1. DHF Presentations 2004 to 2008 +44(0)1423 506 848 +44(0)789 907 4881 www.directhealthfirst.com Kent House 42 Duchy Rd Harrogate HG1 2ER

2. 15% eventually from IS buy NHS 2004 elective over 6m pa Likely to grow

3. Diffusion of MRI Units, 2000 Source: OECD Health Data, 2003

4. Entry Hurdles · UK visas · UK work permits · NCSC · CHI · Professional bodies · Clinical registration bodies · Other government initiatives

5. Pharmacological spend as % of total health spend

6. OTC and non-prescription drugs as % of total drugs

7. Admissions per 1000 patients

8. Average LOS

9. Hospital Beds per 1000 population

10. Bed Occupancy

11. Attractions & Resentments National (Drivers) Factor Local (affordability) +Additionality ? +Capacity ? +VFM ? +Macro - efficiencies ? DHF

12. Govt’s Target 18 weeks to include · OP · Dx · WL DHF

13. Wait Times

15. Drivers Waiting times, lists & capacity Choice, Access and Quality Contestability, Plurality and VFM DHF

16. ISTCs NHS TCs OCTs [2000-2005] NHS Capacity through Systems Redesign & other ways 7/27 43/46 DHF

17. Aims Government wanted to encourage entrants who are: · competent, · provide VFM and are · sustainable

18. PFI PPP Capacity Growth Services FM

19. Sick or well model: In business parks and shopping malls. Range of procedures away from hospital site. Age range. Investigations. Contraindication and risk factors. Length of stay.

20. Procedure v Patient Year Price by procedurePrice by patient year Low volumesHigh volumes High priceLow Price Narrow spread of priceWide spread of price High Consistency of ResourceUnpredictable Resource Large populationsSub populations Specified Intervention onlyChoice of Interventions Interventions always neededValue avoiding interventions

21. ElectiveEither WayCDM Total hipSquintAsthma CataractChemotherapyPsoriasis CholecystectomyClub footRheumatoid Arthritis HerniorrhaRadiotherapyExcema C.A.DReconstructionDepression T.O.P. PhyHair lipSchizophrenia Pain blocksExtreme obesityThyroid dysfunction DentalIncontinenceDialysis Chronic painAngina Osteo Arthritis Chronic pulmonary disease

22. History Churches & Charities Poor Houses and other reforms to 1911 Lloyd George and the panel 1942 to 1948 : The NHS 1968 to 1989 reforms Mrs Thatcher & Waiting times 1992 April Mr Blair & Plurality

23. Waiting Lists 199224 months (+ 6months) 2002-2004…9 Months for treatment 2002… 900K (to 150K) 2008 … 18 weeks total

24. Early (2002) Capacity Predictions FFCEs

25. PM’s Target 18 weeks to include · O.P4/52, · Diagnostics 4/52 · treatment 8weeks……?

26. Differences Equipment & Facilities Buildings & Layouts Turnkey & Systems Health from Sickness Model (Pt walking) Changing Expectations (Drs pushing) Procedure innovation (i.e. blood conservation) Indicators Competencies VS. Apprenticeships

27. Differences... Spot Prices Speciality to Procedure Information, Refining Procedures’ Descriptions (severity, co morbidity, and case mix) Patient Care Pathways Clinical Engagement in real costings & interfaces Financial Flows anticipated

28. Fears: commoditisation of health Contract Failure & VFM Delivery Failure : Impact on - NHS viability - Private Practice: volume -prioritisation Poor Quality

29. Fear of Overcapacity PCTs (allowing lists to go up again) Acute Trusts SHAs DH Risk to NHS estate and base Challenge to National strategy

30. New Opportunities: Direct to NHS Acute Capacity for NHS · Endoscopy · Day surgery · Short stay surgery

31. Opportunities: Direct to NHS Diagnostics · radio diagnostics, · Histopathology · Haematology · Chemical pathology · Physiological measurements

32. Opportunities: Direct Other capacity for NHS · LTC (diabetes) · Primary Care (e.g. CWICs) · Chlamydia etc · Mental Health · LD · Care of Elderly

33. Opportunities: Indirectly to NHS Chambers · Surgeons · Physicians · Other clinicians/Health/Well being · As a provider, · as a FM

34. Investment and capacity Volumes needed 12 months ago Volumes needed now Waiting list Waiting for OP Waiting over 4 weeks Affordability (impact on other services)

35. Status of US Industry: Shift from Inpatient to Outpatient 35000 25000 20000 15000 10000 5000 0 30000 19841988199019921994199619981986 2000 Annual Number of Surgeries (in Thousands) Total Hospital Inpatient Surgeries Total Outpatient Surgeries

36. Grow capacity VFM Delivered quickly Maintain quality Improve access TCs

37. On or Off NHS property Near or far away In their buildings With or without their staff NHS Trusts & PCTs

38. Movable leased refurbished (modular) Buildings

39. The process of NIT procurement No 10, DH, CD, NIT OJEU PQQ Criteria ITT Fixing the deals STBOP

40. First two Phases of NIT procurement Wave 1 (despite delays, was fast by usual standards) · Electives 200 000 (Daventry celebrates 1 year) · GSUP 1 · MRI Wave 2 · Electives (250 000) · Diagnostics (radio, pact, physiological, endoscopy) · LTC (diabetes) · Primary Care (e.g. CWICs) · Chlamydia etc · Renewals and handovers

41. Perceptions of quality risk National govt. Local Govt. Providers (new territories) Investors (due diligence) Professions (mixed interests) Media Public

42. Opportunities Acute Capacity for NHS Other capacity for NHS · Diagnostics (radio, pact, physiological, endoscopy) · LTC (diabetes) · Primary Care (e.g. CWICs) · Chlamydia etc · Mental Health · LD · Care of Elderly Chambers · Surgeons · Physicians · Other clinical/Health/Well being · Sa a provider, as a FM

43. Two’s company, Virtuous contract PayerProvider Client £ ServiceHappiness

44. Three’s a crowd Two third party payers Payer Provider Govt Client £ £ £ services happiness control

45. Inpatient versus Day Surgery: US Number of Procedures (thousands) Source: SMG Marketing

46. Freestanding Ambulatory Surgery Centres in the United States

47. Types of Surgery Centres in the U.S. Hospital owned Joint Venture (Hospital & Physicians) Physician Owned Management Companies with or without physician ownership