Copyright 2011 Right Care

How do you innovate when the NHS budget is no longer growing?

Sir Muir GrayJoint National Director, Right Care

August 2013

Online Learning Series

Right Care for Populations

2

Five major problems.. ..all health services, world wide, still face 5 major problems

• failure to prevent preventable disease

• inequity• patient harm, even when quality is

high• waste of resources• unwarranted variation in:

- activity- quality, safety- outcome & cost = value

3

A Paradigm shift is needed…

4

The third healthcare revolution…

Citizens Knowledge Technology

…clinicians as “stewards”

5

Triple Value Programme

Individual & Personalised

Allocativeresources distributedto optimise value

Technical, resources used to best effect

6

Population Based Systems

Focus on value

Clinicians as Stewards

A New Culture

Patient Centred

7

Allocating resources - Commisioners

Cancer

Respiratory

Gastro-intestinal

MentalHealth

Programme Budgeting, & the use of Marginal Analysis for reallocation is a commissioner responsibility, with public involvement

8

Complexity and Complications

Cancers

Respiratory

Gastro-intestinal

MentalHealth

Many people have more than one problem ; GP’s are skilled in managing complexity

9

Triple DrugTherapy

Rehabilitation

Cancers

Respiratory

Gastro-instestinal

Apnoea

COPD (Chronic Obstructive Pulmonary Disease)

Asthma

O2

Smoking cessation

Allocating resources - Clinicians

Within Programme,Between SystemMarginal analysis is a clinician responsibility

10

The STAR Tool

http://www.health.org.uk/areas-of-work/star/

11

Triple DrugTherapy

Rehabilitation

Cancers

Respiratory

Gastro-instestinal

Apnoea

COPD (Chronic Obstructive Pulmonary Disease)

Asthma

O2

Smoking cessation

Innovation

12

Value = Outcomes / Costs

Outcome = Good – Bad Outcome = Effectiveness (EBM + Quality) – Harm (Safety)

Costs = Money + time + Carbon

Technical efficiency

13

The future

• Need and demand will always increase faster than resources

• More of the same is not the answer – we need innovations#

• Programme Budgeting• Within Programmes – Marginal Analysis• Clinicians and patients as “stewards” of the

resource• Innovation, not only in technology, but in the

way we think

14

Online Learning Series

Right Care for Populations

Follow Right Care online• Subscribe to get a weekly digest

of our blog alerts in your inbox, • Receive occasional eBulletins • Follow us on Twitter

@qipprightcare

Find the full series at:

www.rightcare.nhs.uk/resourcecentre