Transcript Marginal analysis: a worked example from the mental

Online Learning Series
Right Care for Populations
How do you innovate when the NHS budget is no
longer growing?
Sir Muir Gray
Joint National Director, Right Care
August 2013
Copyright 2011 Right Care
Five major problems..
..all health services, world wide, still face 5 major
problems
• failure to prevent preventable
disease
• inequity
• patient harm, even when quality is
high
• waste of resources
• unwarranted variation in:
- activity
- quality, safety
- outcome & cost = value
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A Paradigm shift is needed…
3
The third healthcare revolution…
Citizens
Knowledge
Technology
…clinicians as “stewards”
4
Triple Value Programme
Individual &
Personalised
Allocative
resources distributed
to optimise value
5
Technical,
resources used to
best effect
A New Culture
Focus on value
Population
Based
Systems
Patient
Centred
Clinicians as
Stewards
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Allocating resources - Commisioners
Mental
Health
Cancer
Programme Budgeting,
& the use of Marginal
Analysis for reallocation
is a commissioner
responsibility, with public
involvement
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Respiratory
Gastrointestinal
Complexity and Complications
Mental
Health
Cancers
Respiratory
Gastrointestinal
Many people have more than
one problem ; GP’s are
skilled in managing
complexity
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Allocating resources - Clinicians
Asthma
Cancers
COPD
(Chronic
Obstructive Apnoea
Pulmonary
Disease)
Respiratory
Gastroinstestinal
Within Programme,
Between System
Marginal analysis is a clinician
responsibility
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Triple Drug
Smoking
Therapy
cessation
O2
Rehabilitation
The STAR Tool
http://www.health.org.uk/areas-of-work/star/
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Innovation
Asthma
Cancers
COPD
(Chronic
Obstructive Apnoea
Pulmonary
Disease)
Respiratory
Gastroinstestinal
Triple Drug
Smoking
Therapy
cessation
O2
Rehabilitation
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Technical efficiency
Value = Outcomes / Costs
Outcome = Good – Bad
Outcome = Effectiveness (EBM + Quality) –
Harm (Safety)
Costs = Money + time + Carbon
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The future
• Need and demand will always increase faster
than resources
• More of the same is not the answer – we need
innovations#
• Programme Budgeting
• Within Programmes – Marginal Analysis
• Clinicians and patients as “stewards” of the
resource
• Innovation, not only in technology, but in the
way we think
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Online Learning Series
Right Care for Populations
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www.rightcare.nhs.uk/resourcecentre
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