Cancer Right Care Optimisation Workshop Supplementary data analysis 3rd November 2015

Supplementary analysis Follow on analysis from deep dive Adjust for demand (incidence) Understand local recording variations/ practices Identify where the opportunity exists Focus on initial areas identified i.e. skin, haematolgoical and urology.

Cancer incidence CCG has high incidence in cancer overall 2013 cancer incidence from cancer commissioning toolkit – 25 CCGs CCG has high incidence in cancer overall CCG highest incidence in skin, haematological and gynae cancers in cluster group Opportunity is in reducing demand – public health etc.

Cancer incidence v spend There is a clear correlation between high secondary spend and high incidence of cancer However, not all variances can be explained by high incidence.

Cancer growth rates   National 2WW National 62-day Incidence Cases Incidence Rate 2011/12 1,095,916 111,053 274,233 594 2012/13 1,206,588 115,817 281,335 599 2013/14 1,348,947 123,087 291,847 611 Annual change 126,516 6,017 8,807 8 % change 11.54% 5.42% 3.21% 1.42% Nationally the incidence of cancer has grown by 1.4 percent but the number of urgent GP referrals is up 11.5 percent.

Skin cancer When adjusted for incidence the national top quintile gain reduced from 2585 day-case admissions to 1564 1021 extra day-case admissions are attributable to demand and could be addressed through prevention 1564 remaining day-case admissions is the level of hospital activity above expected level for our population Additionally CCG received rebate of £366k for JC15z in 2014/15 as a result of day-case to outpatient procedures.

Skin cancer Elective inpatients Elective admission opportunity has reduced significant once adjusted for incidence Elective inpatient opportunity further reduced once recent trends included Current activity is forecast to be at top quintile in 2015/16.

Urological cancer When adjusted for incidence the gain to reach national top quintile reduced from 531 day-case admissions to 439.

Urological cancer Activity Inpatients 2013/14 2014/15 2015/16 (FOT) % change Inpatient Plymouth Hospitals NHS Trust 239 265 235 -1.59% Royal Devon & Exeter 445 492 487 9.48% Northern Devon NHS Trust 113 105 132 16.81% Daycase 226 295 350 55.04% 996 888 679 -31.81% 269 276 240 -10.78% Outpatients 2964 3016 3420 15.38% 2433 2890 3497 43.72% 1596 1654 1711 7.22% Outpatient to daycase ratio 13.12 10.22 9.76   2.44 3.25 5.15 5.93 5.99 7.13 There has been a reduction in day-case admissions of 221 from 2013/14 to 2015/16 (FOT) which has halved the potential gain Remaining gain could be achieved if NDHT and RD&E had the same outpatient to day-case ratio as PHNT.

Haematological cancer When adjusted for incidence the gain to reach national top quintile reduced from 2141 day-case admissions to 1571 570 extra day-case admissions are attributable to demand But overall secondary care spend similar to top quintile.

Haematological cancer Activity Inpatients 2013/14 2014/15 2015/16 (FOT) % change Inpatient Plymouth Hospitals NHS Trust 52 74 62 20.00% Royal Devon & Exeter 145 144 130 -10.62% Northern Devon NHS Trust 38 29 24 -36.84% Daycase 828 1161 1200 44.93% 4897 4980 5042 2.97% 648 685 547 -15.56% Outpatients 5525 5855 6007 15.38% 3034 2023 3348 43.72% 3285 3155 3175 7.22% Outpatient to daycase ratio 6.67 5.04 5.01   0.62 0.41 0.66 5.07 4.61 5.80 Trend is showing a shift away from elective inpatients to day-case / outpatients RD&E has high level of outpatients compared to PHNT/ NDHT.

Summary of potential gains Theme Where Gain When Note Skin Prevention Daycase 1021 Long-term High incidence Acute 1054 Short-term Daycase to outpatient procedure? 410 N/A Contract adjustment included Urological 92 218 Haematological 570 1571 Overall gain in secondary care may be less