1. Reflections on Health Care Reform Ann Lloyd CBE CMPO Policy Seminar: Public Service Reform March 2009

2. One country – the United Kingdom l defence, police, borders l national economy l foreign affairs – including international health Four countries – Wales, England, Scotland, Northern Ireland l health, l industry and transport l education l housing l etc.

3. §3 million people §most in the south east §Mid-Wales thinly populated §The Valleys l old mining towns l poor infrastructure l poor health What is Wales like?

4. 3. TOWNSEND AND WANLESS Health is worse in some places

5. Source: CACI information solutions Waless future health?

6. How can people use health services in Wales?

7. hospital - highly specialised care for less common problems hospital - mainstream care primary and community care care Social care There are several major types of service

8. Primary and community care - local services everywhere about 6 visits a year c. 2,000 GPs in 500 practices - c. 9% alone c. 700 local pharmacies c. 1,000 dentists c. 600 opticians community nurses, midwives, therapy staff, social workers

9. HOSPITAL §16 large acute hospitals §a cancer hospital §mental health hospitals §50+ small hospitals §all-Wales ambulance service ACCIDENT & EMERGENCY DEPARTMENT hospital care - 1 after seeing GP 2 ambulance 3 walk in

10. Welsh Government 22 Local Health Boards 10 NHS trusts GPs, etc. Find what is wrong and find a response Provide care Decides policy

11. trusts GPs, etc. 22 Local Health Boards private organisations voluntary organisations 10 NHS trusts The system NOW Welsh Government

12. - health …….. relatively poor…………….. - insupportable burden on the acute sector and its workforce………………. - Wales does not get as much out of its health spending as it should.………….. - ………….. change difficult…………. - too few examples of successfully engaging the public in a change agenda. 2003 Welsh Wanless Report on Health and Social Care Our challenge

13. a new balance before hospital/ not in hospital hospitalafter hospital/ support in community x

14. Statutory local stratgies Health Challenge Wales Public Health Strategic Framework Specific strategies e.g.- food, fitness, housing, environment 1. Improving health and wellbeing Finance strategy Performance improvement Quality Improvement Strategy Improving Planning/ Commissioning Clinical/ Professional Engagement Public Engagement Workforce redesign Information 4. Improving systems and processes National Service Frameworks (NSFs) DECS emergency services Project 2009 Chronic Conditions Care pathways Healthcare Standards 2. Changing the pattern of services Acute Services Review/service reconfiguration Community Services Framework Designed for Life Fulfilled Lives, Supportive Communities Making the Connections Sustainability Duty Equality Duties Welsh Language Action Plan 3. Improving care pathwaysLocal Service Boards

15. trusts GPs, etc. 22 Local Health Boards private organisations voluntary organisations 10 NHS trusts We are changing the system in 2009 Welsh Government Replace by fewer organisations £ £ £ £ £ GPs, etc.

16. trusts GPs, etc. 7 NEW Local Health Boards – not 22 private organisations voluntary organisations The NEW system 2009 Welsh Government 2 NHS trusts – not 10 £ £ £ £