Calling all clinicians dare to lead? Professor Keith Gardiner - Chief Executive, NIMDTA Dr Richard Wright - Medical Director, SHSCT Dr Paul Litchfield - CMO, BT Nicki Patterson - Director of Nursing, Older People and Primary Care SEHSCT
Dr Paul Litchfield OBE OStJ FRCP FFOM Dare to Lead getting health on the business agenda
Succeeding in the Boardroom Know what you want to achieve Understand where power lies Think from a business perspective Argue rationally & emotionally Use business language Focus on outcomes that matter Aim for a win win outcome Be pragmatic and play the long game Never compromise integrity
paul.litchfield@bt.com
Cultural Evolution Is the future in our own hands? Dr Paul Litchfield - Chief Medical Officer, BT Group Laura Collins - Carer and East Belfast ICP member Colette Goldrick - NI Director, APBI Dr Anne Kilgallen - Deputy Chief Medical Officer, DoH NI
Dr Paul Litchfield OBE OStJ FRCP FFOM Cultural Evolution a view from industry
Markets Technology Competitors Customer expectations Leadership is Critical Skills Attitudes Demographics Employee expectations
Appropriate: For a crisis or time sensitive Delivery the priority Well understood processes Low skills and/or trust Creates: Strong sense of hierarchy Clarity of expectation Discipline & compliance Organisational Health Leadership Styles Appropriate: For complex problems Development the priority Behavioural change needed High skills and/or trust Creates: Achievement above expectation Accountability & empowerment Ownership of outcomes
paul.litchfield@bt.com
Programme for Government: New Thinking New Opportunities Dr Colin Sullivan - Director of Strategic Policy and Reform, Department of Finance
Programme for Government: New Thinking New Opportunities NI Confederation 2016 Colin Sullivan Director of Strategic Policy and Reform Department of Finance
Why the need for a new approach? Significant pressure on public finances Rising and Changing demands for existing services Societal Change Many ongoing wicked issues that have not progressed over a lengthy period several of these in the health space
Life Expectancy Metro Life Expectancy Metro Bus Map: DHSSPS 8 Number of the bus 8 years difference in life expectancy People in more deprived areas live much shorter lives than those from less deprived areas This pattern far from unique to here but is a major problem
Those living in the most deprived areas have worse outcomes than those from the least deprived areas 76% 150% 216% higher rate of emergency admission to hospital (2013/14) higher rate of deaths due to preventable causes (2009 13) higher rate of deaths due to respiratory disease (<75s, 2009 13) 421% higher rate admissions due to alcohol related causes (2011/12 2013/14) Source: DHSSPS. All rates standardised Note: Most/least deprived 20% most and least deprived Super Output Areas in Northern Ireland calculated using NIMDM
Suicide rate higher in deprived areas... Most deprived 3x rate in least deprived areas Crude Suicide Rate Deaths per 100,000 population Source: DHSSPS. Note: Most/least deprived 20% most and least deprived Super Output Areas in Northern Ireland calculated using NIMDM
...as are prescriptions for anti depressants Source: DHSSPS. Data relate to 2013 Note: Most/least deprived 20% most and least deprived Super Output Areas in Northern Ireland calculated using NIMDM
Healthy life expectancy much less in Life Expectancy Metro Bus Map: DHSSPS deprived areas Most deprived areas 54.3 Second most deprived areas Middle areas 59.6 63.2 Gap 14.2 years Second least deprived areas 64.4 Least deprived areas 68.4 0 10 20 30 40 50 60 70 80 Female Healthy Life Expectancy (Years) So, people in more deprived areas do not only live much shorter lives than those from less deprived areas......but the time they spend in good health lags even more Source: DHSSPS. Note: Most/least deprived 20% most and least deprived Super Output Areas in Northern Ireland calculated using NIMDM
Underemployment in Northern Ireland Underemployment rate in Northern Ireland (2005 2015) During Jan March 2015, it was estimated that 53,000 workers were underemployed (6.5% of workforce) Younger workers more likely to be underemployed In comparison with the UK, Northern Ireland had a lower rate of underemployment than the UK average (9.6%). NI has had a lower rate of underemployment than the UK over the last decade. Source: NISRA, Underemployment Bulletin, June 2015
Poverty rates in NI are higher than the UK and the gap has widened since the downturn 25% NI UK Poverty rate (whole population) 20% 15% 10% 5% 0% 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 Source: (DSD HBAI) Notes: Before Housing Costs (BHC) measure Relative Poverty is a measure of contemporary household income inequality, in other words, whether the poorest are keeping pace with the growth of incomes in the population as a whole. All individuals in a household are considered to be in relative income poverty if their equivalised household income is less than 60% of the median UK income. Households reporting the lowest incomes may not have the lowest living standards. The bottom 10 per cent of the income distribution should not, therefore, be interpreted as having the bottom 10 per cent of living standards
Need for changed approach Danger of becoming locked in a vicious circle unable to progress the thorny / wicked issues Creating a virtuous circle: output focussed seeking real positive change that is measurable Joined up approach needed to deliver on economic/social priorities: Working on a cross cutting basis to develop the value added opportunities in Northern Ireland Look outside of government Recognise the importance of engaging and working with the private and the community/ voluntary sectors to deliver programmes.
ONS "Life in the UK" report gives snapshot of the nation's well being. Measuring National Well being includes indicators on: health, relationships, education & skills, what we do & where we live, our finances, the economy, governance, the environment and measures of personal wellbeing (self assessments of wellbeing). Programme started a national debate on what really matters.
3 reasons for moving to wellbeing approach: 1. Other measures needed alongside GDP which is an inadequate measure of social progress. 2. Using wellbeing as a guiding narrative helps governments to focus on medium and longterm outcomes, rather than just inputs and processes 3. Public services are focusing increasingly on prevention and require joined up approach.
Outcomes Based Accountability Focuses on impacts on our people rather than actions in Government Use of Indicators to show change required coupled with Measures to highlight success levels Opportunity for the NI Executive to work with other sectors about how to tackle the big challenges facing our society
A New Approach NI Executive has produced a draft framework for an Outcomes Based Programme for Government (PfG) Consistent with recommendations in the Towards a Wellbeing Framework report produced by the Carnegie Roundtable on Measuring Wellbeing in Northern Ireland Lessons Learned from previous PfGs in 2008 11 & 2011 15 o more joined up o focused more on outcomes than inputs Builds on the methodology currently deployed in Scotland
The Scottish Way 7 PURPOSE TARGETS Growth, Productivity, Participation, Population, Solidarity, Cohesion, Sustainability 5 STRATEGIC OBJECTIVES Wealthier, Smarter, Healthier, Safer and Stronger, Greener 16 NATIONAL OUTCOMES for next 10 years 50 NATIONAL INDICATORS
The NI Way HIGH LEVEL OUTCOMES 14 succinct statements describing what we are trying to achieve. KEY INDICATORS Approx 3 per outcome, in key areas indicating progress towards the outcome. Taken in the round, show direction of travel. KEY ACTIONS Actions that will shift key indicators. Collaborative programme subject to review in light of progress. PROGRESS MEASURES Providing information on how the actions are being delivered.
PfG Framework Structure Our Purpose Improve wellbeing for all by tackling disadvantage and driving economic growth Outcomes 14 succinct, high level statements describing what we are trying to achieve Indicators 42 specific changes we want to bring about Taken in the round, show direction of travel Measures Providing information on whether we are succeeding
Draft PfG Framework 14 Outcomes
Outcome supported by indicators We enjoy long, We healthy, enjoy active long, lives healthy, active lives Reduce health inequality Improve support for adults with care needs Increase healthy life expectancy Reduce Poverty Reduce preventable deaths Improve supply of suitable housing Improve the quality of the Increase the use of public transport and healthcare experience active travel Improve mental health Increase the competence and capability of Improve health in pregnancy people and communities Improve child development Increase reconciliation Improve air quality
Outcomes Pyramid PfG Purpose: improving wellbeing for all by tackling disadvantage, and driving economic growth Outcomes, Indicators, and Measures already developed in PfG Framework POPULATION ACCOUNTABILITY PERFORMANCE ACCOUNTABILITY Action Plans linked to outcomes and associated performance measures
Outcomes Pyramid Draft PfG Framework 2016 21 Next Steps
Outcomes Based Approach
Population Accountability Two levels of Accountability Population & Performance Outcome Condition of well being for a population/sub population (adults, children, families, communities) Population Indicator Measurable data which helps quantify achievement of the Outcome e.g. e.g. We live longer, healthier, more active lives Percentage of adults who smoke? Level s of Obesity? Number of avoidable deaths? Performance Accountability Performance Measures Measurable data which helps quantify the impact of a project/service e.g. How much did we do? How well did we do it? Is anyone better off?
So where are we? What have we done? Population based Outcomes Population based Indicators & measures Getting from ends to means? pathfinder learning (Poverty, Citizen Safety from Crime, Economy) And what s left to be done? Connecting outcomes to actions (ends to means) Performance measures Getting from ends to means (performance level)
Timeline Stage Consultation on PfG Framework Date 27 May 22 July Development of PfG Action Plans By Sept 2016 Development of: Economic Strategy; Social Strategy; Investment Strategy; Budget For public consultation by Oct 2016 Executive and Assembly Approval Processes December 2016
Different Mind Set This requires significant changes to traditional ways of working. Many of these changes are captured in the enabling state concept which can be summarised as the move: From setting targets to outcomes From top down to bottom up From representation to participation From silos to working together From crisis management to prevention From doing to to doing with From state provision to the third sector
Opportunities for OBA 1. take a whole of government approach 2. for more innovation to think creatively about solutions to longstanding problems. 3. to engage stakeholders in building shared vision of what is important and what strategies are required this increases confidence that goals are the right ones and that they will be sustained. 4. to systematically collect data, monitor progress and critically assess operations, services, and outcomes. 5. shift from provider interest to user interest. 6. to build confidence in public institutions. 7. shift culture
1. Alignment of budgets Challenges 2. Moving beyond fine words to action 3. Shifting the culture political and administrative 4. Systems may become indicator driven rather than outcome driven. 5. Need to choose the right measures that address challenging problems rather than being easy to collect or affect.
Challenges 1. System must have the capacity to develop outcomes, identify indicators, and collect and utilize data. 2. Training required to assist people with new thinking around Outcomes Based Approaches 3. Changing governance relationships amongst agencies requires new spirit of cooperation and trust. 4. Temptation to judge progress too early. 5. Implications: (a) for the Executive (b) For the NICS (c) For stakeholders
Enablers Public Sector Reform role We have high quality public services One of 14 outcomes
PfG needs to permeate all parts of government OUTCOMES INDICATORS MEASURES ACTIONS Support Activities Shared Services Digitalisation Procurement Cross cutting Reforms
Public Sector Reform Agenda Supporting, Influencing, Leading and Enabling Reform in partnership with others. An Approach to Public Sector Reform & Innovation under 3 key categories: STRATEGIC OECD Review Transformation Fund Cross Cutting Reform Programme Shared Services and Digitalisation OPERATIONAL Innovation Labs Behavioural Insights ENGAGEMENT Ideas Engine NICS Awards NICS Live
Strategic OECD Public Governance Review Recommendations chime with PfG launched on 6 th July 2016
Transformation Fund Strategic Voluntary Exit Schemes across NI Public Sector: Challenging project unprecedented in history of NICS Supported by Public Sector Transformation Fund ( 700m over 4 years) Over 4,000 public servants exited in 2015/16 Greater Emphasis on Shared Services and Digitalisation Increased mandate for ESS and BSO to provide shared services across Public Sector Rolling Programme of Digitalisation e.g. 16x16
Strategic Cross Cutting Reform Programme Executive agreement to a review to identify and assess NICS cross cutting reform opportunities 30 cross cutting projects across six thematic themes Executive agreement was reached in November 2015 to take these ideas forward for full feasibility with the NICS Board providing overarching governance.
Operational A regional Lab offering a fresh approach to developing both strategic and tactical solutions to complex problems using a human centred approach and behavioural insights
Engagement Staff Innovation Scheme promoting collective responsibility for service design & improvement Open to all staff adaptive trial commenced June 2014 over 300 ideas received Considering staff and external challenge prizes Celebrating the excellence of individuals and teams working to improve Public Services. Inaugural awards held in March 2015 with over 118 nominations NICS Awards 2016 in progress with award ceremony scheduled for Parliament Buildings. Successful event held in March 2015 bringing together around 1,500 delegates Event themes -Enabling Our People, Improving Services for People, People Working Better Together, Inspirational Leadership for Our People Currently planning NICS Live 2017
New era of Reform needs to support the PfG Equipping colleagues to maximise the impact of the OBA approach Cross cutting and departmental specific reforms need to be aligned with the PfG ambitions
Reasons to be cheerful * Executive commitment * Start of a new mandate * Recognition of need to take a new approach * Logical methodology * Appetite to succeed
Thank You
Closing remarks Colum Conway - Vice Chair, NICON and Chief Executive, Northern Ireland Social Care Council