Commissioning for Value Where to Look pack

Transcription

1 Commissioning fo Value Whee to Look pack Suffolk and Noth East Essex - STP aea Decembe 2016 Neuological Apil 2016

2 Contents Intoduction to you Whee to Look pack Suppoting the STP pocess NHS RightCae and Getting it Right Fist Time (GIRFT) You data Next steps and actions Futhe suppot and infomation Useful links The NHS RightCae pogamme NHS RightCae and Commissioning fo Value 2

3 Intoduction to you Whee to Look pack What s in this pack? This pack contains data fom the CCG Commissioning fo Value Whee to Look packs, published in Octobe 2016, collated at STP footpint level. The data in this pack includes headline oppotunities, impovement oppotunity tables and slides showing how CCGs in each STP diffe fom thei pees. An STP oppotunity is the sum of all the euivalent oppotunities of the CCGs in that aea. They do not include negative oppotunities o those which ae statistically insignificant. Why you STP aea should eview it The infomation contained in this pack is pesonalised fo each STP footpint aea and can be used to help suppot local discussions about pioitisation to impove the value and utilisation of esouces. By using this infomation each STP aea will be able to ensue its plans focus on those oppotunities which have the potential to povide the biggest impovements in health outcomes, esouce allocation and educing ineualities. Legal duties NHS England, Public Health England and CCGs have legal duties unde the Health and Social Cae Act 2012 with egad to educing health ineualities; and fo pomoting euality unde the Euality Act One of the main focuses fo the Commissioning fo Value seies has always been educing vaiation in outcomes. Commissiones should continue to use these packs and the suppoting tools to dive local action to educe ineualities in access to sevices and in the health outcomes achieved. 3

4 Suppoting the STP pocess This pack has been ceated to align with the new Sustainability and Tansfomation Planning (STP) pocess. Local sevice leades in evey pat of England ae woking togethe fo the fist time on shaed plans to tansfom health and cae in the divese communities they seve. Commissioning fo Value (CfV) suppots CCGs and STP footpint aeas by poviding the most up to date data available. Expenditue data is fom 2015/16. Outcomes data is the latest available at time of publication. The time peiod fo each pathway on a page indicato is included on the chat. In addition the key indicatos fom the seven focus packs (oiginally published in Apil/May 2016) will be efeshed in the CfV online tools in ealy In the meantime, CCGs and local health economies will still be able to use the 2016 focus packs fo futhe investigations as an indication of what to change. Unless a CCG has taken action along a paticula pathway, thei elative position is unlikely to have alteed. 4

5 NHS RightCae and Getting it Right Fist Time (GIRFT) NHS RightCae and GIRFT ae complementay pogammes and should be used togethe to suppot the delivey of population healthcae impovement and financial sustainability. NHS RightCae s Commissioning fo Value woksteam suppots impovement acoss systems by focusing on pathways of cae fom pimay pevention to end of life cae. Whilst suppoting impovement in tems of access to and outcomes fom the acute secto, Commissioning fo Value has not focused in detail on hospital cae. GIRFT povides detailed insight into vaiation in the acute system in a way that has not been available befoe. As such NHS RightCae and GIRFT collectively povide clinical impovement insight acoss the entie health cae system. In 2017 NHS RightCae and GIRFT will be woking closely togethe to suppot STPs and thei local health economies. This will begin with a complementay set of analysis on othopaedic pathways. This pack suppots STP thinking on this collective agenda, including by highlighting oppotunities fo impovement such as by coodinating the eallocation of capacity in the acute system, something that can only be achieved togethe. See pages 9 and 10. 5

6 Headline oppotunity aeas fo Suffolk and Noth East Essex The numbe in the gey cicles below epesents how many CCGs within Suffolk and Noth East Essex shae a paticula oppotunity aea out of 3 CCGs within the STP Spend & Outcomes Outcomes Spend 3 Gasto-intestinal 3 Gasto-intestinal 3 Ciculation 3 Neuological 3 Endocine 3 Neuological 3 Endocine 2 Mental Health 2 Cance 2 Mental Health 1 Cance 2 Gasto-intestinal 1 Ciculation 1 Musculoskeletal 2 Respiatoy These headline lists ae based on the contibuting CCGs which fom the STP. The figue in the gey cicle epesents the numbe of times each pogamme appeas in each individual CCG headline list. This is simply the numbe of CCGs in the STP with a common pogamme as a headline oppotunity. It does not facto in the elative scale of each of the oppotunities fo this anking. E.g. an STP with six CCGs may have all six CCGs with a cance spend oppotunity totalling 3m. In this example, cance would ank above espiatoy which appeas in the list fo five CCGs but has a total oppotunity of 4m. This can be exploed futhe in the detailed sections of this pack. 6

7 Which CCGs in Suffolk and Noth East Essex - STP shae headline oppotunity aeas? Spend & Outcomes Outcomes Spend Gasto-intestinal Neuological Endocine Mental Health Ciculation Gasto-intestinal Endocine Mental Health Cance Musculoskeletal Ciculation Neuological Cance Gasto-intestinal Respiatoy Ipswich and East Suffolk, West Suffolk, Noth East Essex Ipswich and East Suffolk, West Suffolk, Noth East Essex Ipswich and East Suffolk, West Suffolk, Noth East Essex Ipswich and East Suffolk, West Suffolk West Suffolk Ipswich and East Suffolk, West Suffolk, Noth East Essex Ipswich and East Suffolk, West Suffolk, Noth East Essex Ipswich and East Suffolk, West Suffolk Noth East Essex Noth East Essex Ipswich and East Suffolk, West Suffolk, Noth East Essex Ipswich and East Suffolk, West Suffolk, Noth East Essex Ipswich and East Suffolk, West Suffolk Ipswich and East Suffolk, West Suffolk West Suffolk, Noth East Essex 7

8 What ae the potential lives saved pe yea? A value is only shown whee the oppotunity is statistically significant If the CCGs within the STP pefomed at the aveage of: Simila 10 CCGs Best 5 of simila 10 CCGs Cance Neuological Ciculation Respiatoy 11 Gasto Intestinal 11 5 Tauma and Injuies Total Lives Saved The motality data pesented above uses Pimay Cae Motality Database (PCMD) and is fom 2012 to The potential lives saved oppotunities ae calculated on a yealy basis and ae only shown whee statistically significant. Lives saved only includes pogammes whee motality outcomes have been consideed appopia te. 8

9 Coodinating the e-allocation of capacity Impoving a population healthcae system to become high value and optimal euies significant change. It euies change in the pactices and pespectives of all of the pofessions, people and patnes engaged in the system. It euies change in how we engage with individual patients and how we engage with ou local communities, so that we infom and then seek to undestand thei pespectives and thei pefeences. It euies change in how we opeate and think about ou oganisational stuctues, plans and asset models. And, most impotantly of all, it euies us to embace, collectively and individually, the need to make these changes. Vaiation data, as contained in the suite of Commissioning fo Value packs, highlights that in evey health system in England, thee exists a significant volume of oveuse alongside significant undeuse. Oveuse leads to waste and ham. Undeuse leads to a failue to pevent disease and ineuity. Reducing both leads to a bette and moe sustainable system. In ode to do this well, we must wok togethe to coodinate the e-allocation of capacity fom unwaanted activity to waanted activity, wheeve in the system that may be. 9

10 Coodinating the e-allocation of capacity The next page highlights the potential oveuse in bed days fo you STP aea, as implied by vaiation data fo each of you constituent health economies. STP aeas ae able to use this infomation to focus on the oppotunity to fee up bed capacity, and ask the uestions Is this cuent bed use adding value? and Whee might we bette use this capacity and esouce?. In tun this will allow fo discussion and consensus to be eached on whee beds add moe value if e-allocated fo diffeent use. It also allows fo discussion and consensus on what cuent capacity a system could avoid the need fo, if esouces wee e-allocated fo non-bed use, to delive optimal clinical pathways and systems. Avoiding the need fo capacity, in this way, is a key component of deliveing a sustainable healthcae system. Fully integated cae is vey likely to be a key pat of these discussions. Identifying togethe Whee to Look and then designing optimal pathways and systems, that is, What to Change, by collectively answeing the uestion What would we look like if we wee doing the vey best fo ou population?, is the optimal means of achieving this. 10

11 How diffeent ae we on bed days? A value is only shown whee the oppotunity is statistically significant If the CCGs within the STP pefomed at the aveage of: Simila 10 CCGs Lowest 5 of simila 10 CCGs Cance 8,373 9,104 Endocine, nutitional & metabolic 1, Neuological 4,114 8,470 Ciculation 6,070 7,617 Respiatoy 4,253 2,712 Gasto Intestinal Musculo Skeletal Tauma and Injuies Genito Uinay 1,966 1,317 2,789 3, ,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000 20,000 Bed Days The bed days data pesented above uses Seconday Use Sevices Extact Mat (SUS SEM) and is fom financial yea 2015/16. The calculations in this slide ae based on admissions fo any pimay diagnoses that fall unde the listed conditions (based on Pogamme Budgeting classifications which ae in tun based on the Wold Health Oganisation s Intenational Classification of Diseases). This only includes admissions coveed by the mandatoy payment by esults taiff and includes NHS England Diect Commissioning activity. These figues ae a combination of elective and non -elective admissions. Length of stay is deived fom admission and dischage date. Spells that have the same admission and dischage date (includin g planned day cases) have a length of stay in SUS as zeo. These have been ecoded as a length of stay of 1 day in ode to captue the impact of these admissions on total bed days fo a CCGs. 11

12 How diffeent ae we on spend on elective admissions? A value is only shown whee the oppotunity is statistically significant If the CCGs within the STP pefomed at the aveage of: Simila 10 CCGs Lowest 5 of simila 10 CCGs Cance 2,538 2,379 Endocine, nutitional & metabolic Neuological Ciculation 1,767 1,547 Respiatoy 1, Gasto Intestinal 796 Musculo Skeletal 2,317 Tauma and Injuies 104 Genito Uinay 1, ,000 2,000 3,000 4,000 5,000 6,000 The spend data pesented above uses Seconday Use Sevices Extact Mat (SUS SEM) and is fom financial yea 2015/16. Total Diffeence ( 000s) The calculations in this slide ae based on expenditue on admissions fo any pimay diagnoses that fall unde the listed co nditions (based on Pogamme Budgeting classifications which ae in tun based on the Wold Health Oganisation s Intenational Classification of Diseases). This only includes expenditue on admissions coveed by the mandatoy payment by esults taiff and includes NHS England Diect Commissioning expenditue. CCGs can exploe this expenditue in moe detail using the Commissioning fo Value Focus Packs. Fo example, Neuological expenditue contains Chonic Pain, and the focus pack beaks this down by diffeent types of Pain. CCGs should conside whethe these admissions should be consideed alongside othe pogammes e.g. CVD, Gastointestinal, Musculoskeletal poblems 12

13 How diffeent ae we on spend on non-elective admissions? A value is only shown whee the oppotunity is statistically significant If the CCGs within the STP pefomed at the aveage of: Simila 10 CCGs Best 5 of simila 10 CCGs Cance Endocine, nutitional & metabolic Neuological Ciculation 2,842 2,777 2,113 2,478 Respiatoy 1,631 1,781 Gasto Intestinal Musculo Skeletal ,983 Tauma and Injuies 640 1,035 Genito Uinay ,000 2,000 3,000 4,000 5,000 6,000 Total Diffeence ( 000s) The spend data pesented above uses Seconday Use Sevices Extact Mat (SUS SEM) and is fom financial yea 2015/16. The calculations in this slide ae based on expenditue on admissions fo any pimay diagnoses that fall unde the listed co nditions (based on Pogamme Budgeting classifications which ae in tun based on the Wold Health Oganisation s Intenational Classification of Diseases). This only includes expenditue on admissions coveed by the mandatoy payment by esults taiff and includes NHS England Diect Commissioning expenditue. CCGs can exploe this expenditue in moe detail using the Commissioning fo Value Focus Packs. Fo example, Neuological expenditue contains Chonic Pain, and the focus pack beaks this down by diffeent types of Pain. CCGs should conside whethe these admissions should be consideed alongside othe pogammes e.g. CVD, Gastointestinal, Musculoskeletal poblems 13

14 How diffeent ae we on spend on pimay cae pescibing? A value is only shown whee the oppotunity is statistically significant If the CCGs within the STP pefomed at the aveage of: Simila 10 CCGs Lowest 5 of simila 10 CCGs Cance Endocine, nutitional & metabolic 2,678 1,678 Mental Health Poblems 2, Neuological 3,295 1,404 Ciculation 460 1,001 Respiatoy 1, Gasto Intestinal Musculo Skeletal Tauma and Injuies Genito Uinay ,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500 5,000 Total Diffeence ( 000s) The pescibing data pesented above uses Net Ingedient Cost (NIC) fom epact.com povided by the NHS Business Sevices Auth oity and is fom financial yea 2015/16. Each individual BNF chemical is mapped to a Pogamme Budget Categoy and aggegated to fom a pogamme total. The indicatos ha ve been standadised using the ASTRO-PU weightings. Oppotunities have been shown to the CCGs simila 10 and the lowest 5 CCGs. Pescibing oppotunities ae fo local intepet ation and should be viewed in conjunction with the individual disease pathways. Moe detailed analyses of pescibing data, outlie pactices, and time tends can be poduced apidly using the following e souce: 14

15 Impovement oppotunities This table pesents oppotunities fo uality impovement and spend diffeences fo a ange of pogamme aeas. These ae based on compaing the CCGs within Suffolk and Noth East Essex STP to the best / lowest 5 CCGs. A uantified unit is only shown when the oppotunity is statistically significant. Disease Aea Spend 000 Quality Spend on elective and day-case admissions 4,917 Cance and Tumous - Rate of bed days Spend on non-elective admissions 1,108 Motality fom all cances unde 75 yeas Spend on pimay cae pescibing 1,035 Beast cance sceening % fist definitive teatment within 2 months (all cance) Motality fom beast cance unde 75 yeas Bowel cance sceening Motality fom coloectal cance unde 75 yeas Successful uittes, 16+ Cance & Tumous Motality fom lung cance unde 75 yeas Motality fom all cances all ages No. of patients, life-yeas, efeals, etc. 17, , ,

16 Impovement oppotunities This table pesents oppotunities fo uality impovement and spend diffeences fo a ange of pogamme aeas. These ae based on compaing the CCGs within Suffolk and Noth East Essex STP to the best / lowest 5 CCGs. A uantified unit is only shown when the oppotunity is statistically significant. Disease Aea Spend 000 Quality Spend on elective and day-case admissions 3,313 Ciculation - Rate of bed days Spend on non-elective admissions 5,255 Repoted to estimated pevalence of CHD Spend on pimay cae pescibing 1,460 Repoted to estimated pevalence of hypetension Patients with CHD whose BP < 150/90 Patients with CHD whose cholesteol < 5 mmol/l Patients with hypetension whose BP < 150/90 Motality fom CHD unde 75 yeas Motality fom acute MI unde 75 yeas Patients with stoke/tia whose BP < 150/90 % stoke/tia patients on antiplatelet o anticoagulant Ciculation Poblems (CVD) Stoke patients spending 90% of thei time on stoke unit % patients etuning home afte teatment Motality fom stoke unde 75 yeas High-isk AF patients on anticoagulation theapy Repoted to estimated pevalence of AF Patients who go diect to a stoke unit (uate) No. of patients, life-yeas, efeals, etc. 13,687 4,376 8, ,770 2, , Endocine, Nutitional and Metabolic Poblems Spend on elective and day-case admissions Spend on non-elective admissions Spend on pimay cae pescibing 451 Endocine - Rate of bed days 748 % diabetes patients whose cholesteol < 5 mmol/l 4,356 % diabetes patients whose HbA1c is <59 mmol/mol % diabetes patients whose blood pessue is <140/80 % of diabetes patients eceiving all thee teatment tagets % patients eceiving foot examination Retinal sceening % diabetes patients attending stuctued education 2,589 1,108 1, , ,

17 Impovement oppotunities This table pesents oppotunities fo uality impovement and spend diffeences fo a ange of pogamme aeas. These ae based on compaing the CCGs within Suffolk and Noth East Essex STP to the best / lowest 5 CCGs. A uantified unit is only shown when the oppotunity is statistically significant. Disease Aea Spend 000 Quality Spend on elective and day-case admissions 796 Gasto - Rate of bed days Spend on non-elective admissions 2,551 Motality fom gastointestinal disease unde 75 yeas Spend on pimay cae pescibing 778 Motality fo live disease unde 75 yeas % 6+ week waits fo a gastoscopy (4 month snapshots) Alcohol specific hospital admissions Emegency admissions fo alcoholic live disease condition (19+) Rate of emegency gastoscopies Emegency admissions fo Uppe GI bleeds Emegency admissions fo Peptic Ulceations Gastointestinal Repoted Clostidium difficile cases % 6+ week waits fo a colonoscopy (4 month snapshots) Rate of emegency colonoscopies Emegency admissions fo diveticula disease Emegency admissions fo gastoenteitis (0-4) Emegency admissions fo gastoenteitis (5+) No. of patients, life-yeas, efeals, etc. 1, Genitouinay Spend on elective and day-case admissions Spend on non-elective admissions Spend on pimay cae pescibing 1,965 Genitouinay - Rate of bed days 1,099 Repoted to estimated pevalence of CKD 1,493 Patients on CKD egiste with a BP of 140/85 o less Patients on CKD egiste teated with an ACE-1 o ARB Ceatinine atio test used in last 12 months % home dialysis undetaken % of patients on RRT who have a tansplant 3,194 4, ,

18 Impovement oppotunities This table pesents oppotunities fo uality impovement and spend diffeences fo a ange of pogamme aeas. These ae based on compaing the CCGs within Suffolk and Noth East Essex STP to the best / lowest 5 CCGs. A uantified unit is only shown when the oppotunity is statistically significant. Disease Aea Spend 000 Quality Flu vaccine take-up by pegnant women Smoking at time of delivey Live and still biths <2500 gams Beastfeeding initiation (fist 48 hs) Infant motality ate Emegency gastoenteitis admissions ate fo <1s Emegency LRTI admissions ate fo <1s Matenity & Repoductive Health % eceiving 3 doses of 5-in-1 vaccine by age 2 A&E attendance ate fo <5s Emegency admissions ate fo <5s Unintentional & delibeate injuy admissions fo <5s Hospital admissions fo dental caies (1-4 yeas) % eceiving 1 dose of MMR vaccine by age 2 No. of patients, life-yeas, efeals, etc ,394 3, Spend on pimay cae pescibing 2,974 Motality fom suicide and injuy undetemined all ages 10 Mental Health Poblems (all) 18

19 Impovement oppotunities This table pesents oppotunities fo uality impovement and spend diffeences fo a ange of pogamme aeas. These ae based on compaing the CCGs within Suffolk and Noth East Essex STP to the best / lowest 5 CCGs. A uantified unit is only shown when the oppotunity is statistically significant. Disease Aea Spend 000 Quality New cases of depession which have been eviewed Assessment of seveity of depession at outset IAPT efeals with a wait <28days (uate) Completion of IAPT teatment (uate) IAPT: % efeals with outcome measued (6 months) IAPT: % 'moving to ecovey' ate (uate) Mental Health Poblems (common) IAPT: % achieving 'eliable impovement' (uate) Emegency hospital admissions fo self ham No. of patients, life-yeas, efeals, etc , Mental Health Poblems (sevee) Physical health checks fo patients with SMI % Sevice uses on CPA (end of uate snapshot) Mental health hospital admissions People subject to mental health act (uate) Excess unde 75 motality ate in adults with seious mental illness % adults on CPA in settled accommodation (end of uate snapshot) % of EIP efeals waiting >2 wks to stat teatment (Incomplete) (5m) % of EIP efeals waiting <2 wks to stat teatment (Complete) (5m) 94 1,

20 Impovement oppotunities This table pesents oppotunities fo uality impovement and spend diffeences fo a ange of pogamme aeas. These ae based on compaing the CCGs within Suffolk and Noth East Essex STP to the best / lowest 5 CCGs. A uantified unit is only shown when the oppotunity is statistically significant. Disease Aea Spend 000 Quality Mental Health Poblems (dementia) Motality with dementia, 65+ % dementia deaths in usual place of esidence (65+) % shot stay emegency admissions aged 65+ with dementia % new dementa diagnosis with blood test Dementia diagnosis ate (65+) Rate of emegency admissions aged 65+ with dementia % of dementia patients with cae eviewed No. of patients, life-yeas, efeals, etc , Musculoskeletal System Poblems (Excludes Tauma) Spend on elective and day-case admissions Spend on non-elective admissions Spend on pimay cae pescibing Spend on admissions elating to factues whee a fall occued 2,317 MSK - Rate of bed days 360 % osteopoosis patients teated with Bone Spaing Agent 435 % patients 75+ yeas with fagility factue teated with BSA 327 Hip eplacement, EQ-5D Index, aveage health gain Knee eplacement, EQ-5D Index, aveage health gain Hip eplacement emegency eadmissions 28 days Hip factues in people aged 65+ Hip factues in people aged Hip factues in people aged 80+ Hip factue emegency eadmissions 28 days 1, Neuological System Poblems Spend on elective and day-case admissions Spend on non-elective admissions Spend on pimay cae pescibing 1,339 Neuological - Rate of bed days 4,956 Emegency admission ate fo childen with epilepsy aged 0 17 yeas 4,700 Patients with epilepsy on dug teatment and convulsion fee, , Note: Spend on admissions elating to factues whee a fall occued is a sub-set of Tauma and Injuies non-elective spend and is not included in the spend fo oveall MSK non-elective admissions. This indicato as well as Rates of hip factues, Emegency eadmissions to hospital within 28 days fo patients: hip factues and % patients etuning to usual place of esidence following hospital teatment fo factued femu appea in the uality section of the impovement oppotunities table fo both Tauma & Injuies and MSK table. This is due to it being in the Tauma & Injuy pathway as well as the Osteopoosis pathway. Oppotunities fo these five indicatos have only contibuted to the headline; Spend, Outcomes (and hence Spend and Outcomes ) fo MSK only. 20

21 Impovement oppotunities This table pesents oppotunities fo uality impovement and spend diffeences fo a ange of pogamme aeas. These ae based on compaing the CCGs within Suffolk and Noth East Essex STP to the best / lowest 5 CCGs. A uantified unit is only shown when the oppotunity is statistically significant. Disease Aea Spend 000 Quality Spend on elective and day-case admissions 1,846 Respiatoy - Rate of bed days Spend on non-elective admissions 3,412 Motality fom bonchitis, emphysema and COPD unde 75 yeas Spend on pimay cae pescibing 2,608 Motality fom asthma all ages Repoted to estimated pevalence of COPD % of COPD patients with a ecod of FEV1 % of COPD patients with eview (12 months) Respiatoy System Poblems % patients (8ys+) with asthma (vaiability o evesibility) % asthma patients with eview (12 months) Emegency admission ate fo childen with asthma, 0-19ys % of COPD patients with a diagnosis confimed by spiomety No. of patients, life-yeas, efeals, etc. 6, , Tauma & Injuies Spend on elective and day-case admissions Spend on non-elective admissions Spend on pimay cae pescibing Spend on admissions elating to factues whee a fall occued 104 Tauma and injuies - Rate of bed days 1,676 Motality fom accidents all ages 16 Injuies due to falls in people aged All factue admissions in people aged 65+ Hip factues in people aged 65+ Hip factues in people aged Hip factues in people aged 80+ Hip factue emegency eadmissions 28 days 2,

22 How to ead you STP pathways The following slides povide a moe detailed look at 19 'Pathways on a page' fo each CCG within the STP. The intention of these pathways is not to povide a definitive view, but to help commissiones exploe potential oppotunities. These slides help to undestand how pefomance in one pat of the pathway may affect outcomes futhe along the pathway. Each ow in the matix epesents a CCG in you STP aea and how it compaes to its simila 10 CCGs acoss that pathway. The simila 10 CCGs ae not necessaily in the same STP. These Pathways on a Page allow an STP to examine which pogammes have common oppotunities fo seveal CCGs acoss the entie pathway, o fo pat of a pathway (such as pimay cae o detection) fo seveal CCGs. Theefoe, STPs may find it useful to scan the chats both hoizontally and vetically. The key to the ight shows how to intepet the coloued suaes and aows. The STP oppotunities undeneath each indicato name sum the CCG oppotunities benchmaked against the aveage of the best 5 CCGs, unlike the coloued suaes which benchmak against the aveage of the simila 10 CCGs. Oppotunities ae calculated fo all RAG-ated indicatos except fo the stated exceptions. p s tu s s tu CCG is statistically significantly HIGHER CCG is statistically significantly LOWER CCG HIGHER but not statistically significant CCG LOWER but not statistically significant CCG is eual to benchmak CCG WORSE/HIGHER but not statistically significant CCG WORSE/LOWER but not statistically significant CCG BETTER/HIGHER but not statistically significant CCG BETTER/LOWER but not statistically significant CCG is eual to benchmak CCG is statistically significantly WORSE CCG is statistically significantly BETTER CCG has no published data fo this indicato o value is suppessed due to small numbes 22

23 Beast cance pathway / / / / / / (2011) Depivation Beast cance pevalence Incidence of beast cance Obesity pevalence, 16+ Beast cance sceening Pimay cae pescibing spend Ugent GP efeals (beast cance) % fist definitive teatment within 2 months (all cance) Emegency pesentations fo beast cance Elective spend Beast cance detected at an ealy stage <75 Motality fom beast cance 1 yea suvival (beast) STP oppotunity (to Best 5) Ipswich and East Suffolk West Suffolk Noth East Essex 1,263 Ppl. 196 Pats. 12 Lives p p p s p s p p p s s p s p Note: We do not calculate potential oppotunities fo emegency pesentations and one-yea suvival ates owing to missing infomation in published data. 23

24 Lowe gasto-intestinal cance pathway / / / / / / (2011) Depivation Coloectal cance pevalence Incidence of coloectal cance Obesity pevalence, 16+ Bowel cance sceening Ugent GP efeals (coloectal cance) % fist definitive teatment within 2 months (all cance) Emegency pesentations fo coloectal cance Elective spend Non-elective spend Lowe GI cance detected at an ealy stage <75 Motality fom coloectal cance 1 yea suvival (coloectal) STP oppotunity (to Best 5) Ipswich and East Suffolk p p West Suffolk p s Noth East Essex p 2,427 Ppl. 196 Pats. p p s s s p s 336K 9 Lives p s s s p s s Note: We do not calculate potential oppotunities fo emegency pesentations and one-yea suvival ates owing to missing infomation in published data. 24

25 Lung cance pathway / / / / / / / (2011) Depivation Lung cance pevalence Incidence of lung cance Smoking pevalence, 18+ Obesity pevalence, 16+ Successful uittes, 16+ Ugent GP efeals (lung cance) % fist definitive teatment within 2 months (all cance) Emegency pesentations fo lung cance Elective spend Non-elective spend Lung cance detected at an ealy stage <75 Motality fom lung cance 1 yea suvival (lung) STP oppotunity (to Best 5) Ipswich and East Suffolk p s West Suffolk p s Noth East Essex p 777 Ppl. 196 Pats. p s p s p 214K 29 Lives s p p s Note: We do not calculate potential oppotunities fo emegency pesentations and one -yea suvival ates owing to missing infomation in published data. 25

26 Sevee mental illness pathway Apil Apil /16 Q / / / /16 Q2 2015/16 Q4 2015/16 Q4 2014/15 August 2016 August 2016 (Yea End) Depivation Estimate of people with a psychotic disode People with SMI known to GPs: % on egiste Pimay cae pescibing spend Physical health checks % of EIP efeals waiting <2 wks to stat teatment (Complete) % of EIP efeals waiting >2 wks to stat teatment (Incomplete) New cases of psychosis seved by Ealy Intevention teams People teated by Ealy Intevention Teams People on Cae Pogamme Appoach % Sevice uses on CPA Mental health hospital admissions 2015/16 Q2 2015/16 Q2 2015/16 Q2 People subject to mental health act People on CPA in employment % adults on CPA in settled accommodatio n STP oppotunity (to Best 5) 94 Pats. 6 Pats. 6 Pats. Ipswich and East Suffolk p p p p s s p West Suffolk p p s s s Noth East Essex p p p p s p p p 1,715 Pats. 454 Adm. 79 Ppl. 404 Ppl. s Note: Thee is vaiation in the uality of cae coodination unde CPA, meaning CCGs have not been anked bette/wose than thei simila pees fo these indicatos. Howeve, because it is ecommended that moe uses should be offeed CPA suppot, oppotunity figues have been povided fo % sevice uses on CPA. 26

27 Common mental health disodes pathway / / / / /16 Q4 2015/16 Q4 Oct Ma 2016 Oct Ma /16 Q4 2015/16 Q4 Depivation % population with LLTI o disability Estimated pevalence of CMHD (% pop) Depession pevalence 18+ New cases of depession which have been eviewed Antidepessant pescibing IAPT efeals: Rate aged 18+ IAPT: Rate beginning teatment IAPT: % waiting <6 weeks fo fist teatment IAPT: % efeals with outcome measued IAPT: % 'moving to ecovey' ate IAPT: % achieving 'eliable impovement' STP oppotunity (to Best 5) Ipswich and East Suffolk p West Suffolk p Noth East Essex p p 803 Pats. p p p p p p p p s 33 Pats. 240 Pats. 268 Pats. s s s s Note: It isn t possible to obustly calculate an oppotunity of numbe of additional people who should be efeed into IAPT. 27

28 Dementia pathway / /16 Sep 2015 Aug / / / / / % physically inactive adults Smoking pevalence, 18+ Hypetension pevalence, 18+ Dementia pevalence 65+ Dementia diagnosis ate (65+) % new dementa diagnosis with blood test % dementia patients with cae eviewed Ratio of Inpatient Sevice Use to Recoded Diagnoses Rate of % shot stay emegency emegency admissions aged admissions aged 65+ with dementia 65+ with dementia 65+ motality with dementia % dementia deaths in usual place of esidence (65+) STP oppotunity (to Best 5) Ipswich and East Suffolk s West Suffolk p Noth East Essex s 689 Ppl. 29 Pats. 196 Pats. p p s s p s s s p 1,467 Adm. 242 Adm. 71 Lives 49 Deaths s s s 28

29 Heat Disease pathway 2015/ / / / / / / / / / / / CHD pevalence Hypetension pevalence, 18+ Repoted to estimated pevalence of CHD Repoted to estimated pevalence of hypetension Smoking pevalence, 18+ Obesity pevalence, 16+ % CHD patients whose BP < 150/90 % CHD patients cholesteol < 5 mmol/l % hypetension patients whose BP < 150/90 Pimay cae pescibing spend Elective spend Non-elective spend <75 Motality fom CHD <75 Motality fom acute MI STP oppotunity (to Best 5) Ipswich and East Suffolk p West Suffolk Noth East Essex s 4,376 Ppl. 8,610 Ppl. 560 Pats. 2,770 Pats. 2,917 Pats. 2471K 9 Lives 7 Lives p s p p s s p s p s s s s p s s 29

30 Stoke pathway Jan-Ma Jan-Ma 2015/ / / / / / / / / / / Jan-Ma /10-11/ / Stoke o TIA Pevalence, 18+ Smoking pevalence, 18+ Obesity pevalence, 16+ Repoted to estimated pevalence of AF % stoke/tia patients whose BP < 150/90 % stoke/tia patients on antiplatelet o anticoagulan t High-isk AF patients on anticoagulati on theapy Pimay cae pescibing spend % who go diect to a stoke unit % who eceive thombolysis Patients 90% of time on stoke unit Elective spend Non-elective spend % teated by ealy suppoted dischage team Emegency eadmission s within 28 days % patients etuning home afte teatment <75 Motality fom stoke STP oppotunity (to Best 5) Ipswich and East Suffolk s p s West Suffolk p Noth East Essex s s 1,961 Ppl. 191 Pats. 57 Pats. 588 Pats. 14 Pats. 38 Pats. 736K 64 Pats. 7 Lives p s s s p s s s s s 30

31 Diabetes pathway 2015/ / / / / / / / / / /16 Diabetes pevalence, 17+ Obesity pevalence, 16+ % diabetes patients cholesteol < 5 mmol/l % diabetes patients HbA1c is <59 mmol/mol % diabetes patients whose BP < 140/80 % of diabetes patients eceiving all thee teatment tagets % patients eceiving foot examination Retinal sceening % diabetes patients attending stuctued education Pimay cae pescibing spend Non-elective spend STP oppotunity (to Best 5) Ipswich and East Suffolk p West Suffolk Noth East Essex 1,108 Pats. 1,976 Pats. 703 Pats. 1,599 Pats. 632 Pats. 2,191 Pats. 409 Pats. 445K p p 31

32 Renal pathway 2015/ / / / / / / / / Repoted CKD pevalence Repoted to estimated pevalence of CKD % CKD patients whose BP < 140/85 % on CKD egiste with hypetension & poteinuia teated with ACE-I o ARB Ceatinine atio test used in last 12 months Pimay cae pescibing spend Nephology fist outpatient attendance ate Elective spend Non-elective spend Acceptance ate fo enal eplacement theapy % home dialysis undetaken % of patients on RRT who have a tansplant STP oppotunity (to Best 5) Ipswich and East Suffolk p West Suffolk Noth East Essex s 4,372 Ppl. 778 Pats. 91 Pats. 2,065 Pats. s p p s s p p s p p p 806K 23 Pats. 23 Pats. s s s s 32

33 COPD pathway 2015/ / / / / / / / COPD Pevalence Repoted to estimated pevalence of COPD Smoking pevalence, 18+ % COPD patients diagnosis confimed by spiomety % of COPD patients with a ecod of FEV1 % of COPD patients with eview (12 months) Pimay cae pescibing spend Non-elective spend <75 motality fom bonchitis, emphysema and COPD STP oppotunity (to Best 5) Ipswich and East Suffolk West Suffolk Noth East Essex p p 1,654 Ppl. 88 Pats. 682 Pats. 362 Pats. 556K 8 Lives p s p s s s p 33

34 Asthma pathway 2015/ / / / / / Asthma Pevalence % patients (8ys+) with asthma (vaiability o evesibility) % asthma patients with eview (12 months) Pimay cae pescibing spend Non-elective spend Emegency admission ate fo childen with asthma, 0-19ys Motality fom asthma all ys STP oppotunity (to Best 5) Ipswich and East Suffolk West Suffolk Noth East Essex p p 62 Pats. 502 Pats. 253K 212 Adm. 3 Lives p p 34

35 Lowe gasto-intestinal pathway 2015/ / / / / / /16 (Snapshots fo / / / /16 months) 2013/ / / / / Smoking pevalence, 18+ Obesity pevalence, 16+ Repoted Clostidium difficile cases Rate of hemohoid sugey % hemohoid sugeies which ae day cases Rate of colonoscopies % 6+ week waits fo a colonoscopy Pimay cae pescibing spend Elective spend Non-elective spend Rate of emegency colonoscopies Diveticula disease - Emegency admissions Gastoenteitis emegency admissions (0-4) Gastoenteitis emegency admissions (5+) <75 motality fom gastointestina l disease STP oppotunity (to Best 5) 29 Cases 207 Cases 805K 5 Pats. 102 Adm. 298 Adm. 244 Adm. 16 Lives Ipswich and East Suffolk p p p s s West Suffolk p s p s s Noth East Essex p p p s Note: Colonoscopies ae one of 15 key diagnostic tests which the NHS Constitution states less than 1% of patients should wait moe than 6 weeks fo. CCGs which achieve good pefomance compaed to thei pees may still be missing this taget. CCGs ae theefoe advised to examine thei waiting list times in geate detail, which ae available at: 35

36 Uppe gasto-intestinal pathway 2015/ / / / / /16 (Snapshots fo / / / /16 (Povisional) months) Smoking pevalence, 18+ Obesity pevalence, 16+ Alcohol specific hospital admissions Rate of baiatic sugey Rate of gastoscopies Rate of gastoscopies (<40) % 6+ week waits fo a gastoscopy Pimay cae pescibing spend Elective spend Non-elective spend Rate of emegency gastoscopies 2015/ / Uppe GI bleeds - Emegency admissions Peptic ulceations - Emegency admissions <75 motality fom gastointestinal disease STP oppotunity (to Best 5) 241 Adm. 256 Ppl. 1099K 280 Pats. 69 Adm. 50 Adm. Ipswich and East Suffolk p p West Suffolk Noth East Essex p 16 Lives s s s s Note: Gastoscopies ae one of 15 key diagnostic tests which the NHS Constitution states less than 1% of patients should wait moe than 6 weeks fo. CCGs which achieve good pefomance compaed to thei pees may still be missing this taget. CCGs ae theefoe advised to examine thei waiting list times in geate detail, which ae available at: 36

37 Live disease pathway 2015/ (Povisional) 2011/ / / / / / / / Obesity pevalence, 16+ Alcohol specific hospital admissions Rate added to live tansplant waiting list Live tansplant ate Non-elective spend Admissions fo hep C elated end-stage live disease/hcc Alcoholic live disease - Emegency admissions Live cance incidence <75 motality fom live disease STP oppotunity (to Best 5) Ipswich and East Suffolk West Suffolk p Noth East Essex 241 Adm. 130K 21 Adm. 11 Lives s s s s s s s s s s Note: Many cases of live cance ae linked to cihosis. Cihosis is commonly caused by heavy and hamful dinking, hepatit is C and the build-up of fat inside the tissue of the live. Live cance incidence is theefoe elated to a numbe of othe indicatos in the pathway, meaning CCGs have been at ed bette/wose than thei simila pees. Howeve, to be consistent with othe cance incidence indicatos, a uantified oppotunity figue has not been povided. 37

38 Osteopoosis and fagility factues pathway 2013/ / / / / / / / / / / / / / / / /16 GP egisteed pop >75 Rate of DEXA scan activity Pimay cae pescibing spend - bisphosphonat es Hip factues in people aged 65+ Hip factues in people aged Hip factues in people aged 80+ Mean length of stay fo hip factues Mean length of stay fo hip factues 65+ Elective spend Non-elective spend Spend on factue admissions afte a fall occued % factued femu patients etuning home within 28 days Hip factue emegency eadmissions 28 days % osteopoosis patients teated with Bone Spaing Agent % patients 75+ yeas with fagility factue teated with BSA STP oppotunity (to Best 5) p s p s s s s p s s s Ipswich and East West Suffolk Noth East Essex 104 Adm. 26 Adm. 49 Adm. 327K 33 Adm. 21 Pats. 24 Pats. 38

39 Osteoathitis pathway 2012/ / / / / / / / / / / / / /10-11/12 % people (ove 45) who have hip osteoathitis (total) % people (ove 45) who have knee osteoathitis (total) % people (ove 45) who have hip osteoathitis (sevee) % people (ove 45) who have knee osteoathitis (sevee) Rate of hip eplacements Rate of knee eplacements Pimay cae pescibing spend Pe-teatment EQ-5D Index (hips) Pe-teatment EQ-5D Index (knees) Elective spend Non-elective spend EQ-5D Index health gain (hips) EQ-5D Index health gain (knees) Hip eplacement emegency eadmissions 28 days STP oppotunity (to Best 5) Ipswich and East Suffolk s s s s West Suffolk Noth East Essex s p p s s 97K 76 QALYs 46 QALYs 38 Adm. s s s 39

40 Tauma and injuy pathway 2015/ / / / / / / / / / / / / / Injuies due to falls in people aged 65+ Unintentional and delibeate injuy admissions, 0-24ys All factue admissions in people aged 65+ Hip factues in people aged 65+ Hip factues in people aged Hip factues in people aged 80+ Pimay cae pescibing spend Elective spend Non-elective spend % factued femu patients etuning home within 28 days Hip factue emegency eadmissions 28 days Motality fom accidents all ys STP oppotunity (to Best 5) Ipswich and East Suffolk West Suffolk Noth East Essex 510 Adm. 171 Ppl. 104 Adm. 26 Adm. 49 Adm. s 1676K 33 Adm. 17 Lives 40

41 Matenity and ealy yeas pathway 2014/ / / / / / / / / / / / / / /13-14/15 % of delivey episodes whee mothe is <18 Flu vaccine take-up by pegnant women Smoking at time of delivey % of low bithweight babies (<2500g) Beastfeeding initiation (fist 48 hs) Neonatal Motality and Stillbiths Infant motality ate Emegency gastoenteiti s admissions ate fo <1s Emegency LRTI admissions ate fo <1s % eceiving 3 doses of 5-in- 1 vaccine by age 2 A&E attendance ate fo <5s Emegency admissions ate fo <5s Unintentional & delibeate injuy admissions fo <5s % of childen aged 4-5 who ae oveweight o obese % eceiving 1 dose of MMR vaccine by age 2 Hospital admissions fo dental caies (1-4 ys) STP oppotunity (to Best 5) s s West Suffolk s Ipswich and East Suffolk Noth East Essex 357 Cases 220 Cases 42 Cases 132 Cases 5 Lives 155 Adm. s s s s 224 Adm. 80 Cases 3,394 Pats. 3,838 Adm. 21 Adm. 111 Cases 55 Adm. s s 41

42 Next steps and actions STP aeas can take the following steps now: Identify the pioity pogammes in you locality and compae against cuent impovement activity and plans Look at the focus packs on the NHS RightCae website fo those aeas which ae a pioity fo you locality Engage with clinicians and othe local stakeholdes, including public health teams in local authoities and commissioning suppot oganisations and exploe the pioity oppotunities futhe using local data Refe to the pages on coodinated e-allocation of capacity and discuss the wide oppotunities highlighted in this pack as pat of the STP planning pocess and conside STP wide action Revisit the NHS RightCae website egulaly as new content, including updates to tools to suppot the use of the Commissioning fo Value packs, is egulaly added Discuss next steps with you local NHS RightCae Delivey Patne. If you don t know who you Delivey Patne is, please ightcae@nhs.net 42

43 Futhe suppot and infomation The Commissioning fo Value benchmaking tool, exploe tool, full details of all the data used, and links to othe useful tools ae available on the NHS RightCae website. Links ae shown on the next page. The NHS RightCae website also offes esouces to suppot local health economies in adopting the Commissioning fo Value appoach. These include: Focus packs fo the highest spending pogammes coveed in this pack Online videos and how to guides Case studies with leaning fom othe CCGs If you have any uestions o euie any futhe infomation o suppot you can the Commissioning fo Value suppot team diect at: england.healthinvestmentnetwok@nhs.net 43

44 Useful links NHS RightCae website: Commissioning fo Value packs and poducts: NHS RightCae casebooks: Five Yea Fowad View: NHS shaed planning guidance fo 2017/ /19: 44

45 How have the potential oppotunities been calculated? The potential oppotunity at CCG level highlights the scale of change that would be achieved if the CCG value moved to the benchmak value of the aveage of the Best 5 o Lowest 5 CCGs in its goup of simila 10 CCGs. Geneally, whee a high CCG value is consideed wose then it is calculated using the fomula: Potential Oppotunity = (CCG Value Benchmak Value) * Denominato The denominato is the most suitable population data fo that indicato eg CCG egisteed population, CCG weighted population, CCG patients on disease egiste etc. The denominato is also scaled to match the Value. So if the CCG Value and Benchmak Value ae given in pe 1,000 population then the denominato is expessed in thousands, ie 12,000 becomes 12. Fo an indicato, adding the statistically significant oppotunities fom the CCG packs gives the oppotunity fo the STP pesented in this pack. 45

46 The NHS RightCae pogamme The NHS RightCae pogamme is about impoving population-based healthcae, though focusing on value and educing unwaanted vaiation. It includes the Commissioning fo Value packs and tools, the NHS Atlas seies, and the wok of the Delivey Patnes. The appoach has been tested and poven successful in ecent yeas in a numbe of diffeent health economies. As a pogamme it focuses elentlessly on value, inceasing uality and eleasing funds fo eallocation to addess futue demand. NHS England has committed significant funding to olling out the RightCae appoach. All CCGs ae now woking with an NHS RightCae Delivey Patne. We have also aligned Delivey Patnes to STP footpints to bette suppot the system. Fo moe infomation visit: 46

47 NHS RightCae and Commissioning fo Value Commissioning fo Value is a patneship between NHS RightCae and Public Health England. It povides the fist phase of the NHS RightCae appoach - Whee to Look. The appoach begins with a eview of indicative data to highlight the top pioities o oppotunities fo tansfomation and impovement. Value oppotunities exist whee a health economy is an outlie and will most likely yield the geatest impovement to clinical pathways and policies. Phases two and thee then move on to exploe What to Change and How to Change. 47