NHS | Presentation to [XXXX Company] | [Type Date]1 Why act? Helen Hirst Director of CCG Development, NHS England Prof Sir Muir Gray Joint National Lead, NHS Right Care & Public Health England Twitter #CforValue

- Progress in the last 40 years has been amazing but all health services, everywhere, still face 5 major problems one of which is unwarranted variation which reveals the other four HARM, from overuse even when quality is high WASTE OF RESOURCES through low value activity INEQUITY, from underuse by groups in high need FAILURE TO PREVENT DISEASE &DISABILITY And new, additional, challenges are developing RISING EXPECTATIONS INCREASING NEED FINANCIAL CONSTRAINTS CLIMATE CHANGE Variation in utilization of health care services that cannot be explained by variation in patient illness or patient preferences. Jack Wennberg

What do we want to achieve? High Value Healthcare which Allocates resources for optimal value & equity Makes optimal value from the use of allocated resources Ensures each individual receives care that addresses their particular problem and values

More of the same is not the answer, not even better quality, safer, greener cheaper of the same we need to design, plan and build a new paradigm

VALUE

Triple Value Programme Individual & Personalised Allocative, Technical, resources distributed resources used to optimise value to best effect

Cancer Respiratory Gastro- intestinal Between Programme Marginal Analysis and reallocation is a Board responsibility with public involvement ; the aim is optimal allocation ie you cannot get more value by shifting a single £ Allocative value

Cancer Respiratory Gastro- intestinal Mental Health Between Programme Marginal Analysis and reallocation is a commissioner responsibility with public involvement

Cancers Respiratory Gastro- instestinal Apnoea COPD (Chronic Obstructive Pulmonary Disease) Asthma Within Programme, Between System Marginal analysis is a clinician responsibility

Cancers Respiratory AMD Retinopathy Cataract Within Programme Between System Marginal analysis Eyes & Vision £2Bn Low Vision Glaucoma

Cancer Respiratory Gastro- intestinal Mental Health Specialist Commissioning Terra incognita

Cancers Respiratory Gastro- intestinal Mental Health Many people have more than one problem ; GP’s are skilled in managing complexity

Triple Value Programme Individual & Personalised Allocative, Technical, resources distributed resources used to optimise value to best effect

Technical Value = Outcomes / Costs Outcome= Benefit (EBM +Quality) – Harm (Safety ) Costs (Money + time + Carbon)

Cancers Respiratory Gastro- instestinal Apnoea COPD (Chronic Obstructive Pulmonary Disease) Asthma Triple Drug Therapy Rehabilitation O2O2 Smoking cessation Within System Marginal Analysis is a clinician responsibility with patient involvement

The law of diminishing returns Benefits Investment of resources

Harmful effects increase in direct proportion to the resources invested Harmful or Side effects Of care Investment of resources

After a certain level of investment the health gain may start to decline; the point of optimality Benefits Investment of resources Harms Benefits - harm

Triple Value Programme Individual & Personalised Allocative, Technical, resources distributed resources used to optimise value to best effect

Evidence, Derived from the study of groups of patients The values this patient places on benefits & harms of the options The clinical and social condition of this patient; other diagnoses, risk factors and their genetic profile and in particular their problem, what bothers them psychologically Choice Decision Personalised and Stratified Medicine

As the rate of intervention in the population increases, the balance of benefit and harm also changes for the individual patient Necessary appropriate inappropriate futile High value Low value Negative Value

How do we achieve High Value Healthcare? Deliver care through population based sustainable systems focused on symptoms like breathlessness or, conditions such as epilepsy or people with a common characteristic such as being elderly with frailty Be transparent with annual reports from systems to the patients served Have a collaborative culture Have all key people trained in new terms, concepts and skills Engage patients as, at the least, equals

The Healthcare Archipelago GENERAL MENTAL PRACTICE HEALTH COMMUNITY HOSPITAL SERVICES

The Commissioning Archipelago GP/ Pharmacists/ optometrists Public Health Specialist commissioning 211 CCG’s152 Local Authorities

SELF CARE INFORMAL CARE GENERALIST SPECIALIST SUPER SPECIALIST

BetterValueHealthcare IF YOU ASKED EVERY HEALTHCARE PROFESSIONAL What is Equity, and how does it differ from Equality How does Quality of care differ from Value? What is meant by optimal end of life care? How consistent would be the response We need mandatory training

BetterValueHealthcare Map of Medicine - COPD Work like an ant colony; Neither markets nor bureaucracies can solve the challenges of complexity

Right Care for Populations Follow Right Care online Subscribe to get a weekly digest of our blog alerts in your inbox, Receive occasional eBulletins Follow us on Find the full series at: The NHS Right Care website offers resources to support CCGs in adopting this approach: online videos and ‘how to’ guides casebooks with learning from previous pilots tried and tested process templates to support taking the approach forward advice on how to produce “deep dive” packs locally to support later phases, within the CCG or working with local intelligence services access to a practitioner network