Plenary - Professor Sir Mike Richards - Delivering improved outcomes for respiratory diseases Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013, Guoman Tower Hotel, London How to deliver quality and value in chronic care:sharing the learning from the respiratory programme

1. Delivering improved outcomes
for
respiratory diseases
Professor Sir Mike Richards
February 2013
Delivering improved outcomes: Overview The ‘new’ NHS: Context
• Multiple new organisations (but provider
• The ‘new’ NHS. organisations largely unchanged).
• Challenges for respiratory diseases. • New approach to commissioning.
• How can we make the new system work for • New Secretary of State, with new priorities.
respiratory diseases?
• Francis report: Emphasis on cultural change,
transparency and openness.
The new NHS: Multiple new organisations New approach to commissioning
• The Mandate: This sets out the Secretary of State’s
expectations from the NHS.
• The NHS Outcomes Framework: Arranged around 5 ‘domains’
DH LAs with 60 indicators.
NHS CB HWBs • Everyone counts: Planning for patients 2013/14 (NHS CB
guidance to commissioners).
PHE NHS IQ
• Commissioners
CCGs SCNs • NHS CB - Primary care
CSUs AHSNs - Specialist commissioning
• CCGs – The rest (e.g. DGH services)
• Expectation of continuous improvement against indicators, but
with no specific ‘targets’.
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2. The NHS Outcomes Framework The NHS Outcomes Framework made simple
Question: how many people here today are If you were seriously unwell, what would you be
likely to want?
confident that they can name the five
domains of the NHS Outcomes Framework? • To have your life saved
• To have a good quality of life thereafter
• To recover quickly
• To have a good experience of care from the NHS
• To be treated safely
Progress and challenges for respiratory diseases Progress on respiratory diseases
• Leadership
• National Clinical Directors
• We need to recognise and build on the excellent
• DH policy team
work that has been done in recent years
• Key stakeholder organisations
• We then need to consider how we can make the new • NHS Improvement – lung programme
system work best to improve outcomes for people • Primary Care Commissioning
with respiratory diseases
• Regional and local networks
• Toolkit and publications
Eg: Home Oxygen Service contracts – leading to improved service
and substantial cost saving to the NHS (£25m pa)
Challenges: Mortality (Domain 1) Challenges: Mortality (Domain 1)
• Late diagnosis/non-diagnosis
• 2.1m people are living with undiagnosed COPD – an estimated 70% of
• Respiratory diseases are one of the “five big killers” in England all COPD
• COPD accounts for 23,000 deaths pa • 10% of acute admissions for COPD are in people without a prior
diagnosis
• If the whole NHS performed to the level of the top quartile,
• Wrong diagnosis
7,800 lives would be saved each year in COPD alone
• Over 25% of people with a label of COPD have been wrongly
• Premature mortality from pneumonia in people under 75 diagnosed
varies by almost tenfold between PCTs (2.6 to 22.3 per
100,000 between 2007 and 2010) So we need to ensure there is a focus on earlier and
accurate diagnosis, with commissioning of evidence-
based interventions that reduce mortality such as oxygen
and pulmonary rehabilitation
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3. Challenges: Quality of life (Domain 2) Challenges: Recovery (Domain 3)
• How well do we measure QoL in patients with respiratory diseases (or other
long term conditions)?
• Fewer than half of people admitted with COPD are
• How well do we support patients with COPD (e.g. Pulmonary rehabilitation) managed by a respiratory specialist
• We do know that the risk of being admitted as an emergency with COPD • One in 12 people admitted with COPD die during
varies fivefold across England
• We also know that many people with COPD have multiple co-morbididities,
their stay
requiring integrated care • One in three are readmitted within 3 months
• A significant proportion of people with COPD have anxiety and/or depression
So we need to ensure there is a focus on more generic approaches to So we need to ensure we look at how we can drive
management of people with multi-morbidities using templates and the system using levers such as CQUINS
pro-active management
Challenges: Patient experience (Domain 4)
Challenges: Patient safety (Domain 5)
• Until now we have not routinely measured patient • 30% of people with COPD receive high-flow oxygen in
reported experience of care measures (PREMs), but emergency situations without assessment, with risk
this will be done in the forthcoming COPD audit of respiratory failure
So we need to make sure we use COPD audit to So we need to look at making oxygen toxicity a never
measure patient experience event
How can the new system continue to How can the new system continue to
deliver better outcomes? (1) deliver better outcomes? (2)
• Leadership: 5 Domain Directors • Measurement and publication
New National Clinical Director • National Clinical Audits.
• Publication of comparative information on quality/outcomes at
• NHS Improving Quality: Programme will be arranged around LA, CCG, hospital service and general practice levels.
themes (e.g. early diagnosis; integrated care; rehabilitation) – • Publication of expected versus reported prevalence ratios
these themes are central to improving outcomes for people • Commissioning
with respiratory disease • Using NICE Quality Standards and guidelines
• Incentives
• Strategic Clinical Networks: Although there are no dedicated • QOF (e.g. Asthma 2012/13 and COPD x 2 2013(14)
SCNs for respiratory disease, we need to look for alliances • CQUINS (e.g. pneumonia care?)
(e.g. with cancer and CVD) • Tariffs (e.g. year of care?)
• Quality Premium (emergency admissions)
• Training and competencies
• e.g. diagnostics, inhaler technique
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4. Summary
• Thank you for all that you have done to improve
outcomes over the past few years
• The challenges remain huge
• We have many of the building blocks in place – now
need to utilise these tools for COPD and asthma and
look at other areas such as pneumonia
• We must seize the new opportunities to deliver
better outcomes
NHS Blackpool
Knowsley Community COPD Service Isle of Wight NHS Trust & Isle of Wight CCG
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5. Breathe On UK NHS South (South East Coast)
Knowsley Community COPD Service
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