Overview of the UK Health Sector: the NHS. Frances Pennell-Buck

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1 Overview of the UK Health Sector: the NHS Frances Pennell-Buck

2 AGENDA Healthcare Sector in the UK Overview of the National Health Service (NHS) Recent transition where are we now? NHS England Five Year Forward View Innovation and opportunities in the NHS and beyond 2

3 HEALTHCARE IN THE UK Dominated by the public sector (National Health Service) = around 85% of the market Private healthcare = 15% of market Funded either directly by patients or private medical insurance Total market growth 3.9% in 2012/1.4% in 2013 Private healthcare revenues in 2013: Long-term care sector 47.4% Private acute medical care 22.1% Psychiatric care 16%

4 HISTORY OF THE NHS Founded in 1948 Good healthcare should be available to all with access based on clinical need, not the ability to pay Today s Constitution of the NHS: Access to NHS services is based on clinical need, not on an individual s ability to pay The NHS belongs to the people. It provides a comprehensive service, available to all, irrespective of gender, race, disability, age, sexual orientation, religion or belief, gender assignment, pregnancy and maternity, or marital civil partnership status 4

5 WHAT MAKES UP THE NHS? The NHS is an integrated system of organisations and services bound together by the principles and values reflected in the Constitution NHS in Scotland, Wales and Northern Ireland NHS in England 1.6 million employees (in top 5 of world s largest workforces) The NHS is the largest single publicly funded health provider in the world 5

6 BREAKDOWN OF THE NHS NHS Scotland - 12bn 5.3 m people 159,748 employees 14 NHS Boards NHS England 115 bn 53 million people 1.3 million emps NHS Northern Ireland 2 bn 4.5 m people 62,603 employees Health and Social Care Board 5 Health and social care trusts 5 local commissioning groups NHS Wales 7bn 3.5 m people 7 Local health boards 84,817 employees

7 THE RECENT TRANSITION IN THE NHS IN ENGLAND The Health and Social Care Act 2010 will deliver more power to clinicians, it will put patients at the heart of the NHS, and it will reduce the costs of bureaucracy. We now have an opportunity to secure clinical leadership to deliver improving quality and outcomes; better results for patients is our objective. Clinical leadership has never been greater: 75 Clinical Reference Groups 12 Clinical Senates 209 Clinical Commissioning Groups (CCGs) 15 Academic Health Science Networks (AHSNs)

8 ACADEMIC HEALTH SCIENCE NETWORKS (AHSNs)

9 AHSN PRIORITIES BY REGION

10 MORE STATISTICS NHS ENGLAND 247 Trusts Hospitals, mental health, ambulance services 209 Clinical Commissioning Groups (CCGs) 8 Commissioning Support Units Registered professionals (January 2015) General practitioners (family doctors) 40,236 Nurses 351,446 Ambulance staff 18,576 Hospital and Community Health Service medical and dental staff 111,963 The NHS treats over 1 million patients every 36 hours 10

11 SOME OF THE ORGANISATIONS IN THE NEW STRUCTURE MONITOR - protects and promotes the interests of people using health services by making sure that NHS services are effective and offer value for money. Responsible for The Tariff CARE QUALITY COMMISSION - measures whether services meet national standards of quality (both NHS and private providers) NICE National Institute for Health and Social Care provides guidance and recommendations to help health and social care bodies deliver the best possible care MHRA -Medicines and Healthcare Products Regulatory Agency makes sure that medicines and medical devices work and are safe to use. Issues CE markings NIHR - National Institute for Health Research (NIHR) and its clinical research networks form a health research system to enable leading edge research

12 HOW DOES THE MONEY FLOW? HM Treasury Department of Health Centrally Managed Projects and Services Arms Length Body Funding Public Health Spending NHS England ( 98.5 bn) Nationally commissioned services Clinical Commissioning Groups ( 67 bn) Locally commissioned services

13 2015/16 NHS OUTCOMES FRAMEWORK Domain 1 Domain 2 Domain 3 Domain 4 Domain 5 Preventing people from dying prematurely Enhancing quality of life for people with long-term conditions Helping people to recover from episodes of ill health or following injury Ensuring that people have a positive experience of care Treating and caring for people in a safe environment; and protecting them from avoidable harm. 68 indicators to measure performance at a national level and to encourage innovation

14 CHALLENGES FACING THE NHS Ageing population Dementia Increase in long term conditions account for 70% of health service budget Changes in expectations treat me NOW 22 million visits to A&E a year Technology transforming our ability to predict, diagnose and treat disease NHS hasn t changed organisation of care since inception (boundaries between hospitals and primary care, health and social care)

15 BIG PROBLEM! Current model of care unsustainable MISMATCH BETWEEN RESOURCES AND PATIENT NEEDS OF NEARLY 30 BILLION A YEAR BY 2020/21 ACTION NEEDED TO: Reduce demand Increase efficiency Manage funding

16 NHS ENGLAND - FIVE YEAR FORWARD VIEW Opportunity to change future of healthcare: Radical upgrade in prevention and public health Greater control of own care when patients need health services Breaking down the barriers More local control of health services

17 WHAT WILL THE FUTURE LOOK LIKE? Need to manage systems networks of care not just organisations Out of hospital care needs to be much greater Services to be integrated around the patient (mental health, physical health, social care)

18 NEW CARE MODELS Multispeciality Community Providers (MCPs) will become the focal point for wider range of care needed by their patients Primary and Acute Care Systems (PACS) single organisations to provide GP and hospital services, together with mental health and community care services Urgent and emergency care networks Viable smaller hospitals Specialised care eg stroke, cancer Modern maternity services Enhanced health in care homes

19 HEALTH INNOVATION TO BE ACCELERATED Despite history of innovation (vaccines, modern nursing, hip replacements, IVF, CT scanners, DNA double helix), not so good at adopting or implementing innovation. NHS England will: Support the work of the National Institute for Health Research (NIHR) Develop collection and use of health outcomes data Work with NICE to expand work on devices and equipment Combine different technologies to transform care delivery eg monitor elderly patients with heart disease to keep them at home Digital health will play a big part in transformation of service delivery

20 NHS ATTITUDE TO INNOVATION The NHS will become one of the best places in the world to test innovations that require staff, technology and funding all to align in a health system, with universal coverage serving a large and diverse population. NHS England will: Develop a few test bed sites with the AHSNs Work with NIHR and the Department of Health to expand NHS operational research Get involved with the development of health and care new town developments AHSNs will have a key role to adoption of innovation in NHS

21 CONCLUSIONS The NHS is a national treasure the majority of services remain free at the point of access. There is no single NHS but several hundred organisations brought together under a single set of values Just building up from the most radical transformation in its history but more needs to be done Facing critical factors, especially ever-increasing demand on its service Five Year Forward View sets out plan to address issues Innovation key to sustainability of the NHS

22 THANK YOU ANY QUESTIONS? Frances Pennell-Buck Tel: +44(0)