This week marks the first anniversary of the launch of the NHS Five Year Forward View (5YFV) and progress on its delivery will feature as part of NHS England’s Annual General Meeting later today.
Three main planks of the 5YFV involve: prevention, new models of care and efficiency.
Here, in the latest of a series of blogs on these topics Professor Matthew Cripps, the National Director of NHS RightCare, looks at increasing value in healthcare:
The Five Year Forward View set out some clear challenges for the health system. Demand for healthcare is rising and is set to rise further as the population grows and ages.
We need to deliver better outcomes – not the same – and reduce waste at the same time so that we can invest even more in patient care.
We must not tolerate variations in care that result in someone in one part of the country with the same age, profile and healthcare need, receiving better care than someone in another part of the country or locality. This isn’t about blame though – it’s about a rational, evidence based approach that looks at how to put an end to this unwarranted variation. In many cases, this care also costs less.
How can this be? Paul’s story explains how:
Paul is a typical patient in a typical clinical commissioning group (CCG). The following story is seen across the country in many long term condition pathways. Journey one tells of a standard care pathway. Journey two tells of a pathway that has been commissioned for value.
At the age of 45, and after two 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 six visits to the practice nurse and six laboratory tests per year.
Paul knows that he is supposed to manage his diet better but is not sure how to do this and does not want to keep bothering the GP and the practice nurse.
By the age of 50, Paul has given up smoking but continues to drink. His left leg is beginning to hurt. His GP prescribed insulin a year ago and now refers him for outpatient diabetic and vascular support.
At 52, Paul’s condition has deteriorated further. He has to have his leg amputated and he now has renal and heart problems. His vision is also deteriorating rapidly. He is a classic complex care patient. This version of Paul’s patient journey costs £49,000 at 2014/15 prices…
If Paul’s CCG had adopted Commissioning for Value principles and reformed their diabetes and other long term conditions pathways, what might Paul’s patient journey have looked like?
The NHS Health Check identifies Paul’s condition one year earlier, at the age of 44 and case management begins.
Paul is referred to specialist clinics for advice on diet and exercise and he has this refreshed every two years. He is also referred to a stop smoking clinic and successfully quits.
Paul has a care plan and optimal medication and retinopathy screening begins 18 months earlier.
He is supported in his self-management via the Desmond Programme and a local Diabetes Patient Support Group.
JourneyoOne cost £49,000 and managed Paul’s deterioration, while journey two cost £9,000 and keeps Paul well.
Our focus will always be about what is best for the patient, but if this care can be delivered in a smarter way, benefiting the patient and allowing others to receive better care too, then we have a responsibility to remove the barriers to delivering this.
That’s why we are extending RightCare across England. RightCare is a proven, NHS England led-programme that aims to support local health economies to meet the challenge of how to deliver the best possible care in the face of rising demand and expectations.
I am pleased to lead a major new phased roll-out of RightCare to support all CCGs to adopt Right Care and increase the value of healthcare for their populations. This will include direct mentoring for CCGs, development of CSUs to enable them to support CCGs implement RightCare, a further series of Commissioning for Value tools and the development of a series of “Optimal Value Pathways” in collaboration with Public Health England, NICE, Patient Groups, the Royal Colleges, national charities and other key stakeholders.
Some examples of the allocative efficiencies achieved via the RightCare approach include baseline savings of between 3.5 and 5%, achieved via healthcare improvement, such as £18million savings per annum in Wigan Borough CCG, and specific programme achievements such as in Hardwick and Warrington CCGs where both successfully reduced respiratory urgent care activity by 30%. In Warrington a reduction across all of urgent care of 8% to 9% also occurred via the approach.
By providing the commissioning system with data, evidence, tools and practical support around spend, outcomes and quality, the programme can help clinicians and commissioners transform the way care is delivered for their patients and populations.