Right Care Deep Dives NEW Devon CCG Poisoning

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: Poisoning 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

Poisoning

Areas for investigation Toxic effects -Tobacco and nicotine Observation for suspected toxic effect from ingested subs Toxic effects - Gases Poisoning - 4-Aminophenol derivatives Toxic effects -Alcohol Poisoning -Digestants Poisoning - Other and unspecified narcotics Toxic effects - Corrosive acids and acid-like substances Poisoning - Heroin Toxic effects - Metals and compounds Toxic effects -Corrosive substance Poisoning - Other and unspec drugs medicaments & biological subs

Population Poisoning and the adverse affects of poisoning are the terms given to the impact of drugs and alcohol within the community. Data from the 2014/15 Crime Survey for England and Wales shows that illicit Drug use is highest in young men aged 20-34 with over 25% of that cohort reporting use in the previous year. The highest levels of ‘binge drinking’ are recorded for the male population aged between 25-44. However there are sustained levels of high alcohol consumption amongst older populations. The population characteristics of the cities within NEW Devon CCG mean potentially higher risk profiles for actions leading to poisoning or the adverse impact of poisoning. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/462885/drug-misuse-1415.pdf

The Challenge High comparative spend for Emergency Transport (Ambulance and NHS 111) Non Elective spend in middle quintile and data shows some opportunity around alcohol-related admissions There is considerable variation in admission rates and outcomes around alcohol across the county The CCG benchmarks relatively well for years of life lost due to chronic liver conditions

Inpatients (Non-elective) The CCG falls within the middle national quintile for Non-elective spend Rates of alcohol-related and alcohol-specific admissions are in the same quintile Local Alcohol Profiles show Plymouth, Exeter and North Devon with higher rates than the rest of the county

Inpatients (Non-elective) Moving towards the national best quintile performance would deliver some fairly large savings for Poisoning as a whole Continuing to target certain populations where deprivation could be linked to high alcohol usage could help reduce secondary care spend The % of admissions for 4-Aminophenol is also higher than national levels which might warrant further investigation Programme Budget Non-Elective Admissions Spend per 100,000 (£000s) Difference to NEW Devon (£000s) Saving Opportunity (£000s) National Median 131.1 2.5 22.5 National best quintile Median 84.7 48.9 442.9 Similar 10 CCGs median 145.6 -12.0 None Non-elective Opportunity = £0k - £443k

Emergency Transport Opportunity = £0k - £425k Spend in this area relates to Ambulance usage and NHS 111 The CCG benchmarks in the second-highest national quintile and therefore shows opportunity against several benchmarks A lack of detailed, comparative data means further local analysis or interpretation is needed here Programme Budget Emergency Transport Spend per 100,000 (£000s) Difference to NEW Devon (£000s) Saving Opportunity (£000s) National Median 107.0 9.9 89.6 National best quintile Median 70.0 46.9 425.1 Similar 10 CCGs median 117.3 -0.4 None Emergency Transport Opportunity = £0k - £425k

A&E A&E spend is also low (lowest national quintile). When reviewing the detail attendances have risen during 2014-15; seemingly for Bites and Stings which make up 45% of total A&E activity

Outcomes - Good NEW Devon performs well on alcohol-specific mortality (and alcohol-related mortality) and mortality from chronic liver disease Months of life lost due to alcohol compares well to the median of the 10 most similar CCGs and the England average, however there is still room for improvement against the median of the best quintile

Outcomes – Poor Rates of alcohol admissions are high for certain indicators, apparently driven by subsets of the population in North Devon, Exeter and Plymouth Whilst the CCG performs well in mortality from chronic liver disease, Plymouth is well above the rest of the south west for many of the mortality indicators. Admission episodes for alcohol-related mental and behavioural disorders due to use of an alcohol condition is also an area where the CCG benchmarks well above regional rates

Overall Poisoning Opportunity: £0 - £868k Opportunities Non-elective: £0 - £443k Emergency Transport: £0 - £425k Overall Poisoning Opportunity: £0 - £868k

NHS Oxfordshire NHS Nene NHS West Hampshire NHS Dorset Who is doing well? Non-electives NHS Nene NHS West Hampshire NHS Dorset Emergency Transport NHS Oxfordshire CCG performance based on age-sex standardised information

What does this all mean? Opportunity to reduce Non-elective spend to national best median  could be delivered by reducing alcohol-related admissions, particularly by targeting certain communities Opportunities identified in Emergency Transport  drivers likely to be similar to Non-elective admissions, so could be combined under one intervention

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