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Why act?. Helen Hirst Director of CCG Development, NHS England Prof Sir Muir Gray Joint National Lead, NHS Right Care & Public Health England . Twitter # CforValue. HARM, from overuse even when quality is high WASTE OF RESOURCES through low value activity

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Why act

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]


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


  • 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


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


Value
VALUE quality, safer, greener cheaper of the same


Triple value programme
Triple Value quality, safer, greener cheaper of the sameProgramme

Individual &

Personalised

Allocative, Technical,

resources distributed resources used

to optimise value to best effect


Allocative quality, safer, greener cheaper of the same 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


Between quality, safer, greener cheaper of the sameProgramme

Marginal Analysis and reallocation is a commissioner responsibility with public involvement

Mental

Health

Cancer

Respiratory

Gastro-

intestinal


Within Programme, quality, safer, greener cheaper of the same

Between System

Marginal analysis is a clinician responsibility

Asthma

COPD

(Chronic

Obstructive

Pulmonary

Disease)

Apnoea

Cancers

Respiratory

Gastro-

instestinal


Within Programme quality, safer, greener cheaper of the same

Between System

Marginal analysis

Cataract

Low

Vision

Retinopathy

AMD

Eyes &

Vision

£2Bn

Glaucoma

Respiratory

Cancers


Specialist quality, safer, greener cheaper of the same

Commissioning

Terra incognita

Mental

Health

Cancer

Respiratory

Gastro-

intestinal


Many people have more than one problem ; GP’s are skilled in managing complexity

Mental

Health

Cancers

Respiratory

Gastro-

intestinal


Triple value programme1
Triple Value in managing complexityProgramme

Individual &

Personalised

Allocative, Technical,

resources distributed resources used

to optimise value to best effect


Technical value outcomes costs outcome benefit ebm quality harm safety costs money time carbon
Technical Value in managing complexity= Outcomes / CostsOutcome= Benefit (EBM +Quality) – Harm (Safety )Costs (Money + time + Carbon)


Within System in managing complexity

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


The law of diminishing returns

The law of diminishing returns in managing complexity

Benefits

Investment of resources


Harmful effects increase in direct proportion to the resources invested

Harmful effects increase in direct proportion to the resources invested

Harmful or

Side effects

Of care

Investment of resources


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

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

Benefits

Benefits - harm

Harms

Investment of resources


Triple value programme2
Triple Value start to decline; Programme

Individual &

Personalised

Allocative, Technical,

resources distributed resources used

to optimise value to best effect


The values start to decline; 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


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


  • How do we achieve the balance of benefit and harm also changes for the individual patientHigh 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


The healthcare archipelago
The Healthcare Archipelago the balance of benefit and harm also changes for the individual patient

GENERAL MENTAL

PRACTICE HEALTH

COMMUNITY HOSPITAL

SERVICES SERVICES


The commissioning archipelago
The Commissioning Archipelago the balance of benefit and harm also changes for the individual patient

152

Local

Authorities

211 CCG’s

GP/

Pharmacists/

optometrists

Public

Health

Specialist

commissioning


SELF CARE the balance of benefit and harm also changes for the individual patient

INFORMAL CARE

GENERALIST

SPECIALIST

SUPER

SPECIALIST


If you asked every healthcare professional
IF YOU ASKED EVERY HEALTHCARE PROFESSIONAL the balance of benefit and harm also changes for the individual patient

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


Map of medicine copd
Map of Medicine - COPD the balance of benefit and harm also changes for the individual patient

Work like an ant colony; Neither markets nor bureaucracies can solve the challenges of complexity


Right the balance of benefit and harm also changes for the individual patientCare 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


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