Three Tools to Help on our journey towards greater value via NHS confederation

Focusing on reducing variation and realising value as the starting point for conversations between commissioners and providers can help develop strong, sustainable health economy-wide strategic plans. Three practical tools are especially useful, explains Mark Redhead.

Last month, NHS Right Care launched the latest Atlas of Variation. For me, the take home message from the launch event was that by focusing on reducing unwarranted variation, we can realise better value.

Clearly the atlas can be a really important starting point for commissioners and providers to begin to agree common priorities, measures of success, and a potential strategic direction for their health economies, based around a common appreciation of best possible value. And a focus on value (simply put as doing the best we can for patients with the resources we have) is becoming more central to how the service is approaching the transformation challenge – in system planning, the new care models, meeting the efficiency requirement and reducing waste.

So how can the NHS start to approach value practically and make it part of how we do things?

The atlas is one of many complementary tools and resources which can assist with demystifying and applying notions of value to the work we do in the service. Other examples that can work alongside this are the decision-effectiveness framework developed by the Future-Focused Finance (FFF) initiative and Monitor’s strategy development toolkit. I must declare an interest in both, being a member of the FFF Best Possible Value team and earlier a part of the Monitor team promoting use of the toolkit.

In the case of FFF, we focused on decision effectiveness as a route to best possible value, because the quality of decision-making impacts on what benefits can be realised with each investment. Organisations with better decision-making can achieve more with their money, and staff feel a greater sense ownership.

Practically, the FFF decision-effectiveness framework, provides a means to define clearly the questions that are being asked – what are we really trying to solve? It also provides a means of identifying who needs to be involved in the decision and what role they have in the process.

By getting round the table with a value mind-set, and focusing on what and who (as well as how and when), parties can agree what way forward provides the best possible value approach for their organisation, or for their wider health economy. Using the framework enables comparison of alternatives which have been evaluated against commonly agreed metrics or currency.

In the case of Monitor’s strategy development toolkit, since its launch last year there has been a noticeable growth of emphasis system-wide on strategic planning, both in organisations and health economies. While the toolkit was aimed at organisations’ strategic planning, I would suggest that incorporating value and variation into the mix enables it to be applied readily at a local health economy level.

Value enables a comparison of strategic courses based on a common appreciation of impact and the patient interest, rather than organisational interest. Because of the common metrics, it can help narrow the known gaps in perception between commissioners and providers (e.g. in respect of issues such as demand management and organisational health that were noted by the King’s Fund earlier in the year, and continue to exist in many areas).

These three tools (the atlas, the framework and the toolkit) exist against a backdrop of growing system messages where value is increasingly recognised as one of the most helpful ways forward. The NHS Confederation has a number of initiatives addressing the question of value, as does the Academy of Medical Royal Colleges. NHS England has prioritised value through asking the vanguards to provide value propositions, against which their success will be gauged.

The challenge for the service is significant, but I consider that value provides an opportunity to design care effectively and collaboratively in a sustainable way around patient and population needs. The three tools highlighted provide a route in to start doing that systemically at scale.

Mark Redhead is a member of the Future-Focused Finance delivery team.

This blog appeared orginally on NHS Confederation.