Right Care Deep Dives NEW Devon CCG Blood Disorders

Contents 1. Introduction 2. Deep Dive Methodology Right Care Deep Dives, Unwarranted Variation, Using the Evidence 2. Deep Dive Methodology Data Extraction and Processing, Analysis and Presentation 3. Deep Dive Findings: Blood Disorders The Challenge, Population, Activity/Spend, Outcomes, Opportunities Who’s Doing Well? What Does This All Mean?

Introduction: Right Care Deep Dives Commissioning for Value packs help identify Programme Areas in which to look Analytical Deep Dives form part of phase two: ‘What to Change’ Further, specific analytical requests would also support the ‘How to Change’ phase Commissioning for Value Packs Deep Dives Where to look What to change How to change

Introduction: Unwarranted Variation Aim to understand what can’t be explained by patient choice or illness of population A four-stage process Identify the variation Understand if it is warranted What is driving it? How do we eliminate it?

Introduction: Using the Evidence Using evidence to move from: “How can I explain this?” to “What can I do to improve this?”

Methodology: Data Extraction and Processing Downloaded data for NEW Devon and comparator CCGs from a host of national sources: Programme Budgeting HSCIC/iView Prescribing Quality and Outcomes Framework Public Health Profiles Many more! Process this data into formats which allow ease of comparison and further analysis

Methodology: Analysis & Presentation Where NEW Devon CCG is: In ‘worst’ quintile Where a related set of indicators show a tendency toward poor performance Focus on key areas and/or indicators National median Median of national upper quintile Median of ‘most similar 10 CCGs Median used instead of mean to reduce impact of extreme outliers Present comparative data against different scenarios Against national position and benchmarks Similar CCGs Provider Practice Review data at a range of levels to better understand variation at a macro and micro level

Methodology: Analysis & Presentation Inquiry approach Exploring data using key lines of enquiry (KLOEs) Identify ‘golden threads’ present throughout the data Working with partners to understand local issues Identify poorly performing area for KLOE using programme budgeting as a base Review related indicators from other data sources to refine detail Analyse provider and practice level data to illustrate local variation Assess scale of opportunity against various scenarios

Blood Disorders Programme

Areas for investigation

The Challenge • CCG in second highest quintile for spend in four of the nine areas • Outpatient activity is the largest driver, although picture is complex • In some areas there may be opportunities to negotiate local tariffs with providers to help drive down costs

Population Low levels of ‘at-risk’ groups for certain blood disorders High levels of chronic disease which may increase risk of certain blood disorders

Primary Care Prescribing Spend in second lowest quintile nationally Opportunity for savings is relatively low and limited detailed information available to support Addressing practice variation could help deliver the small opportunity in this area Opportunity = £0 - £107k

Community and Integrated Care Data suggests potential opportunity for savings when compared to similar CCGs Lack of detail available about what drives this It could be that high spend in this area is supporting relatively low levels of Non Elective and A&E spend Community and Integrated Care Opportunity = £1.4M - £3.3M

Outpatient Opportunity = £320k - £2.3M Outpatients (1) Outpatient costs in second highest quintile Significant variation across CCGs which may indicate differences in recording practice Outpatient Opportunity = £320k - £2.3M

Outpatients (2) NEW Devon shows a high proportion of activity recorded under Clinical Haematology attracting a mandatory tariff Anticoagulant Service are subject to local cost agreements

Inpatient Opportunity = £30k - £594k Inpatients Non Elective spend benchmarks well Elective spend within middle quintile showing some opportunity Some of this could be delivered through changing the setting of care for Day Case activity Point of delivery NEW Devon 10 most similar CCGs England Ordinary admission 5% 4% 6% Day Case 94% 90% 83% Regular Day 0% 11% Regular Night Inpatient Opportunity = £30k - £594k

Unbundled High Cost Drugs and Devices CCG spend falls within the highest national quintile Limited national data available to understand the detail; local analysis recommended Reduction scenario Spend per 100,000 (£000s) Difference with NEW Devon spend per 100,000 (£000s) Saving opportunity (£000s) National median 35.8 22.0 199.8 National best quintile median 7.0 50.8 460.2 Similar 10 CCGs median 29.3 28.5 258.3 Unbundled High Cost Drugs and Devices Opportunity = £200k - £460k

Overall Blood Disorders opportunity: £1.95M - £6.76M Opportunities Primary Care Prescribing: £0k - £107k Community and Integrated Care: £1.4M - £3.3M Inpatients: £30k - £594k Outpatients: £320k - £2.3M Drugs and Devices: £200k - £460k Overall Blood Disorders opportunity: £1.95M - £6.76M

Community and Integrated Care Who is doing well? Outpatients Gloucestershire CCG Dorset CCG Windsor, Ascot & Maidenhead* Community and Integrated Care South Derbyshire CCG Nene CCG Mansfield & Ashfield CCG* CCG performance based on age-sex standardised information *not a peer CCG, but best-performing CCG in country

What does this all mean? Significant opportunity in Community and Integrated Care  Would need careful consideration as this could be contributing to low Non-elective and A&E spend (*peer CCGs with low Community spend do not have significant Unscheduled Care costs) Opportunity in Outpatients is wide-ranging and blurred by apparent coding disparities  would require more-detailed review to understand potential Elective/Daycase opportunity could be realised by shifting setting of care to Regular Day Attender

Any Questions?