NHS England has produced a toolkit called ‘Any town’, which using high level health system modelling, allows clinical commissioning groups to map how interventions could improve local health services and close the financial gap.
It is an additional guide to help commissioners with their five-year strategic plans, showing how a typical CCG could achieve financial balance over the strategic period up to 2018/19.
This is part of NHS England’s Call to Action for staff, the public and politicians to help the NHS meet future demand and tackle an identified funding gap of £30bn up to 2020/21.
Using 2013/14 as a baseline, ‘Any town’ uses detailed data including population size and disease prevalence, to predict what a typical health system’s quality and financial baseline may look like in 2018/19.
It uses extensive research to highlight both interventions that are already proven to have a significant impact (High Impact Interventions) as well interventions that could have benefit but have not yet been widely adopted or fully impact assessed (Early Adopter Interventions) both with a view to helping health economies to deliver better quality care within the available financial resources.
Professor Robert Harris, Director of Strategy at NHS England, said:
“We have a growing, ageing population with increasingly complex long-term health conditions. This is set against a backdrop, highlighted in NHS England’s Call to Action document, that shows the NHS will have a £30bn funding gap by 2021 if we do nothing. So now is exactly the time to think more radically about the future of the NHS: what we need; how and where we access services; and how we contract and pay for such services.
“NHS staff and services continue to do an excellent job under increasing pressure, but we know this isn’t sustainable. Our ambition is to build on the excellent things we do, preserving and improving services for future generations, but also to ensure that patients get the very best care they deserve.
“A lot of work is already underway to ensure we meet the challenges ahead and we are currently working with local health economies to ensure they have services in place that meet the specific needs of their populations. But we need to make further long-term radical changes to ensure that we have an NHS that can meet health demands, now and in the future, which provides high quality services for patients while being financially sustainable.
“We know there are proven interventions that can make a real difference. This resource brings together a wealth of information, data and research to highlight additional interventions that can potentially applied in ‘Any town’ in the country and make a real difference to patients while contributing to closing the financial black hole. The evidence is there, we now need to customise it for local use.
“In coming months NHS England will be working with national partners to offer a wide range of ‘support products’ such as ‘Anytown’ to help commissioners, providers and others make the best of the opportunity we have to redefine services for future generations.”
Any town recognises that all health economies are different and it is not designed to be prescriptive. It does, however, include modelling specifically to reflect typical urban, suburban and rural health systems and interventions that could have most impact in each of these scenarios.
For example, rural areas tend have an older demographic with a higher prevalence of Coronary Heart Disease (CHD), Heart Failure, Stroke, Chronic Obstructive Pulmonary Disease (COPD), Cancer, Dementia and Lung Disease. The model shows that implementing interventions in rural areas could theoretically mean 7.9% decrease in potential years of life lost, 7.9% increase in average health status of individuals with a long term condition (LTCs) and 19.4% decrease in unplanned hospitalisation for chronic ambulatory care sensitive conditions.
In suburban areas there tends to be a higher level of LTCs, excluding cancer, including heart and endocrine conditions in particular. The model shows that that implementing interventions in rural areas could theoretically mean 7.9% decrease in potential years of life lost, 7.9% increase in average health status of individuals with a LTC and a 24.0% decrease in unplanned hospitalisation for chronic ambulatory care sensitive conditions.
In urban areas there tends to be a younger demographic with a higher prevalence in COPD, Mental Health and Depression. The model shows that that implementing interventions in urban areas could theoretically mean 7.9% decrease in potential years of life lost, 24.9% decrease in unplanned hospitalisation for chronic ambulatory care sensitive conditions and a 60.6% decrease in unplanned hospitalisation for asthma, diabetes and epilepsy in the under 19s.
The primary aim of resource is to improve service quality. There is a significant financial impact though – the implementation of the high impact interventions and early adopter interventions will theoretically reduce the funding gap by up to 40% for rural areas, up to 58% for suburban areas and up to 56% for urban areas. The toolkit goes on to identify additional transformational interventions to help close the financial gap.
The toolkit includes five connected modules:
1. A methodology guide which introduces the work of the Any town project and explains the principles and methodology behind the project and the model. It describes how the interventions were selected and the detailed methodology of how the model calculated the results
2. An urban model module
3. A suburban model module
4. A rural model module
5. A further information guide which provides information on the case studies used for the interventions. These guides are intended to provide a high-level ‘starter for ten’ to assist with initial planning, including:
- Initial selection of priority interventions (based on health economy characteristics and target population groups) and further interventions not included in the results modules;
- Enablers and implementation steps;
- Potential barriers; and
- Suggested phasing of the interventions.
High Impact Interventions
- Early diagnosis – Early detection and diagnosis to improve survival rates and lower overall treatment costs
- Reducing variability within primary care by optimising medicines use – Reducing unwanted variation in primary care referring and prescribing
- Self-management: Patient-carer communities – Self-management programme for those suffering with a long-term condition
- Telehealth/Telecare – Health apps, telehealth and telecare equipment which help people to manage their own long term conditions in conjunction with their clinicians, introduced to empower people whilst at the same time ensure that their own actions remain embedded in the care they receive from the NHS
- Case management and coordinated care – Multi-disciplinary case management for the frail elderly and those suffering with a long-term condition
- Mental Health – Rapid Assessment Interface and Discharge (RAID) – Psychiatric liaison services that provide mental health care to people being treated for physical health conditions
- Dementia pathway – Fully integrated network model to improve health outcomes and achieve efficiencies in dementia care
- Palliative care – Community based, consultant-led palliative care service.
Early Adopter Interventions
- Cancer screening programmes – Early diagnosis of colorectal, breast and lung cancer to increase survival rates
- GP tele-consultation – Systemic approach to tele-consultation in primary care, as a complement to practice-based consultations
- Medicines optimisation – Pharmacist-led interventions to support optimal prescribing and use of medicines
- Safe and appropriate use of medicines – Reducing the number of preventable deaths from medication-related incidents through Eclipse Live
- Acute visiting service – Reducing demand for emergency care through providing a rapid-access doctor at home
- Reducing urgent care demand – Acute GP unit to triage emergency arrivals; occupational therapists in A&E to reduce low-risk admissions
- 24-hour asthma services for children and young people – Reducing unnecessary hospital admissions through a 24-hour home nursing service
- Service user network – Mental health co-designed support service developed for and by people with emotional/behavioural problems
- Reducing elective Caesarean sections – Campaign for Normal Births to lower rate of unnecessary elective Caesarean sections
- Acute stroke services – Creating a hyper-acute stroke unit to optimise acute stroke services and ensure 24/7 access to specialist care
- Integration of health and social care for older people – Integrating care through organisational, procedural and cultural changes
- Electronic palliative care coordination systems (EPaCCS) – Improving care and helping patients to die in the location of their choice through a shared electronic record.