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

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. 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 £810-930 million a year Without change this is set to grow

9. Patient Perspective

10. 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 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 PCT160.37.18.4139 Dudley PCT160.67.58.2123 Herefordshire PCT164.57.78.4110 Telford & Wrekin PCT158.37.78.2107 Warwickshire PCT164.37.78.1108 Wolverhampton City PCT162.87.78.6112 Coventry Teaching PCT162.87.88.5104 South Birmingham PCT171.77.88.6102 Heart of Birmingham Teaching PCT1817.97.8100 South Staffordshire PCT158.77.98.199 North Staffordshire PCT1608.38.277 Sandwell PCT158.38.58.665 Walsall Teaching PCT163.28.78.561 Solihull Care Trust197.68.98.453 Birmingham East & North162.898.648 Stoke on Trent Teaching PCT161.79.39.244 Worcester PCT161.19.49.331 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 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 PCT160.37.18.4139 Dudley PCT160.67.58.2123 Herefordshire PCT164.57.78.4110 Telford & Wrekin PCT158.37.78.2107 Warwickshire PCT164.37.78.1108 Wolverhampton City PCT162.87.78.6112 Coventry Teaching PCT162.87.88.5104 South Birmingham PCT171.77.88.6102 Heart of Birmingham Teaching PCT1817.97.8100 South Staffordshire PCT158.77.98.199 North Staffordshire PCT1608.38.277 Sandwell PCT158.38.58.665 Walsall Teaching PCT163.28.78.561 Solihull Care Trust197.68.98.453 Birmingham East & North162.898.648 Stoke on Trent Teaching PCT161.79.39.244 Worcester PCT161.19.49.331

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 PCT1817.90.8 141 Herefordshire PCT164.57.711.3127 Shropshire County PCT160.37.111.3133 Warwickshire PCT164.37.711.2119 Wolverhampton City PCT162.87.711.4120 Dudley PCT160.67.51.11.4115 South Staffordshire PCT158.77.91.11.2108 Telford & Wrekin PCT158.37.71.11.4104 Worcester PCT161.19.41.11.2102 Sandwell PCT158.38.51.21.490 South Birmingham PCT171.77.81.31.476 Coventry Teaching PCT162.87.81.4 59 North Staffordshire PCT1608.31.51.447 Solihull Care Trust197.68.91.51.322 Walsall Teaching PCT163.28.71.51.442 Birmingham East & North162.891.61.437 Stoke on Trent Teaching PCT161.79.31.81.722 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 PCT1817.90.8 141 Herefordshire PCT164.57.711.3127 Shropshire County PCT160.37.111.3133 Warwickshire PCT164.37.711.2119 Wolverhampton City PCT162.87.711.4120 Dudley PCT160.67.51.11.4115 South Staffordshire PCT158.77.91.11.2108 Telford & Wrekin PCT158.37.71.11.4104 Worcester PCT161.19.41.11.2102 Sandwell PCT158.38.51.21.490 South Birmingham PCT171.77.81.31.476 Coventry Teaching PCT162.87.81.4 59 North Staffordshire PCT1608.31.51.447 Solihull Care Trust197.68.91.51.322 Walsall Teaching PCT163.28.71.51.442 Birmingham East & North162.891.61.437 Stoke on Trent Teaching PCT161.79.31.81.722 Note Airways Disease does not include Asthma

23. West Midlands COPD Non-Elective Admissions

24. Deprivation & Admissions

27. West Midlands non-elective COPD hospitalisation costs

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

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

30. PCT Cost Saving Potentials for COPD

31. North Staffs: COPD Admissions Practice Level Data

32. Stoke: COPD Admissions Practice Level Data

33. South Staffs: COPD Admissions Practice Level Data

34. West Midlands non-elective Asthma hospitalisation data

35. Deprivation & Asthma Admissions

38. West Midlands non-elective Asthma hospitalisation costs

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

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

41. PCT Cost saving Potential for Asthma

42. North Staffs: Asthma Admissions Practice Level Data

43. Stoke: Asthma Admissions Practice Level Data

44. South Staffs: Practice Level Asthma Admissions