Benefit and Impact
ARCH brings together four powerful strands:
- Service Transformation
- Research, Enterprise and Innovation
- Skills and Education
Quantifiable improvement within all four of these areas will lead to both direct and indirect benefits to the wellbeing of the population within the region. The aim of this section is to provide a high-level indication of the extent of benefits that are likely to emerge as a result of the ARCH programme, using the four strands as the basis for such an analysis.
The metric that is widely used to demonstrate improvements in patient outcomes, in general terms, is that of the quality adjusted life year (QALY). One QALY equates to one year of perfect health and is a fundamental requirement of health technology assessments in UK settings, with widespread application across other healthcare systems. The table (below) presents a series of scenarios that highlight the potential value added as a result of QALY gains arising from the seventeen schemes that comprise the ARCH service transformation programme. The current value attached to one QALY equates to £20,000.
The scenarios have been developed to take account of potential QALY gains, the time taken to generate such gains and the value placed on a QALY gain (which, to err on the conservative side, is lower than the accepted NICE threshold value). The first row therefore depicts the position whereby 10% of the ARCH population each ‘receive’ an additional one year of perfect health, which is valued at £10,000 and which will require 5, 10 or 25 years to be produced – again conservatively basing these estimates on the gains being achieved at the end of these time periods.
If every person within the ARCH region were to benefit to the extent of one additional year of perfect health, the value attached to that was £20,000 (as per NICE threshold) and these were generated within a 10-year timescale the potential value added would equate to £14.18 billion.
Given the number of areas classed as being in the most deprived communities in both ABMU and Hywel Dda University Health Board areas, and the differential between rich and poor communities in terms of health life expectancy approaching 20 years for males and 18 years for females within ABMU, for example, these estimates are aligned to those generated by the Public Health Wales Observatory.
It has been estimated that reducing overall mortality from circulatory disease to levels seen in the least deprived areas of Wales would increase life expectancy in the most deprived areas by 1.5 years in males and 1.3 years in females, while similar gains could be made if cancer mortality rates were reduced (1.3 years in males, 1.2 in females). Further, reducing excess deaths from external causes (e.g. accidents, suicide) could have a particularly large effect on males living in the most deprived areas, potentially adding nearly a year to their life expectancy.
The proposed model of care places the patient at its centre and works together with patients and people to co-produce healthier people and communities and deliver better outcomes that matter to people.
We will work with our population to develop local values, focused on the health of our communities. Working with the wider public, third and private sectors, the health boards will implement new regional service models based on the principle of care being provided closer to home.
Expanding access through the development of new infrastructure and redeveloping and redefining the use of existing infrastructure will radically transform patient pathways across the region.
The achievement of these is likely to secure improvements in patient outcomes and narrowing of health inequalities that currently exist across the region.
Furthermore both health boards (and particularly Hywel Dda) are trying to maintain services which in some cases are vulnerable to failure (through lack of appropriately qualified staff and/or low patient volumes). This is directly driving the overspending of both Health Boards.
Tackling the root causes of that spending is extremely important.