1. 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

2. Where are we now? Current PCT performance
Colin Gelder & Sandy Walmsley
Respiratory Leads West Midlands

3. 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

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

7. NHS Costs

8. 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

9. Patient Perspective

10. 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

11. 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

13. 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.

15. 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

16. 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%

17. 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

18. Current Performance in West Midlands

19. PCT Expenditure on Respiratory DH 2009-10 Programme Budgeting Benchmark Workbook v1.0
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
160.3
7.1
8.4
139
Dudley PCT
160.6
7.5
8.2
123
Herefordshire PCT
164.5
7.7
110
Telford & Wrekin PCT
158.3
107
Warwickshire PCT
164.3
8.1
108
Wolverhampton City PCT
162.8
8.6
112
Coventry Teaching PCT
7.8
8.5
104
South Birmingham PCT
171.7
102
Heart of Birmingham Teaching PCT
181
7.9
100
South Staffordshire PCT
158.7 99
North Staffordshire PCT
160
8.3 77
Sandwell PCT 65
Walsall Teaching PCT
163.2
8.7 61
Solihull Care Trust
197.6
8.9 53
Birmingham East & North 9 48
Stoke on Trent Teaching PCT
161.7
9.3
9.2 44
Worcester PCT
161.1
9.4 31
National Average of £8.4m, an SHA average of £8.2m

20. PCT Expenditure on Respiratory DH 2009-10 Programme Budgeting Benchmark Workbook v1.0
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
160.3
7.1
8.4
139
Dudley PCT
160.6
7.5
8.2
123
Herefordshire PCT
164.5
7.7
110
Telford & Wrekin PCT
158.3
107
Warwickshire PCT
164.3
8.1
108
Wolverhampton City PCT
162.8
8.6
112
Coventry Teaching PCT
7.8
8.5
104
South Birmingham PCT
171.7
102
Heart of Birmingham Teaching PCT
181
7.9
100
South Staffordshire PCT
158.7 99
North Staffordshire PCT
160
8.3 77
Sandwell PCT 65
Walsall Teaching PCT
163.2
8.7 61
Solihull Care Trust
197.6
8.9 53
Birmingham East & North 9 48
Stoke on Trent Teaching PCT
161.7
9.3
9.2 44
Worcester PCT
161.1
9.4 31
National Average of £8.4m, an SHA average of £8.2m

21. Spend per 100,000 of own population on COPD DH 2009-10 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
181
7.9
0.8
141
Herefordshire PCT
164.5
7.7 1
1.3
127
Shropshire County PCT
160.3
7.1
133
Warwickshire PCT
164.3
1.2
119
Wolverhampton City PCT
162.8
1.4
120
Dudley PCT
160.6
7.5
1.1
115
South Staffordshire PCT
158.7
108
Telford & Wrekin PCT
158.3
104
Worcester PCT
161.1
9.4
102
Sandwell PCT
8.5 90
South Birmingham PCT
171.7
7.8 76
Coventry Teaching PCT 59
North Staffordshire PCT
160
8.3
1.5 47
Solihull Care Trust
197.6
8.9 22
Walsall Teaching PCT
163.2
8.7 42
Birmingham East & North 9
1.6 37
Stoke on Trent Teaching PCT
161.7
9.3
1.8
1.7
Note Airways Disease does not include Asthma

22. Spend per 100,000 of own population on COPD DH 2009-10 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
181
7.9
0.8
141
Herefordshire PCT
164.5
7.7 1
1.3
127
Shropshire County PCT
160.3
7.1
133
Warwickshire PCT
164.3
1.2
119
Wolverhampton City PCT
162.8
1.4
120
Dudley PCT
160.6
7.5
1.1
115
South Staffordshire PCT
158.7
108
Telford & Wrekin PCT
158.3
104
Worcester PCT
161.1
9.4
102
Sandwell PCT
8.5 90
South Birmingham PCT
171.7
7.8 76
Coventry Teaching PCT 59
North Staffordshire PCT
160
8.3
1.5 47
Solihull Care Trust
197.6
8.9 22
Walsall Teaching PCT
163.2
8.7 42
Birmingham East & North 9
1.6 37
Stoke on Trent Teaching PCT
161.7
9.3
1.8
1.7
Note Airways Disease does not include Asthma

23. West Midlands COPD Non-Elective Admissions

24. Deprivation & Admissions

25. Deprivation & Admissions

26. Deprivation & Admissions

27. West Midlands non-elective COPD hospitalisation length of stay

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

29. West Midlands non-elective COPD hospitalisation costs

30. PCT Cost Saving Potentials for COPD

31. Dudley: COPD Admissions Practice Level Data

32. Walsall: COPD Admissions Practice Level Data

33. Wolverhampton: COPD Admissions Practice Level Data

34. Coventry: COPD Admissions Practice Level Data

35. COPD Admissions to University Hospital Coventry 2010/11

37. Admission Frequency 20 admissions 5 admissions x 5 13 admissions

38. West Midlands non-elective Asthma hospitalisation data

39. Deprivation & Asthma Admissions

40. Deprivation & Asthma Admissions

41. Deprivation & Asthma Admissions

42. West Midlands non-elective Asthma hospitalisation costs

43. West Midlands non-elective Asthma hospitalisation length of stay

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

45. PCT Cost saving Potential for Asthma

46. Dudley: Asthma Admissions Practice Level Data

47. Walsall: Asthma Admissions Practice Level Data

48. Wolverhampton: Asthma Admissions Practice Level Data