1. National Diabetes Information Service Using Data and Information to Improve the Quality of care and Outcomes for People with Diabetes Sharon Finney Commissioning Manager, North Staffordshire Clinical Commissioning Group

2. N ORTH S TAFFORDSHIRE CCG Our Economy :- Population of 213,000 Ex-Industrial area – many people with LTCs Pockets of affluence, areas of deprivation, large rural areas We have 11,617 people* with diagnosed diabetes and Further 13,047 adults with undiagnosed diabetes (*aged 17 years and older. 2011/12 data

3. N ORTH S TAFFORDSHIRE CCG The reports show that generally, we are not outlier when compared to all other areas across the UK. Estimated increase in number of patients with diabetes from 7.3% in 2012 to 8.2% by 2020, if current trends continue.

4. N ORTH S TAFFORDSHIRE CCG Medicines Management Spending on prescription items to treat diabetes £369 per person, compared to £415 across England. Current spend on insulin items is £162.98 per person = Total spend in 2011/12 of £1.9million. If we changed prescribing practice to level required to enter lowest 25% spending CCGs we would reduce spend by £30,000 pa.

5. Total spend on prescribing compared to people with diabetes with a HbA1c of 59mmol/mol or less including exceptions for NHS North Staffordshire CCG

6. N ORTH S TAFFORDSHIRE CCG Foot Care Significantly fewer patients from North Staffordshire CCG admitted to hospital for diabetic foot disease and fewer nights spent in hospital with that diagnosis (2009/10 and 2011/12). Annual nights in hospital for diabetic foot disease calculated at 126.6 per thousand for North Staffordshire compared to 166.1 per thousand for all CCGs in England. During 2009-12 29 major amputations performed. Rates of both minor and major amputations were not significantly different from national average.

7. N ORTH S TAFFORDSHIRE CCG Inpatient Care Our diabetes patients have greater excess emergency bed days compared to all inpatients with diabetes in England (33.8% vs 26.2%) Our diabetes patients have less elective bed days than national average However, risk of them being readmitted as an emergency within 28 days is lower than national average (7.9% vs 19.1%) Additional risk of mortality in North Staffs is 39% compared to 39.8% for England and Wales.

8. N ORTH S TAFFORDSHIRE CCG There are links between patients with : diabetes and stroke diabetes and MI Where diabetes is diagnosed and managed well, these complications can be prevented / reduced. Data shows additional risk of stroke in people living in North Staffs with diabetes is 42% higher than in our local general population For MI this is 26% higher than in the general population of North Staffs. We do not know however whether the stroke or MI had occurred before or after diagnosis of Diabetes.

9. N ORTH S TAFFORDSHIRE H EALTH E CONOMY What are we doing about this ? Working with our Medicines Management team regarding any opportunities to further reduce prescribing costs for diabetes. Working with 3 practices to help us determine whether the diabetes or the Stroke / MI came first. The 3 practices will look at their diabetes population and identify those who also had either an MI or a Stroke

10. N ORTH S TAFFORDSHIRE H EALTH E CONOMY Potential Issue The GP tool has older data, however many of the other tools have been updated to reflect CCG boundaries and are updated more regularly. There is recent practice level data included in the profiles and plans to produce a practice level tool in the near future

11. Thank you for listening Any questions? Sharon Finney, Commissioning Manager, North Staffordshire Clinical Commissioning Group Sharon.finney@northstaffordshire.nhs.uk Sharon.finney@northstaffordshire.nhs.uk