innovation with no more money population healthcare online learning
DESCRIPTION
The NHS has been through a period of ongoing real-terms increase in its budget. Between 1999/00 and 2009/10, real-terms expenditure rose by 92% and is now £102 Billion in 2011/12 and from in terms of GDP, it has risen from 5% of GDP in the 1990s to over 8% of GDP today. Post credit crunch there is famously: “no more money”. In times of plenty, the temptation is to fight to increase your budget or fight professional colleagues for some of their’s- In times of famine, the mantra needs to be that new improvements, adding higher value, can only be funded by reducing lower value activities. The concept of the Programme Budget is critical here. Before making the case for more of someone else’s Programme Budget, you need to be able to answer – “what am I spending on, say, diabetes, and for what outcome?”. In this series, Asking new questions and and Using Programme Budgets will help you understand these issues.TRANSCRIPT
Copyright 2011 Right Care
How do you innovate when the NHS budget is no longer growing?
Sir Muir GrayJoint National Director, Right Care
August 2013
Online Learning Series
Right Care for Populations
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Five major problems.. ..all health services, world wide, still face 5 major problems
• failure to prevent preventable disease
• inequity• patient harm, even when quality is
high• waste of resources• unwarranted variation in:
- activity- quality, safety- outcome & cost = value
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A Paradigm shift is needed…
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The third healthcare revolution…
Citizens Knowledge Technology
…clinicians as “stewards”
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Triple Value Programme
Individual & Personalised
Allocativeresources distributedto optimise value
Technical, resources used to best effect
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Population Based Systems
Focus on value
Clinicians as Stewards
A New Culture
Patient Centred
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Allocating resources - Commisioners
Cancer
Respiratory
Gastro-intestinal
MentalHealth
Programme Budgeting, & the use of Marginal Analysis for reallocation is a commissioner responsibility, with public involvement
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Complexity and Complications
Cancers
Respiratory
Gastro-intestinal
MentalHealth
Many people have more than one problem ; GP’s are skilled in managing complexity
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Triple DrugTherapy
Rehabilitation
Cancers
Respiratory
Gastro-instestinal
Apnoea
COPD (Chronic Obstructive Pulmonary Disease)
Asthma
O2
Smoking cessation
Allocating resources - Clinicians
Within Programme,Between SystemMarginal analysis is a clinician responsibility
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The STAR Tool
http://www.health.org.uk/areas-of-work/star/
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Triple DrugTherapy
Rehabilitation
Cancers
Respiratory
Gastro-instestinal
Apnoea
COPD (Chronic Obstructive Pulmonary Disease)
Asthma
O2
Smoking cessation
Innovation
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Value = Outcomes / Costs
Outcome = Good – Bad Outcome = Effectiveness (EBM + Quality) – Harm (Safety)
Costs = Money + time + Carbon
Technical efficiency
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The future
• Need and demand will always increase faster than resources
• More of the same is not the answer – we need innovations#
• Programme Budgeting• Within Programmes – Marginal Analysis• Clinicians and patients as “stewards” of the
resource• Innovation, not only in technology, but in the
way we think
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Online Learning Series
Right Care for Populations
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Find the full series at:
www.rightcare.nhs.uk/resourcecentre