This new online monthly briefing from Better Value Healthcare in Oxford will provide the latest information on value, based on work in; Oxford, NHS Right Care, and the International literature, because the paradigm shift can be seen in many countries.

The highlight of the month is the publication of the Second Report of Scotland’s CMO on Realistic Medicine http://www.gov.scot/Resource/0049/00492520.pdf, from Cath Calderwood – CMO Scotland, also read her latest blog on the second annual report – This second report has the great title Realising Realistic Medicine and here is the definition from the Executive Summary “Realistic Medicine puts the person receiving health and care at the centre of decision-making and creates a personalised approach to their care. It aims to reduce harm, waste and unwarranted variation, all while managing risks and innovating to improve. These concepts will be essential to a well-functioning and sustainable NHS for the future.”

Word of the Month: Optimality

‘Optimality is reached when resources or productivity create maximal benefit with the least harm. ‘

Significance: There are two different uses of the term optimality, both important. One developed by Vilfredo Pareto describes the best possible allocation of resources. When Pareto Optimality is reached it is not possible to get more value by switching a pound from anyone budget to another. Another term for this is allocative efficiency, which is different from the technical efficacy with which each budget’ s resources are used. The other meaning is from Avedis Donabedian’s work because he used the term to mean the rate at which a service is being delivered that gives the best balance of benefit to harm to a population.

Book of the Month: Daniels, N. and Sabin, J.E. (2008) Setting Limits Fairly, Learning to Share Resources for Health. (p44) Oxford University Press.

Distilled message:

“Accountability for reasonableness is the idea that the reasons or rationales for important limit-setting decisions should be publicly available. In addition, these reasons must be ones that ‘fair-minded’ people can agree are relevant to pursuing appropriate patient care under necessary resource constraints. This is our central thesis, and it needs some explanation. By ‘fair-minded’, we do not simply mean our friends or people who just happen to agree with us. We mean people who in principle seek to cooperate with others on terms they can justify to each other. Indeed, fair-minded people accept rules of the game –or sometimes seek rule changes –that promote the game’s essential skills and the excitement their use produces.”

Why is this book important?

This is one of the most important texts to help you think about decisions that affect
allocative efficiency or trying to reach “A situation in which it is not possible to
improve the welfare of one person in an economy without making someone else
worse off.”

Radio Value – Soundcloud

https://soundcloud.com/user-134930773/sir-muir-gray-podcast-of-the-month-optimality

Video of the Month: NHS England Board Meeting Video – 9th February 2017