Copyright 2014 Right Care Mara Airoldi Systems Modelling for Performance Optimisation & Service Equity Department of Management London School of Economics March 2014 Commissioning for Value STAR A Case Study in the Use of STAR in Sheffield Online Learning Series Right Care for Populations

The Problem Sheffield PCT had an issue with its eating disorders service: -Reacting to demand versus proactive prevention -There was a -some users had to travel to Leeds or Nottingham for inpatient care and -there was a feeling that certain areas of spending on eating disorders were not good value for money -Thee was a lack of analysis to provide evidence for change

Sheffield PCT: eating disorders  Two one day meetings  20 participants  Data-pack each service: Benefits  How many?  How much? Inequalities? Costs?

Assessing QoL for mild eating disorders around anchors

Benefit / person (QoL): intensive residential care Worsen (QoL = 0.05) Stay same (QoL = 0.1) Little improve ment (QoL = 0.12) Become moderate (QoL = 0.5) Recover (QoL = 1) Average QoL After 1 year, if admitted 0%25%0%33%42%0.61 After 1 year, if not admitted 10%30%50%10%0%0.15 Benefit = 0.46 Quality-Adjusted Life Years (QALYs) / person

costs Population benefit = 7.36 Benefit / person = 0.46 Numbers who benefit = 16 VfM Intensive residential care Value

VfM triangles pathway for treatment of eating disorders Residential intensive care 80% costs & 13% benefits Value Costs ?

Value of model: explore scenarios

Results NHS Sheffield then held discussions with providers and the strategy was agreed. Implementation began in September ‘It’s shown you can change the way services are provided,’ says Dr Wight. ‘It’s reassuring to be able to say we did make a difference there and have changed the way things are happening.’ By early 2012, indications suggested the new strategy would achieve savings of £220,000 from the £400,000 previously spent on inpatient services for eating disorders. Further testing will be needed to prove whether the savings have been made through the introduction of the day service or just from there being less demand.

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