1. Getting It Right First Time
Clinically-led programme, reducing variation and improving outcomes Adrian Hopper, Geriatric Medicine lead

2. Introducing GIRFT
Review of 35 clinical specialties leading to national reports for each.
Led by frontline clinicians who are expert in the areas they are reviewing.
Peer to peer engagement helping clinicians to identify changes that will improve care and deliver efficiencies, and to design plans to implement those changes.
Support across all trusts and STPs to drive locally designed improvements and to share best practice across the country.
Agreed efficiency savings: c.£1.4bn per year by , starting with between £240m and £420m in
Tackling unwarranted variation to improve quality of patient care while also identifying significant savings.

3. GIRFT local support
GIRFT Regional Hubs support trusts in delivering the Clinical Leads’ recommendations by:
Helping them to assess and overcome the local and national barriers to delivery.
Working closely with NHSI regions to ensure prioritisation of GIRFT delivery takes account of the wider context within each trust and is joined up with local and regional improvement initiatives.
Joining up with NHSE/RightCare to ensure integrated support for STP level improvements.
Producing good practice manuals of case studies and best practice guidance that trusts can use to implement change locally.
Supporting mentoring networks across trusts.
Each hub will have two clinical ambassadors: regionally recognised leaders of improvement programmes

4. GIRFT cross-cutting themes
GIRFT is delivering 35 workstreams, occurring concurrently at different stages.
Core focus is on peer to peer engagement within specialties, but to maximise improvement opportunities we also need to focus on patient pathways and services that cross specialty boundaries.
GIRFT is therefore delivering a number of cross cutting projects:
And GIRFT Clinical Leads are coming together to work in clinical service lines when beneficial for exploiting opportunities or joining up services across specialty boundaries:
Litigation
Procurement
& Technology
Patient
Safety
Patient
Safety
Medicines
Optimisation
Frailty
Coding
Critical &
Intensive
Care
ED & Acute
Admissions
Brain
conditions
Outpatients
Diagnostic
services
Anaesthetics
Perioperative
Pathology
services

5. GIRFT impact on resource savings
Orthopaedic pilot
Case Study
One NW trust has made c.£700k resource savings between 2014 and 2017 through: cost effective procurement of specialist instruments (£133k), reduced length of stay (£364k), use of best practice tariff (£110k) and improved theatre utilisation (£74k).
Overall position to date
GIRFT business plan target: £240m (£420m stretch target)
Total savings opportunity realised in Q1 & Q2 is £136m (57% of target)
Cumulative realised total to date (Q to Q ) is £242m
Note: figures are for gross notional savings. Actual figure is likely to be higher as not all metrics are currently measurable and greater benefits accrue as impact of recommendations land.  

6. According to HES data, across the region 16
According to HES data, across the region 16.4% of patients 75 and over admitted in an emergency had length of stay zero in 2016/17
Source: Hospital Episode Statistics (HES) 2016/17

7. According to HES data, across the North 18% of patients 75 and over admitted as an emergency had a diagnosis of dementia recorded in 2016/17
Source: Hospital Episode Statistics (HES) 2016/17

8. According to HES data, across the North among patients 75 and over, those admitted for 21 days or more consumed 53.5% of the total bed days in 2016/17
Source: Hospital Episode Statistics (HES) 2016/17

9. According to HES data, across the North 40% of patients 75 and over admitted as an emergency who stay in hospital 21 or more days are discharged to a care home
Source: Hospital Episode Statistics (HES) 2016/17

10. According to SUS data, across the North £143m was spent on Excess Bed Day costs for admissions of patients 75 and over in 2016/17
Source: Secondary Uses Service (SUS) 2016/17

11. According to Unify2, across the North DTOC days resulting from patients waiting for Nursing or Residential Home placements were the equivalent of 264 beds in January 2018
Source: Unify2
Note – this includes delays attributable to the NHS, Social care or both

12. Across the North only 35% of providers included in the audit reported a delirium assessment rate greater than 50%.

13. Contact:
Adrian Hopper
GIRFT Geriatric Medicine Lead

14. RightCare: Supporting improving the quality of life for people with frailty
Shane Hayward-Giles NHS RightCare Delivery Partner West Yorkshire and Harrogate Health and Care Partnership
27th April 2018

15. Contacts Shane Hayward-Giles – West Yorkshire and Harrogate
Alison Hewitt - Cheshire and Merseyside
Mark Johnston - Lancashire and South Cumbria
Gillian Greenhough - Greater Manchester
Eric Power – Humber, Coast and Vale
Martha Coulman - South Yorkshire and Bassetlaw
Fiona Ottewell - Durham, Darlington and Tees, Hambleton, Richmondshire and Whitby
- Northumberland, Tyne & Wear
- North Cumbria

16. Do no harm First Atlas of Variation – 2009 Unwarranted variation in:
Access
Quality
Outcome
Value
Overuse
Underuse

17. The value triangle
Quality
Spend
Outcome

18. Comparator methodology

19. Our data/intelligence resources
Scenarios
Pathways
Focus packs

20. RightCare scenario: The variation between standard and optimal pathways
Janet’s story: Frailty
August 2016

21. RightCare Pathway: Frailty
The National Challenge
Increasing numbers of people not ‘aging well’
Falls, and falls that cause a fracture
The number of people with mild, moderate and severe frailty accessing urgent care
Number of people with mild, moderate and severe frailty who have delayed care, and who are in the wrong part of the system
RightCare Opportunity
….if CCGs achieved the rate of their 5 best peers
….if CCGs achieved the rate of their 5 best peers
*using proxy measures
….if CCGs achieved the rate of their 5 best peers
System Enablers
Identification of Frailty status
eFrailty Index
GP Contract including enriched summary care record
Encourage people to age well
Falls Prevention
Priorities for Optimisation
Support patients with moderate and severe frailty in the community
Speed of hospital transfers/right place right time in acute care
Secondary Prevention
Primary Prevention
Interventions that reduce the need for urgent care
Crisis Response
Prevention strategies
Home Based rehabilitation
Medicines Optimisation
High Value Interventions
Exercise/Activity
Social Prescribing
Timely identification of delirium and cognitive disorder
Shared Decision Making
Care Coordination
Workforce Capability

22. NHS RightCare Frailty Focus Pack
Stakeholders
Martin Vernon - NCD for Older People
Dawn Moody - Associate NCD for Older People
Getting It Right First Time
Public Health England
National Institute for Health and Care Excellence
Association of Directors of Adult Social Services
Chartered Society of Physiotherapy
Royal College of Speech & Language Therapists
Age UK
Pharmacy subject matter experts in the care of older people
Publication this summer

25. Our human resouces Delivery partners Analysts Subject matter experts
Locality support workers

26. Shared decision making
“It is far more important to understand the person who has the disease than it is to know what disease the person has”
Hippocrates

27. RightCare and GIRFT