Programme Where are we now? Current PCT performance within SHA No decision about me, without me: Local patients views Are there alternative ways of delivering care and achieving QIPP targets? Round Table Discussion

COPD COPD causes >25,000 deaths a year in England and Wales (5% all deaths) 835,000 people in England have been diagnosed with COPD DoH estimate >3 million people have COPD Thus 2 million have undiagnosed COPD

Key Facts Approx 9% GP patient population GP consultation rates x2 angina Average list will contain 200 COPD patients

NHS Costs

COPD is an expensive disease for the NHS when it is not identified and treated early >75% costs is due to severe/very severe patients Direct cost of COPD to NHS is £ million a year Without change this is set to grow

Patient Perspective

COPD is a progressive illness, and the number of people dying as a result of COPD increases with age COPD is disabling. Although it affects people in different ways, those with COPD often have breathlessness, reduced exercise tolerance, a cough and repeated chest infections

COPD Exacerbations & Survival 13.9% of people admitted with an exacerbation of COPD die within 90 days 25% of people admitted with an exacerbation of COPD die within 1 year

Social Costs Quality of life is undermined. Restricted mobility leads to social isolation and the psychological conditions that go with it. A British Lung Foundation survey found that 90% of people with severe COPD were unable to participate in socially important activities such as gardening, 66% were unable to take a holiday because of their disease and 33% had disabling breathlessness.

Socio-Economic Bias Smoking is more prevalent in lower socioeconomic groups 26% of routine and manual workers smoke vs. 15% in managerial & professional occupations DoH estimates that the routine and manual occupational group represents 50% people with (diagnosed or undiagnosed) COPD in England Men aged between 20 and 64 employed in unskilled manual occupations are 14 times more likely to die from COPD than men in professional roles, and are around seven times more likely than those in managerial and technical occupations

The Disadvantaged The picture is even worse for smokers from the most disadvantaged sectors of society, where in some cases (e.g. for people with schizophrenia) smoking prevalence can reach 74%

Societal Costs ~25% of people with COPD are prevented from working due to the disease Leading to 20.4 million lost working days among men and 3.5 million days among women every year The annual cost of COPD- related lost productivity to employers and the economy has been put at £3.8 billion

Current Performance in West Midlands

PCT Expenditure on Respiratory DH Programme Budgeting Benchmark Workbook v1.0 PCT Total Expenditure (£m per 100,000 own population) Spend on Respiratory (£m per 100,000 own population) Cluster Sub Group Average (£m per 100,000 own population) National Rank Shropshire County PCT Dudley PCT Herefordshire PCT Telford & Wrekin PCT Warwickshire PCT Wolverhampton City PCT Coventry Teaching PCT South Birmingham PCT Heart of Birmingham Teaching PCT South Staffordshire PCT North Staffordshire PCT Sandwell PCT Walsall Teaching PCT Solihull Care Trust Birmingham East & North Stoke on Trent Teaching PCT Worcester PCT National Average of £8.4m, an SHA average of £8.2m

PCT Expenditure on Respiratory DH Programme Budgeting Benchmark Workbook v1.0 PCT Total Expenditure (£m per 100,000 own population) Spend on Respiratory (£m per 100,000 own population) Cluster Sub Group Average (£m per 100,000 own population) National Rank Shropshire County PCT Dudley PCT Herefordshire PCT Telford & Wrekin PCT Warwickshire PCT Wolverhampton City PCT Coventry Teaching PCT South Birmingham PCT Heart of Birmingham Teaching PCT South Staffordshire PCT North Staffordshire PCT Sandwell PCT Walsall Teaching PCT Solihull Care Trust Birmingham East & North Stoke on Trent Teaching PCT Worcester PCT

Spend per 100,000 of own population on COPD DH Programme Budgeting Benchmark Workbook v1.0 PCT Total Expenditure (£m per 100,000 own population) Spend on Respiratory (£m per 100,000 own population) Spend on Airways Disease Cluster average Spend on Airways Disease National Rank Heart of Birmingham Teaching PCT Herefordshire PCT Shropshire County PCT Warwickshire PCT Wolverhampton City PCT Dudley PCT South Staffordshire PCT Telford & Wrekin PCT Worcester PCT Sandwell PCT South Birmingham PCT Coventry Teaching PCT North Staffordshire PCT Solihull Care Trust Walsall Teaching PCT Birmingham East & North Stoke on Trent Teaching PCT Note Airways Disease does not include Asthma

Spend per 100,000 of own population on COPD DH Programme Budgeting Benchmark Workbook v1.0 PCT Total Expenditure (£m per 100,000 own population) Spend on Respiratory (£m per 100,000 own population) Spend on Airways Disease Cluster average Spend on Airways Disease National Rank Heart of Birmingham Teaching PCT Herefordshire PCT Shropshire County PCT Warwickshire PCT Wolverhampton City PCT Dudley PCT South Staffordshire PCT Telford & Wrekin PCT Worcester PCT Sandwell PCT South Birmingham PCT Coventry Teaching PCT North Staffordshire PCT Solihull Care Trust Walsall Teaching PCT Birmingham East & North Stoke on Trent Teaching PCT Note Airways Disease does not include Asthma

West Midlands COPD Non-Elective Admissions

Deprivation & Admissions

West Midlands non-elective COPD hospitalisation costs

West Midlands non-elective COPD hospitalisation length of stay

West Midlands non-elective COPD hospitalisation 28-day readmission rate

PCT Cost Saving Potentials for COPD

North Staffs: COPD Admissions Practice Level Data

Stoke: COPD Admissions Practice Level Data

South Staffs: COPD Admissions Practice Level Data

West Midlands non-elective Asthma hospitalisation data

Deprivation & Asthma Admissions

West Midlands non-elective Asthma hospitalisation costs

West Midlands non-elective Asthma hospitalisation length of stay

West Midlands non-elective Asthma hospitalisation 28-day readmission rate

PCT Cost saving Potential for Asthma

North Staffs: Asthma Admissions Practice Level Data

Stoke: Asthma Admissions Practice Level Data

South Staffs: Practice Level Asthma Admissions