Right Care in action

1. Right Care in action Professor Matthew CrippsProgramme Director, NHS Right Care Twitter #CforValue NHS | Presentation to [XXXX Company] | [Type Date]

2. 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

3. Where to Look, What to change, How to change 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. 3

4. 5 KEY INGREDIENTS Clinical Leadership (of the reform agenda) Indicative Data(on where variation exists – focus here to improve) Clinical Engagement (in individual reforms, supported by project managers and teams) Evidential Data (on what, why and how to change) Effective processes (BPE) Delivers Reform

5. The NHS Atlases of Variation Reducing unwarranted variation to increase value and improve quality 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

6. 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

7. Deep Dive Service Review Pathway Step 1 – define: Step 2 – define: Step 3 – categorise: Step 4 – recommend: CURRENT SERVICE FUTURE SERVICE Fit for Purpose Fit for Purpose Maintain Efficiency and market options Efficiency and market options Redesign, Contract, Procure Supply and capacity options Supply and capacity options Contract, Procure, Divest No/ low benefit Divest

8. NHS RIGHTCARE HEALTHCARE REFORM PROCESS Service Reviews Contracts Diagnostic Clinical Policy Development and Decommissioning Reform Proposals Clinical Executive Group Implementation Research Procurement Full Business Case Governing Body GP Member Practices Case Outlines Public Engagement Ideas Decision Group Primary Care Development Reform Ideas Partners and Stakeholders Mechanism Miscellaneous (e.g. Commissioning Annual Plan) Decision Process

9. 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

10. 21st Century Healthcare in a 19th Century System • Smart Phone technology • Versus…. • Victorian infrastructure and model

13. iPhone & Android Apps - Patient Decision Aids

15. 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

16. Reminder – 3 phases and 5 ingredients • Five Key Ingredients: • Clinical Leadership • Indicative Data • Clinical Engagement • Evidential Data • Effective processes 16

17. Case Studies • System-wide achievement • Warrington CCG • Key ingredients – Clinical Leadership and Engagement • West Cheshire CCG • Wigan Borough CCG • Key ingredients - Effective processes • Calderdale CCG (Systemising reform) • Sefton CCGs (Optimising focus and delivery) • Doncaster CCG (Planning and prioritising)

18. Why Act - What benefits do the population get? CCGs can and are using the “Right Care approach” to shift spend • 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) Achieving financial stability in West Cheshire 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! • 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 • 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 It’s not just about money - developing the Right Care model in West Cheshire led to real quality improvements in just one annual cycle:

19. Respiratory Care in Warrington Health Economy • 2010/11 – • £Ms Overspending V. Demographic peers • Only 2/3s of asthmatics known • Worst quintiles – COPD rate of emadmns, 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