Carl Marsh, RightCare Delivery Partner, NHS England Phil Wilcock, Senior Manager, Analytical Service, NHS England

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NHS
RightCare
and the
Power of
Variation
Carl Marsh &
Phil Wilcock,
NHS England
19 April 2016

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Inconvenient truths on variation
“The Atlas exposes
some inconvenient
truths about the extent
of variation in care for
some common
conditions”
Professor Sir Bruce Keogh

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2-fold..
.
7-fold..
.

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RightCare Case Book; Tried and Tested

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Why act? Patient case Study
Wrong Care
• At age 45, after 2 years of increased urinary frequency and loss of
energy, Paul goes to his GP
• The GP performs tests, confirms diabetes and seeks to manage with diet,
exercise and pills. This leads to 6 visits to practice nurse and 6 lab tests
per year. Paul is unsure how to manage his diet
• At 50 Paul is still drinking and his left leg is beginning to hurt. He has
been prescribed insulin and the GP now refers him for outpatient diabetic
and vascular support.
• At 52 he has to have leg amputated and has renal plus heart problems.
His vision is deteriorating
Cost of this care = £49,000

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Why act? Patient case Study
Right Care
• The NHS Health Check identifies Paul’s condition one year earlier at 44
and case management begins
• Paul is referred to specialist clinics for advice on diet and exercise and
has this refreshed every 2 years. He’s referred to stop smoking clinic
and quits
• Paul has care plan and optimal medication and retinopathy begins early
• He is supported in self management by Desmond Programme and
diabetes support group
Cost of Right care = £9,000 and keeps Paul well
Cost of Wrong care = £49,000

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One Key Objective – Maximise Value

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The Value Triangle
Improving the value
that patients receive
from their healthcare
and improving the
value that
populations receive
from investment in
their local healthcare
system
Quality
Spend
Patient
Outcome

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The Forward View Challenge
Operational productivity
• Benchmarking
• Workforce productivity
• Approach to
procurement
• Estates optimisation
• Leadership
Allocative efficiency &
demand
RightCare
• Where to look
• What to change
• How to change
New Models of Care
Vanguard programmes:
• Integrated Primary & Acute
Care Systems (PACS)
• Multi-speciality Community
Providers (MCP)
• Enhanced Health in Care
Homes
• Urgent and Emergency Care
• Acute Care Collaboration
Finance input:
• Business models
• Pricing & payment
mechanisms
• Procurement &
contracting support
• Cross-sector
collaboration

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Five Key Ingredients:
1. Clinical Leadership
2. Indicative Data
3. Clinical Engagement
4. Evidential Data
5. Effective processes
1 key objective + 3 key phases + 5 key ingredients =
COMMISSIONING FOR VALUE
10
OBJECTIVE - Maximise Value (individual and population)
Key ingredients and phases

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The 1st principle of
Commissioning for Value
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

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What is ‘Commissioning for Value’?
• A process to help optimise the use of finite budgets to deliver the best
possible health outcomes
• It helps identify priority conditions which offer the best value opportunities to
improve healthcare for populations
• It helps commissioners focus on allocative efficiency as well as technical
efficiency – doing the right things as well as doing things right hence
RightCare
• Key to the approach – the comparison of a CCG with similar
demographic CCGs (peers) using standardised data. This minimises
warranted variation to help identify potentially unwarranted variation
Approach is a collaboration between NHS England and Public Health England

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1 Infectious Diseases
2 Cancers & Tumours
3 Blood Disorders
4 Endocrine, Nutritional and Metabolic Problems
5 Mental Health Problems
6 Learning Disability Problems
7 Neurological System Problems
8 Eye/Vision Problems
9 Hearing Problems
10 Circulation Problems
11 Respiratory System Problems
12 Dental Problems
13 Gastro Intestinal System Problems
14 Skin Problems
15 Musculo Skeletal System Problems
16 Trauma & Injuries
17 Genito Urinary System Disorders
18 Maternity & Reproductive Health
19 Neonates
20 Poisoning
21 Healthy Individuals
22 Social Care Needs
23 Other Conditions
Programme Budgeting Categories
Which do you think is the highest spending
programme?

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Commissioning for Value is focused
on the highest spending
programmes
National PCT Spend 2012/13 (£bn)

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Bradford
City
Birmingham
South & Central
Almost 4 fold difference in spend on CHD emergency admissions between
Birmingham and Bradford (£4 per head in Birmingham compared to £15 per head in
Bradford)

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Mechanism
Decision
Process
Service
Reviews
Clinical Policy
Development
and
Decommissioning
GP Member
Practices
Public
Engagement
Partners and
Stakeholders
Miscellaneous
(e.g. Commissioning
Annual Plan)
BHCBoard
FullBusinessCase
ClinicalExecutiveGroup
Case
Outlines
Reform
Proposals
Contracts
Primary
Care
Development
Procurement
ResearchIVAGroup
ReformIdeas(IVAs)
Implementation
BOLTON HEALTH ECONOMY
HEALTHCARE REFORM
PROCESS

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In summary, RightCare
1. Helps health economies find where they are wasting
resources on sub-optimal healthcare.
2. Helps them replace that with optimal healthcare and
save resources.
3. An improvement methodology that meets needs of
all perspectives and delivers efficiency and a
sustainable health economy
Overview

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RightCare – Further Information
RightCare Delivery Partner
Carl Marsh carl.marsh2@nhs.net
Analyst
Phil Wilcock philip.wilcock@nhs.net
CCG Engagement and Communications
Rob Wakefield rob.wakefield@nhs.net
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‘Commissioning for Value’ for data and tools
‘Right Care’ for everything else
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