In our first event of the new year, Lead-In were joined by three unique innovators: Dr Caz Sayer, Dr Will Barker and Omar Akhtar. Each described a novel approach to the shared goal of improving people’s health. Here we reveal the take home points from the workshop.
Dr Caz Sayer, Chair of Camden Clinical Commissioning Group (CCG) and GP of over 30 years led an insightful workshop into the role of health commissioners and the future of delivering health outcomes for local populations.
What is commissioning?
Commissioning involves getting the best outcomes in the most cost effective way. It starts with understanding a population’s needs and follows an iterative cycle.
You have to understand the approach to commissioning if you want to change the way you do it. Set up as part of the 2013 Health and Social Care Act, CCGs bring front-line clinicians into commissioning roles, as a way to meet the daily needs of patients.
When are commissioning decisions made?
You make a commissioning decision every time you allocate a resource – if you decide to treat a patient, refer a patient or manage them yourself you are making commissioning choices – these decisions are made at an individual and a population level. The role of a CCG is to optimise the way commissioning choices are made at a population level.
Camden CCG has ensured patients are engaged throughout the commissioning process. In this way, patients see that spending resources in one area means they cannot be spent in others. Camden CCG like many others, spends a significant amount on secondary care, leaving little to fund social and primary care services, where most patients will ultimately engage with healthcare provision.
“We have an illness service not a health service.”
A disproportionate amount of spending is reactive. Funding is focused on crisis resolution rather than early prevention. In essence, we have an illness service not a health service. The wider determinants of health are as important to health as acute illnesses. It should be remembered, major improvements in health have been through public health interventions such as smoking prevention, water and sanitary hygiene and immunisation regimes, not high-intensity illness services. Reactive care is unplanned and therefore expensive, dangerous and has poorer outcomes.
“We need to organise care around achieving value for patients, not meeting organisational targets”
A different approach
We need to organise care around achieving value for patients, not meeting organisational targets. This means asking patients (and carers) which health outcomes matter to them. For example, patients in Camden chose ‘number of home days’ as the key measure, when asked to identify how they judged healthcare outcomes. Providers were then better motivated to achieve successful outcomes and it led to better care quality and satisfaction.
We need to commission in more thoughtful and strategic ways, accepting and managing the wider causes of poor health. Using available data in meaningful ways is vital to track and measure progress and outcomes. Having defined “measurable” enables you to see whether changes are worthwhile and lead to improvement. Often, no single part of the system is fully responsible for delivering positive outcomes. Collaboration is required at multiple levels to achieve this; patient outcomes and “measurables” enable and motivate this cohesion. Planning care appropriately around the patient, also reduces the ‘cost of chaos’, which arises through unnecessary and duplicative processes. This leads to efficiency savings.
Breaking the pattern of reactive commissioning requires foresight and investment in prevention. This means re-investing in the commissioning cycle, rather than using short-term measures to plug provider gaps.
There are 3 key strands that improve patient outcomes:
- Identifying the outcomes
- Providing high quality services at the point of need, as close to the community as possible.
- Integrating care, with access to education and self-management.
Implementing this approach, within 2 yrs, Camden CCG has navigated complex healthcare arrangements leading to improved outcomes and increased efficiency (~£20 m savings). Successes in pilot studies now need to be standardised across all commissioning streams.
“Breaking the pattern of reactive commissioning requires foresight and investment in prevention.”
Dr Will Barker, founder of the clinical directory app Dr Toolbox, kicked things off by demonstrating the Japanese concept of ‘poka-yoke’ – to design things with a form that allows them to be used properly, eliminating product defects and reducing human error. This he says is vital in clinical systems and inspired Dr Toolbox.
Why Dr Toolbox?
Your consultant is away and you urgently need to order the patient in bed twelve a CT scan. Where do you even start? This is an all too familiar question asked by newly qualified doctors. When faced with an organisation as large as the NHS, many doctors struggle to navigate the complex systems that can vary from hospital to hospital. This wastes time – time that could be spent caring for patients.
“Dr Toolbox is a Wikipedia for your hospital”
What does Dr toolbox provide?
Dr Toolbox is a Wikipedia for your hospital. It contains vital information about a doctor’s current hospital including bleeps, ext. numbers and guides on how to make referrals. This is maintained through peer collaboration. It is intended to be specific, contemporary, easy to update and secure.
A chance for improvement
With over 3000 app downloads and 1500+ users Dr Toolbox has made excellent progress. However, the event fostered a great deal of discussion among our community who were keen to see continued success. Recurrent themes were the importance of the clinical user interface and of testing innovations in pilot studies.
A new approach to suicide support
The loss of a friend to suicide is a tragic and life-changing event. For Omar Akhtar his personal experience inspired him to create an online community to support loved ones left behind by suicide victims. He was keen to share the early stages of development with our community.
Why is a community needed?
Suicide is the biggest killer of men 18-45. It is a major problem in other communities including prisons and Asian families. People are more likely to commit suicide when they know someone who has taken their own life. Yet no resources or services were available for those affected by suicides. The people Omar knew in this situation were isolated due to being unable to talk. The grief process was made more difficult that it ought to be– people were not able to understand why suicide became an option. There was no one to reach out to.
Within 2 months Omar has formed a collaboration with Manchester university nationwide research on suicide, held focus groups and developed relationships with leading charities: Suicide after-support and Calm. He is keen to engage clinicians and medics – to look at threats, opportunities and what is required from a medical point of view. The event provided a perfect opportunity for Omar to receive a wealth of feedback and suggestions.