>>Matthew Cripps: Hello and welcome to your new Commissioning for Value focus packs. I'm
Matthew Cripps and I am National Director of NHS RightCare. This short video will help
you to work through the pack, highlighting key points and explaining what the data is showing.
This collection of focus packs provides more detailed information for local health economies
on the highest volume programmes of care that were covered in your Commissioning for Value
refresh packs published in January 2016.
The focus packs include a range of process and outcome measures and information focusing
on the most common procedures and diagnoses for which your patients are being admitted
to hospital.
These measures span the whole of the pathway from primary prevention through to the end
of life and facilitate local optimal pathway design and improvement.
Commissioning for Value is part of the RightCare
programme and approach. The RightCare approach aims to help local health economies prioritise
the programmes of care that offer the best opportunities for local population healthcare
improvement.
By providing you with data, evidence, tools and practical support around outcomes, quality
and spend; RightCare helps you to transform the way care is delivered for your patients
and populations - and therefore helps you to reduce unwarranted variation.
Please take a look at the video and if you
need any more help then please do contact us via the email address at the end.
Thank you very much.
>>Voice over:This Focus Pack provides information on Cardiovascular disease, including Diabetes
and Renal. The Pack is a real pack but we have the redacted
the name of the CCG. We will make you aware of where we have reduced the amount of slides
in the pack for the purpose of this short video.
The firsts 6 pages provide background information on RightCare and Commissioning for Value.
Page 7 provides information on the similar CCGs that are used as the basis for comparisons
in this pack. These CCGs are selected based on demographic factors such as deprivation
and age of the CCG population. The Pathways on a Page section of the pack
begins on page 10 and in your packs you will find the Pathways on a Page charts that were
included in the CfV packs published in January. For the purpose of this video we are only
the showing this CCG’s Stroke Pathway as an example.
These charts present a range of indicators from across the patient pathway. Bars above
the 0% line mean that the CCG value is higher than the average value of the ten similar
CCGs. For some indicators a high value is good, for some a high value is bad, and for
some it is not clear cut. For this CCG, spend on elective admissions is over 60% lower than
the average of the similar ten. This is shaded blue because local interpretation is required
in order to decide if this is a good or a bad thing. Spend on non-elective admissions
is higher than similar CCGs and this is shaded red.
Moving on now to the Spend slides - this next page- page 20 - is an example of Spend on
elective and non-elective admissions for the different elements of CVD. This shows age-sex
weighted spend per thousand populations for the CCG and the average of the lowest spending
five CCGs of the similar ten. Note that this is a different comparison to the Pathway on
a Page which compared the CCG to the average of all ten similar CCGs. The advantage of
this chart compared to the Pathway on a Page is that this shows the scale of spend not
just the percentage difference from the similar CCGs. For Stroke, this is particularly important,
even though the CCG has considerably lower spend than similar CCGs for elective admissions,
you can see from the chart that the vast majority of Stroke admissions are non-elective. The
CCG could save £428k a year if it could move down to the level of the five lowest spenders
amongst its similar CCGs. Page 27 provides an even more detailed breakdown
for Stroke. This shows that £279k of the £428k potential opportunity is for Cerebral
infarction. The next two pages show information on length
of stay and day cases for Chronic Rheumatic Disease
and Hypertensive Disease. The full range of conditions is again covered in your local
pack The next page shows information on expenditure
on individual and groups of drugs that are commonly prescribed in Primary Care. The example
page given here is for Chronic Heart Disease medication
This CVD slide shows information on common procedures performed during hospital admissions
for CVD. The full range of conditions is covered on your local pack
On page 70 is an example of a Spine Chart providing information on risk factors, prevalence,
activity, spend and outcomes. On page 77 we have an example of a spine chart
that includes the spend indicators for Stroke. The Spine Chart shows the values for the CCG
for each indicator and the yellow dot shows where this falls in the distribution of all
CCGs in England (the white space in the chart) . The light blue bar shows the range of values
for the similar ten CCGs. The fourth indicator down shows elective spend
The yellow dot is to the right of the similar ten bar , because the CCG has lower elective
spend than all the similar CCGs, and is one of the lowest in England. The ‘Best/Lowest
5 Opportunity’ column is blank for this indicator B, because the CCG already spends
less on elective admissions than all similar CCGs so there is no opportunity to improve
to the level of the lowest spending five similar CCGs. This is shaded blue, because as per
the Pathway on a Page, local interpretation is required to decide if this low rate of
spend is a good thing, or whether it reflects late diagnosis of Cerebrovascular problems.
The indicator below is non-elective spend. Here the yellow dot is in the middle of the
range of the similar ten . The blue diamond shows the level of the best five CCGs, i.e.
those with the lowest spend on non-elective admissions. The ‘Best/Lowest 5 Opportunity’
box includes the figure of £428k from page 20. This is shaded red. The ‘Similar 10
Best’ box names Airedale, Wharfedale and Craven as the CCG with the lowest non-elective
spend rate. Also, the Green diamond shows the value of the best in the wider cluster,
which is included as a stretch target for those CCGs who are already performing well.
The darker blue bar to the left of the yellow dot shows the worse performing two CCGs in
the similar ten. And now we move on to the Further Analysis
Slides Page 86 is a page that shows more detailed
information for all indicators that are red or green. The full range of pages is in your
pack. Page 132 shows the non-elective spend indicator.
The value of £428k- is repeated on the title line and is shaded red. The top bar chart
shows all CCGs in England with the CCG bar in yellow and the similar ten shaded grey.
The bottom chart - shows just the CCG and the similar ten. The horizontal blue line
is the level of the Best 5, where the CCG would need to move to to save £428k a year.
Page 98 shows a similar chart for the percentage of Stroke/TIA patients whose blood pressure
is below 150 over 90. The CCG value is 83%, the third lowest. The average of the best
five is 85.7% If the CCG could improve to this level, an extra 94 patients would have
their blood pressure under control, which is a key factor in preventing a Stroke.
The limitations of this video means that we are unable to go into full details about all
of the elements in the pack but page 30 shows the further information on how to get further
support if you require assistance interpreting these packs.
Thank you and Goodbye