Presentation Transcript

1. Why act?

   Helen HirstDirector of CCG Development, NHS England Prof Sir Muir Gray Joint National Lead, NHS Right Care & Public Health England Twitter #CforValue NHS | Presentation to [XXXX Company] | [Type Date]
2. HARM, from overuse even when quality is high WASTE OF RESOURCES through low value activity INEQUITY, from underuse by groups in high need FAILURE TO PREVENT DISEASE &DISABILITY And new, additional, challenges are developing RISING EXPECTATIONS INCREASING NEED FINANCIAL CONSTRAINTS CLIMATE CHANGE - Progress in the last 40 years has been amazing but all health services, everywhere, still face 5 major problems one of which is unwarranted variation which reveals the other four Variation in utilization of health care services that cannot be explained by variation in patient illness or patient preferences. Jack Wennberg
3. What do we want to achieve? High Value Healthcare which Allocates resources for optimal value & equity Makes optimal value from the use of allocated resources Ensures each individual receives care that addresses their particular problem and values
4. More of the same is not the answer , not even better quality, safer, greener cheaper of the samewe need to design, plan and build a new paradigm
5. VALUE
6. Triple Value Programme Individual & Personalised Allocative, Technical, resources distributed resources used to optimise value to best effect
7. Allocative value Between Programme Marginal Analysis and reallocation is a Board responsibility with public involvement ; the aim is optimal allocation ie you cannot get more value by shifting a single £ Cancer Respiratory Gastro- intestinal
8. Between Programme Marginal Analysis and reallocation is a commissioner responsibility with public involvement Mental Health Cancer Respiratory Gastro- intestinal
9. Within Programme, Between System Marginal analysis is a clinician responsibility Asthma COPD (Chronic Obstructive Pulmonary Disease) Apnoea Cancers Respiratory Gastro- instestinal
10. Within Programme Between System Marginal analysis Cataract Low Vision Retinopathy AMD Eyes & Vision £2Bn Glaucoma Respiratory Cancers
11. Specialist Commissioning Terra incognita Mental Health Cancer Respiratory Gastro- intestinal
12. Many people have more than one problem ; GP’s are skilled in managing complexity Mental Health Cancers Respiratory Gastro- intestinal
13. Triple Value Programme Individual & Personalised Allocative, Technical, resources distributed resources used to optimise value to best effect
14. Technical Value = Outcomes / CostsOutcome= Benefit (EBM +Quality) – Harm (Safety )Costs (Money + time + Carbon)
15. Within System Marginal Analysis is a clinician responsibility with patient involvement Asthma COPD (Chronic Obstructive Pulmonary Disease) Apnoea Cancers Respiratory Gastro- instestinal Triple Drug Therapy Rehabilitation Smoking cessation O2

16. The law of diminishing returns

    Benefits Investment of resources

17. Harmful effects increase in direct proportion to the resources invested

    Harmful or Side effects Of care Investment of resources

18. After a certain level of investment the health gain may start to decline; the point of optimality

    Benefits Benefits - harm Harms Investment of resources
19. Triple Value Programme Individual & Personalised Allocative, Technical, resources distributed resources used to optimise value to best effect
20. The values this patient places on benefits & harms of the options Evidence, Derived from the study of groups of patients Choice Decision The clinical and social condition of this patient; other diagnoses, risk factors and their genetic profile and in particular their problem, what bothers them psychologically Personalised and Stratified Medicine

21. As the rate of intervention in the population increases, the balance of benefit and harm also changes for the individual patient

    Necessary appropriate inappropriate futile High value Low value Negative Value
22. How do we achieve High Value Healthcare? Deliver care through population based sustainable systems focused on symptoms like breathlessness or, conditions such as epilepsy or people with a common characteristic such as being elderly with frailty Be transparent with annual reports from systems to the patients served Have a collaborative culture Have all key people trained in new terms, concepts and skills Engage patients as, at the least, equals
23. The Healthcare Archipelago GENERAL MENTAL PRACTICE HEALTH COMMUNITY HOSPITAL SERVICES SERVICES
24. The Commissioning Archipelago 152 Local Authorities 211 CCG’s GP/ Pharmacists/ optometrists Public Health Specialist commissioning
25. SELF CARE INFORMAL CARE GENERALIST SPECIALIST SUPER SPECIALIST
26. IF YOU ASKED EVERY HEALTHCARE PROFESSIONAL What is Equity, and how does it differ from Equality How does Quality of care differ from Value? What is meant by optimal end of life care? How consistent would be the response We need mandatory training
27. Map of Medicine - COPD Work like an ant colony; Neither markets nor bureaucracies can solve the challenges of complexity
28. Right Care for Populations The NHS Right Care website offers resources to support CCGs in adopting this approach: online videos and ‘how to’ guides casebooks with learning from previous pilots tried and tested process templates to support taking the approach forward advice on how to produce “deep dive” packs locally to support later phases, within the CCG or working with local intelligence services access to a practitioner network Follow Right Care online Subscribe to get a weekly digest of our blog alerts in your inbox, Receive occasional eBulletins Follow us on Twitter @qipprightcare Find the full series at: www.rightcare.nhs.uk/resourcecentre