Is Universal Healthcare

Financially Sustainable?

Howard Lyons
Managing Director
Healthcare UK
 Health system goals
WHO Model Key Function Health System Goals
Policy & Strategy
Service
“ the sum of the organisations, institutions &

Stewardship
Responsiveness
resources devoted to producing health

Regulation
Fairness of
HEALTH SYSTEM

Financing financing
Financing
actions”

HEALTH ACTION
“any effort, whether in
Purchasing personal health care,
public services or Health Status
through inter-sector
Service initiatives, whose
Provision Provision primary purpose is to
promote, maintain or
HEALTH
restore health”
“a state of complete physical,
Resource Resource Mental and social well-being
Generation Generation and not the absence of disease
or infirmity”
Health system goals
WHO Model Key Function Main role within function
• Development of sector-wide policy and legislation
Policy & Strategy • Setting of sector-wide strategy
• Conduction of sector-wide strategic planning
Stewardship
• Translation of strategic / policy intention into rules and guidance
Regulation • Monitoring and/or influencing organisations’ or individuals’ adherence to rules or guidance,
including through licensing or accreditation
• Collection of revenue in order to fund health services, including:
• Governments through tax/other income
Financing Financing • Insurers through premiums
• Individuals through their own savings

Purchasing Health
• Procurement of personal and non-personal health services Status
from providers

Service • Provision of personal health services

Provision
Provision • Provision of non-personal health services

• Generation of suitably trained people to provide services in the sector

Resource Resource
• Generation of physical resources for the sector
Generation Generation • Generation of consumables for use in the sector
Convergence among health system models
Unified public Public contract Structured Segmented Fragmented
model model pluralism model model private model

Stewardship
Regulation Regulation Regulation Regulation
Regulation
Financing
Financing Financing Financing Financing
Financing Financing

Purchasing
Purchasing Purchasing Health Status
Service
Delivery Provision
Provision
Delivery Delivery Delivery
Resource Resource
Generation Generation
Universal Healthcare
Is it financially sustainable?
The UK was the first country to establish universal
coverage for every citizen

“ This is the biggest single experiment in social

service that the world has ever undertaken”
Aneurin Bevan, Minister of Health, 5th July 1948

• founded in 1948 to provide universal healthcare free at the point of use

• is still the world’s largest publically funded healthcare system
• has become one of the most efficient healthcare providers globally
• the UK spends 9.3% of GDP on health, nearly half that of the USA’s
In 2014, the NHS is named the best healthcare system
The NHS in numbers
The UK Population 62.6m GDP $2.6tr
Per capita (total) $3,480 % of GDP 9.6%
Spend Private healthcare (as a
Per capita (government) $2,919 16.1%
on healthcare % of total)
Management cost 3% International rank 1st of 11

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

Medical staff Number of GPs c42,000 Patients per GP 1480
Total nurses in England c330,000

GP surgeries and health centres 8,400

Facilities Acute hospital trusts in England (2014) 160
Hospital beds in the UK (2012) c179,000
The NHS : its defining characteristics

• The world’s largest publically funded healthcare service

Universal providing healthcare for all citizens

• Highly developed primary care
• Expert hospital care

• Treatment provided by a multidisciplinary team

Integrated • Enables continuity and co-ordination of care
• Controls access to specialist care in hospitals

• The right service, workforce and facilities delivered through:

• sophisticated data collection and analysis
Organised • planning and programme implementation
• regulation systems
The NHS – strengths and challenges
Strengths Challenges
Millions of contacts with patients Services that don’t always fit together &
each year
Stewardship can be confusing to navigate
Regulation
Professional ethos and high levels Unwarranted variability in quality
of patient trust and access to services
Improvements
Financing in quality of care,
Financing
Changing public expectations,
e.g. for older people and those with demographics and nature of disease
long term conditions Health Status
People want more involvement
Skilled
Service clinicians, with professional in their health and care
Provision
ethos
Loyalty to hospitals irrespective of care
Strong
Resource
Generation
ties Resource
to local communities
Generation delivered when more can be done away
from hospital settings
 The NHS aims to achieve healthcare outcomes that are
amongst the best in the world
An NHS that puts patients …which focuses on …with autonomy for
and the public first… improving healthcare professionals, accountability to
outcomes… patients…
• Offering choice to patients • Outcomes frameworks • Clinically-led commissioning
• Backed by an “information • Backed by clinically- • Local government involvement
revolution” to boost evidenced NICE quality • Public sector providers will be
transparency standards autonomous
• Strong public/consumer • Incentives for quality • A level playing field with
voice through HealthWatch private/voluntary sector
• Separation of commissioner &
provider
underpinned by reduced bureaucracy and improved efficiency
The NHS Outcomes Framework

Domain 1 Preventing people from dying prematurely

人民
Domain 2 Enhancing quality of life for people with long term conditions

早逝 生活

Domain 3
质量
Helping people recover from episodes of ill health or following injury

Domain 4 Ensuring that people have a positive experience of care

患者的

Domain 5 Treating and caring for people in a safe environment and protecting them from
avoidable harm
 Improving Patient Care
Establishing incentives
Preventing to prematurely
people from dying get the right care, in the right place,
safely and appropriately
Enhancing quality of life for people with long term conditions
人民

早逝 生活

质量
• The NHS Outcome Framework establishes national measures for high-quality, cost-
effective Ensuring
care that people have a positive experience of care
• It covers the treatment and prevention of different diseases and conditions
• It aims to Treating
measure the progress
and caring for people in aof the
safe whole of
environment andthe NHS
protecting them
患者的
from avoidable harm
• One of 3 national outcome frameworks, - others cover social care and public health
The NHS faces similar challenges to other health
services around the globe
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

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
Primary Care The Clinical Gatekeeper
Primary care is the key
• Commissions the services required
• Understands the needs of patients
• Understands what is possible, clinically and financially
• Drives higher quality

Creates a more responsive provider side

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

Protects long term investment

• A dedicated public health system
The clinical pathway Finance

Patient GP (local doctor) Gatekeeper

controls cost

Long term care in

Tests Specialist low cost community
setting

Clinical outcomes
Hospital treatment monitored
Prices controlled
The NHS : 4 Key Building Blocks for Sustainability
Infrastructure and facilities Compatible information systems
• world renowned companies partner with • support the clinician and patient
the NHS to create outstanding facilities: • gather essential management and
• design and build population data
• operating

Training Technology
• UK training produces top class: • cutting edge medical and bioscience
• clinicians technology for:
• nurses and midwives • clinical care
• allied health professionals • diagnostics
• leaders and managers • digital health
• pharmaceuticals
The NHS : key building blocks for sustainability
Infrastructure and facilities Compatible information systems
• world renowned companies partner with • support the clinician and patient
the NHS to create outstanding facilities: • gather essential management and
• design and build population data
• operating

Training Technology
• UK training produces top class: • cutting edge medical and bioscience
• clinicians technology for:
• nurses and midwives • clinical care
• allied health professionals • diagnostics
• leaders and managers • digital health
• pharmaceuticals
Advanced infrastructure and facilities:
fundamental to sustainable healthcare
• Designed to
• optimise outcomes for patients:
• support care pathways
• ensure access to state-of-the-art diagnostic tools
• minimise hospital stay
• minimise secondary infections
• integrate information flows into the infrastructure
• reduce carbon footprint
• reduce costs by financing through value-for-money
vehicles
Queen Elizabeth Hospital, Birmingham
Public Private Partnerships
Partnership:
‘a relationship based on agreements reflecting mutual responsibilities
to further shared interests’
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
PPP structure in UK
Public sector partner Private sector partner
Design facilities – architects, mechanical
Commission new facilities
and electrical engineers

Pay for facilities and facility management

Build facilities – construction company
over term of contract

Commission separately soft FM – hotel Finance facilities – equity and debt

services including a government stake in equity

Facility transfers to public sector partner

Manage facilities – hard and soft FM
at end of term

Provide clinical services, may retain May provide some clinical services,
equipment and IM&T managed equipment services and IM&T
PPP for healthcare in the UK
1991 The UK Government introduces PFI
First contract signed to design, build, finance
20+
1996 and operate a 1,000 bed hospital, in Norwich
The Norwich hospital completed on budget
years of experience
2001 and 5 months ahead of schedule

2006
The largest single PPP hospital contract in
the UK signed for the £1.1b redevelopment of
130
the Royal London and St Bart's
More than 130 healthcare PPPs completed,
healthcare PPP projects
underway or approved since 2001
2012
PF2, 2nd generation PFI introduced £12 billion
2016
Scheduled completion of the Royal London
and St Bart's PPP
capital value
PPP in the UK has transformed the NHS estate
Percentage of the NHS estate more than
50 years old

50%

20%

2007 2014
The NHS : key building blocks for sustainability
Infrastructure and facilities Compatible information systems
• world renowned companies partner with • support the clinician and patient
the NHS to create outstanding facilities: • gather essential management and
• design and build population data
• operating

Training Technology
• UK training produces top class: • cutting edge medical and bioscience
• clinicians technology for:
• nurses and midwives • clinical care
• allied health professionals • diagnostics
• leaders and managers • digital health
• pharmaceuticals
Effective training and development
• The foundation of:
• patient safety
• correct diagnosis
• “right first time” treatment

• Eminent professional bodies with the highest

clinical standards
• Continuous development and assessment
• focuses training where it is needed

• Emphasis on clinical pathways

• sharing best practice across the NHS
UK education and training in numbers

of the world’s top 10 universities:

4 Oxford, Cambridge, Imperial College London, University
College London

31 medical schools

70 universities providing nurse education

80 universities offering training for allied health professionals

26 universities offer a 4 year master of pharmacy course

140 universities and colleges offer health management courses

The NHS : key building blocks for sustainability
Infrastructure and facilities Compatible information systems
• world renowned companies partner with • support the clinician and patient
the NHS to create outstanding facilities: • gather essential management and
• design and build population data
• operating

Training Technology
• UK training produces top class: • cutting edge medical and bioscience
• clinicians technology for:
• nurses and midwives • clinical care
• allied health professionals • diagnostics
• leaders and managers • digital health
• pharmaceuticals
Integrated central systems and services
GP and hospital performance is nationally monitored and managed through
automated systems.

150m
transactions per month
handled by the NHS Spine

100%
GP practises computerised
Self-care solutions
100m
Visits per year to NHS Choices health information site
The NHS : key building blocks for sustainability
Infrastructure and facilities Compatible information systems
• world renowned companies partner with • support the clinician and patient
the NHS to create outstanding facilities: • gather essential management and
• design and build population data
• operating

Training Technology
• UK training produces top class: • cutting edge medical and bioscience
• clinicians technology for:
• nurses and midwives • clinical care
• allied health professionals • diagnostics
• leaders and managers • digital health
• pharmaceuticals
Technology and innovation:
putting the patient at the centre of care

Advanced imaging for

rapid diagnostics and Genomics and
treatment personalised
medicine

“Big data”
Disease registries Telehealth
Outcome assessment Telecare
Healthcare planning mHealth
 The NHS in England has demonstrated the value of telehealth
The world’s largest randomised controlled trial of telehealth was conducted in
England. The results are impressive:

 45% reduction in mortality rates

 20% reduction in emergency hospital admissions

 14% reduction in elective admissions

 14% reduction in bed days

 8% reduction in tariff costs

238 GP Practices and 6,197 telehealth and telecare patients with a diagnosis of congestive heart failure, diabetes or chronic obstructive pulmonary disease participated in
the evaluation
Conclusion: A Relentless Focus on Efficiency,
Effectiveness and Innovation sustains Universal
Healthcare Systems

Infrastructure and Compatible

facilities information systems Intelligent
affordable
healthcare
Training Technology
Who is Healthcare UK?
Healthcare UK:
provides a single gateway into the UK
network of industry, NHS and academia

catalyses the creation of UK consortia

to respond to overseas requirements

facilitates government-to-government
initiatives

promotes the UK’s capabilities overseas

We help the UK healthcare sector access leads and convert
them into business success
2020/21*
£1.5bn
Offer
political
Assist with cultural &
2014/15* negotiation & commercial
Catalyse tender insights
£500m Find local
consortia
formation
process

partners for
Publicise market
specific access
opportunities

* Annual business win targets

Major overseas institutions work with the UK
Many government-to-government agreements are in place
Last year Healthcare UK worked in 10 markets….
This is being extended to include other countries in 2014-15