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Better value in the NHS - innovate stage, 3.30pm, 2 september 2015


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Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.

Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.

This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.

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Better value in the NHS - innovate stage, 3.30pm, 2 september 2015

  1. 1. Better value in the NHS: Lessons from the past and opportunities for the future Prof John Appleby Chief Economist The King’s Fund
  2. 2. • Generic prescribing • Lengths of stay • Day case surgery
  3. 3. Percentage of primary care prescribed items by generic/proprietary prescribing and dispensing: England, 1976/7 to 2013/14.
  4. 4. Estimated saving in 2013 total net ingredient cost due to increases in generic prescribing and dispensing between 1976 and 2013 £7.1bn Saving by 2013/14 of increased generic prescribing since 1976
  5. 5. Variation in generic prescribing by GP practice: England 2013/14
  6. 6. Trends in acute medical and surgical patient lengths of stay: English NHS: 1974-2014 11% (Extra beds that wouldhave been needed in 2013 if no reductionin LOS since 1998) 61% (Increase inbed throughput 1998-2013)
  7. 7. International comparisons of average length of stay (all types of patient): OECD countries
  8. 8. +1.3 m Proportion of all patient activity carries out as day cases: England 1974-2014 Rollout of PbR
  9. 9. Two key lessons from the past 1. The drivers of change are multiple and overlapping Common drivers: › Health technology developments › Clinical/managerial culture › Patient pathway design › Data and information › Frontline support to enable change › Financial incentives › Financial pressures/support 2. Improvement takes time and occurs through a series of small steps rather than giant leaps forward
  10. 10. Opportunities for the future
  11. 11. Variations in clinical practice By PCT/CCG*: • Diagnosis of coronary heart disease ranges from 52 to 89% • Diagnostic tests:1000-fold difference in rate GPs order blood glucose tests • Prescribing practice: 25-fold difference number of anti-dementia drug prescriptions • Management of chronic disease: patients with COPD who had review in past 15 months ranges from 77 to 87% • Rates of clinical procedures: rate of elective tonsillectomy in children ranges from 145 to 424 per 100,000 <17 years • Length of stay in hospital: 11-folddifferencein elective breast surgery LoS • Health outcomes: mortality rate from pneumonia in 75+ ranges from 4 to 11 per 100,000 population
  12. 12. Overuse • Monitor estimated £0.2 – £0.6 a year potential saving from by stopping low-value elective procedures like knee washouts and tonsillectomies. Overtreatmentin hospitals • NICE estimate that following their prescribing policy for antibiotics for respiratory tract infections would reduce prescribing by £3.7m Overprescribing • Eliminating inappropriate pathology testing could save the NHS £1 billion a year Overdiagnosisand use of diagnostic tests
  13. 13. Underuse •In 2012/13 only 60 per cent of people with diabetes received all eight recommended care processes Underuseof effective interventions •1 in 8 people over 35 has COPD butremains undiagnosedUnderdiagnosis •Between a third and half of drugs prescribed for long-term conditions are not taken as recommended Medicines not taken properly
  14. 14. Misuse (preventable harm) • Additional days in hospital as a result of adverse events are estimated to cost the NHS in England and Wales £1 billion each year • Direct cost of falls in hospital estimated to be £15 million in 2007 Adverse events in hospital • Estimate based on 10 GP practices found error rate of around 7% Adverse events outside hospital
  15. 15. Care of long-term conditions Opportunities for: • Earlier detection and diagnosis • Involving patients in decision about their care • Supporting patients to manage their own health • Care co-ordination • Integrated approaches to mental and physical health needs
  16. 16. Care of older people living with frailty and complex needs Opportunities for: • Avoiding preventable and inappropriate hospital admissions • Improving the patient flow within hospitals • Better discharge and reablement
  17. 17. End of life care Opportunities for: • Reducing time in hospital at the end of life • Better care co-ordination • Training generalist staff in end- of-life care
  18. 18. Agenda for action
  19. 19. Frame the productivity debate around quality and outcomes
  20. 20. Hugh Alderwick Ruth Robertson Phoebe Dunn David Maguire More information:
  21. 21. @jappleby123