Challenges in SW
Ian Biggs
Area Director BGSW
10 April 2014
Guiding Principles
Walk in the shoes of the people we serve:
Think like a patient. Act like a taxpayer
Financial
Clinical
Political
Social
3 NHS | Presentation to SW Senate NHS England | 10-04-14
Challenge status quo
• Viable local hospitals that don’t all have to be huge.
• Mental and physical health, unified.
• Employers actively engaged in health of employees.
• Faster uptake of digital technologies.
• The critical role of the Third Sector, and the innovation
value of new providers.
4 NHS | Presentation to SW Senate NHS England | 10-04-14
Challenges: changing demography
• Older population (over 65s)
National
SW
2011
16.4%
19.7%
2021
18.7%
22.8%
• Increased demand: Between 1999 and 2008 the
number of GP consultations per patient rose from
4.1 annually to 5.5 annually.
• Increased survival with long term conditions
leading to increased complexity and comorbidity
• Recruitment challenges to key clinical roles
5 NHS | Presentation to SW Senate NHS England | 10-04-14
Challenges: Older people & frailty
• ‘Everyone Counts: Planning for Patients’ frailty as a priority.
Long lengths of stay. High readmission rates. High rate of long-term care
after discharge.
• Variations in practice: NHS England guidance (DCIoS)
Four key components: identify those who are frail, assess, personalise care
planning, keyworkers.
• Variations in access to services e.g. transport, specialised services,
sensory impairment, rurality
• Changing carer population: shrinking carer population, older,
socioeconomic geographical motility.
6 NHS | Presentation to SW Senate NHS England | 10-04-14
Frailty and older people: Questions
• How do we know the experience of frail, elderly patients?.
• How do we balance clinical effectiveness with easy timely
access to services?
•
•
•
•
How do we work together across health and social care?
How do we keep people at home and reduce admissions?
How do we measure outcomes resulting from service change?
How do we improve quality, especially in SW with rural and
ageing population?
7 NHS | Presentation to SW Senate NHS England | 10-04-14
Challenges: Dementia
• 1 in 3 people aged over 65 will suffer from dementia
• Approx 25% of hospital beds are occupied by people with
dementia. Stay in hospital longer. More readmissions. More
likely to die.
• The national cost £19 billion per year. By 2030 this cost is
expected to treble to over £50 billion per year.
• Currently less than ½ of people living with dementia in
England receive a formal diagnosis.
8 NHS | Presentation to SW Senate NHS England | 10-04-14
Challenges: No health without mental
health
• Single largest cause of disability
• Wide economic costs (£105.2 bn)
• People with severe mental illnesses die on average 20 years earlier
than the general population.
• Associated with other long term conditions
9 NHS | Presentation to SW Senate NHS England | 10-04-14
Challenges: LTCs, complexity and
comorbidity
• Increasing comorbidity: 2/3 of older people
currently live with more than one LTC.
• LTC’s account for 50% of all GP appointments,
70% of all hospital admissions and 70% of
spend on health and social care.
• Variations in preferred place of care in last year
of life.
• More complexity means one size does not fit all
10 NHS | Presentation to SW Senate NHS England | 10-04-14
Questions: Complexity and comorbidity
• How do we ensure personalised care planning
and patient choice?
• How do we tackle fragmentation between
organisations / services?
• How do we empower patients to self-manage and
access services in a timely way 24/7?
• How do we anticipate need of our population both
clinically and strategically?
• How do we balance the need to improve quality
and reduce spend with increased demand?
11 NHS | Presentation to SW Senate NHS England | 10-04-14
Questions…Specialised services
• How do we ensure patients experience joined up care
throughout the pathway?
• How can we solve complex issues, hub and spoke models?
12 NHS | Presentation to SW Senate NHS England | 10-04-14
Simon Stephens’ inaugural speech
‘It’s time to get serious about patient power, prevention and
community partnerships……So it’s time to chart a new
course. One that combines hard-headed realism about the
here-and-now with a sense of shared purpose and – dare I
say it – even optimism about the future.’
..’
13 NHS | Presentation to SW Senate NHS England | 10-04-14