NHS RightCare Update on progress of national NHS programme tackling unwarranted healthcare variation Claire Bradshaw May 2017

What is RightCare? NHS RightCare is a programme committed to reducing unwarranted variation to improve people’s health and outcomes. It aims to help local health economies ensure that the right person has the right care, in the right place, at the right time, making the best use of available resources. NHS RightCare ensures local health economies….. make the best use of resources to give better value – better value for patients, the population and the taxpayer. understand how they are doing – by identifying variation with demographically similar populations get talking about the same stuff - about population healthcare rather than organisations focus on the areas of greatest opportunity - by identifying priority programmes which offer the best opportunities to improve healthcare for populations use tried and tested processes - to make sustainable change to care pathways to reduce unwarranted variation

For the first two phases, we have published data for each local health economy to show where there is variation compared to demographically similar areas

Context NHS Five Year Forward View (FYFV) (2015-20) – Sets out how the NHS needs to change and the direction it will take Economic recession = NHS funding growth slower than historic long term trend The FYFV estimated a possible £30bn gap – difference between trend demand increases and no real increases in funding or efficiency An extra £8bn has been promised, but even with expected productivity gains, there is still a gap RightCare is about reducing variation and ensuring the best value from every penny the NHS spends

What is a Clinical Commissioning Group What is a Clinical Commissioning Group? Local health economies responsible for planning and commissioning health care services for their local population

Timeline of first 15-18 months for local health economies Wave 1 launch events 65 Wave 1 CCGs receive support from 10 Delivery Partners to understand and interpret Where to Look packs and identify emerging opportunities February – April 2016 Wave 1 CCGs receive support to understand and interpret health programme specific Focus Packs. CCGs carry out local deep dive data analysis to identify and agree priorities on What to Change May – July 2016 Wave 1 CCGs work locally - with continued support from RightCare centrally - to agree How to Change and progress improvements to identified priorities using Effective Improvement Processes August 2016 – to date Remaining 144 Wave 2 CCGs receive support from an additional 10 Delivery Partners to understand Where to Look packs and identify priorities November 2016 – February 2017 Wave 2 CCGs agree specific priorities for What to Change following local data deep dives Wave 1 CCGs continue to make improvements as part of How to Change March – July 2017 Wave 1 CCGs will start a second cycle with a new set of priorities Aug/Sept 2017 onwards Progress monitoring Wave 2 launch events

The role of Delivery Partners To mentor and support CCGs to adopt and implement the RightCare approach “The face of the programme” Who are they? Former doctors, nurses, leaders from other parts of the NHS, public health consultants, Directors of transformation in local health economies Key tasks Coaching and supporting local health economies through the 5 key ingredients: Helping them identify and prioritise emerging opportunities Advising – with support from analysts – on local data analysis to support decision making Ensuring clinicians are involved throughout and coming up with solutions themselves Providing local health economies with relevant examples of local best practice examples and national optimal solutions Supporting them with developing and using business improvement processes to deliver changes Helping provide NHS England with relevant information on plans and progress The role is changing from change management to performance management as pressure to deliver improvements increases Indicative data Evidential data Clinical leadership Engagement Effective improvement processes

The role of analysts Producing national products that show variation in healthcare across a patient pathway for 209 local health economies – this is indicative data This means providing variation data on: Health ‘programmes’ we currently cover: Cancer w CVD (inc renal, stroke and diabetes) w Musculoskeletal w Trauma and Injuries w Mental health w Gastro w Neurological w Respiratory Helping local health economies and RightCare Delivery Partners interpret the data and identify ‘where to look’ Supporting them with additional bespoke analysis and training regional analysts to do the same – to identify ‘what to change’ Recorded prevalence – ‘Case’ finding - Risk factors – Primary care – Prescribing – Spend on hospital admissions and procedures – Care quality – Outcomes

Optimal solutions Developed with NHS National Clinical Directors, patient groups, Public Health England, Royal Colleges Aim to provide a set of resources to support local health economies to concentrate their improvement efforts on where there is greatest opportunity to address variation and improve population health. Provide local health economies with: a high-level overarching national case for change; priorities for improvement and key high impact interventions along a pathway underpinning guidance and evidence implementation resources to help make change on the ground; and practice examples that show the potential in population health approaches Bringing together existing evidence based best practice

Links to further info and evidence

What do we ask of local health economies? Awareness of variation Understand your numbers and what they might be saying Don’t ask: “How can I justify or explain away this variation?” Do ask: “Does this variation present an opportunity to improve?” Be a champion in your local health economy We know the RightCare approach works but we also know it needs leadership and focus to be sustainable Look for quick wins as well as longer term gains Add NHS RightCare to your Governing Body agendas Population healthcare improvement is our core purpose Work with your Delivery Partner to identify and deliver your biggest opportunities for change

Role of National Director in 2016…. Raising awareness of variation in healthcare and outcomes – and what RightCare is Shaping and delivering the programme day to day Speaking events and conferences to raise awareness of RightCare and the problem of variation Developing relations with CCGs, providers, charities and wider third sector Supporting early adopters and enthusiasts Then: Cottage industry Now: Industrialisation

…and how it has changed in 2017 The programme has become bigger than expected and the argument on the existence of variation in England has been won The Director’s role is now about telling local health economies they must actively take part in RightCare Tackling variation isn’t an ‘optional extra’ More time devoted to strategic discussions and risks e.g. making sure the programme is delivering what was promised Raising awareness of variation in hospital bed usage “Coordinating the reallocation of capacity” – away from hospitals where appropriate

Successes  Every CCG in England – covering the whole population – is involved in identifying and tackling variation in healthcare  We know that improvements have been made as a result of that  Embedding the concept of comparator with demographic peers  Programme has grown from 3 to >50 – and is likely to grow further  Data really has helped to shine a light on areas CCGs hadn’t thought about much – wake up call and focussing  Difficult for local health economies to keep ignoring problems now that this is nationally mandated  Optimal solutions and pathways – RightCare is a useful vehicle for pulling together and presenting evidence based best practice

…and challenges “NHS RightCare is like flying an aeroplane whilst you’re building it”  Setting up the system and programme at the same time as implementing The programme has expanded quicker than our internal team processes have Don’t always have time to test things out in advance – frustrating when it doesn’t work  Delivery partners from different backgrounds is an asset But risk of variation in implementation  More to do on clinical leadership and engagement Don’t want the programme to be about ‘box ticking’ Need to reach out to wider audiences e.g. providers  Shifting to the whole health economy rather than just commissioners Ensuring we’re relevant to the structures that make decisions  Now need to prove the approach works at a national level Pressure to demonstrate release of cash  High expectations from the centre But need to balance with what’s practical on the ground Can be difficult to measure success  Paperwork and knowledge management Need to balance the need to monitor with risk of stifling innovative improvements

Success factors Variation is reduced and healthcare and outcomes have improved – demonstrably and measurably Local health economies have: A clear understanding of how to identify opportunities to reduce variation and improve care Active and visible senior management support – both managerial and clinical A nominated day to day contact who sees RightCare delivery as a key part of their job An engaged Commissioning Support Unit* GP clinical leads actively involved in shaping and implementing improvements A full understanding of population health care value We want identifying and tackling variation to become business as usual A focus on doing the right thing, and doing it consistently for the right people

Further info 8 https://www.england.nhs.uk/rightcare All the materials and supporting documents are on the NHS England website at: 8 https://www.england.nhs.uk/rightcare 8 https://www.england.nhs.uk/rightcare/intel/cfv/ * rightcare@nhs.net @NHSRightCare * Claire.bradshaw5@nhs.net @ClaireB_NHS