48
Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Embed Size (px)

Citation preview

Page 1: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Healthcare in the UK

Dr Andrew Vallance-Owen MBA FRCSEdSpecialist Medical AdvisorHealthcare UK

Page 2: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Healthcare in the UK

• The National Health Service

• Primary care

• Private healthcare in the UK

• Public Private Partnerships (PPP and PFI)

Page 3: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Founding principles

The NHS was launched on 5 July 1948 and was founded on three core principles:

• that it meet the needs of everyone• that it be free at the point of delivery• that it be based on clinical need, not ability to pay

65 years later, these principles remain at the heart of the NHS and have been supplemented in the NHS Constitution

Page 4: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

The NHS faces similar challenges to other health services around the globe

Money. Maintaining the quality of services within the hardest ever funding settlement since the inception of the NHS

Population change. In the UK, we live longer, but are becoming less healthy. Non-communicable diseases, like

diabetes and cardiovascular disease and their costs are rising sharply

Expectations and treatment costs. Patients rightly expect a higher level of service than in the past. The cost of medicines has

been growing on average by nearly £600m a year

Page 5: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Clinical gatekeeper

• Commissions the services required • Understands the needs of patients• Understands what is possible, clinically and financially• Drives higher quality

Primary care is the key

• Consistent regulation and pricing• Providers compete on quality, outcomes and patient experiences• Greater competition where this is in the patients’ interest

Creates a more responsive provider side

• A dedicated public health system

Protects long term investment

Page 6: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

An NHS that puts patients and the public first…

• Offering choice to patients• Backed by an “information

revolution” to boost transparency

• Strong public/consumer voice through HealthWatch

…which focuses on improving healthcare outcomes…

• Outcomes frameworks • Backed by clinically-

evidenced NICE quality standards

• Incentives for quality

…with autonomy for professionals, and accountability to patients…

• Clinically-led commissioning• Local authority involvement• All public sector providers to

become autonomous; a level playing field with private/voluntary sector

• Separation of commissioner & provider

underpinned by reduced bureaucracy and improved efficiency

The NHS aims to achieve healthcare outcomes that are amongst the best in the world

Page 7: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

The NHS Outcomes Framework

• The performance of the NHS is being held to account through the NHS Outcomes Framework. It is split into five domains:

Page 8: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

The NHS : its defining characteristics

• The world’s largest publically funded healthcare service providing healthcare for all citizens

• Highly developed primary care • Expert hospital care

Universal

• Treatment provided by a multidisciplinary team• Enables continuity and co-ordination of care• Controls access to specialist care in hospitals Integrated

• The right service, workforce and facilities delivered through:• Sophisticated data collection and analysis• Planning and programme implementation• Regulation systems

Organised

Page 9: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

The NHS : key building blocks

Infrastructure and facilities• World renowned companies partner

with the NHS to create outstanding facilities:

• design• build• operating

Training• UK training produces top class:

• clinicians• Nurses and midwives• Allied health professionals• Leaders and managers

Compatible information systems• Support the clinician and patient• Gather essential management and

population data

Technology• Cutting edge medical and bioscience

technology for:• clinical care• diagnostics• telemedicine• pharmaceuticals

Page 10: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

The NHS in numbersThe UK Population 62.6m GDP $2.6tr

Spend on healthcare

Per capita (total) $3,480 % of GDP 9.6%

Per capita (government) $2,919 Private healthcare (as a % of total) 16.1%

Management cost 3% International rank 15th of 23

Medical staff

Doctors per 10,000 27.43 Total doctors in England c125,000

Number of GPs c42,000 Patients per GP 1480

Total nurses in England c330,000

Facilities

GP surgeries and health centres 8,400

Acute hospital trusts in England (2010) 168

Hospital beds in England (2009) 159,000

Page 11: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Regulators and Watchdogs Commissioners

NHS Structure in England

Government represented by Secretary of State for Health

Department of Health

Public Health EnglandNHS England Monitor (economic regulator)

Care Quality Commission (quality regulator)

Healthwatch England

Local Authorities

Clinical Commissioning Groups

Primary Care Services

NHS Foundation Trusts, Private and Voluntary Service Providers

Hospitals Community Services

Mental Health

NHS England regional and local offices

Tertiary Care and Specialist Services

Public Health Departments

Local Healthwatch

Funding

Regulation

Members of local Health & Wellbeing

Boards

Health Overview and Scrutiny Committees

Page 12: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

All the population can register with a primary care centre (General Practice).They have doctors (GPs) and nurses with general clinical knowledge and skills. GPs can refer people to other services where necessary.

Tertiary specialist services

HospitalsCommunity-based care

Mental health

Primary care

The NHS: types of care services and access to them

Hospitals have doctors that are experts in particular areas of the body & conditions. They normally see people referred by Primary Care by appointment. People who need emergency care can be seen without an appointment. There are separate centres that care specifically for people with mental health problems.If people are able to be cared for in their own homes community based nursing and therapy services can support them.

Rare, expensive conditions are cared for in a few centres that take referrals from regions or the whole country. They usually have strong links with academic research institutions.

LocalPopulation

Page 13: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Primary Care

Page 14: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Focus on primary care

• First-contact care for new health problems

• Comprehensive care for the majority (90%) of health problems

• Patient-focussed care for people with long term conditions

• Care coordination and access to secondary care

Page 15: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

What is a health centre for?

Outpatient clinic/Minor treatments

Diagnostics Clinical education

Primary care

Health and Wellbeing

Page 16: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

The primary care pathway• Patient education

• Nutrition • Maternal and child health• Life style• Sanitation

• Prevention

• Immunisation• Surveillance• Environment• Nutrition• Communicable disease

• First response• Minor injury treatment• Diagnosis of illness• Prescribing medicines

• Care Coordination• Monitoring• Rehabilitation• Education• Crisis management

• Referral to• Community health services• Care services• Palliative care

• Referral to • Confirmation of diagnosis• Acute care• Specialist treatment

Return to Primary Care

Page 17: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

The primary care team

Family Doctor

Therapist

Social workerAdministrator

Nurse

Therapist

Pharmacist

DentistMidwife

Psychologist

Page 18: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Primary Care: A Critical Review Of The Evidence On Quality And Costs Of Health Care Health Affairs, May 2010

Does primary care work?

Page 19: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

• Provide effective treatment, rehabilitation and care outside hospital• Improve good access to and continuity of care• Improve patient satisfaction with their care• Become the gateway to hospital care• Provide cost effective care• Promote healthier lifestyles• Improve the training of family medicine doctors and nurses• Support monitoring and accreditation of the quality of the service

Effective primary care can….

Page 20: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Private healthcare in the UK

Page 21: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Private healthcare in the UK

• All citizens are entitled to NHS• Private healthcare is supplementary to

NHS• Small international market

• mainly in London• Private providers almost all secondary

care• A few private GPs in London

9%of the population buy private medical insurance

3%of the population self pay (including cosmetic procedures)

Page 22: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Public funding and provision dominates elective care in England

NHS FundingNHS Provision

“The NHS”

NHS FundingIndependent Provision

“Independent hospitals”

Private FundingNHS Provision

“Private Patient Units”

Private FundingIndependent Provision

“Private Hospitals”

NHS Provided

Private

Independent

PPUs

88.5%

6.7%

3.9%

0.8%

Elective Admissions 2012-13

Sources: HSCIC (HES) 2012-13; PHIN

Page 23: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

200 independent hospitals conduct around 1 million patient episodes each year• Privately funded: 650,000

• NHS-funded: 350,000+

NHS FundingNHS Provision

“The NHS”

NHS FundingIndependent Provision

“The Independent Sector”NHS “patient choice” at ISTCs

and private hospitals

Private FundingNHS Provision

“NHS Private Patient Units”

Private FundingIndependent Provision

“Private Hospitals”

Page 24: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Private patients come from across the UK

© PHIN 2013. HES data re-used with permission of HSCIC. All rights reserved.

Warning: example data may not be complete and should not be relied upon.

Page 25: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Patients treated in independent hospitals

© PHIN 2013. HES data re-used with permission of HSCIC. All rights reserved.

Warning: example data may not be complete and should not be relied upon.

Page 26: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Why buy private care?

Immediate accessReduced waiting

time for treatment

Consultation/treatment always with a

specialist

Generally better facilities

Customer focus

Page 27: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Private insurance market

Per-sonal cus-

tomers 30%Large

corpo-rates 35%

Small/ medium enter-prises 35%

Customers Providers

40%

25%

35%All other providers

AXA-PPP

BUPA

Page 28: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Private providers

200Private hospitals and clinics

100Beds per hospital on average

Private Hospitals• Conduct routine elective surgery• Regulated by the Care Quality

Commission• as are NHS hospitals

Small Providers• Out-patient cosmetic and laser

treatments• Largely unregulated

Page 29: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Private specialists

• Most work mainly in NHS with one or two sessions a week in the private sector

• Some full-time private specialists in London

• Specialists are independent practitioners

• may work in a number of hospitals

• are not employed by private hospitals

Page 30: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Public Private Partnerships

Page 31: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Public Private Partnerships - PPP

Public and private sectors working in partnership and sharing risk

SimpleOutsourcing a

serviceShort /medium term

contract

ComplexMajor hospital development

Design + buildFinancing

Long term operation

Page 32: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Public Private Partnerships

Aims:

• clearly specified, realistic and shared goals• clearly delineated and agreed roles and responsibilities • distinct benefits for all parties • transparency • active maintenance of the partnership • equality of participation • meeting agreed obligations

Partnership: ‘a relationship based on agreements reflecting mutual responsibilities

to further shared interests’

Page 33: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

A new children’s eye centre for Moorfields Hospital

Page 34: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Types of PPP in UK• A particular method of financing capital investment with requires that the private

sector design, build, finance and operate specific facilities• Long term contracts of 25-30 years• Payments only made if the service is delivered as per the agreement• Transfers substantial risk to the private sector

Private finance initiative

• Local Investment Finance Trusts (LIFT)• Department of Health/commercial company

• The Information Centre and Dr Foster IntelligenceJoint ventures

• Consumables, pharmaceuticals, management consultancy, laundry, cleaning etc• Treatment and care

• independent sector treatment centres

Contracts with suppliers

Page 35: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

35

Redevelopment of the Royal Marsden Sutton Campus

Page 36: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

PPP for Healthcare in the UK

20+years of experience

130healthcare PPP projects

£12 billioncapital value

1991 The UK Government introduces PFI

1996First contract signed to design, build, finance and operate a 1,000 bed hospital, in Norwich

2001 The Norwich hospital completed on budget and 5 months ahead of schedule

2006The largest single PPP hospital contract in the UK signed for the £1.1b redevelopment of the Royal London and St Barts

2012More than 130 healthcare PPPs completed, underway or approved since 2001

2016 Scheduled completion of the Royal London and St Barts PPP

Page 37: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Private Finance Initiative:Capital raised and projected repayments

12

79

Page 38: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Private Finance Initiative:Private sector participants

• Private sector partners can often be a consortium

• Leading participants include:

• Building contractors

• Service companies

• Insurance companies

• Banks, equity investors, pension funds

Page 39: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Public Sector Partner

Commission new facilities

Pay for facilities and facility management over term of contract

Commission separately soft FM – hotel services

Facility transfers to public sector partner at end of term

Provide clinical services, may retain equipment and IM&T

Private Sector Partner

Design facilities – architects, mechanical and electrical engineers

Build facilities – construction company

Finance facilities – equity and debt including a government stake in equity

Manage facilities – hard and soft FM

May provide some clinical services, may provide managed equipment services and IM&T

PPP structure in UK

Page 40: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Benefit of PPPs

Finance and risk• Transfers construction, maintenance and operation risk to

private sector in return for a guaranteed annual payment• Converts major capital expenditure into a rental stream which

may make it more “affordable” for a public authority as a payment from annual revenues.

• Projects can be re-financed after the construction phase, which is perceived to be the period of greatest risk, to obtain cheaper on-going finance rates and lower rental repayments

Page 41: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Benefit of PPPsDesign and construction• Fixed design brief which prevents cost escalation due to changes in

specification mid-construction• Delivery on time and on budget. The public sector pays nothing until

it has occupation and the private sector cannot come back for additional cash having agreed a fixed price and delivery date.

• Private sector can bring design innovation that facilitates optimal delivery of services combined with buildings that remain energy and maintenance efficient over their whole life

• Buildings are designed to the latest space standards• Modern designs work better for patients and staff

Page 42: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Benefit of PPPsWhole life maintenance• Contractor must maintain the buildings in an ‘as new’

condition throughout the contract period and can be penalised if they fail to do so. 

• Contract allows for change mechanisms after construction completion.

• Whole life maintenance encourages low-carbon and energy efficient design

• Building consistently maintained to a high standard makes a better environment for patients and staff

Page 43: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Potential pitfalls of PPP

• Process is rigid and inflexible and design brief quickly becomes locked in and is expensive to change

• Contract variations are expensive because the IRR of the deal needs to be maintained

• Insurance and risk are priced into to deal and may prove excessive over time

• Public sector is poor at managing the operational phase of the contract and does not always secure value for money

• The deal locks the private sector into a fixed price, but it also locks the public sector in and reduces the public sector’s flexibility to downsize costs

Page 44: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Private Finance Initiative

Page 45: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

Public Private Partnerships

Advantages• Access to capital and expertise• Transfer of risk• Quicker delivery of projects• Performance efficiencies from private sector management

Disadvantages• Lengthy procurement process• Lifetime costs• Loss of direct control• Need strong, informed client• Culture tensions

Page 46: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

How can the Healthcare UK help?

• Introductions to NHS services and private sector companies experienced in PPP

• Creating consortia to meet specific needs

• Local UKTI contact and diplomatic support

• Arrange missions and visits to and from Brazil

• Provide expert advisers and speakers

Page 47: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

A public system …with many partners

Page 48: Healthcare in the UK Dr Andrew Vallance-Owen MBA FRCSEd Specialist Medical Advisor Healthcare UK

The vital partner in global health