LSP Consultation Event: Resourcing of the public sector and its response to the recession : Denise McLellan, Chief Executive NHS Walsall 8 February 2010

Commissioning challenge Investment shift Manage illness Invest in equality Raise levels of general health Health not illness 1 23 NHS Walsall Long Term Strategic Aims

Demographic Change NHS Walsall and NHS West Midlands 2007 – 2018

Life Expectancy by Ward manifest as eight year difference in life expectancy between most and least deprived wards Within Walsall the widest gap in male life expectancy is 8.4 years Significant geographic divide between the health experiences in the East and West of the Borough.

NHS Walsall Revenue Allocation Growth

Walsall is up to the challenge CHD Mortality Rate – Persons aged Rate more than halved in ten years and inequalities gap against national avge. rate closed by fewer people dying each year. Lung Cancer Mortality Rate - Persons under % reduction in ten years and inequalities gap against national avge.rate narrowing. 24 fewer people dying each year. Source: NCHOD

Walsall is up to the challenge ‘Our Healthier Nation’ Progress in Walsall All circulatory disease:  41.5% mortality rate reduction, 209 fewer deaths each year, on track for 2010 target. Cancer:  13.6% mortality rate reduction, 53 fewer deaths each year, 2010 target may be achieved. Accidents:  28.8% reduction, 11 fewer deaths each year, Walsall has lowest accident mortality rate in the West Midlands. Mental Health (Suicide rate)  Walsall has struggled to reduce suicides further, as the suicide rate has been below the national rate in most years in the last decade and remains below the national rate. 272 fewer deaths each year already achieved by Over 390 fewer deaths each year when targets are achieved in 2010

NHS Walsall Long Term Financial Modelling Key Financial Assumptions –Resource Allocation –Changes in the national tariff –Inflation Key Cost Drivers: –Demographic Change –Disease Prevalence –Medical Technology –Access Rates/Activity Changes –Prescribing Rates Saving Strategies –Demand Management –Service Redesign –Upstream Interventions

Base Scenario Reasonable expectation (pre-budget) regarding: –Financial Assumptions –Cost Drivers Demand Management and Service Redesign –Based on top 25% benchmarked best practice nationally

NHA Walsall High Priority Outcomes Life expectancy Deprivation score (IMD) Infant mortality Obesity CVD mortality Smoking Teenage conception Alcohol related harm Stroke Patient Experience

Programmes of work and associated strategic initiatives Children, young people and maternity –alcohol, service redesign, healthy child programme Mental health -psychological intervention Older people –Dementia, frail elderly Health and wellbeing –Staying healthy, obesity and smoking Planned care –Redesign to improve effectiveness Unscheduled care –Urgent care and stroke Long term conditions –Self care, redesign Learning disability –Independence and personalisation Cross Cutting themes –Includes provider management and risk stratification

Final comments Health inequalities remain significant NHS Walsall is committed to retaining local, high quality services Clinical and financial sustainability is critical Need to work together to create the right levers and incentives for rapid change

Workshop questions How can different organisations in Walsall work better together to improve outcomes in a tighter financial environment? What principles should guide this? What are your group’s top three ideas to make a difference to the most important outcomes at same or less costs?