pain, guts, skin.  Improve primary and secondary prevention programmes – cardiovascular, diabetes and weight, mental health.  Improve rapid response, out of hours and emergency medication services.  Improve patient flows and rapid hospital discharges – TIOs, information and therapeutic handovers. Key Goals © Practices made Perfect Ltd *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk

12. 16e17466aso1 *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk © Practices made Perfect Ltd Genetic Profiling and Therapeutic Targeting. Proton Beam Therapy and Novel Treatments. High-speed informatics and cooling technology. Stem-cell based research and new science. Prosthetics, regeneration and bio-engineering developments. BIG SCIENCE COMING TO YOU SOON RCTS, Cash Flow, Research  New Ways of Working

13. 16e17466aso1 *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk © Practices made Perfect Ltd 16e17466aso1 LOOKING AT THE HORIZON AND DEVELOPING HEALTHCARE  Genetics and Genomics  Predictive Analytics  Personalised/Stratified Medicine  Bioinformatics  Stem Cell Therapies Science-based Diagnostics and Therapeutics © Practices made Perfect Ltd *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk

14. 16e17466aso1 *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk © Practices made Perfect Ltd 16e17466aso1 LOOKING AT THE HORIZON AND DEVELOPING HEALTHCARE  Pharmacogenomicists supporting general physicians  Stem cell and laser technologists supporting surgeons  Molecular cytology/pathology supporting diagnosticians.  Clinical engineers and computer technologists supporting intensivists.  Clinical informaticians and bioinformaticians supporting genomicists and predictive analytic programmes. Implications for Medical Staff © Practices made Perfect Ltd *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk

15. © Practices made Perfect Ltd *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk 16e17466aso1 Independent Reconfiguration Panel Care Quality Commission Monitor-Market Regulator Workforce Regulators Pay Review Bodies Local Authority and Primary Care Trust Service Commissioning Agency: − economies of scale service commissioning; − Public Health Programmes; − “residual” services commissioning. Clinical Commissioning Groups – Managed Agencies for majority of local people’s needs. GP-Patients Commissioning Partners: − Individual Choice; − Co-Payment Choice; − Means-Tested Services. Foundation Trusts and Academic Health Science Centres. Social Enterprises. Companies. Partnerships. ££ Service Providers Network Dept. of Health and Social Care Permanent Secretary and Chief Medical Officer. £ Independent NHS Board and its Regional Directorates Service Commissioning Agencies £ £ Chief Executive. Commissioning Director. Medical Director  Chief Officers Nursing Director £ Controller. Clinical Senates’ Guidelines and Advice. New “NICE”. R&D Agency National Specialist Commissioning Group e.g. Transplant Programmes, Proton Beam Therapy and “Orphan” Drugs. Local Education Training Boards Workforce – Human Resources Development Workforce – Strategic Planning and E&T Investment Deanery Schools, HIECs and All SCs. Assessment Centres. Leadership and Organisational Development Consortia. Recruitment and Payroll Agencies. Workforce Planning and Information Consortium. Education and Training Commissioning Consortium. Health Education England COMMISSIONING AND PROVIDER STREAMLINED ARCHITECTURE*

16. 16e17466aso1 *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk © Practices made Perfect Ltd 16e17466aso1 MANCHESTER COMMISSIONING AUTHORITY (Bolton, Manchester, Rochdale, Stockport, Trafford, Bury, Oldham, Salford, Tameside, Wigan)  10 Local Authorities, 12 CCGs, 15 NHS Providers, Police and Crime and Fire and Rescue Commissioners, Primary Care, and the 3 rd Sector.  Greater Manchester Health and Social Care Strategic Partnership Board’s Priorities:  Chronic care and long-term conditions  Severe and long-term mental health  Community and mental health care  Learning Disabilities Investment Strategy  Dementia and “Dementia United”  Greater Manchester Police’s Priorities:  Anti-social behaviour and community cohesion  Victim support  Protecting vulnerable people  Transformation Fund of £450m/£6bn.  Cornwall, Essex and Greater London Authority similar shifts and developments. © Practices made Perfect Ltd *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk

17. 16e17466aso1 *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk © Practices made Perfect Ltd 16e17466aso1 HEALTH AND WELLBEING BOARD Prevention and Proactive Intervention Programmes  Cardiac Review – fags, booze and do’nuts.  Statins and Fluorine – heart attacks and fillings.  Loneliness and Isolation – diabetes (& others?).  Fire Alarms and Education – fires and deaths.  Deprivation and Problem Families – exclusion and career criminals. © Practices made Perfect Ltd *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk

18. 16e17466aso1 *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk © Practices made Perfect Ltd 16e17466aso1 HEALTH AND WELLBEING BOARD Prevention and Proactive Intervention Programmes  Atlas of Variation – big differences in:  Diabetes  Children and young people  Kidney disease  Respiratory disease  Liver disease.  Schizophrenia and psychoses – 20 year gap in death rates.  Rehabilitation and resettlement of offenders – 60% recidivism rates. © Practices made Perfect Ltd *Prepared by Dr. Patricia Oakley, Practices made Perfect Ltd | Telephone 0845 862 0372 | e-mail: office@practices.co.uk | web: www.practices.co.uk