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

Right Care in actionProfessor Matthew CrippsProgramme Director, NHS Right Care

Twitter#CforValue

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The primary objective for Right Care is to maximise value

• the value that the patient derives from their own care and treatment

• the value the whole population derives from the investment in their healthcare

To successfully increase value for both patient and population, health service reform must integrate both in an single model; separately, they become opposing imperatives

The Right Care model has three basic steps: Where to Look; What to Change, and; How to Change.

Determine Where to Look by indicating the areas of care your population can gain most benefit from your reform energies.

What to Change helps you to define what the optimal value care looks like for your population.

How to Change helps you to implement the changes to deliver that care.

Where to Look, What to change, How to change

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5 KEY INGREDIENTS

1. Clinical Leadership (of the reform agenda)

2. Indicative Data (on where variation exists – focus here to improve)

3. Clinical Engagement (in individual reforms, supported by project managers and teams)

4. Evidential Data (on what, why and how to change)

5. Effective processes (BPE)

Delivers Reform

Reducing unwarranted variation to increase value and improve quality

The NHS Atlases of Variation

Awareness is the first step towards value –

If the existence of clinical and financial variation is unknown, the debate about whether it is unwarranted cannot take place

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Clinical & Financial Variation

• When faced with variation data, don’t ask:• How can I justify or explain away this variation?

• Instead, ask:• Does this variation present an opportunity to

improve?

• Deep dive service reviews support this across whole programmes & systems and deliver Phase 2:

• What to Change

CURRENTSERVICE

FUTURESERVICE

Fit forPurpose

Efficiencyand

marketoptions

Supplyand

capacityoptions

No/ lowbenefit

Step 1 – define:

Step 3 –

categorise:

Step 2 – define:

Redesign,Contract,Procure

Contract,Procure,Divest

Step 4 –

recommend:

Maintain

Divest

Deep Dive Service Review Pathway

Fit forPurpose

Efficiencyand

marketoptions

Supplyand

capacityoptions

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Mechanism

Decision

Process

ServiceReviews

Clinical PolicyDevelopment

andDecommissioning

GP MemberPractices

PublicEngagement

Partners andStakeholders

Miscellaneous(e.g. Commissioning

Annual Plan)G

over

ning

Bod

y

Full

Busi

ness

Cas

e

Clin

ical

Exe

cutiv

e G

roup

CaseOutlines

ReformProposals

Contracts

PrimaryCare

Development

Procurement

Diagnostic

ResearchId

eas

Dec

isio

n

Gro

up

Ref

orm

Id

eas

Implementation

NHS RIGHTCARE

HEALTHCARE REFORM PROCESS

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Change is inevitable

• Choice Whether to change

• Choice Whether to change yourselves or wait to be changed

• People and Organisations who wait to be changed lose control, become resistant and block improvement

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21st Century Healthcare in a 19th Century System

• Smart Phone technology

Versus….

• Victorian infrastructure and model

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iPhone & Android Apps - Patient Decision Aids

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The Right Care approach - Case studies

• Some use holistically, others use components of• Some take off shelf, others tweak…• …Others take principles and build own to galvanise

system (where ownership is an issue locally)

• ALL adopt the 3 phases and the 5 key ingredients and improve their improvement!

• “Right Care is a better value way of delivering better value” – a GP

Five Key Ingredients:

1. Clinical Leadership

2. Indicative Data

3. Clinical Engagement

4. Evidential Data

5. Effective processes

Reminder – 3 phases and 5 ingredients

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Case Studies

1. System-wide achievement

Warrington CCG

2. Key ingredients – Clinical Leadership and Engagement

West Cheshire CCG

Wigan Borough CCG

3. Key ingredients - Effective processes

Calderdale CCG (Systemising reform)

Sefton CCGs (Optimising focus and delivery)

Doncaster CCG (Planning and prioritising)

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Why Act - What benefits do the population get?• Achieved Turnaround (Warrington CCG - Winner of HSJ Commissioning

Organisation of the Year 2012)• Financial sustainability (West Cheshire CCG - Winner of HSJ

Commissioning Organisation of the Year 2010)• Clinically led annual QIPP planning and delivery (Borough of Wigan)

Clinical Leaders driving change (Vale of York CCG)• Galvanising commissioners in a growing number of health economies (20+

CCGs and growing)

CCGs can and are using the “Right Care approach” to shift spend

Year 1 – “Came from behind” - Implemented system mid year

Year 2 – “Delivered as went along” - Began at year start, achieved by end

Year 3 – “Planned ahead” - Began before year start, over-achieved

Year 4 – “Ahead of the curve” - 20% of QIPP delivered by start

Year 5 – Increased focus on Quality!

Achieving financial stability in West Cheshire

• A&E attends & admissions, Elective & Non-elective activity, OP Firsts and Follow-ups – all decreased

• Outcomes & Quality – improved• Integration occurred across

health sectors and with social care

It’s not just about money - developing the Right Care model in West Cheshire led to real quality improvements in just one annual cycle:

Enabled by, for example -• Medicines administration training to

care homes• Personalised care plans (LTC)• Community endoscopy, optometry,

ophthalmology, neurology & pain management pathways

• MRI Scanner Direct Access

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Respiratory Care in Warrington Health Economy

• 2010/11 –• £Ms Overspending V. Demographic peers• Only 2/3s of asthmatics known• Worst quintiles – COPD rate of em admns, deaths

within 30 days, %age receiving NIV, readmns

• 2012/13 –• Spend below average for demographic (and still

reducing)• Delivered by focus on variation – problems fixed or

improving (e.g. 30% less COPD NEL admissions)• HSJ Commissioner of the Year