Getting It Right First Time

1. Getting It Right First Time Clinically-led programme, reducing variation and improving outcomesAdrian Hopper, Geriatric Medicine lead

2. Introducing GIRFT • Review of 35 clinical specialties leading to national reports for each. • Led by frontline clinicians who are expert in the areas they are reviewing. • Peer to peer engagement helping clinicians to identify changes that will improve care and deliver efficiencies, and to design plans to implement those changes. • Support across all trusts and STPs to drive locally designed improvements and to share best practice across the country. • Agreed efficiencysavings: c.£1.4bn per year by 2020-21, starting with between £240m and £420m in 2017-18. Tackling unwarranted variation to improve quality of patient care while also identifying significant savings.

3. GIRFT local support • GIRFT Regional Hubs support trusts in delivering the Clinical Leads’ recommendations by: • Helping them to assess and overcome the local and national barriers to delivery. • Working closely with NHSI regions to ensure prioritisation of GIRFT delivery takes account of the wider context within each trust and is joined up with local and regional improvement initiatives. • Joining up with NHSE/RightCare to ensure integrated support for STP level improvements. • Producing good practice manuals ofcase studies and best practice guidance that trusts can use to implement change locally. • Supporting mentoring networks across trusts. Each hub will have two clinical ambassadors: regionally recognised leaders of improvement programmes

4. GIRFT cross-cutting themes • GIRFT is delivering 35 workstreams, occurring concurrently at different stages. • Core focus is on peer to peer engagement within specialties, but to maximise improvement opportunities we also need to focus on patient pathways and services that cross specialty boundaries. • GIRFT is therefore delivering a number of cross cutting projects: • And GIRFT Clinical Leads are coming together to work in clinical service lines when beneficial for exploiting opportunities or joining up services across specialty boundaries: Litigation Procurement & Technology Patient Safety Patient Safety Medicines Optimisation Frailty Coding Anaesthetics Perioperative Critical & Intensive Care Brain conditions Diagnostic services Outpatients Pathology services ED & Acute Admissions

5. GIRFT impact on resource savings Orthopaedic pilot Case Study One NW trust has made c.£700k resource savings between 2014 and 2017 through: cost effective procurement of specialist instruments (£133k), reduced length of stay (£364k), use of best practice tariff (£110k) and improved theatre utilisation (£74k). Overall position to date • GIRFT 2017-18 business plan target: £240m (£420m stretch target) • Total savings opportunity realised in 2017-18 Q1 & Q2 is £136m (57% of target) • Cumulative realised total to date (Q1 2016-17 to Q2 2017-18) is £242m Note: figures are for gross notional savings. Actual figure is likely to be higher as not all metrics are currently measurable and greater benefits accrue as impact of recommendations land.

6. According to HES data, across the region 16.4% of patients 75 and over admitted in an emergency had length of stay zero in 2016/17 Source: Hospital Episode Statistics (HES) 2016/17

7. According to HES data, across the North 18% of patients 75 and over admitted as an emergency had a diagnosis of dementia recorded in 2016/17 Source: Hospital Episode Statistics (HES) 2016/17

8. According to HES data, across the North among patients 75 and over, those admitted for 21 days or more consumed 53.5% of the total bed days in 2016/17 Source: Hospital Episode Statistics (HES) 2016/17

9. According to HES data, across the North 40% of patients 75 and over admitted as an emergency who stay in hospital 21 or more days are discharged to a care home Source: Hospital Episode Statistics (HES) 2016/17

10. According to SUS data, across the North £143m was spent on Excess Bed Day costs for admissions of patients 75 and over in 2016/17 Source: Secondary Uses Service (SUS) 2016/17

11. According to Unify2, across the North DTOC days resulting from patients waiting for Nursing or Residential Home placements were the equivalent of 264 beds in January 2018 Source: Unify2 Note – this includes delays attributable to the NHS, Social care or both

12. Across the North only 35% of providers included in the audit reported a delirium assessment rate greater than 50%.

13. Contact: Adrian Hopper GIRFT Geriatric Medicine Lead Adrian.hopper@gstt.nhs.uk

14. RightCare: Supporting improving the quality of life for people with frailty Shane Hayward-GilesNHS RightCare Delivery Partner West Yorkshire and Harrogate Health and Care Partnership 27th April 2018

15. Contacts Shane Hayward-Giles – West Yorkshire and Harrogate shane.hayward-giles@nhs.net Alison Hewitt - Cheshire and Merseyside alison.hewitt14@nhs.net Mark Johnston - Lancashire and South Cumbria mark.johnston8@nhs.net Gillian Greenhough - Greater Manchester gillian.greenhough@nhs.net Eric Power – Humber, Coast and Vale ericpower@nhs.net Martha Coulman - South Yorkshire and Bassetlaw m.coulman@nhs.net Fiona Ottewell - Durham, Darlington and Tees, Hambleton, Richmondshire and Whitby - Northumberland, Tyne & Wear - North Cumbria fiona.ottewell@nhs.net

16. Do no harm First Atlas of Variation – 2009 Unwarranted variation in: Access Quality Outcome Value Overuse Underuse

17. The value triangle

18. Comparator methodology

19. Our data/intelligence resources • Scenarios • Pathways • Focus packs www.england.nhs.uk/rightcare/

20. RightCare scenario: The variation between standard and optimal pathways Janet’s story: Frailty August 2016

21. RightCare Pathway: Frailty The National Challenge Increasing numbers of people not ‘aging well’ Falls, and falls that cause a fracture The number of people with mild, moderate and severe frailty accessing urgent care Number of people with mild, moderate and severe frailty who have delayed care, and who are in the wrong part of the system ….if CCGs achieved the rate of their 5 best peers ….if CCGs achieved the rate of their 5 best peers *using proxy measures ….if CCGs achieved the rate of their 5 best peers ….if CCGs achieved the rate of their 5 best peers RightCare Opportunity System Enablers • Identification of Frailty status • eFrailty Index • GP Contract including enriched summary care record Support patients with moderate and severe frailty in the community Speed of hospital transfers/right place right time in acute care Priorities for Optimisation Falls Prevention Encourage people to age well • Exercise/Activity • Social Prescribing • Timely identification of delirium and cognitive disorder High Value Interventions Medicines Optimisation Shared Decision Making Care Coordination Workforce Capability • Secondary Prevention • Primary Prevention • Interventions that reduce the need for urgent care • Crisis Response • Prevention strategies • Home Based rehabilitation

22. NHS RightCare Frailty Focus Pack • Stakeholders • Martin Vernon - NCD for Older People • Dawn Moody - Associate NCD for Older People • Getting It Right First Time • Public Health England • National Institute for Health and Care Excellence • Association of Directors of Adult Social Services • Chartered Society of Physiotherapy • Royal College of Speech & Language Therapists • Age UK • Pharmacy subject matter experts in the care of older people Publication this summer

25. Our human resouces • Delivery partners • Analysts • Subject matter experts • Locality support workers

26. Shared decision making “It is far more important to understand the person who has the disease than it is to know what disease the person has” Hippocrates

27. RightCare and GIRFT