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

2. 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

3. 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

4. Context
NHS Five Year Forward View (FYFV) ( ) – 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. Links to further info and evidence

11. 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

12. 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

13. …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

14. 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

15. …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

16. 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

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