Transcript Follow the Value

Follow the Value
Martin McShane
Director for Long Term conditions
“Enhancing the quality of life for people
with long term conditions”
www.england.nhs.uk
17/07/2015
www.england.nhs.uk
5YFV:
There are new opportunities
New technologies and treatments
•Improving our ability to predict, diagnose and treat disease
•Keeping people alive longer
•But resulting in more people living with long term
conditions
New ways to deliver care
•Dissolving traditional boundaries in how care is delivered
•Improving the coordination of care around patients
•Improving outcomes and quality
…but the financial challenge remains, with the gap in 2020/21
previously projected at £30bn by NHS England, Monitor and
independent think-tanks
www.england.nhs.uk
The new ‘epidemic’?
Number of Conditions1
% self reporting
1
30%
2
13%
3+
10%
The 15 million people in England with long term
conditions have the greatest healthcare needs of the
population (50% of all GP appointments and 70% of all
bed days) and their treatment and care absorbs 70% of
NHS and social care budgets in England
www.england.nhs.uk
1. The percentage of people aged 18 and over self-reporting experiencing long-term conditions in the GP Patient Survey
Multimorbidity is very common
Percentage with more than one of 17 major chronic conditions, by age and sex
50
45
40
MALE
35
FEMALE
30
%25
20
15
10
5
Salisbury et al, BJGP, 2011
0
18-24
25-34
35-44
45-54
55-64
65-74
75-84
85+
Age-group
Overall:
16% of population have multimorbidity (based on 17 QOF diseases)
57% have multimorbidity (based on 115 ACG diseases)
Impact on health care system
Annual consultation rate by age and multimorbidity status
annual consultation rate
14
12
multimorbid
not multimorbid
10
8
6
Salisbury et al, BJGP 2011
4
2
0
18-24
25-34
35-44
45-54
55-64
65-74
75-84
85+
People with multimorbidity account for 16% of the population
but account for 33% of all consultations
Bridging the gap: Financial Context
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The number of bed days increases very strongly by age. This ranges from less than 1
million for all age bands under 40, to over 7 million for the age band 85+. Those age
75+ account for 46% of bed days.
www.england.nhs.uk
Financial and population ‘gearing’
www.england.nhs.uk
Primary
£200
(6.5k)
Community &
MH
£500
Specialist
£300
Acute
£1000
(330k)
Social Care
Public Health
17/07/
2015
1990
A
c
t
i
v
i
t
y
2015
CARE
GAP
GP
Specialist Specialist
Complexity
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Bridging the care gap…..
www.england.nhs.uk
17/07/2015
Enablers
• Linking data
• Tracking costs
• Demonstrating value (quality/cost)
• Directors of Finance….
www.england.nhs.uk
http://www.england.nhs.uk/resources/resources-forccgs/comm-for-value/
Commissioning for Value is about identifying priority
programmes which offer the best opportunities to
improve healthcare for populations; improving the value
that patients receive from their healthcare and improving the
value that populations receive from investment in their local
health system.
By providing the commissioning system with data, evidence,
tools and practical support around spend, outcomes and
quality, the Commissioning for Value programme can help
clinicians and commissioners transform the way care is
delivered for their patients and populations.
www.england.nhs.uk
17/07/2015
Paul Adams is a typical patient in a typical CCG.
Journey One
• At the age of 45, - Diagnosed diabetic.
• 6 visits to the practice nurse and 6 laboratory tests per
year.
• No self management support
• Age 50, develops vascular disease - .attends specialists
• Age 52, leg amputated plus renal, heart & visual
problems.
• This version of Paul’s patient journey costs £49,000
at 2014/15 prices…
www.england.nhs.uk
17/07/2015
Journey Two
• The NHS Health Check identifies Paul’s condition one year
earlier, at the age of 44 and case management begins…
• Paul is supported in self management & access advice on
smoking cessation, diet and exercise and he has this
refreshed every 2 years.
• Paul has a collaborative care plan and optimal medication
and retinopathy screening begins 18 months earlier
• Journey Two costs £9k and keeps Paul well
www.england.nhs.uk
17/07/2015
www.england.nhs.uk
17/07/2015
Primary
• Capitation
• ‘Locked’ information
Community
• Block contracts
• Poor/no information
Acute
www.england.nhs.uk
• Activity based
• Lots of information
5YFV:
Developing new care models
•We need to take decisive steps to transition towards
better care models
•There is wide consensus that new care models need
to:
 Manage systems (networks of care), not just
organisations
 Deliver more care out of hospital
 Integrate services around the patient
 Learn faster, from the best examples around the
world
 Evaluate success of new models to ensure value
for money
www.england.nhs.uk
17/07/
2015
Multispecialty Community Providers
What they are
• Greater scale and scope of
services that dissolve traditional
boundaries between primary and
secondary care
• Targeted services for registered
patients with complex ongoing
needs (e.g. the frail elderly or
those with chronic conditions)
• Expanded primary care leadership
and new ways of offering care
• Making the most of digital
technologies, new skills and roles
• Greater convenience for patients
www.england.nhs.uk
17/07/2015
How they could work
• Larger GP practices could bring in
a wider range of skills – including
hospital consultants, nurses and
therapists, employed or as
partners
• Shifting outpatient consultations
and ambulatory care out of
hospital
• Potential to own or run local
community hospitals
• Delegated capitated budgets –
including for health and social
care
• By addressing the barriers to
change, enabling access to
funding and maximising use of
technology
The Function of care models…
www.england.nhs.uk
17/07/2015
Goal
My
goals/outcomes
Communication
Person centred
coordinated care
Emergencies
“My care is planned with people who
work together to understand me and my
carer(s), put me in control, co-ordinate
and deliver services to achieve my best
outcomes”
Information
Transitions
Care planning
www.england.nhs.uk
Decision-making
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Whole system approach
LTC Framework:
•
•
•
•
Empowered patient and carers
Professional collaboration
Best Practice (clinical and organisational)
Commissioning
www.england.nhs.uk
The Future: 2015-2020
Social Care
ICare
Community
Care
www.england.nhs.uk
Primary
Care
General
Hospital
University/
Specialist
Facilities
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That’s the intellectual stuff…
…what about the passion?
www.england.nhs.uk
17/07/
2015
And let it be noted that there is no more delicate matter
to take in hand, nor more dangerous to conduct, nor
more doubtful in its success, that to set up as a leader in
the introduction of changes. For he who innovates will
have for his enemies all those who are well off under the
existing order of things, and only lukewarm supporters in
those who might be better off under the new. This
lukewarm temper arises partly from the fear of
adversaries who have the laws on their side, and partly
from the incredulity of mankind, who will never admit the
merit of anything new, until they have seen it proved by
the event.
Machiavelli – ‘The Prince’
www.england.nhs.uk
The soft stuff…is the hard stuff
Individual
behaviours
Mindsets
and beliefs
Values
Needs
(met or unmet)
SOURCE: Scott Keller and Colin Price, ‘Performance and Health: An evidence-based approach to transforming
your organisation’, 2010.
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