1. Improving Healthcare in a Constrained Financial Environment
Dr Kathy McLean
Medical Director

2. Context The NHS has enjoyed a decade of growth and expansion
We have seen real improvements:
More patients treated than ever before
Reduced waiting times
Better outcomes for cancer and heart patients, and others
The focus on improving quality culminated in 2008 in regional and county clinical visions
We have been working to implement these visions and want to continue with greater urgency

3. The NHS faces increasing pressures
Quarter more over 85s by 2015
The cost of new drugs is increasing
Diseases of modern lifestyles
Rising consumer expectations

4. The Challenge
From April 2011 we expect that funding increases will be negligible. At the same time:
Prices will increase by 2.9% per year
Demand for activity will increase by 3.1% per year
By 2014 we will face a funding gap of around £1.3 billion
The NHS must respond by becoming much more efficient. We will need to do things differently to get more value from the resources we have

5. How do we respond?
There is much evidence that we can reduce costs by focusing on improving quality:
Eliminating waste
Avoiding duplication
Performing at the levels of the best

6. What are we doing about this?
We have identified 8 areas where the biggest gains can be made
Making urgent care systems work effectively
Supporting people with long term conditions
Preventing ill-health (large scale)
Improving primary care
Delivering high quality planned care
Making services safer
Streamlining non-clinical services
Improving mental health and well-being

7. Work has been progressing at all levels
National
Regional
County health system
PCT / Provider
Organisation
Team / Individual

8. Focus on tackling variation
Huge variation in the rate of emergency admissions for COPD within the East Midlands
LCR: 155 admissions per 100,000 population
Leicester City: 275 admissions per 100,000 population

9. Tackling variation
% NOF fracture patients operated on within 24-48h of admission (Q4 2008/09)
Regional control limits
National control limits
Trust Score
3SD Confidence Limits
Mean
Peer Min-Max
98% Target
Legend

10. Tackling variation
Years of Life Lost per 10,000 population – Bronchitis, Emphysema & COPD
PCT
VALUE
NATIONAL RANK (1 Best)
BASSETLAW
13.47
95 / 152
DERBY CITY
11.81
77 / 152
DERBYS
11.71
75 / 152
LCR
7.60
21 / 152
LEICS CITY
14.73
110 / 152
LINCS
14.59
107 / 152
NORTHANTS
10.22
53 / 152
NOTT CITY
18.39
140 / 152
NOTTS
12.12
83 / 152
NHS EAST MIDLANDS
12.09
6 / 10

11. How should we move forward?
We have developed a regional delivery plan:
Driven by lead clinicians
Sponsored by chief executives leading individual work streams
Underpinned by metrics for quality improvement as well as financial savings
We need to engage GPs – as future commissioners – more directly in achieving the required improvements

12. For Discussion In light of the proposed White Paper reforms:
Are we doing the right things in the right way?
How do you want to be involved?
How can we best engage you in key change projects?