Together

we’re better

Populations or Pathways?

Liane LangdonAnthony Lawton

NHS Leeds North CCG

Local Strategic Context –Leeds Joint Health and Well Being Strategy

Together

we’re better

Together

we’re better

What did we do with Commissioning for Value?

Together

we’re better

Use CFV but also locally what fits – the life expectancy gap by cause of death

8

So Summary: Overarching messages for LeedsSum

mary on a page

Public health focus on prevention; specifically smoking prevalence (Leeds South & East and Leeds West) smoking cessation (All) and Obesity (Leeds South & East)

Significant benefit to patients if improvement to Primary Care management indicators were made (All)

High emergency admissions for CVD (Leeds South & East), costs (Leeds North and Leeds South & East) and lengths of stay (All)

High costs for CHD emergency admissions (Leeds North and Leeds South & East) and high costs for CHD elective admissions (Leeds South & East)

High emergency admissions for Heart Failure and Stroke (Leeds South & East and Leeds West)

High costs for Angiography procedures (All), CABG procedures (All) and Angioplasty procedures (Leeds West)

High lengths of stay for Angiography procedures (Leeds West)

Actions …………..

• Public Health – challenge to jointly re look at commissioning of healthy living services key priority for the Council.

• Primary care – variation target work with key practices and embed into engagement schemes in each CCG

• Whole pathway – flow and variation – LIQH.• CCG commissioning – using packs as part of

prioritisation framework• Transformation work streams -Acute – elective care

value approach; Integrated Care – Pathways work.Together

we’re better

The LIQH approach

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we’re better

LIQH – focussed areas

CVD• improving the management of chest pain;• optimise outcomes and quality of care for people requiring

interventions/ treatment for suspected/confirmed arrhythmia and to prevent inappropriate use of secondary services.

COPD • support people with COPD to manage their own condition

and to reduce the likelihood and impact of exacerbations;• reduction in variation of approach to COPD patients in crisis; • Improving the early and accurate diagnosis of COPD whilst

improving patient experience.

Together

we’re better

Pathways

• So, for pathways – The data gives us some clear indication of

pathways to consider– We have established clear programmes of work

• But, is this enough?

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we’re better

Populations• Great for quality improvement• But – is this enough for transformation?• What about complex populations?

– CfV tells us where the challenges are– But we know that with populations, pathway

approaches are not always enough– What can CfV do to inform work with the frail

elderly?

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we’re better

Liberating CfV for Populations• What we did next:

– Used the CfV intelligence– Used part of the £5 per head for primary care (£2.36)– Identified our target population – frail elderly 2%– Applied Outcomes Based Accountability to liberate

practices to use CfV knowledge creatively to tackle an issue requiring transformation, not quality improvement

– Look for contribution not attribution – asked practices to work in localities to give something a go

Together

we’re better

Overview of OBA

• Outcome Based Accountability™ was first developed in the early 1990s by Mark Friedman

• Principles:SIMPLE

COMMON SENSE

PLAIN LANGUAGE Together

we’re better

Definitions

OUTCOMEA condition of well-being for adults, children, families, communitiesi.e. Being Healthy, Staying Safe, Safe Communities, Clean Environment

INDICATORA measure which helps to quantify the achievement of the outcome.i.e. Rate of diagnosis of Dementia in Primary Care, Rate of teenage pregnancies

PERFORMANCE MEASUREA measure of how well a program, service is workingBased on the 3 following questions:

• How did we do?• How well did we do it?• Is anyone better off?

Popu

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ENDS

MEANS

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we’re better

Leaking Roof

Experience:

Measure:

Story behind the baseline (causes):

Partners:

What Works:

Action Plan:

Not OK

? Fixed

Turning the curve

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we’re better

What now?• Supported practices in locality groupings to

identify meaningful local measures relating to how they are contributing to the issues identified within CfV

• Practices are all enhancing community nursing – but in different ways

• Measure and look for learning and impact – and share

• Worry about contribution, not attribution• Do more of whatever works!

Together

we’re better

Questions