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STPs using ‘RightCare approach’ to tackle bed shortages

The NHS ‘RightCare approach’ is being implemented at a local level as the programme moves to work with STPs and CCGs in order to identify system priorities and deliver whole-population change, particularly by cracking down on “unwarranted use” of bed capacity.

The RightCare programme was designed to provide local health economies with the support needed to understand where opportunities exist and how to address them. Designed and built at a local level, RightCare was developed and tested by and with clinicians and frontline staff, keeping at its core a strong evidence base and a keen focus on using data and intelligence.

According to NHS England papers from a board meeting last week, early adopters proved the concept delivers improved outcomes more efficiently. This provided the foundation for an accelerated roll-out of the RightCare approach at national level last year, with 65 local health economies receiving support since February and the remaining 144 economies joining the programme in November.

Since then, the RightCare programme has focused on three strategic pillars: intelligence, or using data to highlight variation and identify areas of opportunity; innovation, or working in partnership with organisations, patient groups and other programmes to test new concepts and influence policy; and implementation, or supporting health economies to embed sustainable change that improves population health.

With regards to the latter, NHS England revealed that the RightCare delivery partners have been working alongside STP footprints and their stakeholders to encourage planning and change. This ensures that when CCGs have common improvement opportunities, these are addressed at STP level, the board papers explained.

Some examples of the impact of this work have already been pinpointed nationwide. Slough CCG has reduced targeted demand on A&E by 24% through new complex case management service; Blackpool CCG tackled demands from top 50 frequent callers by 89% (999 calls) and 93% (A&E attends), saving £2m; and Cumbria CCG is on track to save £350,000 via new community-based patient support.

The board papers added: “In 2017 NHS RightCare and Getting It Right the First Time (GIRFT) will be working closely together to support STPs and local health economies. This will begin with a complementary set of analysis on orthopaedic pathways as well as aligned support to STPs, in particular on coordinating the reallocation of capacity as it is released from unwarranted use.

“This alignment will also be developed in the context of NHS England’s emerging new operating model, looking to facilitate and support delivery of the Five Year Forward View and STPs.”

NHS RightCare and GIRFT jointly published ‘Commissioning for Value’ intelligence packs for each STP in December last year, linking the opportunity to reduce ‘unwarranted’ variation to the number of bed days that this would then require being re-allocated to ‘warranted use’.

“This is the first step in ensuring co-ordinated reallocation of capacity (CROC) is considered and handled appropriately across all local health economies,” explained NHS England. “An example of CROC opportunity at STP level includes a local health economy in the south that, compared with the 75th percentile of performance amongst their demographic peers, has [around] 500 beds that, at the point of data capture, were being used for potentially unwarranted activity.

“NHS RightCare is working at STP level to support health economies in addressing CROC. Working alongside GIRFT, regions and other national programmes, this initiative will ensure that released capacity resulting from adoption of the RightCare approach is re-allocated for optimal population healthcare use.

“In support of this, techniques on phased management of capacity release and potential frameworks for managing future use, via improvement, contractual and framework mechanisms, are being developed to share with the frontline.”

(Top image c. Peter Byrne)


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