Better services that are sustainable and fair
... to the ‘Improving planned care’ pages of the Partnership’s website.
This programme, like our other priority areas, will help support people to have more control over their own health and wellbeing by tailoring care to suit people’s needs and choices. We know that patients who are actively involved in their own healthcare generally have more positive experiences, and better outcomes, than those who feel their treatment is out of their hands.
As a programme team, we also want to make sure that the work we do creates more opportunities for everyone to improve their quality of life through better health and wellbeing. In addition to the benefits for individuals, families, communities and the economy in West Yorkshire and Harrogate, having a healthier population will help to counteract the rising demands on local health services.
In summary, our focus is as much about prevention as it is about cure by supporting people to make healthier choices whilst making sure that the most effective and appropriate healthcare services are there for when people do need them.
Dr Matt Walsh, CEO lead - Improving planned care
The conclusion from NHS England's consultation on Evidence Based Interventions has now been published. Evidence Based Interventions link in with one of the Partnership’s key areas of work in its ‘Improving planned care’ programme which is to review the procedures currently being carried out in West Yorkshire and Harrogate that are of limited clinical value. Read more here.
Glaucoma is a common eye condition where the optic nerve is damaged, often by the pressure of fluid inside the eye. For around 10% of those in the UK who register as being blind, having glaucoma led to their sight loss. This doesn’t have to be the outcome. For people with the condition, early diagnosis and treatment can help stop their vision getting worse and sight loss can be avoided. Read more here.
What is this programme all about?
Improving planned care is one of our West Yorkshire and Harrogate priorities.
Planned or ‘elective’ care is treatment that people choose to have to help manage a health problem, rather than treatment that is required urgently or in an emergency. Planned care includes scheduled operations such as hip and knee replacements and cataract surgery. People are usually referred onto planned care by their GP or other health professional.
The overall aim of this programme is to deliver the most appropriate and effective planned healthcare for the people of West Yorkshire and Harrogate, and achieve the best value in how we use our resources to deliver that healthcare.
This programme can only be progressed through collaboration with those who deliver planned care services. The West Yorkshire Association of Acute Trusts (WYAAT) brings together the NHS hospital trusts in West Yorkshire and Harrogate to drive forward the best possible care for local patients. Along with WYAAT, the involvement of GPs and other healthcare professionals enables us to look at how things are done now, what works well and not so well, how things need to change and what benefits those changes could bring for patients and staff.
We serve a diverse range of communities and recognise that people have different needs that require different solutions. A big part of this is not presuming we know what people think, but asking, involving and listening instead. You can find details of all engagement and consultation work that has taken place across West Yorkshire and Harrogate relating to this programme of work.
More people are currently being referred to hospitals for treatment than hospitals can treat. This is leading to longer waiting lists and longer waiting times for patients. This programme of work will help the NHS manage the rising demand for planned care by providing more patient focussed health services, out of hospital settings where appropriate. This shift away from hospitals will help to improve access to healthcare and patients’ experiences of it.
Providing the most efficient care and making the best use of our existing capacity is vital if we are to increase the responsiveness of our services and improve access to them. This will also reduce the numbers of people who have to wait longer than they should to receive planned treatment.
One significant way in which we can improve planned care is by removing the so called ‘postcode lottery’ that currently exists across West Yorkshire and Harrogate, to make sure that the care people receive is fair and consistent. Access to health services and the eligibility criteria for them should be the same for everyone. By removing existing variation wherever it exists, we can make sure that all patients have a positive experience of care, regardless of where they live.
We have nine clinical commissioning groups (CCGs) in West Yorkshire and Harrogate that are responsible for commissioning (planning and buying) healthcare services for their communities.
Different CCGs currently have different commissioning policies for some of the healthcare services they provide. To make sure these policies are fair and consistent, the CCGs have formed a joint committee that is working towards standardising these commissioning policies and reducing this unnecessary variation.
Our work plan
These five key areas make up our first phase of work for this programme. Our joint committee of the nine CCGs has agreed that we will move forward with this approach.
The expectation is that phase 1 will be implemented in stages across West Yorkshire and Harrogate over the next few years resulting in an end point where all local CCGs are taking the same approach for their areas by 2020/21
Experts believe that certain routine treatments have only limited or temporary benefit. These treatments are referred to as ‘Procedures of Limited Clinical Value’ (PLCV). In many cases, there are alternative treatments that are more effective and some of the more traditional procedures will have been replaced by modern techniques.
We are reviewing these procedures because we believe that more needs to be done to make sure that such treatments are not routinely performed, or only performed in specific circumstances. This review also gives us the perfect opportunity to standardise the commissioning policies for the treatments. By reducing the unnecessary variation that currently exists in the area, we can make sure that people can access the same treatment for the same reasons, wherever they live in West Yorkshire and Harrogate.
The outcome of this work plan will be that, instead of having a procedure of limited clinical value, patients would be offered a better alternative.
There may be cases when a GP or consultant believes that a patient would benefit from a PLCV rather than an alternative. In such cases, the individual funding request (IFR) process can be followed to potentially apply for the treatment to be funded. Each request for treatment would be considered on a case-by-case basis.
The demand for orthopaedic and MSK services continues to increase year on year which has resulted in the budget for these services being one of the largest in the NHS.
There’s no doubt that this rise in demand will continue, particularly as we have an ageing population, so we must address this concern and make positive changes that focus on patients’ needs.
By providing more integrated care, and reducing the number of unnecessary follow-up appointments, we can maximise capacity to reduce waiting times and make sure we have sustainable orthopaedic and MSK services for years to come.
In addition to transforming orthopaedic and MSK services, we are working in partnership with hospitals and service providers to reduce variation in the way those services are delivered in West Yorkshire and Harrogate. By having standard patient pathways and policies, we can remove the ‘postcode lottery’ and variation that currently exists.
Eye care services don’t always have to be delivered in hospitals and many can be safely delivered at local clinics or high street opticians for example. By adjusting how and where eye care services are delivered, we can make the best use of the expertise we already have in our communities and move some services out of hospitals and into local settings. This is usually much easier and more convenient for the patient - and often less daunting.
It’s a shocking fact that around half of all sight loss is preventable, and many people are unaware that smoking, obesity, diabetes and high blood pressure can all contribute to avoidable sight loss. One key aspects of our eye care work will be to support and promote eye health, sight checks and the use of medicines where appropriate to reduce people’s risk of sight loss.
We all know that our eyesight tends to get worse as we get older but this doesn’t always have to be a done deal and help is available. We are assessing the support that is currently available in West Yorkshire and Harrogate to make sure it is as good as it can be.
People who are referred onto planned care services will be encouraged and supported to make healthier choices such as stopping smoking, losing weight or becoming more physically active. These lifestyle changes will help to improve their health in case they need an operation.
In some cases, the result of such lifestyle changes could mean that an operation is no longer needed and if it is, being in better shape will give patients the best possible chance of a good outcome from their surgery.
Of course it’s much better for everyone if people live healthier long before they may need to access healthcare. To support this, we are working with colleagues from social care, public health, housing and community organisations to direct people to local services that could help them get started on those lifestyle improvements that will make a real difference now and in the future.
By supporting people to make healthier choices and preventing avoidable conditions we can improve the health of the population and, in the longer term, reduce the demand on some planned healthcare services. This will release money that can be used to good effect elsewhere in the NHS.
We want to identify and address unwarranted variation and waste in prescribing. To do this, we must make sure that the same criteria apply throughout West Yorkshire and Harrogate by introducing a standard prescribing policy for CCGs to implement. Everyone should have the same access to the same treatments, including when new medicines become available on the NHS.
We are already very efficient in relation to prescribing and achieving best value from our medicines budgets, but there are still opportunities to improve. We will continue to reduce the prescribing of medicines that have little evidence to show that they work well, and medicines that can be bought ‘over-the-counter’ such as paracetamol and antihistamines for short term use.