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Plan B for the NHS

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Plan B for the NHS

  1. 1. Devising Plan B for the NHS Dr Margaret Hannah Deputy Director of Public Health, NHS Fife IFF Fellow
  2. 2. Founding of the NHS “Every man, woman and child can have the benefit of this service. It is there for rich and poor alike. We are paying for it out of taxes”.
  3. 3. Founding of the NHS • Designed for disease patterns of 1948 • Relatively simple system of healthcare • Provided a service from cradle to grave • Designed to reduce demand by improving health.
  4. 4. Now we have concerns • Costs have risen sharply • It is proving hard to maintain equity and fairness • The change in demography and disease patterns is putting increasing strain on services • Demands and expectations continue to rise
  5. 5. Now we have concerns • Populist politics stifles the long-term strategic direction • People are not aware of the real cost of the services they receive • We base our decisions about the NHS on an assumption that we live forever • Vested interests drive the agenda
  6. 6. Real percentage increase in spend on NHS from 1950 to 2010 Source: Institute of Fiscal Studies 2010
  7. 7. Current strategies to contain costs will not work • Financial Efficiency – stripping out costs without strategic direction will hasten collapse • Managing demand – off-setting costs onto other agencies and families has reached its limits • Prevention – worrying uncertainty around effectiveness and timescales • Innovation – to improve on existing system or design a new one?
  8. 8.
  9. 9. Tony Beesley – in Beyond Survival, International Futures Forum, 2009
  10. 10. IFF Three Horizon Model increasing synchronous failure Innovation to try and keep things going Radically new ideas with better fit to new environment new context for useful old ways less disruptive change new paradigm fits and takes off innovation shifts allegiance TIME THE TURBULENT TRANSITION HORIZON 1 HORIZON 2 HORIZON 3 VIABILITY radically different operating environment NOW
  11. 11. Plan B for the NHS • Stretch ourselves to imagine a third horizon • Look for examples of this already happening • Review our innovation effort • Decide what we need to keep • Let go of the rest
  12. 12. Third Horizon for Plan B • Health is what it takes to make life worth living and is rooted in everyday life • Health has physical, mental, emotional and spiritual dimensions • Health includes illness, disability and death as part of a bigger life-death-life process in which we all participate • Illness and death challenge us to grow as human beings
  13. 13. Third Horizon for Plan B • Majority of treatment, care and recovery takes place outside acute hospital settings • Lay support, holistic clinical help, pervasive technology combine to provide highly effective care and treatment in the community • This care is safer, more effective and more homely than hospital • Builds community resilience and capacity to take care of itself • Shifts power relationships from clinicians to the public
  14. 14. The Alaskan story • Complete system redesign based on Alaskan Native values – > 40% decrease in A&E and emergency admissions – > 50% decrease in specialist care (out-patients) – > 20% decrease in visits to primary care – > 35% decrease in admissions and length of stay • Improved health outcomes • Improved satisfaction indicators – “customer” and staff
  15. 15. “What drives the system is belief” • Medical Model has not been questioned in 100 years • ‘Healthcare’ built on one philosophy yet its span is so huge • Grown a system beyond recognition since 1948 – but not the basic healthcare paradigm • Professionals in charge, patients passive recipients of care
  16. 16. Plan B for the NHS • Aim for most advanced technology but within the context of holistic care – We grow a new generation of healthcare practitioners who “work with both hands” • Plan for anything, not everything – Common to all healthcare interactions is the relationship – “People have diseases, diseases don’t have people”
  17. 17. Plan B for the NHS • Face the future with courage – This next few years will not dismantle but transform the NHS in Scotland – “The end of the world as we know it but not the end of the world”
  18. 18. Plan B for the NHS • We all have a part to play – Patients as active participants – Clinicians as coaches, mentors – Managers as designers for transition – “Re-designing the plane whilst flying it” – Politicians in having honest debate
  19. 19. Plan B for the NHS • There is no easy technical fix – This is a culture change – Cant plan this journey, but can learn our way into the future
  20. 20. Tony Beesley – in Beyond Survival, International Futures Forum, 2009
  21. 21. Acknowledgments • Participants at “Plan B” workshop • Promising Pathways Group, NHS Fife • Team from SCF, Alaska • Andrew Lyon and Graham Leicester, IFF • David Reilly and Phil Hanlon, “Fifth Wave” • NHS Education Scotland and Joint Improvement Team, Scottish Government Health Department