Evaluating the national NHS RightCare programme

Following five years of delivery and a change of leadership, as part of the NHS England and NHS Improvement restructure, the national NHS RightCare programme needed an independent evaluation.

Focusing on the extent to which RightCare was achieving its objectives, how this was supported by the programme’s ‘theory of change’ and future potential changes, Arden & GEM’s service transformation experts designed a tailored evaluation approach.

A wide-ranging interview programme was delivered, with insights themed and detailed in a final project report, along with recommendations to further improve the programme.

The challenge

NHS RightCare is a national programme aimed at supporting healthcare systems to improve population health, reduce unwarranted variation and achieve sustainable finance. Following the restructure of NHS England and NHS Improvement, in 2019, NHS RightCare moved under the Improvement Directorate as one of a suite of national tools to support system-wide improvement.

To fully understand the extent to which the programme was achieving its overall objectives and to identify potential future changes in its support of local health and care systems – as they look to implement the NHS Long Term Plan – a programme evaluation was required. The evaluation needed to gain insight at a CCG, STP and ICS level into the activities, outputs and outcomes of the RightCare programme.

Having worked with the national RightCare team since its inception in 2015, Arden & GEM was tasked with undertaking an independent evaluation, drawing upon the service transformation team’s expertise in research methods and direct knowledge of the programme, both locally and nationally.

Our approach

The CSU developed an evaluation approach comprising three phases:

1. a national survey to explore a broad range of views on the programme and components of the logic model that could be assessed more readily using quantitative methods
2. interviews with organisational representatives throughout NHS England and NHS Improvement regions to explore how the improvement outputs relate to the system and methodology outcomes of the programme, and the links between activities, outputs and outcomes
3. triangulation of the findings from phases one and two to consider the extent to which the programme’s current ‘theory of change’ helps to achieve its objectives.

Gathering insights
Interviews were undertaken with contacts from four regions and included a diverse range of participants from clinicians to commissioners to service redesign leaders. Feedback from the interviews was analysed and informed a number of thematic findings:

• Acceptability and utility - exploring RightCare data is a good starting point and identifies potential opportunities. It needs to be supported by local intelligence to fully explore context to enable opportunities to be realised.
• The role of delivery partners and wider access to support was found to be an important resource to local healthcare economies to help interpret data packs and contextualise data to ensure relevance to clinical (and other) audiences.
• Planning, reporting and monitoring – systems highlighted that appropriate metrics (and baseline data) to measure outcomes are important. Also, they felt it was too early to see the impact of specific RightCare interventions.
• Improved health outcomes – participants felt there are too many variables to attribute improvements directly to the programme; however, RightCare shows systems where to start looking and what to focus on.

Client engagement
The Arden & GEM team worked directly with the National Programme Evaluation Lead at NHS England and NHS Improvement, using weekly update calls and regular highlight reports to keep the client informed of work completed, planned activity and project milestones. This regular contact and communication helped the project to respond flexibly to changes in scope, such as a pause in phase one (national survey) of the approach following a staff consultation in respect of NHS England and NHS Improvement becoming a single organisation.

The outcomes

A wide-ranging interview programme was delivered, with insights themed and detailed in a final project report, along with recommendations to further improve the programme.

Recommendations – which included focusing on ‘value’ rather than cost savings, using appropriate measures to capture potential opportunities, and providing timely up-to-date data – reflect the shift nationally to ensure an integrated toolset to support system-level improvement activities.

The final report informed the Improvement Directorate’s ongoing work with regions to develop the RightCare programme to support systems for future planning rounds.