1

PAN LONDON VALUE MEETINGHosted by

Kings Health Partners & Imperial College London

Thursday 11 February 2016

13.30 to 16.30

2

“If you were a member of my own family I

would be doing it like this.

If I were spending my own money I would

be spending it like this.

If our roles were reversed, this how I

would want to be treated”

Roy Lilly’s view on value

3

Variation

Source: Internal data (2006); Boston Teaching Hospital

8 fold variation in rate of scanning

Physician 1 uses 40% more head CTs than next highest user

Number of head CT scans per 1000 patients seen in Emergency Dept.

Each bar is one physician

0

50

100

150

4

Operational productivity

and performance in English

NHS acute hospitals:

Unwarranted variations

An independent report for the Department of Health

by Lord Carter of Coles

5

Carter review, headline examples of variation

Explaining the fall in CHD mortalityThe IMPACT model 1981-2000 (England and Wales)

-80000

-60000

-40000

-20000

0

Risk Factors worse +13%Obesity (increase) +4%Diabetes (increase) +5%Physical activity (less) +4%

Risk Factors better -71%Smoking -41%Cholesterol -9%Population BP fall -9%Deprivation -3%Other factors -8%

Treatment -42%AMI treatments -8%Secondary prevention -11%Heart failure -12%CABG & PTCA - 4%Angina: Aspirin etc - 5%Hypertension therapies -3%

Unal, Critchley & Capewell Circulation 2004 109(9) 1101

Incidence CHD : improved population risk factors, &

detection/treatment high risk individuals

Case-fatality : better treatments in acute phase, & improved secondary

prevention

50%-75% due to

net risk factor

reduction

25%-50%: due

to evidence-

based therapies

Value for money in schools

Cost per pupil

Effe

ct S

ize

(m

on

ths g

ain

)

£00

10

£1000

Feedback

Meta-cognitive

Peer tutoring Pre-school

1-1 tutoringHomeworkICTOutdoor

learning

Parental involvement

Sports

Summer schools

After school

Individualised learning

Learning styles

ArtsPerformance

pay

Teaching assistants

Smaller classes

Ability grouping

Phonics

Source: Education Endowment Foundation