>>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 Respiratory
disease, including Chronic Obstructive Pulmonary Disease and asthma.
The Pack is a real pack but we have 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 first six 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 repeats 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 showing the COPD pathway on page 10. The full range
of pages are in your packs This chart presents 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,
the reported to estimated prevalence percentage is lower than similar CCGs. This is shaded
red because this means that GPs are detecting and recording fewer patients with COPD than
we would expect based on the population characteristics of the CCG. The CCG has higher spend on
primary care prescribing. This is shaded blue because local interpretation is required
– a high value may indicate inefficient prescribing or it could mean that GPs are
managing their patients well and high prescribing is preventing hospital admissions and leading
to better outcomes. Non-elective admission rates and mortality rate are shaded red because
high values are clearly bad but please note the wide confidence intervals on these indicators,
which mean it is not possible to say whether the CCG is statistically significantly worse
than similar CCGs. The next set of pages show spend on hospital
admissions for Respiratory conditions broken down in different ways.
This page shows all Respiratory spend – not just COPD and asthma. This shows age-sex
weighted spend per thousand population 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 CCG could save
over 1.3 million pounds if it moved down to the level of the five lowest spending similar
CCGs. Although the majority of the CCGs spend is non-elective, the bigger potential
opportunity is for elective admissions – the CCG has a potential opportunity of 744 thousand
pounds because they currently spend more than double the rate of the lowest spending CCGs
for elective admissions. Please note that elective admissions are considered to need
local interpretation in a similar way to primary care prescribing, so a high value should not
automatically be considered to be bad. The next set of pages show the break down
this spend in more detail. Page 15 shows the CCG spends 250 thousand pounds more on
elective admissions for chronic lower respiratory problems than the lowest five similar CCGs.
This Page shows the equivalent figure for non-elective admissions is 341 thousand pounds
Page 20 is an example slide of information on length of stay and day cases. The full
range of pages is in your pack. This page shows information on expenditure
on drugs prescribed in Primary Care for COPD and asthma. The CCG spends 325 thousand
pounds more than the lowest spending five CCGs on COPD drugs but as explained for the
pathway on a page this requires local interpretation to determine whether this represents an opportunity.
This page breaks this down by individual drugs.
The CCG spends 399 thousand pounds more than the lowest five on Symbicort alone.
This page is an example of a slide showing information on common procedures performed
during hospital admissions for COPD and asthma. Pages 45 is an example of the Spine Charts
providing information on risk factors, prevalence, activity, spend and outcomes.
Page 45 includes the spend indicators. 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 second indicator down is elective spend for all respiratory
admissions. The yellow dot is to the left of the similar ten bar, because the CCG has
higher elective spend than all the similar CCGs. The ‘Best/Lowest 5 Opportunity’
box shows the opportunity figure of 744 thousand pounds seen on page 13 that the CCG could
achieve if it could improve to the level of the lowest spending five similar CCGs. This
is shaded blue for local interpretation. The indicator below is non-elective spend
for all respiratory admissions. 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 646 thousand pounds from page 13. This is shaded red. The
‘Similar 10 Best’ box names Newark and Sherwood as the best in the similar ten. The
green triangle shows the value of the best CCG 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.
These features are not included for the elective admissions indicator because this
needs local interpretation so it would not be right to name best and worst CCGs.
This is an example of a slide showing more detailed information for all indicators that
may be red or green. The full range of slides showing information for all indicators that
may be red or green is in your pack This Page shows the non-elective spend indicator
already discussed. The value of 646 thousand pounds 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 in order to save 646 thousand pounds a year.
This page shows a similar chart for the percentage of deaths that occur at home. The CCG value
is 18.7%, lower than all the similar ten CCGs. The average of the best five is 23%. If
the CCG could improve to this level, an extra 70 patients would die in their own home rather
than a hospital. The length of this video means that we are
unable to go into full details about all of the elements in this pack but page 159 shows
how to get further support if you require assistance interpreting these packs. This
includes a link to the website where the data used in the packs, a metadata file and an
interactive tool will be paced. Thank you.