QUALITY Right Care is designed to seize the opportunity provided by the tight financial climate to improve the way we use resources in the NHS whilst improving health outcomes and patient experience. By focussing on commissioning care pathways as - PowerPoint PPT Presentation

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QUALITY Right Care is designed to seize the opportunity provided by the tight financial climate to improve the way we use resources in the NHS whilst improving health outcomes and patient experience. By focussing on commissioning care pathways as

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QIPP national workstream briefing paper Slide 1 of 4 Workstream Right Care Workstream Lead Sir Muir Gray and Philip DaSilva 1. The opportunity QUALITY Right Care ... – PowerPoint PPT presentation

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Title: QUALITY Right Care is designed to seize the opportunity provided by the tight financial climate to improve the way we use resources in the NHS whilst improving health outcomes and patient experience. By focussing on commissioning care pathways as


1

QUALITY Right Care is designed to seize the
opportunity provided by the tight financial
climate to improve the way we use resources in
the NHS whilst improving health outcomes and
patient experience. By focussing on
commissioning care pathways as whole systems
instead of commissioning activity from
bureaucratic structures and by collaborating with
clinicians, within the context of programme
budgets, we can eliminate wasteful spend on low
value activities and focus resources on high
value activities, maximising value for the
population as a whole. We can also improve
patients care and outcomes by ensuring they do
not undergo inappropriate or unnecessary
interventions. Right Care will encourage a
debate between the public, clinicians and
managers in order to achieve a common agreement
about what is high and low value. The Shared
Decision Making project will empower patients to
make rational healthcare decisions, based upon a
fuller understanding of the risks and benefits of
treatment options. There is clear international
evidence that patients, when supported with
decisions aids, increasingly choose less invasive
and therefore less costly treatments which result
in a better patient experience and at least as
good outcomes as usual care.
EFFICIENCY Right Care will produce estimated
efficiency savings of 2.4 billion by 2013/14.
This estimate is based on reducing unwarranted
variation in PCT spend in the first instance on
elective activity i.e. by high-spending PCTs
reducing their spend to the average and by
reducing spend on low value interventions. For
example, this graph shows the distribution in
spend on inpatient cardiac valve procedures
(adjusted for age, sex and need).
2
NHS management has often focussed on
organisations and structures. Clinicians have
held the balance of power, creating clinical
systems of an ever increasing sophistication.
Historically, use of NHS resource has been driven
by un-checked demand, often supported by
clinician and health organisational imperatives
which have a tendency towards expanding and
providing more services or use of new technology,
sometimes without a sound evidence base and with
little regard to ceasing other ways of working or
paying much attention to the impact on the health
system as a whole. Currently patients undergo
treatment in the face of avoidable ignorance
and consent to interventions which they would not
undergo if they were provided with a fuller
understanding of the risks, benefits and
alternatives to fully exercise their values and
preferences. The ambition of Right Care is to
change thinking on commissioning care away from
organisations and contracts to commissioning high
value, whole system pathways, under-pinned by
networks rather than institutions and putting the
citizen and the patient at the centre of this
discussion. Those systems and networks can begin
to take on programme budgetary financial risk and
rewards in addition to whole pathway clinical
quality accountability. A key component is the
provision of tools and analysis which highlight
the often large and unexplained variations in
spend on healthcare and health outcomes for the
commissioners population. It is also evident
that the public and patients have not always been
included in the debate about the development or
design of services. The NHS is unlikely to hold
sufficient resource to meet ever rising demand
and thus we need to change the nature of the
debate between the public and the NHS about how
resources are utilised for their care - to do the
right things, at the right time and place, safely
and effectively. This activity will also
increase the sustainability of healthcare. Evidenc
e from the Public Health Commissioning Network
shows that clinical networks are cost effective
and feasible and that integrating systems of care
are an effective means of delivering value and
quality. They can help us to address problems
such as
  • failure to adopt and implement strong evidence
  • massive unknowing duplication of effort in
    appraising new technologies
  • a lack of focus on common expensive problems
    such as epilepsy or headache.

3

Sir Muir has worked in public health for 35
years. He helped pioneer Britain's breast and
cervical cancer screening programmes and was
knighted in 2005 for the development of the
foetal, maternal and child screening programme
and the creation of the National Library for
Health.
Sir Muir Gray Chief Knowledge Officer of the NHS,
DH
Philip DaSilva National QIPP Lead, Primary
Community Services
Phil has a nursing background and brings more
than 30 years NHS experience to the team,
operating at all levels including as a PCT Chief
Executive and in a range of senior Executive
Director positions.

WHAT Right Care will create better value
programmes and systems of care within programme
budget areas by supporting networks of lead
clinicians and commissioners in local health
economies to develop and commission high value
pathways for specific clinical programmes. Right
Care will support this work with learning
programmes, knowledge management tools and
Accelerated Design Events. It will also support
clinical commissioners with a range of tools
including the NHS Atlas of Variation, the Annual
Population Value Review, lists of high and low
value interventions and the systematic use of the
Map of Medicine and NHS Evidence . A project on
Shared Decision Making, led by East of England
SHA, complements and feeds into Right Care. This
will deliver a National Strategy for Shared
Decisions and at least six new NHS decision aids
on a national platform (see screenshot).
HOW Right Care will provide the focus,
leadership and support to drive momentum and
accelerated change in clinical commissioning,
where improvement is currently recognised to be
slow and sporadic. The work will become core to
the review of World Class Commissioning with the
extension and enhancement of WCC competencies. A
small national reference group will advise on
using national levers (e.g. standard contracts,
tariff, ring-fenced budgets) to drive change.
4
  • A team of clinicians and commissioners is using
    clinical evidence to redesign the COPD pathway
    ensuring that access to health care is improved
    for patients that will result in fewer
    readmissions.
  • Central lancashire PCT has identified three
    interventions to reduce cost on the COPD pathway
  • 1. Invest in community health care
  • . Reduce readmissions
  • . Work to reduce length of stay of hospitalised
    patients
  • COPD patients receive appropriate care in a
    community setting and are less likely to need
    emergency admission to hospital
  • By redesigning the clinical pathway for COPD and
    commissioning more community based care this PCT
    has an aspiration to reduce its spend on hospital
    readmissions for COPD patients by 500,000 a year.

Quality outcome
This workstream sets out to increase value by
improving clinical commissioning - the right
allocation of resources to different clinical
specialties clinical management - the right use
of allocated resources each group of patients
and patient choice - to ensure that the patient
makes the decision that is right for
them Central Lancashire PCT is taking this
approach to increase the value it derives from
the 34m it allocates for respiratory disease,
initially by improving the quality and health
outcomes of the chronic obstructive pulmonary
disease (COPD) service. It is working to reduce
readmission rates by 10 and at the same time
ensure that more people are cared for at
home. In this PCT the COPD spend is 7million a
year. This is 17 more than neighbouring PCTs.
The main hospital has a COPD admission rate of
46 compared with a 27 national admission rate.
Emergency hospital admissions due to
exacerbations of COPD account for 70 of the
total costs for COPD patients.
Productivity outcome
  • The workstream will work to derive increased
    value from three programmes
  • Respiratory disease, current cost 4.27bn a year
  • Gastrointestinal and liver disease, current cost
    4.10bn a year
  • Genito-urinary disease including kidney disease,
    current cost 4.0bn
  • The above costs do not count GP costs other than
    prescribed medication
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