Professor Nick Harding explains how NHS RightCare can support commissioners to reduce variation, spread innovation, and deliver more effective patient care
Every local health system in England has the support of an NHS RightCare team that provides delivery assistance on the ground. Using robust data collected nationally, this collaborative working arrangement helps promote improvements in both spending and patient outcomes within systems. Delivery plans are completed on a continuous basis, to evaluate the system and establish a base plan to maximise opportunities and address turnaround issues. Throughout this process, we ensure patient care is at the top of the agenda by promoting the strong clinical interventions developed with the Senior Clinical Advisors and key stakeholders. NHS RightCare Delivery Partners and their teams will highlight good practice to accelerate delivery, standardise reporting, and embed practices to ensure that systems use optimal care pathways.
Clinical leadership and engagement is integral to NHS RightCare, and is provided by national clinical leads and other clinical experts with a focus on building consensus in a collaborative way. Senior clinicians are at the core of all product development, seeking out and adopting the best approach to care across the population.
NHS RightCare works closely with the Elective Care Transformation Programme and the Getting It Right First Time (GIRFT) Programme to provide full-system patient care to ensure the best possible outcomes for patients, and secure the most efficient use of resources, to create a sustainable NHS. Each programme is clinically led; together, they help identify opportunities to reduce unwarranted variation, aiming to remove barriers to care across all local health systems in England.
Clinical leadership and engagement is integral to NHS RightCare …
The NHS Long Term Plan was published in January 2019 and sets out a 10-year vision for a sustainable and efficient NHS.1 It is expected that the impact of this strategic direction will be felt now, and for years to come. The plan makes explicit reference to NHS RightCare across a broad range of topics. It also refers to other areas that NHS RightCare will be integral to delivering, including quality improvement, reduction in variation, and enhanced use of data to inform priorities.
NHS RightCare’s offer starts with a review of indicative data to identify opportunities to reduce unwarranted variation and improve population health. The NHS RightCare delivery methodology is based around three simple principles of working with local systems to:
- diagnose the issues and identify the opportunities with data, evidence, and intelligence
- develop solutions, guidance, and innovation
- deliver improvements for patients, populations, and systems.
Working with NHS RightCare Delivery Partners, systems use NHS RightCare data and toolkits to develop a roadmap from the current to the future state to make improvements in patient outcomes and spending. The range of support will depend on system need, and may include helping systems with leadership, engagement, and delivering the roadmap from the current to the future state.
NHS RightCare data packs are produced at the system and CCG levels. The packs are available on the NHS RightCare website, and are also brought to the attention of systems directly via Delivery Partners.
Because most health conditions are linked to demographic factors such as deprivation and age, NHS RightCare compares systems to their closest demographically similar geographies. This is to provide realistic comparisons, taking into account the healthcare needs of different populations. Deprived populations will have much higher rates of admissions and poorer health outcomes for conditions such as respiratory disease, cardiovascular disease (CVD), cancer, diabetes, etc. By comparing 10 demographically similar CCGs, NHS RightCare ensures that comparisons are fair and meaningful.
NHS RightCare data demonstrates variation and the impact of that variation on patient outcomes and unnecessary admissions. It helps data users make a positive impact on efficiency, patient outcomes, and demand/operational pressure. This has led to the ‘Similar 10 CCG Explorer’ tool, which allows users to investigate all the different demographic variables that comprise the Similar 10 calculations and see how similar their CCG is to the Similar 10 CCGs on each of these factors. The tool also allows users to create their own bespoke Similar 10 grouping by changing the weightings of any of the different variables.
The Long Term Plan for the NHS … makes explicit reference to NHS RightCare across a broad range of topics.
NHS RightCare also provides sustainability and transformation partnerships opportunity data by presenting the sum of all the equivalent opportunities of the CCGs in that area in one pack. They do not include negative opportunities or those that are statistically insignificant. Primary care network level packs are also in development.
Toolkits and scenarios
NHS RightCare toolkits and scenarios are designed from a patient point of view, starting with prevalence right through to end of life. They are developed in close collaboration with NHS England’s National Clinical Directors, patient groups, Public Health England, medical Royal Colleges, and other key stakeholders.
The data and evidence provide a set of resources to support systems to concentrate their improvement efforts where there is greatest opportunity to address variation and improve population health. NHS RightCare products are available on the website2 and can be accessed via healthcare condition area, making it easier for systems to access the resources.
NHS RightCare national priority initiatives
NHS RightCare has national clinical support to deliver two national priority initiatives on CVD prevention and respiratory disease in 2019/20. CVD and respiratory disease are both national clinical priorities, reflected in the NHS Long Term Plan,1 and there are clear opportunities to improve health outcomes for people across the country and deliver efficiencies.
These initiatives have been developed in collaboration with NHS England’s National Clinical Directors, various arm’s-length bodies, and national programmes to develop a clinically led approach for identifying high-impact interventions for improving patient outcomes. These partners include Public Health England, NICE, NHS Improvement, GIRFT, and charities, including the British Heart Foundation and British Lung Foundation.
The impact of delivering both initiatives will be improved patient outcomes, reduced heart attacks and strokes, reduced exacerbations of respiratory disease, fewer admissions to hospital, and financial benefits to health systems.
NHS RightCare Delivery Partners and their teams will be supporting local health systems to implement these initiatives.
NHS RightCare’s high intensity user programme
The High Intensity User (HIU) programme is a core offer to systems via NHS RightCare. Every area of the country faces a rapidly growing challenge of individuals presenting frequently to medical services with needs that are not met by clinical intervention—high intensity service users. NHS RightCare’s HIU programme helps some of the most vulnerable people in our society to flourish while saving NHS resources through reductions in accident and emergency attendances, 999 calls, and non-elective admissions.
Over 80 sites have launched the HIU programme across England, and we are working with all local health systems to implement this service, delivering the requirements of the NHS Operational Planning and Contracting Guidance 19/203 and supporting demand management in urgent and emergency care.
NHS RightCare’s HIU programme was awarded the 2018 Kate Granger Awards for Compassionate Care4 and a Healthcare Transformation Award for Innovation in Improving Outcomes and Reducing Variation in 2019.
The HIU programme is one of a number of innovations that NHS RightCare is working to scale up and spread across the country to improve patient outcomes, drive efficiency, and reduce spend. NHS RightCare is uniquely placed to drive innovation in the NHS by sharing best practice and spreading opportunities for improvement across England.
NHS RightCare has a set of resources and evidence regarding what works, what doesn’t, and what’s replicable to share with systems and to scale up across the country. Commissioners should work with their NHS RightCare Delivery Partners and their teams to use this set of resources to make improvements for their population.
For more information about NHS RightCare and to find out who your NHS RightCare Delivery Partner is, visit www.england.nhs.uk/rightcare.
Case study: NHS RightCare toolkit for physical ill health and cardiovascular disease prevention for people with severe mental illness
The life expectancy for people with severe mental illness (SMI) is 15–20 years lower than the general population, and excess premature mortality rates are more than three times higher amongst people with mental illness in England compared with the general population.
Published in March 2019, the NHS RightCare toolkit for physical ill health and cardiovascular disease (CVD) prevention in people with SMI defines the core components of an optimal service for people with SMI who are at risk of developing CVD.
Developed in collaboration with NHS England’s National Clinical Director for CVD Prevention, the British Heart Foundation, MIND, Rethink Mental Illness, University College London, and Public Health England, the toolkit provides a national case for change and a set of resources to help local health systems concentrate their improvement efforts where there is the greatest opportunity to address variation and improve population health.
Commissioners responsible for improving CVD prevention and improving outcomes for people with SMI for their population should:
- focus on the key components of care across the system:
- primary prevention and early detection of CVD risk factors in people with SMI
- implement the NHS RightCare CVD prevention pathway and provide dedicated appointments with trained mental health staff to undertake checks
- ensuring long‑term management of modifiable risk factors
- provide personalised care and support planning through shared decision‑making
- strong clinical leadership to champion the physical healthcare of people with SMI and embed a proactive culture of addressing the needs of this population
- work across their system to ensure that schemes to deliver the key interventions and priorities for optimisation are in place, including:
- systematic approaches to screening, assessing, and monitoring CVD risk factors in people with SMI
- smoking cessation interventions.
Relevant links to support implementation are included throughout the resource. Health systems are supported by their NHS RightCare Delivery Partner and should use this resource as a framework for their local improvement discussions.
- NHS. NHS Long Term Plan. NHS, 2019. Available at: www.longtermplan.nhs.uk/publication/nhs-long-term-plan/
- NHS England. NHS RightCare. www.england.nhs.uk/rightcare/ (accessed 9 July 2019).
- NHS England. NHS Operational Planning and Contracting Guidance 2019/20. Available at: www.england.nhs.uk/publication/preparing-for-2019-20-operational-planning-and-contracting/
- NHS England. Inspirational nominations on shortlist for Kate Granger Awards 2018. www.england.nhs.uk/2018/08/inspirational-nominations-on-shortlist-for-kate-granger-awards-2018/ (accessed 9 July 2019).