Implementing Value at Scale
Aneurin Bevan is one of seven Health Boards across NHS Wales, an integrated system responsible for planning and securing the delivery of primary, community and secondary care and specialist services to a population of c 650,000 (approximately 21% of Welsh population), with a budget of £1.1billion and employs over 13,000 staff. In 2014 Welsh Minister for Health & Social Services laid down a set of principles to achieve more efficient healthcare across Wales, ‘Prudent Healthcare’. Aneurin Bevan welcomed the National Policy but struggled to see how these principles would be delivered when competing with increased financial pressure and repeated cost cutting exercises leaving staff demotivated. A lack of patient and clinical outcomes and detailed costing pathways were proving difficult to assess the Value to patients in Aneurin Bevan. Following attendance by a few Senior Managers at a course at Harvard Business School to support Value the Board agreed to launch a programme to deliver a Value-Based Care System.
The initial aim of the programme was to create a culture and common language between clinicians, managers and finance whilst leveraging the resources more efficiently. The Programme is made up of a number of component parts and specific projects, organised around medical conditions and patient cohorts (15 at present). It is unique in its approach and incorporates a number of layers of implementation, not least the collection of outcomes and cost, but also considers a common IT platform integrated with care pathways to support the digital patient programme. The size and scope of the programme is vast, its ambition is to cover as many of the medical conditions across ABUHB as practicable over the next 5 years, and extend the thinking and approach across NHS Wales.
Preliminary results have provided the opportunity to re-design pathways and workforce models, early observations made whilst shadowing clinics has resulted in some early wins, e.g. a dedicated HCSW to support Parkinsons clinics improving both patient experience and the environment in which patients are treated. Integration of efficiency costing using time driven activity based costing (TDABC) in cataracts surgery showing clinical variation in practice which is not supported by variation in outcomes. Combining the outcomes and costing data has highlighted opportunities to increase productivity, review referrals, review scheduling of templates which at the very lease will help to support the gap in demand and capacity.
The partnership formed with ICHOM and more latterly ICON has allowed Aneurin Bevan to participate in a GLOBE benchmarking exercise providing outcome data using the ICHOM standard set, alongside a number of other international specialist eye care centres, highlighting challenges of data collection where no EPR is in place, ABUHB were successful at providing the most accurate complete patient reported data set and are now working to compare results.
The programme is vast, unique in its approach and recognises that each of its projects are at different stages of maturity, the next 6 months will be crucial in accelerating the Value in some of the early adopters i.e. Parkinsons and Cataracts, as well as being able to grow in line with the ambition to create a Value-Based System across NHS Wales.