QIPP Right Care - Blog

the Right Care blog has moved…

rightcare — Wed, 28 Sep 2011 11:48:12 +0000

We now have a shiny new website at www.rightcare.nhs.uk – check it out. We have moved our WordPress blog onto that new sight and will no longer be posting here.

If you have subscibed to this blog we have moved your subscription – you may get a WordPress system email about that – and should continue to receive email digests. Please contact me if there are any problems: ian.mckinnell@btopenworld.com. You can also follow us on Twitter #qipprightcare.

Ian

Right Care Casebooks – Sharing Commissioning Experiences

rightcare — Tue, 13 Sep 2011 20:36:36 +0000

Right Care will enable sharing of good practice – one of the ways we will facilitate this is by compiling local examples of commissioning work which demonstrates the philosophy behind Right Care or showcases the tools available through the programme. We will publish these though a series of “Casebooks”.

Casebooks will vary in style and structure but they will all work on the principle of ‘caveat lector’, in order to encourage routine sharing of work there is no formal peer review which means that readers should use their own judgment when interpreting and applying work to their own situation, but we will always include contact details to allow readers to follow-up details with the originating authors.

Casebooks will be sourced from various contributors. The first of our collection is the result of collaboration with the Public Health Commissioning Network and we plan further Casebooks with other collaborators.

Read this if you read nothing else…

rightcare — Tue, 13 Sep 2011 13:08:42 +0000

To promote the themes underlying Right Care we are producing a series of Essential Reading lists – I would call them “bucket lists” but I’ve been shouted down on that term.

The Reading lists are based on a systematic search of the academic literature on specific themes – the sources searched and the methodology of the search is included in the reading list – and then we select the top 10-20 key articles to read, and a summary paragraph of the key finding/recommendation.

The first two lists are on the themes of the “Accountable Care Organisation” and on “Variation in Healthcare”. We plan future lists on “Shared Decision Making” and on “Programme Budgeting”.

‘rationing by stealth’ … or more appropriate care?

rightcare — Sun, 11 Sep 2011 16:38:12 +0000

This article appeared in the Telegraph and the same story was covered in the Guardian.

“Rationing by stealth” is hitting the NHS, the Royal College of Surgeons (RCS) has claimed, after official figures were released showing a steep fall in the number of people referred to hospital by GPs. Department of Health statistics show the number of referrals made by GPs in the year up to July was 4.7 per cent lower than for the same period in 2010. These referrals had shown a 3.5 per cent increase at the same stage last year, according to the department. Professor Norman Williams, president of the RCS, described the figures as “extremely disturbing”.He said: “These data provide further evidence that rationing by stealth is occurring across the NHS.”

However, a Department of Health spokesman said the figures demonstrated that people were being treated in “the most appropriate setting”. He said: “The Government has protected NHS spending and will continue to deliver improvements in care. “These figures suggest that the NHS is starting to treat more people in the most appropriate setting, with a movement of care away from hospital settings and towards care closer to home – preventing unnecessary admissions.”

Dr Clare Gerada, chair of the Royal College of General Practitioners, said the decrease in the number of referrals could be down to “a combination of any number of things”. She added: “There has, however, been an immense amount of work carried out in recent years to reduce the number of referrals and offer a more preventative style of healthcare, and these figures could be reflecting the fruits of this work.”

The Right Care programme is engaging with surgical specialist societies and SHA commissioning leads to establish a knowledge base which examines the 10 key commissioning questons that need to be answered and understood to make appropriate, personalised care decisions for a range of elective surgical interventions. The objective is to provide clinical engagement and inform policies on funding elective procedures. Read Sir Muir’s paper on “How to get better value by doing the right things“.

The ACO – an experiment in improving patient health care

rightcare — Thu, 08 Sep 2011 18:50:34 +0000

From the San Fransisco Chronicle…”Researchers long ago established that certain medical procedures are performed at dramatically different rates from place to place, and that these disparities affect the quality and cost of health care.

Now, health insurers, hospitals and government agencies from the Bay Area to Washington, D.C., are getting more aggressive about tackling variation in medical care.

The partnership is modeled after a similar one in the Sacramento region whose early efforts to rein in variation resulted in training doctors in newer medical techniques and offering patients less-invasive treatment options.

In the case of weight-loss surgeries, procedures fell in one year by 13 percent.”

Competition between systems for pride is effective and essential

rightcare — Wed, 07 Sep 2011 16:55:45 +0000

Sir Muir Gray blogging on the BMJ site:

“Competition, like all medical care, can do harm as well as good. Competition between “providers” on hospital criteria such as compliance with standards, appears to do more good than harm, though quality improvement too can have unintended consequences. What is needed are population based systems competing on value, on outcome, and cost. The issue of cost cannot be avoided because if resources are used and produce low, or no, value it is not the tax payer who pays but those other patients whose needs could have been met with that wasted resource, and there is evidence that this type of competition works…

Ambulance data reveals variation in survival rates

rightcare — Sun, 04 Sep 2011 19:24:54 +0000

Treatment times and survival rates for heart attacks, cardiac arrest and stroke victims vary by region, according to new figures ( Ambulance Clinical Outcomes 2011-12 April 2011 ) outlining the performance of ambulance trusts.

The statistics reveal that the survival rate for patients resuscitated by ambulance staff after an unwitnessed cardiac arrest varied from 0% for those treated by the Isle of Wight Healthcare NHS Trust to 12% of patients attended to by North West Ambulance Service NHS Trust. The national average rate was 6%.

The data showed that nationally, 90.8% of heart attack patients eligible for primary angioplasty received the treatment within 150 minutes. For patients treated by North West Ambulance Service NHS Trust the same timeframe was achieved in 82.3% of cases, compared with Great Western Ambulance Service NHS Trust which achieved 97.6%.

Nationally, 66.2% of suspected stroke patients who were assessed face-to-face arrived at a hyperacute stroke centre within 60 minutes. Regionally, that figure varied from 0% in the Isle of Wight to 90.9% for patients treated by the North East Ambulance Service NHS Trust.

The proportion of suspected stroke patients assessed face-to-face who received an appropriate care bundle varied from 84% to 100%, with a national average of 91.3%.

The health secretary, Andrew Lansley, said: “Transparency is at the heart of our plans to modernise the NHS. We know that it can be a powerful tool to help improve services, foster innovation and empower patients and clinicians.

“The data published for the first time today shows that there is variation in the results for patients across the country.

By making this information available we are giving the NHS the tools to identify areas where they can improve and take action. Patients should be able to expect a 24/7 accessible and safe emergency care service. I expect all ambulance trusts, commissioners and the wider NHS to look at the data for their region and work towards reaching the levels of the best.”

Guardian Society 02/09/2011

Document of the Week (Aug 29th): Commissioning with the Community

rightcare — Tue, 30 Aug 2011 15:24:47 +0000

Deciding where to allocate resources is a critical process for the NHS. This document entitled Improvement in Practice: Commissioning with the Community (London School of Economics and Health Foundation, Jan 2010) demonstrates how the Isle of Wight used a value for money approach to set local priorities. This briefing describes an approach that critically incorporates engagement with a wide range of stakeholders, and couples this with technical value for money analysis.

This allows commissioners to take account of different factors when deciding which areas of healthcare to focus on, and provides evidence to determine where resources can most effectively be invested. For example, successes at one PCT include a 50% reduction in emergency admissions for asthma thanks to support for an innovative new service design.

Geographical variation in the extent to which patients feel they have benefited from their surgery

rightcare — Thu, 25 Aug 2011 13:22:55 +0000

The NHS Information Centre have published a series of maps based on the results of questionnaires completed by patients before and after they undergo surgery, which show geographical variation in the extent to which patients feel they have benefited from their care. It seems that patients’ treatment varies from procedure to procedure as well as from place to place. These maps are taken from the report Patient Reported Outcome Measures (PROMS) in England 2009/2010. The report concentrates on: hip replacements, knee replacements, groin hernia surgery and surgery on varicose veins.

Findings: 87.2% of hip replacement respondents recorded an increase in their general health following their operation, based on a combination of five key criteria concerning their general health (EQ-5D Index score), compared to 77.6% of knee replacement respondents, 52.4% for varicose veins and 49.3% for groin hernias.

See:

NHS Information Authority Press release
PROMS 2009/10 report

An App a day

rightcare — Thu, 25 Aug 2011 12:58:52 +0000

Health secretary Andrew Lansley has launched a call for new ideas for health apps that will help patients make informed decisions about their care. Patients, health professionals and app developers are invited to submit new ideas of health apps and online maps they think would be useful. The best apps will be chosen by a panel of judges and showcased at an event in autumn.

For the next six weeks, people can visit maps and apps and suggest favourite apps, ideas for apps or health maps they would like to see, as well as vote for their favourite ideas submitted by others.