Commissioning for Value Where to Look pack

Transcription

1 Commiioning for Value Where to Look pack North Eat London - STP area December 2016 Neurological April 2016

2 Content Introduction to your Where to Look pack Supporting the STP proce NHS RightCare and Getting it Right Firt Time (GIRFT) Your data Next tep and action Further upport and information Ueful link The NHS RightCare programme NHS RightCare and Commiioning for Value 2

3 Introduction to your Where to Look pack What in thi pack? Thi pack contain data from the CCG Commiioning for Value Where to Look pack, publihed in October 2016, collated at STP footprint level. The data in thi pack include headline opportunitie, improvement opportunity table and lide howing how CCG in each STP differ from their peer. An STP opportunity i the um of all the equivalent opportunitie of the CCG in that area. They do not include negative opportunitie or thoe which are tatitically inignificant. Why your STP area hould review it The information contained in thi pack i peronalied for each STP footprint area and can be ued to help upport local dicuion about prioritiation to improve the value and utiliation of reource. By uing thi information each STP area will be able to enure it plan focu on thoe opportunitie which have the potential to provide the bigget improvement in health outcome, reource allocation and reducing inequalitie. Legal dutie NHS England, Public Health England and CCG have legal dutie under the Health and Social Care Act 2012 with regard to reducing health inequalitie; and for promoting equality under the Equality Act One of the main focue for the Commiioning for Value erie ha alway been reducing variation in outcome. Commiioner hould continue to ue thee pack and the upporting tool to drive local action to reduce inequalitie in acce to ervice and in the health outcome achieved. 3

4 Supporting the STP proce Thi pack ha been created to align with the new Sutainability and Tranformation Planning (STP) proce. Local ervice leader in every part of England are working together for the firt time on hared plan to tranform health and care in the divere communitie they erve. Commiioning for Value (CfV) upport CCG and STP footprint area by providing the mot up to date data available. Expenditure data i from 2015/16. Outcome data i the latet available at time of publication. The time period for each pathway on a page indicator i included on the chart. In addition the key indicator from the even focu pack (originally publihed in April/May 2016) will be refrehed in the CfV online tool in early In the meantime, CCG and local health economie will till be able to ue the 2016 focu pack for further invetigation a an indication of what to change. Unle a CCG ha taken action along a particular pathway, their relative poition i unlikely to have altered. 4

5 NHS RightCare and Getting it Right Firt Time (GIRFT) NHS RightCare and GIRFT are complementary programme and hould be ued together to upport the delivery of population healthcare improvement and financial utainability. NHS RightCare Commiioning for Value worktream upport improvement acro ytem by focuing on pathway of care from primary prevention to end of life care. Whilt upporting improvement in term of acce to and outcome from the acute ector, Commiioning for Value ha not focued in detail on hopital care. GIRFT provide detailed inight into variation in the acute ytem in a way that ha not been available before. A uch NHS RightCare and GIRFT collectively provide clinical improvement inight acro the entire health care ytem. In 2017 NHS RightCare and GIRFT will be working cloely together to upport STP and their local health economie. Thi will begin with a complementary et of analyi on orthopaedic pathway. Thi pack upport STP thinking on thi collective agenda, including by highlighting opportunitie for improvement uch a by coordinating the reallocation of capacity in the acute ytem, omething that can only be achieved together. See page 9 and 10. 5

6 Headline opportunity area for North Eat London The number in the grey circle below repreent how many CCG within North Eat London hare a particular opportunity area out of 7 CCG within the STP Spend & Outcome Outcome Spend 5 Repiratory 5 Repiratory 6 Gatro-intetinal 5 Endocrine 5 Maternity 6 Endocrine 4 Circulation 5 Endocrine 5 Circulation 4 Cancer 4 Circulation 5 Genito Urinary 4 Genito Urinary 4 Cancer 5 Repiratory Thee headline lit are baed on the contributing CCG which form the STP. The figure in the grey circle repreent the number of time each programme appear in each individual CCG headline lit. Thi i imply the number of CCG in the STP with a common programme a a headline opportunity. It doe not factor in the relative cale of each of the opportunitie for thi ranking. E.g. an STP with ix CCG may have all ix CCG with a cancer pend opportunity totalling 3m. In thi example, cancer would rank above repiratory which appear in the lit for five CCG but ha a total opportunity of 4m. Thi can be explored further in the detailed ection of thi pack. 6

7 Which CCG in North Eat London - STP hare headline opportunity area? Spend & Outcome Outcome Spend Repiratory Endocrine Circulation Cancer Genito Urinary Repiratory Maternity Endocrine Circulation Cancer Gatro-intetinal Endocrine Circulation Genito Urinary Repiratory City and Hackney, Havering, Newham, Redbridge, Tower Hamlet Barking and Dagenham, Havering, Newham, Redbridge, Waltham Foret Havering, Newham, Redbridge, Waltham Foret Barking and Dagenham, City and Hackney, Newham, Tower Hamlet Barking and Dagenham, Havering, Newham, Redbridge City and Hackney, Havering, Newham, Redbridge, Tower Hamlet Barking and Dagenham, City and Hackney, Havering, Tower Hamlet, Waltham Foret Barking and Dagenham, Havering, Newham, Redbridge, Waltham Foret Havering, Newham, Redbridge, Waltham Foret Barking and Dagenham, City and Hackney, Newham, Tower Hamlet Barking and Dagenham, City and Hackney, Havering, Redbridge, Tower Hamlet, Waltham Foret Barking and Dagenham, City and Hackney, Newham, Redbridge, Tower Hamlet, Waltham Foret City and Hackney, Havering, Newham, Redbridge, Waltham Foret Barking and Dagenham, Havering, Newham, Redbridge, Tower Hamlet Barking and Dagenham, Havering, Newham, Tower Hamlet, Waltham Foret 7

8 What are the potential live aved per year? A value i only hown where the opportunity i tatitically ignificant If the CCG within the STP performed at the average of: Similar 10 CCG Bet 5 of imilar 10 CCG Cancer Neurological Circulation Repiratory Gatro Intetinal Trauma and Injurie Total Live Saved The mortality data preented above ue Primary Care Mortality Databae (PCMD) and i from 2012 to The potential live aved opportunitie are calculated on a yearly bai and are only hown where tatitically ignificant. Live aved only include programme where mortality outcome have been conidered appropria te. 8

9 Coordinating the re-allocation of capacity Improving a population healthcare ytem to become high value and optimal require ignificant change. It require change in the practice and perpective of all of the profeion, people and partner engaged in the ytem. It require change in how we engage with individual patient and how we engage with our local communitie, o that we inform and then eek to undertand their perpective and their preference. It require change in how we operate and think about our organiational tructure, plan and aet model. And, mot importantly of all, it require u to embrace, collectively and individually, the need to make thee change. Variation data, a contained in the uite of Commiioning for Value pack, highlight that in every health ytem in England, there exit a ignificant volume of overue alongide ignificant underue. Overue lead to wate and harm. Underue lead to a failure to prevent dieae and inequity. Reducing both lead to a better and more utainable ytem. In order to do thi well, we mut work together to coordinate the re-allocation of capacity from unwarranted activity to warranted activity, wherever in the ytem that may be. 9

10 Coordinating the re-allocation of capacity The next page highlight the potential overue in bed day for your STP area, a implied by variation data for each of your contituent health economie. STP area are able to ue thi information to focu on the opportunity to free up bed capacity, and ak the quetion I thi current bed ue adding value? and Where might we better ue thi capacity and reource?. In turn thi will allow for dicuion and conenu to be reached on where bed add more value if re-allocated for different ue. It alo allow for dicuion and conenu on what current capacity a ytem could avoid the need for, if reource were re-allocated for non-bed ue, to deliver optimal clinical pathway and ytem. Avoiding the need for capacity, in thi way, i a key component of delivering a utainable healthcare ytem. Fully integrated care i very likely to be a key part of thee dicuion. Identifying together Where to Look and then deigning optimal pathway and ytem, that i, What to Change, by collectively anwering the quetion What would we look like if we were doing the very bet for our population?, i the optimal mean of achieving thi. 10

11 How different are we on bed day? A value i only hown where the opportunity i tatitically ignificant If the CCG within the STP performed at the average of: Similar 10 CCG Lowet 5 of imilar 10 CCG Cancer Endocrine, nutritional & metabolic 702 3,558 2,431 Neurological 1,662 5,576 Circulation 9,798 11,579 Repiratory 6,558 5,276 Gatro Intetinal 5,644 9,699 Muculo Skeletal Trauma and Injurie 3,496 5,686 7,163 4,199 Genito Urinary 13,230 11, ,000 10,000 15,000 20,000 25,000 30,000 Bed Day The bed day data preented above ue Secondary Uer Service Extract Mart (SUS SEM) and i from financial year 2015/16. The calculation in thi lide are baed on admiion for any primary diagnoe that fall under the lited condition (baed on Programme Budgeting claification which are in turn baed on the World Health Organiation International Claification of Dieae). Thi only include admiion covered by the mandatory payment by reult tariff and include NHS England Direct Commiioning activity. Thee figure are a combination of elective and non -elective admiion. Length of tay i derived from admiion and dicharge date. Spell that have the ame admiion and dicharge date (includin g planned day cae) have a length of tay in SUS a zero. Thee have been recoded a a length of tay of 1 day in order to capture the impact of thee admiion on total bed day for a CCG. 11

12 How different are we on pend on elective admiion? A value i only hown where the opportunity i tatitically ignificant If the CCG within the STP performed at the average of: Similar 10 CCG Lowet 5 of imilar 10 CCG Cancer Endocrine, nutritional & metabolic Neurological Circulation Repiratory ,202 1,799 1,180 Gatro Intetinal 2,415 2,624 Muculo Skeletal 2,077 4,664 Trauma and Injurie Genito Urinary 851 1, ,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 The pend data preented above ue Secondary Uer Service Extract Mart (SUS SEM) and i from financial year 2015/16. Total Difference ( 000) The calculation in thi lide are baed on expenditure on admiion for any primary diagnoe that fall under the lited co ndition (baed on Programme Budgeting claification which are in turn baed on the World Health Organiation International Claification of Dieae). Thi only include expenditure on admiion covered by the mandatory payment by reult tariff and include NHS England Direct Commiioning expenditure. CCG can explore thi expenditure in more detail uing the Commiioning for Value Focu Pack. For example, Neurological expenditure contain Chronic Pain, and the focu pack break thi down by different type of Pain. CCG hould conider whether thee admiion hould be conidered alongide other programme e.g. CVD, Gatrointetinal, Muculokeletal problem 12

13 How different are we on pend on non-elective admiion? A value i only hown where the opportunity i tatitically ignificant If the CCG within the STP performed at the average of: Similar 10 CCG Bet 5 of imilar 10 CCG Cancer 2,057 1,372 Endocrine, nutritional & metabolic Neurological 302 3,036 Circulation 3,889 3,336 Repiratory 1,114 2,549 Gatro Intetinal 607 1,718 Muculo Skeletal Trauma and Injurie ,535 Genito Urinary 3,554 2, ,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 Total Difference ( 000) The pend data preented above ue Secondary Uer Service Extract Mart (SUS SEM) and i from financial year 2015/16. The calculation in thi lide are baed on expenditure on admiion for any primary diagnoe that fall under the lited co ndition (baed on Programme Budgeting claification which are in turn baed on the World Health Organiation International Claification of Dieae). Thi only include expenditure on admiion covered by the mandatory payment by reult tariff and include NHS England Direct Commiioning expenditure. CCG can explore thi expenditure in more detail uing the Commiioning for Value Focu Pack. For example, Neurological expenditure contain Chronic Pain, and the focu pack break thi down by different type of Pain. CCG hould conider whether thee admiion hould be conidered alongide other programme e.g. CVD, Gatrointetinal, Muculokeletal problem 13

14 How different are we on pend on primary care precribing? A value i only hown where the opportunity i tatitically ignificant If the CCG within the STP performed at the average of: Similar 10 CCG Lowet 5 of imilar 10 CCG Cancer Endocrine, nutritional & metabolic 5,123 5,928 Mental Health Problem Neurological Circulation ,567 1,640 Repiratory 912 2,934 Gatro Intetinal Muculo Skeletal ,344 1,562 Trauma and Injurie Genito Urinary ,000 4,000 6,000 8,000 10,000 12,000 Total Difference ( 000) The precribing data preented above ue Net Ingredient Cot (NIC) from epact.com provided by the NHS Buine Service Auth ority and i from financial year 2015/16. Each individual BNF chemical i mapped to a Programme Budget Category and aggregated to form a programme total. The indicator ha ve been tandardied uing the ASTRO-PU weighting. Opportunitie have been hown to the CCG imilar 10 and the lowet 5 CCG. Precribing opportunitie are for local interpret ation and hould be viewed in conjunction with the individual dieae pathway. More detailed analye of precribing data, outlier practice, and time trend can be produced rapidly uing the following re ource: 14

15 Improvement opportunitie Thi table preent opportunitie for quality improvement and pend difference for a range of programme area. Thee are baed on comparing the CCG within North Eat London STP to the bet / lowet 5 CCG. A quantified unit i only hown when the opportunity i tatitically ignificant. Dieae Area Spend 000 Quality Spend on elective and day-cae admiion 214 Cancer and Tumour - Rate of bed day Spend on non-elective admiion 3,428 Mortality from all cancer under 75 year Spend on primary care precribing 1,131 Breat cancer creening % firt definitive treatment within 2 month (all cancer) Mortality from breat cancer under 75 year Bowel cancer creening Lower GI cancer detected at an early tage Mortality from colorectal cancer under 75 year Cancer & Tumour Succeful quitter, 16+ Lung cancer detected at an early tage Mortality from lung cancer under 75 year Mortality from all cancer all age No. of patient, life-year, referral, etc. 3, , , ,

16 Improvement opportunitie Thi table preent opportunitie for quality improvement and pend difference for a range of programme area. Thee are baed on comparing the CCG within North Eat London STP to the bet / lowet 5 CCG. A quantified unit i only hown when the opportunity i tatitically ignificant. Dieae Area Spend 000 Quality Spend on elective and day-cae admiion 2,538 Circulation - Rate of bed day Spend on non-elective admiion 7,225 Mortality from all circulatory dieae under 75 year Spend on primary care precribing 1,840 Reported to etimated prevalence of CHD Reported to etimated prevalence of hypertenion Patient with CHD whoe BP < 150/90 Patient with CHD whoe choleterol < 5 mmol/l Patient with hypertenion whoe BP < 150/90 Mortality from CHD under 75 year Mortality from acute MI under 75 year Patient with troke/tia whoe BP < 150/90 Circulation Problem (CVD) % troke/tia patient on antiplatelet or anticoagulant Stroke patient pending 90% of their time on troke unit Emergency readmiion within 28 day for troke patient % patient returning home after treatment Mortality from troke under 75 year High-rik AF patient on anticoagulation therapy Reported to etimated prevalence of AF Patient who go direct to a troke unit (quarter) Stroke patient treated by early upported dicharge team (quarter) No. of patient, life-year, referral, etc. 21, ,217 20, , , Endocrine, Nutritional and Metabolic Problem Spend on elective and day-cae admiion Spend on non-elective admiion Spend on primary care precribing 211 Endocrine - Rate of bed day 1,055 % diabete patient whoe choleterol < 5 mmol/l 11,051 % diabete patient whoe HbA1c i <59 mmol/mol % diabete patient whoe blood preure i <140/80 % of diabete patient receiving all three treatment target % patient receiving foot examination Retinal creening % diabete patient attending tructured education 3,133 3,158 5, ,054 3,

17 Improvement opportunitie Thi table preent opportunitie for quality improvement and pend difference for a range of programme area. Thee are baed on comparing the CCG within North Eat London STP to the bet / lowet 5 CCG. A quantified unit i only hown when the opportunity i tatitically ignificant. Dieae Area Spend 000 Quality Spend on elective and day-cae admiion 5,039 Gatro - Rate of bed day Spend on non-elective admiion 2,325 Mortality from gatrointetinal dieae under 75 year Spend on primary care precribing 2,012 Mortality for liver dieae under 75 year % 6+ week wait for a gatrocopy (4 month naphot) Alcohol pecific hopital admiion Emergency admiion for alcoholic liver dieae condition (19+) Rate of emergency gatrocopie Emergency admiion for Upper GI bleed Emergency admiion for Peptic Ulceration Gatrointetinal Reported Clotridium difficile cae % of hemorrhoid urgerie which are day cae % 6+ week wait for a colonocopy (4 month naphot) Rate of emergency colonocopie Emergency admiion for diverticular dieae Emergency admiion for gatroenteriti (5+) No. of patient, life-year, referral, etc. 15, Genitourinary Spend on elective and day-cae admiion Spend on non-elective admiion Spend on primary care precribing 1,973 Genitourinary - Rate of bed day 6,020 Reported to etimated prevalence of CKD 1,028 Patient on CKD regiter with a BP of 140/85 or le Patient on CKD regiter treated with an ACE-1 or ARB Creatinine ratio tet ued in lat 12 month % of patient on RRT who have a tranplant 24,422 7, ,

18 Improvement opportunitie Thi table preent opportunitie for quality improvement and pend difference for a range of programme area. Thee are baed on comparing the CCG within North Eat London STP to the bet / lowet 5 CCG. A quantified unit i only hown when the opportunity i tatitically ignificant. Dieae Area Spend 000 Quality % of delivery epiode where mother i <18 Flu vaccine take-up by pregnant women Smoking at time of delivery Live and till birth <2500 gram Infant mortality rate Emergency gatroenteriti admiion rate for <1 Emergency LRTI admiion rate for <1 Maternity & Reproductive Health % receiving 3 doe of 5-in-1 vaccine by age 2 A&E attendance rate for <5 Emergency admiion rate for <5 Unintentional & deliberate injury admiion for <5 % of children aged 4-5 who are overweight or obee Hopital admiion for dental carie (1-4 year) Neonatal Mortality and Stillbirth % receiving 1 doe of MMR vaccine by age 2 No. of patient, life-year, referral, etc. 40 1, , Mental Health Problem (all) Spend on primary care precribing 1,462 Mortality from uicide and injury undetermined all age People with mental illne and or diability in ettled accomodation

19 Improvement opportunitie Thi table preent opportunitie for quality improvement and pend difference for a range of programme area. Thee are baed on comparing the CCG within North Eat London STP to the bet / lowet 5 CCG. A quantified unit i only hown when the opportunity i tatitically ignificant. Dieae Area Spend 000 Quality New cae of depreion which have been reviewed Aement of everity of depreion at outet IAPT referral with a wait <28day (quarter) Completion of IAPT treatment (quarter) IAPT: % referral with outcome meaured (6 month) IAPT: % 'moving to recovery' rate (quarter) Mental Health Problem (common) IAPT: % achieving 'reliable improvement' (quarter) Emergency hopital admiion for elf harm IAPT: % waiting <6 week for firt treatment (6 month naphot) No. of patient, life-year, referral, etc , Mental Health Problem (evere) Phyical health check for patient with SMI % Service uer on CPA (end of quarter naphot) Mental health hopital admiion People ubject to mental health act (quarter) People on CPA in employment (end of quarter naphot) % of EIP referral waiting >2 wk to tart treatment (Incomplete) (5m) % of EIP referral waiting <2 wk to tart treatment (Complete) (5m) 286 1,112 1,

20 Improvement opportunitie Thi table preent opportunitie for quality improvement and pend difference for a range of programme area. Thee are baed on comparing the CCG within North Eat London STP to the bet / lowet 5 CCG. A quantified unit i only hown when the opportunity i tatitically ignificant. Dieae Area Spend 000 Quality Mental Health Problem (dementia) Mortality with dementia, 65+ % dementia death in uual place of reidence (65+) % hort tay emergency admiion aged 65+ with dementia % new dementa diagnoi with blood tet Dementia diagnoi rate (65+) Rate of emergency admiion aged 65+ with dementia % of dementia patient with care reviewed No. of patient, life-year, referral, etc ,216 1, Muculokeletal Sytem Problem (Exclude Trauma) Spend on elective and day-cae admiion Spend on non-elective admiion Spend on primary care precribing Spend on admiion relating to fracture where a fall occurred 6,741 MSK - Rate of bed day 952 % oteoporoi patient treated with Bone Sparing Agent 1,452 % patient 75+ year with fragility fracture treated with BSA 1,400 Hip replacement, EQ-5D Index, average health gain Knee replacement, EQ-5D Index, average health gain Hip replacement emergency readmiion 28 day Hip fracture in people aged 65+ Hip fracture in people aged Hip fracture in people aged 80+ % fractured femur patient returning home within 28 day Hip fracture emergency readmiion 28 day 9, Neurological Sytem Problem Spend on elective and day-cae admiion Spend on non-elective admiion Spend on primary care precribing 562 Neurological - Rate of bed day 3,338 Emergency admiion rate for children with epilepy aged 0 17 year 2,262 Patient with epilepy on drug treatment and convulion free, 18+ 7, Note: Spend on admiion relating to fracture where a fall occurred i a ub-et of Trauma and Injurie non-elective pend and i not included in the pend for overall MSK non-elective admiion. Thi indicator a well a Rate of hip fracture, Emergency readmiion to hopital within 28 day for patient: hip fracture and % patient returning to uual place of reidence following hopital treatment for fractured femur appear in the quality ection of the improvement opportunitie table for both Trauma & Injurie and MSK table. Thi i due to it being in the Trauma & Injury pathway a well a the Oteoporoi pathway. Opportunitie for thee five indicator have only contributed to the headline; Spend, Outcome (and hence Spend and Outcome ) for MSK only. 20

21 Improvement opportunitie Thi table preent opportunitie for quality improvement and pend difference for a range of programme area. Thee are baed on comparing the CCG within North Eat London STP to the bet / lowet 5 CCG. A quantified unit i only hown when the opportunity i tatitically ignificant. Dieae Area Spend 000 Quality Spend on elective and day-cae admiion 2,382 Repiratory - Rate of bed day Spend on non-elective admiion 3,663 Mortality from bronchiti, emphyema and COPD under 75 year Spend on primary care precribing 3,846 Reported to etimated prevalence of COPD % of COPD patient with a record of FEV1 % of COPD patient with review (12 month) % patient (8yr+) with athma (variability or reveribility) Repiratory Sytem Problem % athma patient with review (12 month) Emergency admiion rate for children with athma, 0-19yr % of COPD patient with a diagnoi confirmed by pirometry No. of patient, life-year, referral, etc. 11, , , Trauma & Injurie Spend on elective and day-cae admiion Spend on non-elective admiion Spend on primary care precribing Spend on admiion relating to fracture where a fall occurred 921 Trauma and injurie - Rate of bed day 1,535 Mortality from accident all age 779 Injurie due to fall in people aged 65+ 1,400 Unintentional and deliberate injury admiion, 0-24yr All fracture admiion in people aged 65+ Hip fracture in people aged 65+ Hip fracture in people aged Hip fracture in people aged 80+ % fractured femur patient returning home within 28 day Hip fracture emergency readmiion 28 day 10,

22 How to read your STP pathway The following lide provide a more detailed look at 19 'Pathway on a page' for each CCG within the STP. The intention of thee pathway i not to provide a definitive view, but to help commiioner explore potential opportunitie. Thee lide help to undertand how performance in one part of the pathway may affect outcome further along the pathway. Each row in the matrix repreent a CCG in your STP area and how it compare to it imilar 10 CCG acro that pathway. The imilar 10 CCG are not necearily in the ame STP. Thee Pathway on a Page allow an STP to examine which programme have common opportunitie for everal CCG acro the entire pathway, or for part of a pathway (uch a primary care or detection) for everal CCG. Therefore, STP may find it ueful to can the chart both horizontally and vertically. The key to the right how how to interpret the coloured quare and arrow. The STP opportunitie underneath each indicator name um the CCG opportunitie benchmarked againt the average of the bet 5 CCG, unlike the coloured quare which benchmark againt the average of the imilar 10 CCG. Opportunitie are calculated for all RAG-rated indicator except for the tated exception. p q r tu r r tu CCG i tatitically ignificantly HIGHER CCG i tatitically ignificantly LOWER CCG HIGHER but not tatitically ignificant CCG LOWER but not tatitically ignificant CCG i equal to benchmark CCG WORSE/HIGHER but not tatitically ignificant CCG WORSE/LOWER but not tatitically ignificant CCG BETTER/HIGHER but not tatitically ignificant CCG BETTER/LOWER but not tatitically ignificant CCG i equal to benchmark CCG i tatitically ignificantly WORSE CCG i tatitically ignificantly BETTER CCG ha no publihed data for thi indicator or value i uppreed due to mall number 22

23 Breat cancer pathway / / / / / / (2011) Deprivation Breat cancer prevalence Incidence of breat cancer Obeity prevalence, 16+ Breat cancer creening Primary care precribing pend Urgent GP referral (breat cancer) % firt definitive treatment within 2 month (all cancer) Emergency preentation for breat cancer Elective pend Breat cancer detected at an early tage <75 Mortality from breat cancer 1 year urvival (breat) STP opportunity (to Bet 5) p q r p q r q r p q q p q q r r r Havering p q q q r q q r r Newham p q q p q q r q r q r q r q p p p q q q q p r q p q q q p r r r r Barking and Dagenham City and Hackney Redbridge Tower Hamlet Waltham Foret 9,336 Ppl. 213 Pat. 19 Live Note: We do not calculate potential opportunitie for emergency preentation and one-year urvival rate owing to miing information in publihed data. 23

24 Lower gatro-intetinal cancer pathway / / / / / / (2011) Deprivation Colorectal cancer prevalence Incidence of colorectal cancer Obeity prevalence, 16+ Bowel cancer creening Urgent GP referral (colorectal cancer) % firt definitive treatment within 2 month (all cancer) Emergency preentation for colorectal cancer Elective pend Non-elective pend Lower GI cancer detected at an early tage <75 Mortality from colorectal cancer 1 year urvival (colorectal) STP opportunity (to Bet 5) 6,370 Ppl. 213 Pat. 382K 24 Pat. 12 Live Barking and Dagenham p p q q City and Hackney p q q p q r r q Havering p q q r q r r Newham p q q p q q Redbridge q r q r p q r r Tower Hamlet p q q q r q r Waltham Foret p q q q r q r r r Note: We do not calculate potential opportunitie for emergency preentation and one-year urvival rate owing to miing information in publihed data. 24

25 Lung cancer pathway / / / / / / / (2011) Deprivation Lung cancer prevalence Incidence of lung cancer Smoking prevalence, 18+ Obeity prevalence, 16+ Succeful quitter, 16+ Urgent GP referral (lung cancer) % firt definitive treatment within 2 month (all cancer) Emergency preentation for lung cancer Elective pend Non-elective pend Lung cancer detected at an early tage <75 Mortality from lung cancer 1 year urvival (lung) STP opportunity (to Bet 5) 3,208 Ppl. 213 Pat. 402K 24 Pat. 114 Live Barking and Dagenham p r p p p r City and Hackney p p p r r r r r r Havering p r r q p r r Newham p q q q p q r Redbridge q q q q q p q Tower Hamlet p r p q r p Waltham Foret p q q p q r r r r Note: We do not calculate potential opportunitie for emergency preentation and one -year urvival rate owing to miing information in publihed data. 25

26 Severe mental illne pathway April April /16 Q / / / /16 Q2 2015/16 Q4 2015/16 Q4 2014/15 Augut 2016 Augut 2016 (Year End) Deprivation Etimate of people with a pychotic diorder People with SMI known to GP: % on regiter Primary care precribing pend Phyical health check % of EIP referral waiting <2 wk to tart treatment (Complete) % of EIP referral waiting >2 wk to tart treatment (Incomplete) New cae of pychoi erved by Early Intervention team People treated by Early Intervention Team People on Care Programme Approach % Service uer on CPA Mental health hopital admiion 2015/16 Q2 2015/16 Q2 2015/16 Q2 People ubject to mental health act People on CPA in employment % adult on CPA in ettled accommodatio n STP opportunity (to Bet 5) 286 Pat. 15 Pat. 12 Pat. 1,112 Pat. 1,537 Adm. 153 Ppl. 106 Ppl. Barking and Dagenham p q q q r City and Hackney p p p q p q q q Havering p q q r p q q q Newham p q q p p q q r Redbridge q q q q r r p q q p Tower Hamlet p p p p r r q q r r Waltham Foret p q p r r q q q Note: There i variation in the quality of care coordination under CPA, meaning CCG have not been ranked better/wore than their imilar peer for thee indicator. However, becaue it i recommended that more uer hould be offered CPA upport, opportunity figure have been provided for % ervice uer on CPA. 26

27 Common mental health diorder pathway / / / / /16 Q4 2015/16 Q4 Oct Mar 2016 Oct Mar /16 Q4 2015/16 Q4 Deprivation % population with LLTI or diability Etimated prevalence of CMHD (% pop) Depreion prevalence 18+ New cae of depreion which have been reviewed Antidepreant precribing IAPT referral: Rate aged 18+ IAPT: Rate beginning treatment IAPT: % waiting <6 week for firt treatment IAPT: % referral with outcome meaured IAPT: % 'moving to recovery' rate IAPT: % achieving 'reliable improvement' STP opportunity (to Bet 5) 764 Pat. Barking and Dagenham p p q q q City and Hackney p p q p q r Havering p q q r q Newham p q q q q Redbridge q q q q q Tower Hamlet p q q r p Waltham Foret p q q p 753 Pat. 19 Pat. 124 Pat. 121 Pat. r r r r Note: It in t poible to robutly calculate an opportunity of number of additional people who hould be referred into IAPT. 27

28 Dementia pathway / /16 Sep 2015 Aug / / / / / % phyically inactive adult Smoking prevalence, 18+ Hypertenion prevalence, 18+ Dementia prevalence 65+ Dementia diagnoi rate (65+) % new dementa diagnoi with blood tet % dementia patient with care reviewed Ratio of Inpatient Service Ue to Recorded Diagnoe Rate of % hort tay emergency emergency admiion aged admiion aged 65+ with dementia 65+ with dementia 65+ mortality with dementia % dementia death in uual place of reidence (65+) STP opportunity (to Bet 5) 1,216 Ppl. 100 Pat. 308 Pat. 1,339 Adm. 271 Adm. 107 Live 138 Death Barking and Dagenham p p City and Hackney r p q r p r r Havering r q r p r Newham p q q q r r Redbridge p q q q r r Tower Hamlet r p q r r r Waltham Foret p q p r p 28

29 Heart Dieae pathway 2015/ / / / / / / / / / / / CHD prevalence Hypertenion prevalence, 18+ Reported to etimated prevalence of CHD Reported to etimated prevalence of hypertenion Smoking prevalence, 18+ Obeity prevalence, 16+ % CHD patient whoe BP < 150/90 % CHD patient choleterol < 5 mmol/l % hypertenion patient whoe BP < 150/90 Primary care precribing pend Elective pend Non-elective pend <75 Mortality from CHD <75 Mortality from acute MI STP opportunity (to Bet 5) Barking and Dagenham q City and Hackney q q Havering q q Newham q q Redbridge q q Tower Hamlet q q Waltham Foret q q 8,217 Ppl. 20,156 Ppl. 209 Pat. 383 Pat. 3,531 Pat. 2788K 172 Live 90 Live p q r r p p q r r r r r q r q r r q p r q p r r q q r q p p q q p r p q r r q p 29

30 Stroke pathway Jan-Mar Jan-Mar 2015/ / / / / / / / / / / Jan-Mar /10-11/ / Stroke or TIA Prevalence, 18+ Smoking prevalence, 18+ Obeity prevalence, 16+ Reported to etimated prevalence of AF % troke/tia patient whoe BP < 150/90 % troke/tia patient on antiplatelet or anticoagulan t High-rik AF patient on anticoagulati on therapy Primary care precribing pend % who go direct to a troke unit % who receive thrombolyi Patient 90% of time on troke unit Elective pend Non-elective pend % treated by early upported dicharge team Emergency readmiion within 28 day % patient returning home after treatment <75 Mortality from troke STP opportunity (to Bet 5) 2,958 Ppl. 190 Pat. 103 Pat. 186 Pat. 50 Pat. 68 Pat. 3694K 24 Pat. 23 Adm. 114 Pat. 36 Live Barking and Dagenham q p r r q r r r r City and Hackney q p p r r q r r p Havering q r q r q p r r Newham q q p r q r p r Redbridge q q q r r q r r Tower Hamlet q p q q r r r r Waltham Foret q p q r q r r r q r 30

31 Diabete pathway 2015/ / / / / / / / / / /16 Diabete prevalence, 17+ Obeity prevalence, 16+ % diabete patient choleterol < 5 mmol/l % diabete patient HbA1c i <59 mmol/mol % diabete patient whoe BP < 140/80 % of diabete patient receiving all three treatment target % patient receiving foot examination Retinal creening % diabete patient attending tructured education Primary care precribing pend Non-elective pend STP opportunity (to Bet 5) Barking and Dagenham p p City and Hackney q p Havering q q Newham p p Redbridge p q Tower Hamlet q q Waltham Foret q q 3,158 Pat. 5,970 Pat. 415 Pat. 379 Pat. 3,054 Pat. 3,317 Pat. r r 307 Pat. 829K p p r p p r r p q r q 31

32 Renal pathway 2015/ / / / / / / / / Reported CKD prevalence Reported to etimated prevalence of CKD % CKD patient whoe BP < 140/85 % on CKD regiter with hypertenion & proteinuria treated with ACE-I or ARB Creatinine ratio tet ued in lat 12 month Primary care precribing pend Nephrology firt outpatient attendance rate Elective pend Non-elective pend Acceptance rate for renal replacement therapy % home dialyi undertaken % of patient on RRT who have a tranplant STP opportunity (to Bet 5) 7,932 Ppl. 219 Pat. 70 Pat. 2,416 Pat. 2960K 160 Pat. Barking and Dagenham q r q q q r City and Hackney q r r q q q r Havering q r q q p r Newham q r q q r Redbridge q r r q q q p Tower Hamlet q r q p q r r Waltham Foret q r q q r 32

33 COPD pathway 2015/ / / / / / / / COPD Prevalence Reported to etimated prevalence of COPD Smoking prevalence, 18+ % COPD patient diagnoi confirmed by pirometry % of COPD patient with a record of FEV1 % of COPD patient with review (12 month) Primary care precribing pend Non-elective pend <75 mortality from bronchiti, emphyema and COPD STP opportunity (to Bet 5) 6,826 Ppl. 186 Pat. 780 Pat. 486 Pat. 1863K 94 Live Barking and Dagenham p r p q p q r Havering r q r Newham q q p Redbridge q q q Tower Hamlet p p p Waltham Foret q p r r q City and Hackney 33

34 Athma pathway 2015/ / / / / / Athma Prevalence % patient (8yr+) with athma (variability or reveribility) % athma patient with review (12 month) Primary care precribing pend Non-elective pend Emergency admiion rate for children with athma, 0-19yr Mortality from athma all yr STP opportunity (to Bet 5) Barking and Dagenham q r p q q r r Havering q q r r Newham q q r r Redbridge q r r q q q q p City and Hackney Tower Hamlet Waltham Foret 904 Pat. 1,298 Pat. 280K 226 Adm. 34

35 Lower gatro-intetinal pathway 2015/ / / / / / /16 (Snaphot for / / / /16 month) 2013/ / / / / Smoking prevalence, 18+ Obeity prevalence, 16+ Reported Clotridium difficile cae Rate of hemorrhoid urgery % hemorrhoid urgerie which are day cae Rate of colonocopie % 6+ week wait for a colonocopy Primary care precribing pend Elective pend Non-elective pend Rate of emergency colonocopie Diverticular dieae - Emergency admiion Gatroenteriti emergency admiion (0-4) Gatroenteriti emergency admiion (5+) <75 mortality from gatrointetina l dieae STP opportunity (to Bet 5) 14 Cae 14 Cae 277 Cae 147K 41 Pat. 32 Adm. 303 Adm. 58 Live Barking and Dagenham p r r p q q r r City and Hackney p p q p r Havering r q r p q p r r Newham q p r p q p Redbridge q q r r p p p Tower Hamlet Waltham Foret p p q q p r r p p p p p p r r r Note: Colonocopie are one of 15 key diagnotic tet which the NHS Contitution tate le than 1% of patient hould wait more than 6 week for. CCG which achieve good performance compared to their peer may till be miing thi target. CCG are therefore advied to examine their waiting lit time in greater detail, which are available at: 35

36 Upper gatro-intetinal pathway 2015/ / / / / /16 (Snaphot for / / / /16 (Proviional) month) Smoking prevalence, 18+ Obeity prevalence, 16+ Alcohol pecific hopital admiion Rate of bariatric urgery Rate of gatrocopie Rate of gatrocopie (<40) % 6+ week wait for a gatrocopy Primary care precribing pend Elective pend Non-elective pend Rate of emergency gatrocopie 2015/ / Upper GI bleed - Emergency admiion Peptic ulceration - Emergency admiion <75 mortality from gatrointetinal dieae STP opportunity (to Bet 5) Barking and Dagenham p p p q p q p q q q p r r Havering r q r p p q p Newham q p q p p p p r r Redbridge q q p p q p Tower Hamlet p q q p p p p r r Waltham Foret p q p p p p r r City and Hackney 63 Adm. 659 Ppl. 826K 191 Pat. 157 Adm. 78 Adm. 58 Live Note: Gatrocopie are one of 15 key diagnotic tet which the NHS Contitution tate le than 1% of patient hould wait more than 6 week for. CCG which achieve good performance compared to their peer may till be miing thi target. CCG are therefore advied to examine their waiting lit time in greater detail, which are available at: 36

37 Liver dieae pathway 2015/ (Proviional) 2011/ / / / / / / / Obeity prevalence, 16+ Alcohol pecific hopital admiion Rate added to liver tranplant waiting lit Liver tranplant rate Non-elective pend Admiion for hep C related end-tage liver dieae/hcc Alcoholic liver dieae - Emergency admiion Liver cancer incidence <75 mortality from liver dieae STP opportunity (to Bet 5) Barking and Dagenham p r r r r r r p Havering q q q r r r r r Newham p p r r p Redbridge q r r q Tower Hamlet q p r r r Waltham Foret q r r p City and Hackney 63 Adm. 499K 61 Adm. 34 Live Note: Many cae of liver cancer are linked to cirrhoi. Cirrhoi i commonly caued by heavy and harmful drinking, hepatit i C and the build-up of fat inide the tiue of the liver. Liver cancer incidence i therefore related to a number of other indicator in the pathway, meaning CCG have been rat ed better/wore than their imilar peer. However, to be conitent with other cancer incidence indicator, a quantified opportunity figure ha not been provided. 37

38 Oteoporoi and fragility fracture pathway 2013/ / / / / / / / / / / / / / / / /16 GP regitered pop >75 Rate of DEXA can activity Primary care precribing pend - biphophonat e Hip fracture in people aged 65+ Hip fracture in people aged Hip fracture in people aged 80+ Mean length of tay for hip fracture Mean length of tay for hip fracture 65+ Elective pend Non-elective pend Spend on fracture admiion after a fall occurred % fractured femur patient returning home within 28 day Hip fracture emergency readmiion 28 day % oteoporoi patient treated with Bone Sparing Agent % patient 75+ year with fragility fracture treated with BSA STP opportunity (to Bet 5) Barking and Dagenham q q p r p p r r r q q q r r r r r Havering p q p r r p r q r r Newham q q p r r r q r r r Redbridge q q p r p p r r Tower Hamlet q q p r p r r r Waltham Foret q q q r r r q r r r City and Hackney 180 Adm. 21 Adm. 125 Adm. 1400K 84 Pat. 11 Adm. 8 Pat. 7 Pat. 38

39 Oteoarthriti pathway 2012/ / / / / / / / / / / / / /10-11/12 % people (over 45) who have hip oteoarthriti (total) % people (over 45) who have knee oteoarthriti (total) % people (over 45) who have hip oteoarthriti (evere) % people (over 45) who have knee oteoarthriti (evere) Rate of hip replacement Rate of knee replacement Primary care precribing pend Pre-treatment EQ-5D Index (hip) Pre-treatment EQ-5D Index (knee) Elective pend Non-elective pend EQ-5D Index health gain (hip) EQ-5D Index health gain (knee) Hip replacement emergency readmiion 28 day STP opportunity (to Bet 5) 130K 25 QALY 118 QALY 5 Adm. Barking and Dagenham r p r r q r p r r r City and Hackney r r p q r q r r Havering r r q q q q q Newham r r r r q r q q r Redbridge r q r r q r r Tower Hamlet q q q q q q q r r r Waltham Foret q r p q p p 39

40 Trauma and injury pathway 2015/ / / / / / / / / / / / / / Injurie due to fall in people aged 65+ Unintentional and deliberate injury admiion, 0-24yr All fracture admiion in people aged 65+ Hip fracture in people aged 65+ Hip fracture in people aged Hip fracture in people aged 80+ Primary care precribing pend Elective pend Non-elective pend % fractured femur patient returning home within 28 day Hip fracture emergency readmiion 28 day Mortality from accident all yr STP opportunity (to Bet 5) Barking and Dagenham City and Hackney r r Havering Newham Redbridge Tower Hamlet Waltham Foret 254 Adm. 298 Adm. 186 Ppl. 180 Adm. 21 Adm. 125 Adm. 1535K 84 Pat. 11 Adm. 38 Live r r p r r p r r r r r p q r r p q r r r r q q r p p r r r r p r r 40

41 Maternity and early year pathway 2014/ / / / / / / / / / / / / / /13-14/15 % of delivery epiode where mother i <18 Flu vaccine take-up by pregnant women Smoking at time of delivery % of low birthweight babie (<2500g) Breatfeeding initiation (firt 48 hr) Neonatal Mortality and Stillbirth Infant mortality rate Emergency gatroenteriti admiion rate for <1 Emergency LRTI admiion rate for <1 % receiving 3 doe of 5-in- 1 vaccine by age 2 A&E attendance rate for <5 Emergency admiion rate for <5 Unintentional & deliberate injury admiion for <5 % of children aged 4-5 who are overweight or obee % receiving 1 doe of MMR vaccine by age 2 Hopital admiion for dental carie (1-4 yr) STP opportunity (to Bet 5) Barking and Dagenham r r r Havering r Newham r Redbridge r Tower Hamlet Waltham Foret City and Hackney 40 Cae 1,537 Cae 446 Cae 403 Cae 45 Live 10 Live 31 Adm. 96 Adm. 493 Cae 14,995 Pat. 797 Adm. 170 Adm. 526 Cae 473 Cae 282 Adm. 41

42 Next tep and action STP area can take the following tep now: Identify the priority programme in your locality and compare againt current improvement activity and plan Look at the focu pack on the NHS RightCare webite for thoe area which are a priority for your locality Engage with clinician and other local takeholder, including public health team in local authoritie and commiioning upport organiation and explore the priority opportunitie further uing local data Refer to the page on coordinated re-allocation of capacity and dicu the wider opportunitie highlighted in thi pack a part of the STP planning proce and conider STP wide action Reviit the NHS RightCare webite regularly a new content, including update to tool to upport the ue of the Commiioning for Value pack, i regularly added Dicu next tep with your local NHS RightCare Delivery Partner. If you don t know who your Delivery Partner i, pleae rightcare@nh.net 42

43 Further upport and information The Commiioning for Value benchmarking tool, explorer tool, full detail of all the data ued, and link to other ueful tool are available on the NHS RightCare webite. Link are hown on the next page. The NHS RightCare webite alo offer reource to upport local health economie in adopting the Commiioning for Value approach. Thee include: Focu pack for the highet pending programme covered in thi pack Online video and how to guide Cae tudie with learning from other CCG If you have any quetion or require any further information or upport you can the Commiioning for Value upport team direct at: 43

44 Ueful link NHS RightCare webite: Commiioning for Value pack and product: NHS RightCare caebook: Five Year Forward View: NHS hared planning guidance for 2017/ /19: 44

45 How have the potential opportunitie been calculated? The potential opportunity at CCG level highlight the cale of change that would be achieved if the CCG value moved to the benchmark value of the average of the Bet 5 or Lowet 5 CCG in it group of imilar 10 CCG. Generally, where a high CCG value i conidered wore then it i calculated uing the formula: Potential Opportunity = (CCG Value Benchmark Value) * Denominator The denominator i the mot uitable population data for that indicator eg CCG regitered population, CCG weighted population, CCG patient on dieae regiter etc. The denominator i alo caled to match the Value. So if the CCG Value and Benchmark Value are given in per 1,000 population then the denominator i expreed in thouand, ie 12,000 become 12. For an indicator, adding the tatitically ignificant opportunitie from the CCG pack give the opportunity for the STP preented in thi pack. 45

46 The NHS RightCare programme The NHS RightCare programme i about improving population-baed healthcare, through focuing on value and reducing unwarranted variation. It include the Commiioning for Value pack and tool, the NHS Atla erie, and the work of the Delivery Partner. The approach ha been teted and proven ucceful in recent year in a number of different health economie. A a programme it focue relentlely on value, increaing quality and releaing fund for reallocation to addre future demand. NHS England ha committed ignificant funding to rolling out the RightCare approach. All CCG are now working with an NHS RightCare Delivery Partner. We have alo aligned Delivery Partner to STP footprint to better upport the ytem. For more information viit: 46

47 NHS RightCare and Commiioning for Value Commiioning for Value i a partnerhip between NHS RightCare and Public Health England. It provide the firt phae of the NHS RightCare approach - Where to Look. The approach begin with a review of indicative data to highlight the top prioritie or opportunitie for tranformation and improvement. Value opportunitie exit where a health economy i an outlier and will mot likely yield the greatet improvement to clinical pathway and policie. Phae two and three then move on to explore What to Change and How to Change. 47