1. The case for change Time to Think Differently www.kingsfund.org.uk/think

2. Major progress has been made in improving the performance of the NHS in the past decade.

3. Waiting times for treatment in hospital have fallen dramatically and generally remain stable.

4. Hospital-acquired infection rates like MRSA have fallen dramatically.

5. The NHS continues to be highly valued by the public. Source: Ipsos Mori 2013

6. The NHS continues to perform well on most indicators when compared to other countries.

7. However, the current health and social care delivery system has failed to keep pace with the needs of an ageing population, the changing burden of disease, and rising patient and public expectations.

8. Fundamental change is needed. It is time to think differently.

9. The case for change is compelling: 1. Variations in quality and outcomes of care 2. Funding pressures 3. Delivery system not fit for the future 4. Future trends – magnifying the pressures

10. 1. Variations in quality and outcomes of care

11. ‘The UK has the second highest rate of mortality amenable to health care in 16 high-income nations.’ Source: Nolte and McKee 2011

15. For many diseases, there is unwarranted variation.

16. There are wide variations in performance and gaps in the quality of care of general practice.

17. 2. Funding pressures

18. Current spending projections suggest significant financial pressures on services for the next 20 years.

19. Historic pressures to increase NHS spending. Source: Appleby 2012

21. Increasing pressure to achieve productivity gains. By 2015 £20 billion Nicholson challenge for productivity gains By 2021 £30 billion more NHS England estimates of a funding gap

22. Projected spending on long-term care 2016/17–2061/2 Source: OBR 2012

23. 3. Delivery system not fit for the future

24. A significant proportion of patients occupying beds do not need to be in hospital on clinical grounds. Source: Goddard et al 2000; Audit Commission 2003

25. The separation between general practitioners and hospital-based specialists, and between health and social care, often inhibit the provision of timely and high-quality, integrated care to people who need to access a range of services relevant to their needs. Source: Ham et al 2012

27. There are significant problems with standards of dignity and care.

30. Obesity is associated with an increased risk of diseases including diabetes, heart disease, osteoarthritis and cancer. Source: National Obesity Observatory 2012

31. 4. Future trends: magnifying the pressures

32. Demographics are changing.

33. More people with long-term conditions.

34. A rise in chronic disease. Arthritis up 100% to 17m by 2030 People with 3+ long-term conditions up 100% to 2.9m by 2018 Diabetics up 29% by 2025 to reach 4 million People living with cancer doubling by 2034 to 4m People living with dementia will more than double over the next 30 years to 1.4m

36. Population lifestyles present significant risks to health.

37. What is the future model of care? Integrated care, co-ordinated around the needs of patients and service users. Patients and service users actively involved in the design of their care and working with professionals as part of the care team. Re-designing the care pathway, with greater specialisation in hospitals, increased capacity and more consistent standards in primary care. Stronger focus on prevention.

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