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HARM, from overuse even when quality is high WASTE OF RESOURCES through low value activity

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

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HARM, from overuse even when quality is high WASTE OF RESOURCES through low value activity

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  1. 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

  2. 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

  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. Triple Value Programme Individual & Personalised Allocative, Technical, resources distributed resources used to optimise value to best effect

  5. Between Programme Marginal Analysis and reallocation is a commissioner responsibility with public involvement Mental Health Cancer Respiratory Gastro- intestinal

  6. Many people have more than one problem or may have an ill defined symptom ; GP’s are skilled in managing complexity Mental Health Cancers Respiratory Gastro- intestinal

  7. Within Programme, Between System Marginal analysis is a clinician responsibility Asthma COPD (Chronic Obstructive Pulmonary Disease) Breathlessness Apnoea Cancers Respiratory Gastro- instestinal

  8. Technical Value = Outcomes / CostsOutcome= Benefit (EBM +Quality) – Harm (Safety )Costs (Money + time + Carbon)

  9. 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

  10. The law of diminishing returns Benefits Investment of resources

  11. Harmful effects increase in direct proportion to the resources invested Harmful or Side effects Of care Investment of resources

  12. After a certain level of investment the health gain may start to decline; the point of optimality Benefits Benefits - harm Harms Investment of resources

  13. The values this patient places on the problem that matter most to them, and 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 Personalised and Stratified Medicine

  14. The Healthcare Archipelago GENERAL MENTAL PRACTICE HEALTH COMMUNITY HOSPITAL SERVICES SERVICES

  15. The Commissioning Archipelago 152 Local Authorities 211 CCG’s GP/ Pharmacists/ optometrists Public Health Specialist commissioning

  16. SELF CARE INFORMAL CARE GENERALIST SPECIALIST SUPER SPECIALIST

  17. This is an example of a national service set up as a system

  18. Hierarchy Network

  19. Implications for the professionspopulation basedsystem designers and co-ordinatorsknowledge managers, for patients and clinicians (blood in; knowledge outuncertainty in; knowledge out )

  20. Dr Jones is a respiratory physician in the Derby Hospital Trust and last year she saw 346 people with COPD and provided evidence based, patient centred care, and to improve effectiveness, productivity and safety

  21. Dr Jones estimated that there are 1000 people with COPD in South Derbyshire and a population based audit showed that there were 100 people who were not referred who would benefit from the knowledge of her team

  22. Dr Jones is given 1 day a week for Population Respiratory Health and the co-ordinator of the South Derbyshire COPD Network and Service has responsibility, authority and resourcesfor Working with Public Health to reduce smoking Network development Quality of patient information Professional development of generalists, and pharmacists Production of the Annual Report of the service She is keen to improve her performance from being 27th out of the 106 COPD services, and of greater importance, 6th out of the 23 services in the prosperous counties

  23. Map of Medicine - COPD Work like an ant colony; Neither markets nor bureaucracies can solve the challenges of complexity

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