1. NHS Atlas of Variation in Diagnostic Services Prof Erika Denton NCD Diagnostics

2. Projected Rate Of Population Growth By Age Last Birthday (Source: Government’s actuarial department).

3. Causes Of Death, over 60s 80% of death of the over 60s attributed to 3 underlying causes

4. 6+ week waits April 06 – July 13

5. Waiting List & Activity: all imaging

6. 1 – Data refer to exams in hospital only. 2 – Data refer to exams outside hospital only. 1 – Data refer to exams in hospital only. 2 – Data refer to exams outside hospital only.

7. 1 – Data include equipment in hospital only.

8. Map 1: Rate of magnetic resonance imaging (MRI) activity per weighted population by PCT 2012/3 Domain 1: Preventing people from dying prematurely © Crown copyright and database rights 2013 Ordnance Survey 100039906

9. Map 2: Rate of magnetic resonance imaging (MRI) activity per weighted population by PCT 2012/3 Domain 1: Preventing people from dying prematurely © Crown copyright and database rights 2013 Ordnance Survey 100039906

10. Map 3: Rate of non-obstetric ultrasound activity per weighted population by PCT 2012/3 Domain 1: Preventing people from dying prematurely © Crown copyright and database rights 2013 Ordnance Survey 100039906

11. Map 6: Median time (minutes) from arrival at hospital to brain imaging for stroke patients by hospital October–December 2012 Domain 1: Preventing people from dying prematurely Domain 2: Enhancing quality of life for people with long-term conditions Domain 3: Helping people to recover from episodes of ill health or following injury © Crown copyright and database rights 2013 Ordnance Survey 100039906

12. Map 7: Proportion (%) of stroke patients undergoing brain imaging within 1 hour of arrival at hospital by hospital October–December 2012 Domain 1: Preventing people from dying prematurely Domain 2: Enhancing quality of life for people with long-term conditions Domain 3: Helping people to recover from episodes of ill health or following injury © Crown copyright and database rights 2013 Ordnance Survey 100039906

13. Rising to the Challenge? Demographics + Patient/Public Expectations + Quality Money Solution = transformational change to the current way of delivering health care

14. Traditional vs ‘New’ change methodology Transactional change: Doing things better Transformational change: Doing better things

15. Tools to effect change Accurate diagnostic data: activity, capacity, reporting times Published evidence Guidelines: NICE, collegiate etc Official reports: NAO, NCEPOD, CQC, Francis etc Policy drivers, eg: Commissioning changes, Stroke Strategy, Cardiac networks, Cancer reform, Predictable demographic changes Communication: clinical, managerial & with commissioners

16. ‘You can’t solve a problem by using the same thinking that created it’ Albert Einstein