Professor Matthew Cripps Director of NHS RightCare - Delivering the NHS RightCare potential

NHS RightCare is a programme committed to delivering the best care to patients, making the NHS’s money go as far as possible and improving patient outcomes. This programme helps to ensure the best possible care is delivered as efficiently as possible, which is right for patients and will help us have a sustainable NHS, now and for the future.At the core of NHS RightCare’s work is the concept of unwarranted variation and the vital importance of using our shared NHS resources to deliver the best outcomes for our population. There are differences in outcomes between populations, which we know cannot be explained by the rule of evidence-based medicine or the demographics of the population.The RightCare approach involves presenting those variations and supporting local health and social care economies to ensure the best possible patient pathway is in place. This is where NHS RightCare begins - by presenting commissioners and STPs with their outcomes and data along pathways of care and how that looks in relation to their demographic (rather than their geographic) peers. NHS RightCare provides local health and social care economies the opportunity to open up lines of enquiry about whether they are delivering optimal care for their population.It’s recognised that local health and social care economies are different from one another, with some clinical commissioning groups (CCGs) having made greater progress in certain areas than others. NHS RightCare aims to harness the headway and duplicate advancement across all CCGs, by creating a culture of innovation and education. NHS RightCare opens up a platform to share examples of the methodical approach that the programme advocates. The use of data aides this selection of opportunity and highlights where to focus in order to deliver the greatest improvements for the population. By engaging clinical leaders NHS RightCare ensures that the best clinical practice is at the heart of improvement. The aim of NHS RightCare is to make sustainable change to improve population health whilst also making the best investment decisions; this is central to NHS RightCare’s approach. This methodology includes three stages to provide a systematic, evidence-based approach; including;

• Where to look
• What to change
• How to change

This approach gives health economies a straightforward structure and a series of tools and techniques that support rational decision making and whole system engagement in delivering optimal care.Every local health and social care economy in England has an NHS RightCare team working with them, led by a Delivery Partner, providing data and intelligence and focussing support for transformation. This relationship between health economy and NHS RightCare helps support optimal stewardship of NHS resources and improve health and outcomes for more people. With strategic focus on the NHS RightCare programme moving to a regional delivery model, a recruitment drive to increase the amount of Delivery Partners is in place. By mid 2018 NHS RightCare aim to have 30 highly driven individuals helping to carry forward this work with the frontline of the NHS in England.NHS RightCare Delivery Partners support health economies by;

• helping health economies to make the most out of the NHS RightCare programme and initiatives to meet clinical commission groups priorities to highlight opportunities and reduce unwarranted variation.
• Sign-posting to examples of the how the RightCare approach has helped other health economies to improve pathways. Working on best practise and sharing innovative ideas which work.
• being open, honest and transparent and by constructively challenging thinking to help unpick reasons for non-delivery.

NHS RightCare supplies the Delivery Partners with tools and products to structure and shape their conversations with health economies. One suite of these tools is the NHS RightCare focus packs. These packs provide more detailed information on those highest spending programmes. The areas covered are: cancer; the cardio vascular disease family of conditions including renal, stroke and diabetes; maternity and early years; mental health and dementia; musculoskeletal and trauma; neurology; and respiratory.The packs include a wider range of outcome measures and information on the most common procedures and diagnoses for the condition in question. They help CCGs begin work on phase two of the NHS RightCare approach ‘What to Change’ by using indicative data to identify improvement opportunities.Because of NHS RightCare’s focus on population health, this means that prevention and early detection are key priorities.The NHS RightCare Commissioning for Value Focus Pack Neurological (April 2016) presents analysis of a wide range of indicators, per individual Clinical Commissioning Group (207 packs produced) focussing on spend, activity, quality and outcomes. The indicators have been chosen with advice from national clinical leads and other key stakeholders including the National Mental Health Dementia and Neurology Intelligence Network.The intention of the NHS RightCare focus pack is not to provide a definitive view on priorities but to help commissioners explore potential opportunities. It helps commissioners to understand how performance in one part of a pathway may affect outcomes further along the pathway. Each indicator is shown as the percentage difference from the average of your 10 most similar CCGs.In the ‘How to Change’ phase NHS RightCare Delivery Partners help to bring the right people together to have key conversations. They translate ideas from these discussions into logic models and work through the options for application. By prioritising ideas they can then build the case for change with clear outputs and assumptions, ensuring the quickest and easiest route to implementation is framed.To aim for full system patient care NHS RightCare is committed to working closely with NHS Improvement’s ‘Getting it right first time’ (GIRFT) programme, a ‘Five year forward view’ commitment. This will ensure a joined up approach with efforts to reduce variation within hospitals to ensure a complete system approach to tackling health inequalities.NHS RightCare is ambitious by nature to create a fair system for patients, sharing best system practise and facilitating conversations to ensure structures are efficient and deliver for everyone in England.For a video explanation of how the NHS RightCare Neurology packs work, click here.For more information about NHS RightCare please email: rightcare@nhs.netBy Professor Matthew Cripps, Director of NHS RightCare