1. Using the commissioning for value packs and resources to improve population health

2. What will this session cover? Explore the opportunities to use Commissioning for Value to improve population health Using examples from the CfV packs discuss how to identify and make the most of these opportunities Discuss the issues/barriers Discuss further support needs Population health workshop

3. Who is in the room? Welcome and introductions Where do you work? What is your role? Experience of using commissioning for value packs? Population health workshop

5. The packs available so far… October 2013 Insight packs produced for every CCG. Looked at the top 10 highest spending programmes and identified opportunities for improving spend, quality and outcomes June 2014 Focus pack on CVD. Identified opportunities for improvement across the cardiovascular pathway November 2014 Pathways on a page. Focus on 13 programmes and sub-programmes drawn from the highest spending programmes http://www.england.nhs.uk/resources/resources-for- ccgs/comm-for-value/ Population health workshop

8. Tips on where to start The pathways on a page take the average of the 10 similar CCGs as the benchmark - improvement to the middle line is effectively seen as aspiring to be average. Discuss the blue and see what other intelligence might be available to explore further. Focus on the red and test out – but don’t ignore green (see above) Look for themes across pathways – for example management in primary care, non-elective spend etc Who in the similar 10 CCGs are doing better – is it worth a chat with them around their pathway? Primary care indicators include excepted patients in the denominator – so a population view Population health workshop

10. Using the packs to investigate further Using Haringey CCG as an example From the integrated care packs: 2% of the most complex patients account for 17.6% of the spend Haringey spend 2.7% more on patients with circulation as a main condition than similar CCGs Circulation, GI and Cancer are the main conditions which account for the highest number of complex patients The pack show opportunities for prevention Population health workshop

14. Investigating further - the pathways on a page packs For Haringey the heart and stroke pathways show potential opportunities to Reduce unmet need Improve management in primary care Reduce high non-elective spend COPD, Asthma and Diabetes pathways on a page tell a similar story Population health workshop

18. Exploring even further… The NCVIN focus packs show potential opportunities for Haringey to Reduce unmet need Improve management in primary care Improve management in secondary care Population health workshop

21. Exploring further Opportunity to obtain data by practice for all the indicators in the NCVIN focus packs Adding additional data The link to inequalities LHO segment tool http://www.lho.org.uk/LHO_Topics/Analytic_Tool s/Segment/TheSegmentTool.aspx http://www.lho.org.uk/LHO_Topics/Analytic_Tool s/Segment/TheSegmentTool.aspx Population health workshop

24. DRAFT Local Data: Smoking prevalence Local Data Practices which have a high % of smokers and low percentage of smokers referred: Smoking prevalence versus % smoking referrals High % smokers High% smokers referred High % smokers Low % smokers referred Low % smokers Low% smokers referred Low % smokers High% smokers referred Practices within the dotted line do not have statistically different level of smoking prevalence and % of smoking referrals to the CCG as a whole

25. DRAFT Local Data: Obesity prevalence Local Data Practices which have high % obesity and low % of weight management referrals : (For a full list of all practice's see appendix 5) Obesity prevalence versus % weight management referrals High obesity prevalence High weight management referrals High obesity prevalence Low weight management referrals Low obesity prevalence Low weight management referrals Low obesity prevalence High weight management referrals Practices within the dotted line do not have statistically different level of smoking prevalence and % of smoking referrals to the CCG as a whole

26. Opportunities for using local data The most recent intelligence from providers Contract monitoring data Local prescribing data Joint Strategic Needs Assessment (JSNA) Preventative activity commissioned by local authorities Data on inequalities Local community data Adult and children’s social care data Population health workshop

28. Produced by PHE Knowledge & Intelligence Team – Northern and Yorkshire The data is wrong DENIAL It does not apply to me ANGER I will get the correct data BARGAINING There is nothing I can do about it DEPRESSION Acceptance and action RESOLUTION Adapted from Elisabeth Kübler-Ross 5 stage model (Though more modern grief theories such as that of John Bowlby described as ‘ebb and flow of processes such as shock and numbness, yearning and searching, disorganization and despair, and reorganization’ have some attraction) The five stages of grief Source: East Midlands Quality Observatory

29. And finally… Summing up Further questions? Sue.baughan@phe.gov.uk Population health workshop