Contenu connexe Similaire à New models for NHS delivery (20) Plus de Palveluseteli-hanke (20) New models for NHS delivery2. Outline
Structure of Health and Social Care in
the UK
Moving from a state-run NHS to a
patient-led NHS
A bumpy ride
Templates for change
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3. Overview of Provision of Health and Social
Care
Department of
(Public) Health
DH Social Local Authorities
DH - NHS
Care Policy (Social Care)
Strategic Health Public Sector Private Sector
Authorities Providers Providers
Commissioners
Public and Private
Sector Providers
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4. A new market
The NHS has changed…
System Management Oversight
New NHS
Providers Market Commissioners
£100bn pa
380+ NHS trusts, 152 PCTs
GPs, GP fundholders
Private providers, Patient choice
Third sector
… Markets come with a regulatory framework. This framework needs
to be reliable and enforceable. It needs to enhance competition and
help deliver integrated, value for money end to end services.
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5. Outline
Structure of Health and Social Care in
the UK
Moving from a state-run NHS to a
patient-led NHS
A bumpy ride
Templates for change
© 2010 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member
firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved.
4
6. Moving from a state-run to a patient-led NHS
Key policy drivers
Efficient procurement introducing real risk transfer
PFI
NHS Shared Business Services
Creating/commissioning a patient-led NHS (March/July 2005)
developing the idea of choice and contestability
tasking PCTs as commissioners, not providers
Implications
The state operates primarily as the champion of the user of public services (the patient,
the pupil, the infirm, the offender, the traveller)
Where the state is involved in delivery of public services, it is a “means” to achieving
good, stable, value-for-money public services; it is not an end in itself
James Stewart, Infrastructure UK, Nov 2008
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7. The increasing role of the private sector
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
PFI Hospital Programme
LIFT
ISTC Waves 1-2
NHS shared business services
Pathology
outsourcing
Increasing breadth of service delivery
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firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved.
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8. Outline
Moving from a state-run NHS to a
patient-led NHS
A bumpy ride
Templates for change
© 2010 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member
firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved.
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9. The rise and fall of PFI
Number of deals to close by year
20
15
10
5
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Capital value of deals to close by year
2,500
2,000
£ million
1,500
1,000
500
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
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firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved.
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10. The Private Finance Initiative
Features:
Private sector design, build, finance and maintain the facility
Payment mechanism rewards availability of facility
Transfer of lifecycle cost risk
Hard FM included
Soft FM included to varying degrees in some deals
Key issues:
TUPE
Constraints on changing use of facilities
Initial overscoping of many facilities
Exhaustion of pipeline
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11. The rise and fall of central clinical contracting
Independent sector treatment centres
800
Five year scheme value (£m)
700 Fairness in Primary Care
600
500
400
300
200
100
0
2003 2004 2005 2006 2007 2008 2009
Year of full service commencement
Source: Department of Health
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12. Independent sector treatment centres
Features:
Initially take or pay contracts
Transfer of all construction (where applicable) and operating risk
The first major programme of private sector clinical provision in secondary care in the NHS
Key issues:
Attracting new players
TUPE
Demand risk – estimating demand, NHS perception, new entrant issues
Clinical negligence coverage
Contract specification
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13. The rise (?) of NHS-led contracting
Ongoing devolution to local NHS organisations has meant a loss of focus but a broader
range of opportunities with greater local buy-in
Transactions of note:
Back office outsourcing
PCTs
Acutes
Pathology outsourcing – acute led
Radiology/imaging outsourcing – acute led
Community health provision
Clinical pathway management
Hospital management
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14. Outline
Moving from a state-run NHS to a
patient-led NHS
A bumpy ride
Templates for change
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firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved.
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15. Templates for change – case studies
Guys/Serco Pathology
Great Yarmouth and Waveney
Community Services
Hinchingbrooke Hospital Franchising
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16. GSTS pathology
Guys and St Thomas NHS Foundation Trust
Improve efficiency of service delivery esp back office
Improve patient care
Develop the business
Serco
Beachhead for a market leading pathology business
Opportunity to extend into a growing market
Access to NHS “family”
Features
Serco control of JV
Outsourcing arrangement between Guys and JV for delivery of pathology services
Secondment of Trust Staff
Allowed Serco the opportunity to enhance NHS provider efficiency, rather than to
compete directly with that provider
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17. Great Yarmouth and Waveney Community
Services
Policy Background
All PCTs required to have a plan for separating provider arms by Oct 2009
Deadline then dropped…
… then changed to 31 March 2010
Great Yarmouth and Waveney (GYW) PCT
A pathfinder for externalising provision of community health
Initially planned as a procurement open to the private and third sectors
October 2009: Andy Burnham states that the NHS is the “preferred provider” of services
and should be given two chances to improve poor performance before contracting out
GYW therefore switched tack and allowed only NHS organisations to bid
Challenge by ACEVO
Procurement cancelled by the DH
Transactions in the NHS are rarely smooth and frequently politically complex
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18. Hinchingbrooke Next Steps Project
Background
Hinchingbrooke Healthcare NHS Trust has a £40 million accumulated deficit on annual
revenues of around £100 million
Strategic Health Authority has agreed to guarantee the future of the hospital – but on the
basis that the status quo is not an option
The Transaction
Operational Franchise
The Trust remains an NHS organisation but with management outsourced
Current bidders: Ramsay Health Care UK, Circle, Serco
Transfer of all financial and operational risks to the successful franchisee, subject to total
liability caps and profit share arrangements
7-10 year term
If successful, this transaction provides a genuinely new model for transforming
performance in the NHS
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firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved.
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