Right Care in action
Professor Matthew Cripps
Programme Director, NHS Right Care
Twitter
#CforValue
1 NHS | Presentation to [XXXX Company] | [Type Date]
The primary objective for Right Care is to
maximise value
• the value that the patient derives
from their own care and
treatment
• the value the whole population
derives from the investment in
their healthcare
To successfully increase value for both
patient and population, health service
reform must integrate both in an single
model; separately, they become
opposing imperatives
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Where to Look, What to change, How to change
The Right Care model has
three basic steps: Where
to Look; What to
Change, and; How to
Change.
Determine Where to Look
by indicating the areas of
care your population can
gain most benefit from
your reform energies.
What to Change helps you
to define what the
optimal value care looks
like for your population.
How to Change helps you
to implement the changes
to deliver that care.
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5 KEY INGREDIENTS
1. Clinical Leadership (of the reform agenda)
2. Indicative Data (on where variation exists –
focus here to improve)
3. Clinical Engagement (in individual reforms,
supported by project managers and teams)
4. Evidential Data (on what, why and how to
change)
5. Effective processes (BPE)
Delivers Reform
4
The NHS Atlases of Variation
Reducing unwarranted variation to increase
value and improve quality
Awareness is the first step
towards value –
If the existence of clinical and
financial variation is unknown,
the debate about whether it is
unwarranted cannot take place
Clinical & Financial Variation
• When faced with variation data, don’t ask:
• How can I justify or explain away this variation?
• Instead, ask:
• Does this variation present an opportunity to
improve?
• Deep dive service reviews support this across whole
programmes & systems and deliver Phase 2:
• What to Change
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Deep Dive Service Review Pathway
Step 1 – define:
CURRENT
SERVICE
Step 2 – define:
Step 3 –
Step 4 –
categorise:
recommend:
Fit for
Purpose
Maintain
Efficiency
and
market
options
Redesign,
Contract,
Procure
Supply
and
capacity
options
Contract,
Procure,
Divest
No/ low
benefit
Divest
FUTURE
SERVICE
NHS RIGHTCARE
Partners and
Stakeholders
Case
Outlines
Mechanism
Miscellaneous
Decision
(e.g. Commissioning
Annual Plan)
Process
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Contracts
Implementation
Governing Body
Reform
Proposals
Full Business Case
Public
Engagement
Reform Ideas
GP Member
Practices
Ideas Decision
Group
Clinical Policy
Development
and
Research
Decommissioning
Clinical Executive Group
HEALTHCARE REFORM
PROCESS
Service
Reviews
Procurement
Primary
Care
Development
Change is inevitable
• Choice ≠ Whether to change
• Choice = Whether to change yourselves or wait to be
changed
• People and Organisations who wait to be changed
lose control, become resistant and block
improvement
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21st Century Healthcare in a 19th Century System
• Smart Phone technology
Versus….
• Victorian infrastructure and model
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iPhone & Android Apps - Patient Decision Aids
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The Right Care approach - Case studies
• Some use holistically, others use components of
• Some take off shelf, others tweak…
• …Others take principles and build own to galvanise
system (where ownership is an issue locally)
• ALL adopt the 3 phases and the 5 key ingredients and
improve their improvement!
• “Right Care is a better value way of delivering better
value” – a GP
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Reminder – 3 phases and 5 ingredients
Five Key Ingredients:
1. Clinical Leadership
2. Indicative Data
3. Clinical Engagement
4. Evidential Data
5. Effective processes
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Case Studies
1. System-wide achievement
Warrington CCG
2. Key ingredients – Clinical Leadership and Engagement
West Cheshire CCG
Wigan Borough CCG
3. Key ingredients - Effective processes
Calderdale CCG (Systemising reform)
Sefton CCGs (Optimising focus and delivery)
Doncaster CCG (Planning and prioritising)
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Why Act - What benefits do the population get?
CCGs can and are
using the “Right Care
approach” to shift
spend
•
•
•
•
Achieving financial
stability in West
Cheshire
It’s not just about
money - developing
the Right Care model
in West Cheshire led
to real quality
improvements in just
one annual cycle:
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Achieved Turnaround (Warrington CCG - Winner of HSJ Commissioning
Organisation of the Year 2012)
Financial sustainability (West Cheshire CCG - Winner of HSJ
Commissioning Organisation of the Year 2010)
Clinically led annual QIPP planning and delivery (Borough of Wigan) Clinical
Leaders driving change (Vale of York CCG)
Galvanising commissioners in a growing number of health economies (20+
CCGs and growing)
Year 1 – “Came from behind” - Implemented system mid year
Year 2 – “Delivered as went along” - Began at year start, achieved by end
Year 3 – “Planned ahead” - Began before year start, over-achieved
Year 4 – “Ahead of the curve” - 20% of QIPP delivered by start
Year 5 – Increased focus on Quality!
•
•
•
Enabled by, for example A&E attends & admissions,
•
Medicines administration training to
Elective & Non-elective activity,
care homes
OP Firsts and Follow-ups – all
•
Personalised care plans (LTC)
decreased
•
Community endoscopy, optometry,
Outcomes & Quality – improved
ophthalmology, neurology & pain
Integration occurred across
management pathways
health sectors and with social
•
MRI Scanner Direct Access
care
Respiratory Care in Warrington Health Economy
• 2010/11 –
• £Ms Overspending V. Demographic peers
• Only 2/3s of asthmatics known
• Worst quintiles – COPD rate of em admns, deaths
within 30 days, %age receiving NIV, readmns
• 2012/13 –
• Spend below average for demographic (and still
reducing)
• Delivered by focus on variation – problems fixed or
improving (e.g. 30% less COPD NEL admissions)
• HSJ Commissioner of the Year
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