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2 Email: futurefocusedfinance@nhs.netfuturefocusedfinance@nhs.net Web: www.futurefocusedfinance.nhs.ukwww.futurefocusedfinance.nhs.uk

3 Commissioning for Value & Future Focused Finance

4 Five Key Ingredients: 1.Clinical Leadership 2.Indicative Data 3.Clinical Engagement 4.Evidential Data 5.Effective processes 1 key objective + 3 key phases + 5 key ingredients = COMMISSIONING FOR VALUE OBJECTIVE - Maximise Value (individual and population)

5 Future Focused Finance: Close Partnering Finance educator network- Teaching clinicians about finance & finance staff about clinical care Consider value not cost - Using value in decision making, not just cost Public & patient network - Public involvement in service design and decision making Survey, collate & disseminate – What works well, what doesn’t, best practice Reducing waste - Medicines, over diagnosis, over treatment, litigation

6 Finance educators

7 Engagement Cycle- “Cycle of Grief” Denial AngerDialogue Acceptance

8 Budget Report

9 Assumptions  Clinicians want to know about navigating NHS finances  Clinicians are competitive, want to have the best services and out perform colleagues  Clinicians are suspicious of ‘ initiatives ’ & managers  Barriers (there are many!) will stop them and they will become disengaged

10 Barriers  Knowledge  Lack of signposting  Lack of any finance training  Awareness  Head in sand syndrome  Time  Bureaucracy  Information ‘ dead ends ’  IT support  NHS moving goalposts  Revolving door of management staff  Memories like elephants – ‘previous own goals’  Finance gobbledygook (language transaltion)

11 Purpose of the finance educator network  Network with like minded people  Pick up and share top tips  Break down local boundaries  A ‘bottom up’ approach  Demystify finance for clinicians  Learn about clinical pathways  Develop continuous working relationships with clinicians  Pick up and spread good practice  Develop services that add value Purpose of the finance educator role Finance educator network

12 Finance Educators Over 80% have more than 5 years’ experience

13 Top reasons to become a Finance Educator 1.To help me engage with clinicians 2.Essential to the future of the NHS 3.To improve my ability to deliver training 4.Personal development 5.Support of NHS colleagues

14 Enablers to good engagement with clinicians  Good communication  Understand each other, and what they want/need  Make it interesting and jargon-free  Enthusiasm  Keep it authentic, practical and realistic (meaningful to them)  Keep it patient focused

15 Future Focused Finance: Close Partnering Finance educator network- Teaching clinicians about finance & finance staff about clinical care Consider value not cost - Using value in decision making, not just cost Public & patient network - Public involvement in service design and decision making Survey, collate & disseminate – What works well, what doesn’t, best practice Reducing waste - Medicines, over diagnosis, over treatment, litigation

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17 Who defines value?

18 Value Clinical outcome e.g. population health, survival rate, extent of functional recovery Patient experience e.g. comfort, treatment by staff, waiting time, ease of access Safety e.g. diagnostic error, post-op complications, infections Revenue costs e.g. income, time, salaries, system maintenance, facilities Capital costs e.g. Investment in infrastructure / equipment Outcome Resources 123 45 Source: based on Michael Porter (HBR, NEJM), HFMA “Value in Health Care”, Delivery Group interviews

19 Future Focused Finance: Close Partnering Finance educator network- Teaching clinicians about finance & finance staff about clinical care Consider value not cost - Using value in decision making, not just cost Public & patient network - Public involvement in service design and decision making Survey, collate & disseminate – What works well, what doesn’t, best practice Reducing waste - Medicines, over diagnosis, over treatment, litigation

20 National patient champion – starting a patient and public network

21 Patient Decision Aids

22 Decision Aids reduce rates of discretionary surgery RR=0.76 (0.6, 0.9) O’Connor et al., Cochrane Library, 2009

23 Cochrane review update 2014 115 studies across 6 countries (>34,000 participants) Found good evidence that PDAs Increase patient knowledge Improve accuracy of patient expectations Improve communication between patient and practitioner Reduce volume of elective surgery DO NOT worsen health outcomes

24 Patient Decision Aids 36 NHS PDAs available – sdm.rightcare.nhs.uk Including; Stable angina Stroke prevention High cholesterol Smoking cessation Some sit in primary care, some in secondary care There are dozens more internationally

25 Future Focused Finance: Close Partnering Finance educator network- Teaching clinicians about finance & finance staff about clinical care Consider value not cost - Using value in decision making, not just cost Public & patient network - Public involvement in service design and decision making Survey, collate & disseminate – What works well, what doesn’t, best practice Reducing waste - Medicines, over diagnosis, over treatment, litigation

26 Berwick & Hackbarth ‘Waste is theft’

27 Thank you- Questions? Email: futurefocusedfinance@nhs.netfuturefocusedfinance@nhs.net Web: www.futurefocusedfinance.nhs.ukwww.futurefocusedfinance.nhs.uk


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