Great innovations of the first and second healthcare revolution

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Great innovations of the first and second
healthcare revolution
The First
The Second
Broad Street - John Snow

• MRI and CT scanning
• Anti psychotics
• Antibiotics
• Genetics
• Hip and knee replacement
• Chemotherapy
• Antidepressants
• Randomised controlled trials
• Systematic reviews

Gower Street - Doll Hill
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- BUT the NHS still faces 5 major problems

• SAFETY
• QUALITY
• FAILURE TO MAXIMISE VALUE
• INEQUALITIES
• FAILURE TO PREVENT
• AND new, additional challenges are developing
• Rising expectations
• Increasing need
• Climate change
• Financial constraints

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• We need to do the right things and, every year,
  do them
• Better,
• Safer,
• Cheaper, and
• Greener (More sustainable)

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Doing the Right Things Cheaper Lowest cost
locationlowest cost stafflowest cost drugs and
technologylowest cost administration
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Sustainable Sustainable Sustainable
Healthcare Estate
Clinical practice
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• We need to do the right things and, every year,
  do them
• Better,
• Safer,
• Cheaper, and
• Greener (More sustainably)

BETTER VALUE HEALTHCARE
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High


Value Low

Value

The economic meaning in the Shorter English
Dictionary is that amount of some commodity,
medium of exchange, etc. which is considered to
be an equivalent for something else, and it
gives as an example of the meaning of the term
the use in 1806, we could hardly be said to have
value for our money.
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Value
Waste
Value
Waste
We hate muda
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Manage. IT
Res Ed
Prevention
Complicated eg Trauma, Very old people
Chronic Health Problems
Diagnosis
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Healthcare Waste
How many patients attend for appointments without
knowing why they are there? How often are tests
repeated because doctors don't know about earlier
results? How many drugs are continued when no
longer needed? How often do patients come on
separate days to see separate teams for related
problems? Are hi-tech interventions most likely
to be chosen, even where alternatives exist?
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• 15Problems of the Musculo Skeletal System
  400M
•  
•  
• Problems of the Respiratory System
  400M
• Obstructive Airways Disease
  70M
• Asthma
  110M
• Problems of the Respiratory System, Other
  220M

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cancer
RESPIRATORY
GASTRO
BVHP The Better Value Healthcare Programme
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APNOEA
BRONCHITIS
cancer
ASTHMA
RESPIRATORY
GASTRO INTESTINAL
BVHP The Better Value Healthcare Programme
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The law of diminishing returns
Benefits
Investment of resources
BVHP The Better Value Healthcare Programme
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Harmful effects increase in direct proportion to
the resources invested
Harmful or Side effects Of care
Investment of resources
BVHP The Better Value Healthcare Programme
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After a certain level of investment the health
gain may start to decline
Benefits
Benefits - harm
Harms
Investment of resources
BVHP The Better Value Healthcare Programme
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HIGH VALUE LOWER VALUE
Generic statins Non generic statins
Repair of cruciates for occupational reasons repair for leisure reasons
Walking and weight loss for knee OA arthroscopic washout of knee
Advice on self care for rhinitis turbinectomy operation
One cycle IVF three cycle IVF


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High High

Carbon
Value Low
Low
Value
Carbon
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What should public health do for
healthcare?Using the power of knowledge,
citizens and the InternetCreate systems and
Change the culture
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This is an example of a national service set
up as a system
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Ideas and Information
Patient Clinician
Knowledge
System
Information
Ideas and Information
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www.healthcaresystemsprogramme.org
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www.healthcarecultureprogramme.org
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