>>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