- 1 -Investing in your health

Building a better NHS for people in Bedfordshire & Hertfordshire

PROPOSED MONITORING ARRANGEMENTS

20th June 2005

- 2 -Investing in your health

Building a better NHS for people in Bedfordshire & Hertfordshire

Five key questions

1. Is the NHS doing what it said it would do?

2. Is the timetable being adhered to?

3. Are the changes having the predicted impact?

4. What is the public understanding of the changes?

Plus

5. What else is going on and to what extent (if any) do local plans need to be modified?

- 3 -Investing in your health

Building a better NHS for people in Bedfordshire & Hertfordshire

Three general issues

1. Difficulty in separating out specific impact of IIYH from impact of general changes in health and healthcare.

2. Balance between hard and soft measures.

3. Appropriateness of the level of detail.

- 4 -Investing in your health

Building a better NHS for people in Bedfordshire & Hertfordshire

What we said we would do

More local services• Expanded primary care and 15 (?) Community DTCs • Expanded intermediate care facilities

Expansion of elective care facilities and separation from emergency care• Different approach now between Hertfordshire & Bedfordshire

Concentration of hospital based services onto fewer sites• 4 major acute hospitals but 6 A&E departments remaining

Development of specialist services• Cancer centre within Beds and Herts• Distributed model of supra DGH services

Development of postgraduate medical school

Proposal : Annual report and presentation

- 5 -Investing in your health

Building a better NHS for people in Bedfordshire & Hertfordshire

Timetable

Transitional plan

Key milestones for:• DTCs• Development of intermediate care• Elective treatment centres• Business case process for 2 major hospitals

Proposal : Annual report and presentation

Summary Gantt chart

- 6 -Investing in your health

Building a better NHS for people in Bedfordshire & Hertfordshire

Predicted impact (1)

Shift in expenditure• % revenue expenditure in acute, primary and other NHS care

More care locally• % fces delivered within Beds & Herts• % fces delivered in non-acute hospitals• % diagnostic tests delivered in non-acute hospitals• emergency bed days (also efficiency measure)• travel time assessment (emergency care)

Quality of care• standardised mortality rates• readmission rates• post operative infection rates (MRSA)• specific services and/or conditions? (e.g. cancer, cardiac)• PCT and Trust surveys on patient satisfaction

- 7 -Investing in your health

Building a better NHS for people in Bedfordshire & Hertfordshire

Predicted impact (2)

Separation of elective from emergency care• access times• transfers• patient satisfaction

Population’s health• wide range of indicators

More attractive place to work• vacancy rates• staff surveys

Proposal : Annual report and presentation

Web based population health

- 8 -Investing in your health

Building a better NHS for people in Bedfordshire & Hertfordshire

Public understanding

Do people know about IIYH and the proposed changes?

Are the changes having a beneficial impact?

Do behaviour changes reflect changes to model of care?

How are the changes being communicated?

Proposal : Three-yearly major survey (MORI) with annual updates

- 9 -Investing in your health

Building a better NHS for people in Bedfordshire & Hertfordshire

External events and comparisons

Changes in government policy and national context, e.g. plurality, payment by results, choice, NHS funding

Changes in local organisations and local context, e.g. structural changes, financial performance, Harefield

Legal and procedural issues, e.g. judicial reviews, business cases

Beds & Herts compared to England average

Combined impact on IIYH

Proposal : Annual report and presentation