Our health and care system is under significant pressure. We know that demand for health and care services is increasing and the COVID-19 pandemic has accelerated the need to make optimal use of the resources we have and provide better value care – for patients and our system.
Many factors affect the sustainability or our NHS. The NHS in the UK has experienced growth in demand for healthcare services of around 4.5% per annum and almost two thirds of it is generated by increases in the volume of activity, or innovation. Less than 10% of the growth is due to the healthcare needs of our ageing population. A significant portion of the increase in volume in clinical practice is clinician led, and we need to support clinicians to understand and tackle the unwarranted variation within healthcare systems that leads to overuse of tests and interventions.
The OECD estimate that up to 35% of this increase in clinical activity is likely to be low value treatment and care, or waste. Low value and futile tests and treatments lead to more patient regret. We know too, that all healthcare has potential to cause harm – exposure to radiation from imaging, risks from procedures, and side effects from medication. Over investigation and overtreatment leads to unwarranted variation in health, treatments and outcomes and is likely to be causing harm, while also wasting our precious healthcare resources that could be better used elsewhere.
There is also an underuse of some tests and interventions which are very high value, and that is often linked to inequality of access to services. Disinvestment in low value tests and interventions allows resources to be redeployed to meet these unmet needs and improve outcomes more equally for our population
All of this suggests we are going beyond the ‘point of optimality’ – the point of delivering the best balance of benefit to harm to a population. As we remobilise and reform services, we must build towards a more sustainable healthcare system that delivers the better value care we are looking for.
We know that if people are fully involved in decisions about their care, they choose less treatment, or more conservative treatment. They are also far more likely to value the treatment they choose and this reduces waste and potential harm. Practising Realistic Medicine can help us deliver a change in culture where professionals have a clear, forward looking vision to deliver Value Based Health & Care.
Value Based Health & Care (VBH&C)
The definition of Value Based Health & Care (VBH&C) includes the provision of high-quality care. However, it also includes person centred care; care where healthcare professionals work in partnership with the people they care for, to provide care based on what matters most to them – not just “value” based on cost, measurable outcomes, and efficiency metrics. We’d like healthcare professionals – as the stewards of healthcare resources to focus on delivering better value care for both patients and for our health and care system.
Delivering VBH&C will help ensure the long term sustainability of NHSScotland. With access to conventional medical and surgical therapies having been restricted for public health reasons, the need for personalised and value-based care is stronger than ever.
Value Based Health & Care is not about saving money, or delivering efficiencies. It’s about healthcare professionals working with the people they care for, to consider whether a treatment or an investigation is going to be of value. By discussing the evidence, the risk and the benefits of available test and treatment options, we will be able to optimise the use of our precious healthcare resources and reduce harm and waste.
The primary focus of our health and care system should be achieving the outcomes that matter to people focusing on their wellbeing, in both health, care and disease, at the lowest possible cost when building on people’s strengths and targeting our interventions on what really makes a difference. This is the essence of Value Based Health & Care (VBH&C).
A central theme of our Realistic Medicine work has been to engage clinicians in efforts to become stewards of NHS resources by helping them understand that it is their decisions that commit resources. We need to invest in the people, education, tools and training needed so that professionals across the system can understand the principles and practise VBH&C, tackle unwarranted variation and provide the personalised care that will help deliver a sustainable health and care system.
We have run a series of workshops to help us work with our stakeholders to agree and promote the definition of’ ‘Value’ and ‘Value Based Health & Care’ and develop a Value Based Health & Care Strategy that will create a shared understanding and common purpose of what we wish to achieve in Scotland. The feedback from these events is helping to inform the next stages of our strategy development.