1. Right Care Deep Dives
NEW Devon CCG
Poisoning

2. 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?

3. 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

4. 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?

5. Introduction: Using the Evidence
Using evidence to move from:
“How can I explain this?” to
“What can I do to improve this?”

6. 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

7. 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

8. 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

9. Poisoning

10. 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

11. 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 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 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.

12. 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

13. 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

14. 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

15. 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

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

17. 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

18. 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

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

20. 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

21. 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

22. Any Questions?