This webinar discussed the business case for self-management support. It outlined evidence that self-management programs can deliver savings to the NHS through reduced GP, nurse, outpatient, A&E and medication usage. A ROI model was presented that calculates potential savings for commissioners based on their population. Case studies showed programs achieving a £2.24 return for every £1 spent. Challenges like an aging population and rising long-term conditions were discussed. The webinar argued for an experienced provider and defined outcomes to make an evidence-based case for self-management.

1. WELCOME
Wednesday 7 January 2015
Webinar
Self-Management Support
Return on Investment

2. Self-Management Support
Return on Investment
Wednesday 7 January 2015
1pm – 1.45pm
Renata Drinkwater
CEO & Trustee Self-Management UK
&
Beverley Matthews
LTC Programme Lead, NHS Improving Quality

3. Bev Matthews
A nurse by background, Beverley has worked extensively throughout the NHS in a variety of
clinical, managerial and strategic roles. Beverley’s current role as Programme Delivery Lead
for Long Term Conditions Improvement Programmes: LTC Year of Care Commissioning
Model and LTC Framework. Prior to joining NHS Improving Quality in April 2013, Beverley
was Director of NHS Kidney Care and NHS Liver Care.
Passionate about service transformation through developing networks and leading complex
programmes. Providing strategic leadership to partners within health communities,
managing stakeholders and working across agencies.
Renata Drinkwater
Chief Executive of self management uk (formerly the Expert Patients Programme
Community Interest Company), a position that she has held since December 2010. Prior to
this, Renata was a Non Executive Director of the organisation from July 2008.
In common with over 70% of self management uk staff and volunteers, she lives with
several long-term health conditions herself, and therefore has both a personal and
professional interest in health sector issues, with a strong focus on the improvement of
outcomes for those living with long-term health conditions, for which she is a passionate
advocate.
Meet the Speakers

4. Self-Management Support Return on Investment
• Better understanding of return on investment for
self-management training and support.
• Impact on self-management on NHS resources.
• How to make a business case for self-management.
Learning Outcomes

5. Beverley Matthews
LTC Programme Lead
NHS Improving Quality
Beverley.matthews@nhsiq.nhs.uk

6. www.england.nhs.uk
LTC Framework
6
Organisational &
Clinical
Processes
Informed and
engaged patients
and carers
Health & Care
Professionals
committed to
partnership
working
Commissioning
• Information and
technology
• Case finding & risk
stratification
• Care Planning
• Safety and
Experience
• Guidelines,
evidence and
national audits
• Care Delivery
• Self Management
• Information and
Technology
• Group and Peer
Support
• Care Planning
• Policies for carers
• Voluntary sector
patient & carer
support
• HSC Integration
• Multi Disciplinary
Teams
• Culture
• Workforce
• Technology
• Care Co-
ordination
• Care Planning
• Needs
Assessment and
Planning
• Joint
Commissioning
• Metrics and
Evaluation
• Service User and
Public Involvement
• Contracting and
Procurement
• Care Planning
• Tools and Levers
The table below sets out some of the key components needed to deliver the central
aim for LTC Framework - Person Centred Coordinated Care

7. Bespoke Support

9. Tools and Resources

10. Links
Long Term Conditions Dashboard
http://ccgtools.england.nhs.uk/ltcdashboard/flash/atlas.html
Long Term Conditions House of Care Toolkit
www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/house-of-care.aspx
SIMUL8: Simulation Model
http://www.simul8.com/viewer/download.htm
#LTCyearofcare #LTCimprovement @NHSIQ

11. LTC Learning Forum
“Lunch & Learn” Webinar Series
&
Bite Size Master-classes

12. Virtual Learning Network
“Lunch & Learn”
• 45 minute “real time” Webinar
sessions
• Topics agreed and learning outcomes
identified
• Faculty of Speakers identified and
booked
Open invitation
Bite Size Learning Master-Classes
• Pre-recorded 20 minute Master-
classes
• Master-class either as stand alone
sessions or pre-requisites for “Lunch
& Learn” Webinars
• Faculty of Speakers identified and
booked
Open invitation

13. To register email LTC@nhsiq.nhs.uk
LTC Lunch & Learn Series
….coming soon…
Date Webinar Hosted by Bev Matthews &
21 January 2015 Commissioning for Outcomes Bob Ricketts CBE
Director of Commissioning Support
Services & Market Development,
NHS England
4 February 2015 The Organisation of Integrated
Care: encouraging collaboration
through contractual
mechanisms
Dr Rachael Addicott
Senior Research Fellow
The Kings Fund

14. The business case for self-management
NHSIQ webinar – 7th January 2015
Renata Drinkwater
Chief Executive

15. Agenda
 What is self management uk?
 What are the evidence based benefits of self-
management to patients?
 How does self-management deliver savings to the
NHS?
 Return on investment
 Making the business case for self-management
 Discussion

16. self management uk
 Formerly the Expert Patients Programme Community
Interest Company, now a registered Charity
 Over 12 years’ experience working within/for the NHS
 At the forefront of self-management education and training
 Facilitated delivery of programmes to 100,000+ patients with
long-term conditions
 Also programmes for clinicians/healthcare professionals
 Delivered face-to-face or online

17. Benefits of self-management to patients
 Increased self-confidence and reassurance
 Increased control over own health and wellbeing
 Better involvement in shared-decision making about own health
and wellbeing
 Reduced time off work
 Better symptom management, such as reduction in pain,
anxiety, depression and tiredness
 Improved physical symptoms and clinical outcomes in people
with arthritis, asthma, diabetes, hypertension, heart disease,
heart failure, stroke, cancer and other conditions

18. Benefits to clinicians, healthcare
professionals and the wider system
Percentage savings delivered by self-management
programmes [1]
GP visits 2.3% Inpatient visits 50%
Nurse visits 13.8%
Outpatients
visits
6.2%
A&E visits 12%
Medication
saved
5.4%
[1] Figures were extrapolated from The National Evaluation of the Pilot Phase of the Expert Patient Programme – Rogers et.al.
December 2006

19. ROI model for commissioners
 New self management uk tool developed for Commissioners to
demonstrate benefits
 Based on model originally co-developed with the Department of
Health, now significantly enhanced
 Shows financial benefits of delivering our programmes patients
(e.g. Self Management for Life/Expert Patients Programme)
 Uses Department of Health/Office for National Statistics figures
and evidence from other key studies
 Calculates impact for any Clinical Commissioning Group

20. Calculating the savings
[1] DH figures
Percentage savings
GP visits 2.3% Inpatient 50%
Nurse visits 13.8% Outpatients 6.2%
A&E visits 12% Medication 5.4%
Unit costs NHS services [1]
GP visits £52 Inpatient £2,195
Nurse visits £11 Outpatients £126
A&E visits £100

21. CCG Case Study - Typical system usage and
medication spend
Statistics for CCG Value
People with a Long-Term Condition 61,539
People Newly Diagnosed (Per year) 4,308
Total GP Visits 300,347
Total Nurse Visits 165,191
Total A&E visits 67,941
Total Emergency Admissions 17,015
Total Hospital Admissions 40,004
Total Outpatients Visits 203,576
Total Medication Spend £27,968,172

22. Typical return on investment
For every £1 spent: £2.24 is
saved!

23. Yes, £2.24 saving per £1.00 spent
Cost Benefit Default Costs
Total Cost of Programme £93,750
Total Practice and Commissioner Savings £210,073
Total Saving over Contract Length £116,323
Saving per Year £116,323
Return on Investment: For every £1 spent: £2.24 is saved
Typical Return on Investment

24. Reduced A&E admissions - Kingston
Study from Kingston CCG - 4 courses for 74 participants
Hospital attendance: 180 visits for the 12 months prior to
attending a course to 70 for the 12 months post attending a
course = 62% reduction

25. Making the business case for self-management
Key
Elements
Issues
Evidence
Provider
OutcomesChallenges
Potential
savings
Options

26. Key issues & policy
 House of Care
 Promoting independence & helping older and
vulnerable people with LTCs and their carers
better manage their own health
 Identifying people’s health and social care needs
at an early stage
 Delivering care in, or close to, home where
possible
 Developing actions that reduce urgent
interventions and improve value for money

27. Evidence-based approach
 There is strong evidence that the most effective way to
support self-management is through a range of
approaches that empower and activate people
 Action planning and goal setting, combined with regular
and proactive follow-up
 Strategies co-created by service users and care
professionals or co-led by service users
 Interventions that support care professionals in working
with service users to improve their motivation to
change
 Access to advice, information and support and self-
management programmes

28. Choose an experienced provider
self management uk – the ‘preferred provider’:
 From the evidence available, this is the only credible
provider - informed by web searches and the review
of available evidence of the impact of patient
education programmes
 A former NHS and now a not-for-profit organisation
 Strongly endorsed by the NHS
 A strong, prolonged and independently evidenced
track record of successful delivery of generic long-
term condition patients and care professional
education programmes within the NHS

29. Define your outcomes
 Reductions in crisis and associated unplanned
activity (primary outcome)
 Improved clinical outcomes
 Reduced demand on other health services
 Improved physical activity
 Better medicines adherence
 Continued impact over the long-term

30. What are your challenges?
Bromley CCG: the challenges are an ageing population and an
increase in long-term conditions
QOF Registers Prevalence Data 2012-13 Total % of population
Coronary Heart Disease 10,165 3.2%
Stroke or Transient Ischaemic Attacks 5,122 1.6%
Hypertension Register 46,028 14.4%
Diabetes Mellitus (Diabetes) (ages 17+) 13,681 4.3%
Chronic Obstructive Pulmonary Disease 4,371 1.4%
Mental Health 2,616 0.8%
Asthma 17,348 5.4%
Heart Failure 2,252 0.7%
Dementia 1,794 0.6%
Chronic Kidney Disease (ages 18+) 10,183 3.2%
Atrial Fibrillation 5,252 1.6%
Obesity (ages 16+) 25,585 8.0%
Smoking Indicators 74,111 23.2%
Cardiovascular Disease Primary Prevention 7,927 2.5%

31. Calculate your savings
 Cost of commissioning self-management interventions
 Potential savings gained from reduced use of NHS
resources
Include social value
 Self-management courses are delivered by local
volunteers, who have either first-hand experience of
living with a long-term condition or care for someone
who has
 They gain valuable transferable skills
 Local peer support network for people with long-term
conditions

32. Weigh your options
For example:
Option 1: Do nothing – this is not an option. There is strong evidence of
the value of supported self-management programmes
Option 2: commission Self-Management for Life Health and Social care
Professionals – designed to build upon existing skills to help ensure that
self-management is actively supported. This option alone does not fully
support patients and their carers; clinical support is necessary but is not
sufficient to change health behaviours
Options 3: commission self-management programmes for patients,
carers and healthcare professionals

33. Thank you
 Questions?

34. Renata Drinkwater
Chief Executive
T: 03333 445 840
M: 07500 039 736
renata.drinkwater@selfmanagementuk.org
hello@selfmanagmentuk.org

35. To register email LTC@nhsiq.nhs.uk
LTC Lunch & Learn Series
….coming soon…
Date Webinar Hosted by Bev Matthews &
21 January 2015 Commissioning for Outcomes Bob Ricketts CBE
Director of Commissioning Support
Services & Market Development,
NHS England
4 February 2015 The Organisation of Integrated
Care: encouraging collaboration
through contractual
mechanisms
Dr Rachael Addicott
Senior Research Fellow
The Kings Fund