1. 1 Commissioning for Value, and the NHS Atlas of Variation in Healthcare 3.0 Philip daSilva: Co-Founder, NHS Right Care & Co-Author, NHS Atlas of Variation Erica Ison: Production Editor, NHS Atlas Series Jake Abbas: Director, Northern and Yorkshire Knowledge & Intelligence Service, PHE

2. 2 Describe how the NHS Atlas series supports the Commissioning for Value approach Revisit the importance of addressing unwarranted variation Explain how the NHS Atlas series is prepared and published Using the NHS Atlas at a local level Preview the NHS Atlas compendium 3.0, June 2015 Outline future plans for NHS Atlas series What will this session cover?

3. 3 Who is in the room? Welcome and introductions Where do you work? What is your role? Experience of using the NHS Atlas series and/or Commissioning for Value packs

4. 4 Commissioning for Value

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6. 6 Background and history First NHS Atlas (a compendium) published in 2010; second compendium in 2011 Followed by a series of six specialist atlases covering specific diseases, population groups or services (March 2012 through to November 2013) The third compendium NHS Atlas is a collaboration between Public Health England, NHS England and Right Care

7. 7 Unwarranted variation has been defined as: “… variation in the utilization of health care services that cannot be explained by variation in patient illness or patient preferences.” Professor John Wennberg (2010) “Tracking Medicine, A Researcher’s Quest to Understand Healthcare.” The NHS Atlas series is a first step in highlighting variation not only in activity and cost but also in quality, safety, equity and outcome It is a way of promoting transparency and increasing accountability in the NHS It is an important driver for improving not only the quality of services but also patient-determined and population health outcomes. It supports the use of information locally to involve patients and the population in the debate about achieving greater value, i.e. better outcomes at lower cost Identifying unwarranted variation

8. 8 Put together 1-2 slides around value Improving value

9. 9 Process Domain Directors, National Clinical Directors (NCDs), and other clinical leads are invited to suggest indicators for inclusion Clinical leads are supported by PHE Knowledge and Intelligence Teams (KITs), national audits, specialist societies and academic units Some indicators are suggested by the Third Sector, and some by Atlas users Using a set of agreed criteria, NHS Atlas Management Team and Steering Group select indicators to be published from suggestions received Data and metadata are obtained from data-holders, prepared, and QA’d Commentaries to accompany each map are drafted, edited, and are approved by NCDs and key members of the Atlas Management Team Proofs are read and QA’d by all contributors, and senior staff at Department of Health, NHS England and Public Health England Early sight of publication given to key Third Sector organisations, through the Richmond Group and other avenues, such as KITs How is NHS Atlas produced?

10. 10 Collaboration with a range of organisations within and outside the NHS Clinical input at a senior level Acts as an entry point to a difficult problem – it is not simply a description of the problem but a spur to take action (Options for action, Resources and Case- studies) Acts as a catalyst to pose questions at a local level Can be used to turn a negative – “postcode lottery” – into a positive – “responsive care for local population Provides a rational basis for increasing value at a time of fiscal constraint Provides a framework to “house” patient-centred care, shared decision-making, networks, systems of care and population medicine and healthcare Policy of NO “naming and shaming” Design and layout – everything you need on a double-page spread Easy to read Key features of NHS Atlas

11. 11 What are the opportunities for improvement? Is my health economy placed in less-good quintiles nationally and relative to its demographic peers? (Where to Look) Is the improvement opportunity generic across many pathways, a few pathways or only one? For instance, do the maps showing condition-based detection indicators all highlight an opportunity for improvement or is it only those within, respiratory pathways, for example? (What to Change) Are there opportunities along an entire pathway, such as stroke, and is whole- pathway transformation required or is the opportunity for improvement an individual project within a pathway? (How to Change) What questions will it help me to answer?

12. 12 Which organisation is best with respect to an indicator, or group of related indicators, both nationally and among demographic peers? Do reasons for warranted variation, such as local population characteristics, explain the degree of variation observed? That is, do all demographic peers show similar degrees of variation? What can be done about the unwarranted variation observed? That is, “What to Change”: following the suggestions in the “Options for action” section in the commentary associated with each map; exploring the potential to learn from what other organisations, which achieve higher value in relation to that indicator or group of indicators, are doing. What questions will it help me to answer?

13. 13 Add worked example with screenshots from printed maps Which ones to use? Demo Instant Atlas and benchmarking against peers Using the Atlas

14. 14 Examples: - Rate of asthma emergency admissions to hospital children aged 0-19 years per population (4.8) - Rate of emergency admission to hospital for people aged 75 years and over with length of stay (days) under 24 hours per population (4.2) - Ratio of colonoscopy procedures to flexible sigmoidoscopy procedures (5.0) Magnitude of Variation Have trimmed top as there are a few with fold variation over 100 – will mention this but thought this gives a feel for level of variation (in variation)

15. 15 Foreword by Dr David Goodman, The Dartmouth Atlas of Health Care Preface by Sir Bruce Keogh, Duncan Selbie and Professor John Newton Introduction by Professor Sir Muir Gray and Dr Philip DaSilva Contains over 100 indicators Indicators cover 16 national Programme Budget Categories (PBCs), cross-cutting themes, e.g. diagnostic services, and population groups, e.g. frail elderly, and children and young people Accessible online in different formats: low-resolution and high-resolution downloadable pdfs and as an interactive InstantAtlas Due for publication in June 2015 NHS Atlas 3.0, 2015

16. 16 Future plans KVS to add PHE Links with Right Care and other partners Training, worlkforce, capacity

17. 17 Contacts

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