Presented by Julian Denney,Assistant Chief Executive

NHSI strategy : Driving innovation by example

Presentation Overview

NHSI Overview

Current Information based products - BCBV

Strategy Going Forward

Our mission

The NHS Institute for Innovation and Improvement supports the NHS to transform healthcare for patients and the public by rapidly developing and spreading new ways of working, new technology

and world class leadership.

The Case for Improvement

• The NHS is improving;Improved mortality from CHD and CancerFaster access to A&E, GP, Outpatients and SurgeryImproved patient satisfaction

• It bears comparison with most other health care systems;

• But it needs to improve a lot more becauseThere is wide variation in clinical practiceEvidence that care is not as safe as it could beCosts of care are rising in a manner which is unsustainablePatient experience is still not satisfactory

LearningLearning LeadershipDevelopmentLeadership

Development

Product and technological

Innovation(NIC)

Product and technological

Innovation(NIC)

Service Improvement

Service Improvement

Priority programmes

that help drive the NHS reform

agenda

Priority programmes

that help drive the NHS reform

agenda

The NHS Institute: Scope

Our priorities

• Safer Care

• Delivering Quality and Value

• Care Outside Hospital

• No Delays

• Building Capability for a self improving NHS

– Learning

– Leadership

– Service Transformation

• Exploiting Innovation - National Innovation Centre

(NIC)

Presentation Overview

NHSI Overview

Current Information based products - BCBV

Strategy Going Forward

The challenge facing the NHS is improving clinical and service quality while controlling costs……..

NHS providers and commissioners operate in an environment where :

•Frontline clinical services use 80% of NHS resources

•Productivity & efficiency varies widely

•A focus on access related targets has meant less concern about delivering VFM

•Achieving financial balance is a challenge

•A Payment by Results system that is beginning to highlight where costs exceed income

•There is relatively poor benchmark information to help inform decision making

Clear benchmarks to guide performance analysis, comparison and best practice

Sustainable solutions to improve performance of core clinical processes

To help the NHS meet this challenge :

Patients who were admitted to hospital 3 times or more during the year

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Primary Care Trusts

% T

otal

- H

ospi

tal C

osts NHS Better Care,

Better Value Indicators

High Volume Care

The NHS Better Care, Better Value Indicators help the NHS know where to look…….

Clear high level performance comparison

Opportunity scaling

…and what to focus on by using the Indicator Explorer…..

Breakdown by specialty

NHS Indicators – Clinical

• Reduced variation in length of stay ( bed days saved)

• Day case rate for Audit Commission basket for 25 procedures• Reduction in wasted bed days as a result of admission prior to operation

• Admission rates for selected procedures where thresholds for surgery vary

• Reduction of avoidable emergency admissions against 19 recognised diagnoses

• Referral rate standardised - first Outpatient appointment

• Proportion of statin prescriptions that are low cost

AHT

AHT

AHT

PCT

PCT

PCT

PCT

Reduce wasted bed days

Percentage of patients admitted on the day of operationHip Replacement

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Acute Hospital Trusts

Procedure thresholds

Control chart for Standardised Admissions Ratios - Tonsillectomy

0

50

100

150

200

250

0 100 200 300 400 500

Expected number of cases

Sta

ndar

dise

d A

dmis

sion

Rat

ios

95% confidence limits

Productivity Opportunity Indicator Changes between Q1 06/07 and Q1 07/08

£0

£500

£1,000

£1,500

£2,000

£2,500

2006-Q1 2006-Q2 2006-Q3 2006-Q4 2007-Q1

To

tal P

rod

uct

ivit

y O

pp

ort

un

ity

(£m

)

£0

£200

£400

£600

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£1,000

£1,200

Ind

ivid

ual

Ind

icat

or

Pro

du

ctiv

ity

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po

rtu

nit

y (£

m)

Total Productivity Opportunity Length of Stay Day Case rate Pre-Op Beddays

Surgical variation Emergency Admissions Outpatients Statins

Low cost statin Indicator Changes between Q1 06/07 and Q1 07/08

£0

£10

£20

£30

£40

£50

£60

£70

£80

£90

2006-Q1 2006-Q2 2006-Q3 2006-Q4 2007-Q1

Pro

du

ctiv

ity

Op

po

rtu

nit

y (£

m)

64%

66%

68%

70%

72%

74%

76%

78%

Up

per

Qu

arti

le R

ate

Productivity opportunity of low cost prescribing Upper quartile rate of low cost statin prescribing

Low cost statin Indicator Changes by SHA between Q1 06/07 and Q1 07/08

Better Care, Better Value Indicators

Feedback

87% PCT and Trust Board /clinical Directors awareness

The “productivity opportunity” illustrated by the indicators, was seen as a key element in raising

interest and incentivising organisations.

PCTs had a lower level of knowledge about the BCBVIs. It was suggested that in PCTs, BCBVIs and other data

could be promoted as a lever for change through commissioning.

Indicators AHT PCT Q1 Q2 Q3 Q4

Existing indictors – modifications etc

FCEs per consultant (publish) √ X

pre op length of stay (add trust drill to specialty and emergency /elective split) √ X

outpatient referral rates (add drill down to specialty) √ X

day case rate (expand to larger basket) √ X

surgical rates (add drill down to HRG) √ X

emergency admissions (add drill down to HRG) √ X

New indictors

new to follow up outpatient ratio ( by speciality) √ X

Outpatient DNA rates ( by speciality) √ X

elective readmission rates (up to 14 days) √ X

non elective readmission rates (up to 14 days) √ X

generic prescribing savings √ X

basket of specific prescribing savings (inc. statins, proton pump inhibitors, ACE inhibitors and antiplatelet prescribing) √ X

Mental health admissions/bed days √ X

Staff stability √ √ X

T I

M E

T A

B L

E

Presentation Overview

NHSI Overview

Current Information based products - BCBV

Strategy Going Forward

Our Strategy:Information Tools and Services

“Some is not a number, soon is not a time” (Institute for healthcare improvement: Don Berwick)

•We see good quality information as absolutely critical part of improvement – we have done so since the NHSI Institute was founded and will continue to do so in the future. Therefore, where appropriate our products will have an information component.•However – we are an improvement and innovation organisation – not an information organisation . Our information strategy is derived from improvement and innovation imperatives rather than the other way round

Our Strategy:NHS Partners

•DH are our sponsors , so our approach to information strategy is developed with them •We’re at the early stages of building a partnership with the NHS Information Centre. We see our role as complementary: we provide tools and techniques to interpret information produced by the NHSIC to support innovation and improvement in the NHS.•We have a partnership with Connecting for Health , with a senior manager seconded to them

Our Strategy:Private Sector Role

•We are a commissioning organisation and will continue to be one

•We value the pace, responsiveness and good market understanding that the private sector can bring

•The private sector have given us expertise , innovation and customer impact

•We would like to see a more plural market so that we get a wider range of credible tenders for our work in future