Challenges in SW

Challenges in SWIan BiggsArea Director BGSW

10 April 2014

Guiding Principles

Walk in the shoes of the people we serve:Think like a patient. Act like a taxpayer

NHS | Presentation to SW Senate NHS England | 10-04-143

Financial

Political Social

Clinical

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.


Challenges: changing demography• Older population (over 65s)

• 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 rolesNHS | Presentation to SW Senate NHS England | 10-04-145

National SW2011 16.4% 19.7%2021 18.7% 22.8%

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.NHS | Presentation to SW Senate NHS England | 10-04-146

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?


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.


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


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


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?


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?


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.’..’


Challenges in SW

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