Copyright 2011 Right Care Using “Deep Dive” Insights packs in Northern and Yorkshire CCGs Sue Baughan Associate Director, Knowledge and Intelligence Team (Northern and Yorkshire) Public Health England January 2014 Online Learning Series Right Care for Populations

Produced by PHE Knowledge & Intelligence Team – Northern and Yorkshire 2 Commissioning Insights packs 2013 Where to Look - Prioritising opportunities

Produced by PHE Knowledge & Intelligence Team – Northern and Yorkshire Diving deeper into the data –Deep dive packs were piloted in Yorkshire and Humber in 2012/13 –An example of the pack is available herehere 3

Commissioning for Value insight pack NHS England Gateway ref: 00525

Produced by PHE Knowledge & Intelligence Team – Northern and Yorkshire Programme deep dives – preparing to act – key elements CCGs identified programmes to look at further Commitment to use intelligence to drive transformation Clinical, commissioning, business intelligence and public health engagement Local intelligence Quantifying potential impact – how ambitious to be Analysis at practice level 6

Produced by PHE Knowledge & Intelligence Team – Northern and Yorkshire Programme deep dives - Methodology 7 Analysed indicators across the pathway from prevention to end of life focussing on spend and quality Compared CCG with other similar CCGs and identified key opportunities for value improvement and quantified the potential impact Identified high performing CCGs in the cluster and ‘what works’ from the evidence base Worked with multi-disciplinary team in CCG to; add local data agree clear summary and key messages

Annex 1: Spine Charts Minimum value in clusterMaximum value in cluster Key: Prevention Worse outcomeBetter outcome Prevalence Higher prevalence / Worse outcome Lower prevalence / Better outcome

9 Two CCGs in bottom Quintile

10 Two CCGs in bottom Quintile This CCG

11 Two CCGs in bottom Quintile This CCG Ambition

12 Two CCGs in bottom Quintile This CCG Ambition Average of ten PCTs

13

Number of Indicators (/of those looked at) where CCG below the average for the top two quintiles – (best 40% in its benchmark group) See Annex for full list Indicators in the bottom quintile v benchmark group -difference between NHS XXX CCG and the benchmark average of the top 40% in brackets, (p) – PCT based indicator Opportunity if NHS XXX CCG were to equal the benchmark average of the top 40% 60/66  CVD emergency admissions (DSR) (27.2% higher),  CHD emergency admissions (DSR) male (44.2% higher),  CHD emergency admissions (DSR) female (53.3% higher),  Heart failure emergency admissions (DSR) male (43.8% higher),  CHD: average cost per elective admission (female) (38.4% higher),  Non-elective Angioplasty procedures (DSR) males (48.9% higher),  CHD: average LOS per elective admissions (male) (83.1% higher),  Stroke: average LOS per emergency admissions (female) (90.2% higher),  Stroke: average LOS per emergency admissions (male) (112.4% higher),  Angiography: average LOS per procedure (101.8% higher),  Proportion of non-STEMI patients seen by member of cardiology team (p) (- 12.3% lower),  Non elective spend (p) (52.1% higher),  Ambulance spend (p) (55.9% higher),  A&E spend (p) (69.7% higher)  381 fewer people  117 fewer people  66 fewer people  34 fewer people  £161k (total cost savings)  45 fewer procedures  202 bed days  1,693 bed days  1,695 bed days  1,089 bed days  12% of non-STEMI patients  £2.9M  £0.4M  £0.2M 2/2  None  None 1/1  Death at home or usual place of residence (p) (66.3 % higher)  78 more people Where does the CCG compare poorly against its benchmark group? Analysis by pathway stage (2) 14 \ \ Management in Secondary Care Social Care End of life Care 14

Number of Indicators (/of those looked at) where CCG below the average for the top two quintiles – (best 40% in its benchmark group) See Annex for full list Indicators in the bottom quintile v benchmark group -difference between NHS XXX CCG and the benchmark average of the top 40% in brackets, (p) – PCT based indicator Opportunity if NHS XXX CCG were to equal the benchmark average of the top 40% 60/66  CVD emergency admissions (DSR) (27.2% higher),  CHD emergency admissions (DSR) male (44.2% higher),  CHD emergency admissions (DSR) female (53.3% higher),  Heart failure emergency admissions (DSR) male (43.8% higher),  CHD: average cost per elective admission (female) (38.4% higher),  Non-elective Angioplasty procedures (DSR) males (48.9% higher),  CHD: average LOS per elective admissions (male) (83.1% higher),  Stroke: average LOS per emergency admissions (female) (90.2% higher),  Stroke: average LOS per emergency admissions (male) (112.4% higher),  Angiography: average LOS per procedure (101.8% higher),  Proportion of non-STEMI patients seen by member of cardiology team (p) (- 12.3% lower),  Non elective spend (p) (52.1% higher),  Ambulance spend (p) (55.9% higher),  A&E spend (p) (69.7% higher)  381 fewer people  117 fewer people  66 fewer people  34 fewer people  £161k (total cost savings)  45 fewer procedures  202 bed days  1,693 bed days  1,695 bed days  1,089 bed days  12% of non-STEMI patients  £2.9M  £0.4M  £0.2M 2/2  None  None 1/1  Death at home or usual place of residence (p) (66.3 % higher)  78 more people Where does the CCG compare poorly against its benchmark group? Analysis by pathway stage (2) 15 \ \ Management in Secondary Care Social Care End of life Care 15

Number of Indicators (/of those looked at) where CCG below the average for the top two quintiles – (best 40% in its benchmark group) See Annex for full list Indicators in the bottom quintile v benchmark group -difference between NHS XXX CCG and the benchmark average of the top 40% in brackets, (p) – PCT based indicator Opportunity if NHS XXX CCG were to equal the benchmark average of the top 40% 60/66  CVD emergency admissions (DSR) (27.2% higher),  CHD emergency admissions (DSR) male (44.2% higher),  CHD emergency admissions (DSR) female (53.3% higher),  Heart failure emergency admissions (DSR) male (43.8% higher),  CHD: average cost per elective admission (female) (38.4% higher),  Non-elective Angioplasty procedures (DSR) males (48.9% higher),  CHD: average LOS per elective admissions (male) (83.1% higher),  Stroke: average LOS per emergency admissions (female) (90.2% higher),  Stroke: average LOS per emergency admissions (male) (112.4% higher),  Angiography: average LOS per procedure (101.8% higher),  Proportion of non-STEMI patients seen by member of cardiology team (p) (- 12.3% lower),  Non elective spend (p) (52.1% higher),  Ambulance spend (p) (55.9% higher),  A&E spend (p) (69.7% higher)  381 fewer people  117 fewer people  66 fewer people  34 fewer people  £161k (total cost savings)  45 fewer procedures  202 bed days  1,693 bed days  1,695 bed days  1,089 bed days  12% of non-STEMI patients  £2.9M  £0.4M  £0.2M 2/2  None  None 1/1  Death at home or usual place of residence (p) (66.3 % higher)  78 more people Where does the CCG compare poorly against its benchmark group? Analysis by pathway stage (2) 16 \ \ Management in Secondary Care Social Care End of life Care 16

Number of Indicators (/of those looked at) where CCG below the average for the top two quintiles – (best 40% in its benchmark group) See Annex for full list Indicators in the bottom quintile v benchmark group -difference between NHS XXX CCG and the benchmark average of the top 40% in brackets, (p) – PCT based indicator Opportunity if NHS XXX CCG were to equal the benchmark average of the top 40% 60/66  CVD emergency admissions (DSR) (27.2% higher),  CHD emergency admissions (DSR) male (44.2% higher),  CHD emergency admissions (DSR) female (53.3% higher),  Heart failure emergency admissions (DSR) male (43.8% higher),  CHD: average cost per elective admission (female) (38.4% higher),  Non-elective Angioplasty procedures (DSR) males (48.9% higher),  CHD: average LOS per elective admissions (male) (83.1% higher),  Stroke: average LOS per emergency admissions (female) (90.2% higher),  Stroke: average LOS per emergency admissions (male) (112.4% higher),  Angiography: average LOS per procedure (101.8% higher),  Proportion of non-STEMI patients seen by member of cardiology team (p) (- 12.3% lower),  Non elective spend (p) (52.1% higher),  Ambulance spend (p) (55.9% higher),  A&E spend (p) (69.7% higher)  381 fewer people  117 fewer people  66 fewer people  34 fewer people  £161k (total cost savings)  45 fewer procedures  202 bed days  1,693 bed days  1,695 bed days  1,089 bed days  12% of non-STEMI patients  £2.9M  £0.4M  £0.2M 2/2  None  None 1/1  Death at home or usual place of residence (p) (66.3 % higher)  78 more people Where does the CCG compare poorly against its benchmark group? Analysis by pathway stage (2) 17 \ \ Management in Secondary Care Social Care End of life Care 17

Where to focus: Understanding practice variation Practices compared against other practices within their practice cluster for all the indicators where data is available at practice level The start of a conversation…… Practices will have less influence on management in secondary care than they do on management in primary care and this should be taken into account in the way CCGs interpret the information on practice variation 18 Analysis

Where to focus: Understanding practice variation 19 Analysis

Produced by PHE Knowledge & Intelligence Team – Northern and Yorkshire Programme deep dives - bringing in local intelligence Have the plans worked? Testing the size of the opportunities identified Links to identified needs of the population –JSNA –Unmet need –Inequalities Preventative activity 20

Produced by PHE Knowledge & Intelligence Team – Northern and Yorkshire What happened? Half of the CCGs in the patch took up the offer of a deep dive – all chose respiratory or CVD initially Opportunities identified used in transformation programmes and QIPP Many evidenced this approach as part of ‘clear and credible plans Half of CCGs in the patch have received training in the Right Care approach to transformation Four CCGs have embedded this approach 21

22 Online Learning Series Right Care for Populations Follow Right Care online Subscribe to get a weekly digest of our blog alerts in your inbox, Receive occasional eBulletins Follow us on Find the full series at: Doncaster CCG Calderdale CCG Anonymous deep dive pack