Excel in Health: Understanding the NHS
Download as PPTX, PDF0 likes275 views
This document provides an overview of a three day programme on understanding the NHS. Day one focuses on understanding the structure and system of the NHS. Day two covers relevant knowledge and skills for success working with the NHS. Day three is about applying the learning and pitching innovations. The document discusses the NHS landscape including its history, structures, priorities and statistics. It also covers integrated care systems, clinical commissioning groups, primary care networks and their roles. Opportunities for procurement within the NHS are discussed including frameworks and portals.
Excel in Health: Understanding the NHS
- 1. Excel in Health Understanding the NHS
- 2. Three day programme overview 1. Understanding the NHS 2. Relevant knowledge and skills for success 3. Applying your learning and pitching your innovation
- 3. Find someone you’ve never met: ● Spend TWO MINUTES (each) sharing: o What challenges do you bring with you today? o What are you hoping to get from this experience? ● Repeat with another new contact…
- 4. By the end of our session today, you will be able to: ● Identify characteristics of NHS structure and system ● Recognise processes for working with the procurement system ● Identify relevant elements of NHS culture that may impact your work Respond to Reflection #1 in your workbook
- 6. ● NHS history overview ● NHS structures ● National context ● STP/ICS priorities
- 7. ● Created in 1948 ● Free at point of care to all ● £125bn = 7% of GDP ● 1m patients every 36 hours ● 1.7m staff (5th largest employer in world & 2/3 of £) ● 135 acute non-specialist trusts ● 17 acute specialists trusts ● 54 mental health trusts ● 35 community providers ● 9,200 GP practices (ave. list size 7,800) ● 14,000 Community Pharmacies ● 211 CCGs / 1,300 Primary Care Networks ● 44 STPs / ICSs
- 8. ● The NHS provides a comprehensive service, available to all ● Access to NHS services is based on clinical need, not an individual’s ability to pay ● The NHS aspires to the highest standards of excellence and professionalism & quality of care is highest when staff are valued, empowered and supported. ● The patient will be at the heart of everything the NHS does ● The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population ● The NHS is committed to providing best value for taxpayers’ money and the most effective, fair and sustainable use of finite resources ● The NHS is accountable to the public, communities and patients that it serves
- 11. ● An ambitious approach linked to the NHS Long Term Plan ● Seeks to: o Support the first 5 years and provide evidence for the next 5 years funding o Support the ‘Triple Aims and Integration’ ● and… ‘dissolve the historic divide between primary and community health services’
- 12. ● PCNs are not about commissioning, they are about provision as ‘investment and delivery vehicles’ ● Essential Contribution’ to be defined for PCNs, as ‘…part of the wider service that ICSs will be organising’ - and to play its part in partnership with community services ● Increased funding from NHSE for Primary Care (Additional Staffing / Indemnity etc.) ● 100% coverage / membership expected of PCNs ● Additional roles (with PCNs having capitated budgets and flexibility of staff provision from 2020) ● 7 national service specifications
- 13. ● Anticipatory Care - Structured care and targeted MDT support for physical / mental health needs / multi morbidities ● ‘...can only be delivered by fully integrated primary & community health teams...input from community providers, GP, social care & hospitals’ ● Full requirements developed by ICSs, and commissioned by CCGs ● Personalised Care - ‘What matters to you?’ Rather than ‘what’s the matter with you?’ ● Social prescribing link workers fully funded to support the NHS Comprehensive Model, e.g. choice, care planning, self management & personal health budgets ● Care Homes - PCNs ... ‘will be responsible for working with emergency services to provide emergency support, including where advice or support is needed out-of-hours’
- 14. ● Setting national policy & developing best practice for NHS technology, digital & data, data-sharing & transparency ● Setting standards – developing, agreeing & mandating clear standards for the use of technology in the NHS ● Ensuring that NHS systems can talk to each other across the health & care system ● Helping to improve clinical care by delivering agile, user-focused projects ● Supporting the use of new technologies by the NHS, both by working with industry & via its own prototyping & development capability ● Ensuring common technologies & services (e.g. NHS App) are designed so NHS orgs don’t reinvent wheels ● Making sure that all source code is open by default ● Reforming procurement – helping the NHS buy the right technology through the application of technology standards, streamlined spend controls & new procurement frameworks that support our standards ● Setting national strategy & mandating cyber security standards so security is designed in from the start ● Championing & developing digital training, skills & culture so our staff are digital-ready ● Develop AI capability via funding programmes & development of NHSx AI Lab Respond to Reflection #2 in your workbook
- 15. ICS / HCP/ ACO / ACS Geographic area (not CCG) PCN
- 18. •Early detection •Breast, prostate, lung, bowelCancer •Prevention •Familial Hypercholesterolaemia; Cardiac Arrest; Stroke servicesCVD •Prevention •Monitors; self care; choices and consequencesDiabetes •Prevention •Rehab; Meds Opimisation; Risk ScoringRespiratory •Children and young people (25% prevalence) •Crisis; suicide prevention, eating disorders, learning disabilitiesMental Health
- 19. • Primary Care Networks • To integrate teams and digital servicesPrimary Care • Urgent treatment centres, NHS 111 • To reduce pressure on A&EUrgent Care • Digital transformation • To reduce wait times and delayed transfersAcute Care • IAPT expansion • Crisis; suicide preventionMental Health
- 20. • 75% of Trusts are in the red • We pay for activity not outcomes • Annual budgets Finance • More patients, less staff • 100k workforce gap • Retention and skill developmentWorkforce • Digitalising the system for patients and clinicians • Interoperability of digital systems • Patient information and record sharingDigital
- 21. 30% of people in NWC live with one or more long term conditions The difference in life expectancy between areas across NWC can vary by more than 10 years By 2021 there will be 9% (5700) MORE people living beyond 65 years with the biggest growth in those aged 70-75 and 85+ Over half of adults are overweight or obese
- 22. ● Shift the emphasis from disease and distress to prevention and promotion (prevent the fires) ● Passive patient becomes more discerning and responsible for their health and wellbeing – choices and consequences ● Technology ● Resource optimisation ● Reducing duplication ● Greater standardisation and reliability
- 23. Integrated Care System Currently a shadow integrated care system called Healthier Lancashire and South Cumbria: ● Five integrated care partnerships ● 1.7m population ● 8 CCGs ● 5 Trusts ● 4 upper tier Local Authorities ● NHS England and NHS Improvement ● Wider partners such as voluntary, charity, hospices and education Morecambe Bay Pennine Lancashire Central LancashireWest Lancashire Fylde Coast Lancashire and South Cumbria
- 24. Healthier Lancashire Out of Hospital Acute and Specialised Mental Health Prevention and Population Health • Regulated Care • Primary Care • Stroke • Cancer Alliance • Better Births • Head and neck • Vascular • Diagnostics • Pathology • Children and Young People • Suicide Prevention • Leaning disabilities • Preventing Diabetes • Public Health • Population Health • Personalised care Commissioning Urgent and Emergency Workforce Digital • Commissioning development • Clinical policy reviews • Respiratory • Falls • UTIs Careers Clinician Passport It's Your Move Well at Work Our digital future
- 25. Cheshire and Merseyside Healthcare Partnership ● 12 CCGs ● 9 Local Authorities ● 20 Provider Trusts Focussed on: ● Collaboration and partnership ● Joined up care ● Targeting localised priorities ● Implementing a place based care matrix
- 26. Cheshire and Merseyside Healthcare Partnership Health Inequalities Focus • Mental wellbeing • Zero suicide • Cardiovascular disease – zero strokes • No harm from alcohol • Every child immunised • Reducing falls • No violent crime
- 27. INDEPENDENCE & PREVENTION Products & services that: • Improve the physical, mental & emotional wellbeing of individuals & carers • Are targeted at healthy people to keep them well & prevent illness • Support early diagnosis by identifying people at risk of developing disease • Identify people with an existing diagnosis to who are at risk of deterioration PATIENT ACTIVATION & SELF CARE Products & services that: • Support people with an existing diagnosis to manage their condition • Use of support & education to increase patient activation that will reduce likelihood of exacerbation • Provide information & advice which helps people maximise their wellbeing GREATER SUPPORT & RESOURCE FOR PRIMARY CARE Products & services that: • release GP capacity • Make GP practices more effective & efficient places to work WORKFORCE RESOURCE OPTIMISATION Products & services that: • Support the creation of new roles • Increase productivity of the workforce • Offer new technologies that plug gaps in workforce (eg AI in diagnostics) • help reduce/avoid duplication & variation in staffing • Support integration of health & social care teams DIGITISING THE SYSTEM Products & services that: • Trigger a shift from paper based working to digital working • Introduce remote & assistive technology • Enable record sharing & interoperability • Population-based intelligence systems • greater patient access to information & records • reduce the burden of travel for staff & patients IMPROVING SYSTEM FLOW Products & services that: • Reduce time spent in hospital • Help the navigation of the urgent care system to prevent admissions • Reduce delayed transfers of care • Identify bed availability across the system • Reducing time lost waiting for access & discharge OPERATIONAL EXCELLENCE Products & services that: • Improve effectiveness & efficiency of “back office” non-clinical systems • Reduce running costs of organisations • “Carter” products • Doing the basics really well, everywhere • reduce variation & duplication in processes • Help an organisations do things better, faster, safer, cheaper PATIENT SAFETY & QI Products & services that: • Increase the quality & safety of clinical services • Reduce impact of human factors • Reduce serious incidents & never events • Improve patient experience • Improves outcomes & reduce side effects Develop – Matching Innovation Products to NHS “System Need” Making it relevant
- 28. Where does your innovation match system needs? Respond to Reflection #3 in your workbook
- 29. Commissioning and the need for procurement
- 30. What is commissioning? • What is procurement? • Procurement towers • Procurement frameworks • Other portals Commissioning and Procurement: Our Topics
- 31. What is commissioning? What is procurement? Commissioning and Procurement Respond to Reflection #4 in your workbook
- 33. C https://www.kingsfund.org.uk/sites/default/files/2017-10/NHS_structure_2017.pdf Commissioning Clinical Commissioning Groups (CCGs) NHSE/I Local Authorities Private providers Commissioners Contract with Providers Integrated Care Systems Voluntary sector GPs and other primary care Primary Care Networks (PCNs) Primary Care Networks (PCNs)
- 34. How the money flows Public Health England Other arm’s length bodies, including NHS Improvement, Care Quality Commission and Health Education England Department of Health Parliament NHS England Clinical Commissioning Groups Better Care Fund Local authorities Public health Community services Mental health Hospital services Ambulance services Primary care Specialised services Primary Care Networks £122.2 billion £105.9 billion £7.4 billion £4.2 billion £76.6 billion £3.4 billion £15.4 billion£12.8 billion £2.1bn Sustainability and Transformation Fund
- 35. What does this mean for you? ● Providers procure products, Commissioners commission services ● Emerging Integrated Care Systems hold some funds but aren’t real yet ● The organisation that uses a product may not be the organisation that reaps the benefit ● Operational efficiencies vs cost savings ● 70% NHS costs are in staff. Incremental changes are not cash releasing for commissioners ● What will your product replace or improve? ● The tariff for PbR is available publically. Use it. https://improvement.nhs.uk/resources/national-tariff-1719/
- 36. The NHS mantra Procurement seen as key solution to these problems ● More with less ● Reduce variation ● Increase efficiency ● Reduce cost without clinical compromise Repeat…
- 37. NHS Supply Chain The new NHS Supply Chain was designed to help the NHS deliver clinically assured, quality products at the best value, through a range of specialist buying functions. ● Aims to deliver savings of £2.4bn back into NHS frontline services by 2023. ● The new model consists of eleven specialist buying functions, known as Category Towers ● Three enabling services for logistics, supporting technology and transactional services underpin the model. Key benefits: Suppliers • Lowering sales and marketing costs • Single route into the national market • A joined-up approach across the NHS • Clear route for innovative products NHS Trusts • Savings channelled back to frontline services • Releasing more time for core clinical activities • Greater NHS clinical involvement in purchasing decision • More effective introduction of new products
- 38. Procurement Towers There are 11 specialist buying functions knowns as category towers…. Non Medical Tower 11 NHS Hotel Services Tower 4 Orthopaedics, Trauma & Spine, Ophthalmology Medical Tower 3 Infection Control And Wound Care Tower 5 Rehabilitation, Disable Services, Women’s Health & Associated Consumables Tower 2 Sterile Intervention Equipment And Associated Consumables Tower 10 Food Tower 9 Office Environment Capital Tower 7 Large Diagnostic Capital Devices incl. Mobile & Consumables Tower 8 Diagnostic Equipment and Associated Consumables Tower 1 Ward Based Consumables Tower 6 Cardio-Vascular, Radiology, Audiology & Pain Management
- 39. Talk at your table: Respond to Reflection #5 in your workbook Where do you fit within the Procurement Towers and why?
- 40. Opportunities: If yes… ● Register on procurement towers framework - [email protected] ● Consider partnering with a larger supplier ● Consider forming a consortia ● Use your AHSN as conduit
- 41. Health system support framework What is is?: a quick and easy route to access support services from innovative third party suppliers at the leading edge of health and care system reform. ● Can be used by any NHS organisation, including NHS Trusts, Clinical Commissioning Groups (CCGs), national Arm’s-Length Bodies and local authorities ● Integrated Care Systems (ICSs) and Sustainability and Transformation Partnerships (STPs) can use the HSS to access innovative technologies and digital vendors to drive forward system reform ● The Framework focuses particularly on services that can support the move to integrated models of care based on intelligence-led population health management
- 42. Framework areas ● Infrastructure: o Electronic Patient Records and place-based digitalisation o local health and care records across different care settings o primary care IT support and cyber security ● Intelligence: o targeted population health analytics o digital tools for system modelling, actuarial assessment, planning, research, risk stratification and impactability modelling o clinical decision support tools ● Impact and Intervention: o transformation and change support o patient empowerment and activation (including self-care support, personalisation, assistive technologies and remote consultations) o demand management and capacity planning support solutions o system assurance and provider modernisation o medicines management support
- 43. G-Cloud What is it?: G-Cloud (RM1557ix) is a framework where supplier cloud-based solutions are made available through a front-end catalogue called the Digital Marketplace. o G-Cloud framework is THE place to be, for companies who are thinking about selling their cloud-based solutions to the UK government. o The Digital Marketplace is an online service for public sector organisations to find people and technology for digital projects. Any public sector organisation, including agencies and arm's length bodies, can buy using the Digital Marketplace.
- 44. What is a Framework Agreement? Definition: an agreement between a Contracting Authority (e.g. NHS SBS, an NHS Trust, or a local council) and one or more suppliers, the purpose of which is to establish the terms governing contracts to be awarded during a given period, in particular with regard to price and, where appropriate, the quantity. ● 6-9 month procurement process ● Awarded following a fully OJEU compliant process under the 2015 Public Contracts Regulations ● Usually awarded for a period of 4 years ● *Legal requirement for public sector procurements over the value of £118K ● Approx. cost of £25,000 per tender process for a Contracting Authority
- 45. Where to look for NHS opportunities NHS Opportunities MUST be published online - you need to put the work in, you have to search! Essential Sites: Above OJEU >£118k DoH, NHS Trusts / £181k NHS England, CCGs & NHS Foundation Trusts o TED Europa http://www.ted-Europa.eu Below OJEU >£10k to £118k / £181k o Contracts Finder http://online.contractsfinder.businesslink.gov.uk Contracts Finder pulls from all sites where possible (One Place – Full Transparency) Other Useful Sites: o Public Contracts Scotland – www.publiccontractsscotland.gov.uk o Sell2Wales – www.sell2wales.gov.uk o eSourcing Northern Ireland – www.e-sourcingni.bravosolutions.co.uk
- 46. How to look for NHS opportunities ● Registering is essential ● Register for all or as many as possible ● Searching for Opportunities is critical ● CPV Codes, NUTS codes and / or Key Words o CPV Codes – define what is being sourced (e.g. 3314000 Medical Consumables) o NUTS codes define the location (e.g. Essex – UKH3) ● Use Alerts ● Regularly review sites and evaluate opportunities
- 48. What do we mean when we talk about culture? Culture describes the rich pattern of social behaviour present in an organisation over time, including all spoken and unspoken rules, symbols, routines and stories. Culture binds together an organisation’s different parts, giving identity to the whole.’ This includes: ● Values ● Assumptions ● Artefacts
- 51. VALUES: old and new power Old power values New power values Formal (representative) governance, managerialism, institutionalism Informal (networked) governance, opt-in decision-making, self- organisation Competition, exclusivity, resource consolidation Collaboration, crowd wisdom, sharing, open-sourcing Confidentiality, discretion, separation between private and public spheres Radical transparency Expertise, professionalism, specialisation Maker-culture, “do it ourselves” ethic Long-term affiliation and loyalty, less overall participation Short-terms conditional affiliation, more overall participation
- 53. NHS culture improvement themes •Learning culture •Listening culture •Open and transparent culture •Just culture
- 54. Principles of NHS culture • Vision and values • Goals and performance • Support and compassion • Learning and innovation • Teamwork
- 55. Vision and values Value The way we do things Constant commitment to quality of care Everyone taking responsibility in their work for living a shared vision and embodying shared values
- 56. Goals and performance Value The way we do things Effective, efficient, high quality performance Everyone ensuring that there are clear priorities and objectives at every level and intelligent data constantly informing all about performance.
- 57. Support and compassion Value The way we do things Support, compassion, and inclusion for all patients and staff Everyone making sure all interactions involve careful attention, empathy, and intent to take intelligent helping action.
- 58. Learning and innovation Value The way we do things Continuous learning, quality improvement, and innovation Everyone taking responsibility for improving quality, learning, and developing better ways of doing things.
- 59. Teamwork Value The way we do things Enthusiastic cooperation, team working, and support within and across organisations Everyone taking responsibility for effective team-based working, interconnectedness with and across organisations, systems thinking and acting.
- 60. Your work and NHS culture principles Vision and Values Goals and Performance Support and Compassion Learning and Innovation Teamwork
- 61. Resistance to change Shock Frustration Resistance Exploration Commitment Integration Valley of Despair
- 63. Respond to Reflection #6 in your workbook
Editor's Notes
- #3: 15 minutes Two or three rounds, depending on time
- #4: 15 minutes Two or three rounds, depending on time
- #5: 15 minutes Two or three rounds, depending on time
- #7: 15 minutes Two or three rounds, depending on time
- #8: 15 minutes Two or three rounds, depending on time
- #9: 15 minutes Two or three rounds, depending on time
- #10: 15 minutes Two or three rounds, depending on time
- #11: 15 minutes Two or three rounds, depending on time
- #12: 15 minutes Two or three rounds, depending on time
- #13: 15 minutes Two or three rounds, depending on time
- #14: 15 minutes Two or three rounds, depending on time
- #15: 15 minutes Two or three rounds, depending on time
- #16: 15 minutes Two or three rounds, depending on time
- #17: 15 minutes Two or three rounds, depending on time
- #18: 15 minutes Two or three rounds, depending on time
- #19: 15 minutes Two or three rounds, depending on time
- #20: 15 minutes Two or three rounds, depending on time
- #21: 15 minutes Two or three rounds, depending on time
- #22: 15 minutes Two or three rounds, depending on time
- #23: 15 minutes Two or three rounds, depending on time
- #34: Statutory bodies Split into commissioners and providers. Commissioners (planning and buyers, place contracts with a range of different providers – NHS and non-NHS – for delivery of front line care) commissioners CCGs – 209 CCGs NHS England – 4 regional teams (many more “Directors of Commissioning Operations”) LA - 152 Local authorities. GM Health and Care Partnership - From April 2016, leaders in Greater Manchester have taken greater control of the region’s health and social care budget. This includes taking on delegated responsibility for several commissioning budgets previously controlled by NHS England. Providers NHS Trusts and Foundation Trusts – include acute trusts (hospitals), mental health trusts, community trusts (district nursing etc). Voluntary sector – hospices, Age uk, Macmillan, local groups GPs and other primary care – eg pharmacists, dentists, opticians etc. Regulators – CQC and NHS I. NHS E have a role in regulating CCGs Other, non statutory bodies STP - Since December 2015 NHS providers, CCGs, local authorities and other health care services have come together to form 44 STP ‘footprints’. These are geographic areas that are coordinating health care planning and delivery, covering all areas of NHS spending on services from 2016/17 to 2020/21. Charged with making sure changes that span more than one provider/commissioner relationship are delivered. Across this wider footprint ensuring that variation is reduced and that systems are as efficient as possible. Also have a specific role in terms of estates Accountable Care Systems – moving to Integrated Care Systems. New model of delivering care, integrating delivery of care and aligning incentives without the need for a legislative change. They are areas where commissioners and NHS providers, working closely with GP networks, local authorities and other partners, agree to take shared responsibility (in ways that are consistent with their individual legal obligations) for how they operate their collective resources for the benefit of local populations May also hear integrated care organisations – a new provider entity, capable of holding a population health budget. None of these exist yet.