NHS | Presentation to [XXXX Company] | [Type Date]1

Why act?Helen HirstDirector of CCG Development, NHS EnglandProf Sir Muir GrayJoint National Lead, NHS Right Care & Public Health England

Twitter#CforValue

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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

• 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

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 same

we need to design, plan and build a new paradigm

VALUE

Triple Value Programme

Individual & Personalised

Allocative, Technical,resources distributed resources used to optimise value to best effect

Cancer

Respiratory

Gastro-intestinal

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 £

Allocative value

Cancer

Respiratory

Gastro-intestinal

MentalHealth

Between Programme Marginal Analysis and reallocation is a commissioner responsibility with public involvement

Cancers

Respiratory

Gastro-instestinal

Apnoea

COPD (Chronic Obstructive Pulmonary Disease)

Asthma

Within Programme, Between SystemMarginal analysis is a clinician responsibility

Cancers

Respiratory

AMD

Retinopathy

Cataract

Within ProgrammeBetween SystemMarginal analysis

Eyes & Vision £2Bn

Low Vision

Glaucoma

Cancer

Respiratory

Gastro-intestinal

MentalHealthSpecialist

CommissioningTerra incognita

Cancers

Respiratory

Gastro-intestinal

MentalHealth

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

Triple Value Programme

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)

Cancers

Respiratory

Gastro-instestinal

Apnoea

COPD (Chronic Obstructive Pulmonary Disease)

Asthma

Triple DrugTherapy

Rehabilitation

O2

Smoking cessation

Within SystemMarginal Analysis is a clinician responsibility with patient involvement

The law of diminishing returns

Benefits

Investment of resources

Harmful effects increase in direct proportion to the resources invested

Harmful orSide effectsOf care

Investment of resources

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

Benefits

Investment of resources

Harms

Benefits - harm

Triple Value Programme

Individual & Personalised

Allocative, Technical,resources distributed resources used to optimise value to best effect

Evidence,Derived from the study of groups of patients

The values this patientplaces on benefits & harms of the options

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

Choice Decision

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 futileHigh value Low value Negative Value

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

The Healthcare Archipelago

GENERAL MENTAL PRACTICE HEALTH

COMMUNITY HOSPITALSERVICES SERVICES

The Commissioning Archipelago

GP/ Pharmacists/optometrists

Public Health

Specialistcommissioning

211 CCG’s 152Local Authorities

SELF CARE

INFORMAL CARE

GENERALIST

SPECIALIST

SUPER SPECIALIST

BetterValueHealthcare

IF YOU ASKED EVERY HEALTHCARE PROFESSIONAL What is Equity, and how does it differ from

EqualityHow 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

BetterValueHealthcare

Map of Medicine - COPD

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

Right Care for Populations

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Find the full series at:www.rightcare.nhs.uk/resourcecentre

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