1. NHS Benchmarking Data Susan Hamilton Consultant in Public Health South Gloucestershire Council

2. Purpose 1.Understand the range of NHS benchmarking tools available to support CCG commissioning 2.Explore the pros and cons of each tool 3.Share experience of using the tools 4.Understand how these tools can be used in South Glos to support commissioning, including incorporating into the JSNA

3. NHS Better Care, Better Values http://www.productivity.nhs.uk/ Potential areas for improving quality and saving £ CCG, Hospital & GP – elective and emergency care CCG / Hospital ranks, numbers, opportunity £, trends, details of specialities / procedures Supporting documents / rationale / case studies Method Opportunities are calculated for each percentile within the ‘buckets’ of activity based on age, sex, deprivation and diagnosis. Values then aggregated to give performance / opportunity. £ Opportunity calculated by an average using PbR tariff +ve sophisticated but not an average … -ve won’t align with local SUS / Dr Foster

4. NHS Programme Budgeting https://www.england.nhs.uk/resources/resources-for-ccgs/prog-budgeting/ Estimates NHS expenditure across 23 disease areas in different healthcare settings CCGs to benchmark their expenditure Programme Budgeting Marginal Analysis (PBMA) – impact of incremental changes in costs and benefits when resources are deployed in different ways Used in Commissioning for Value Packs +ve: PB data quality improved over time, benchmarking, review pathways -ve: quality of data, time to complete full PBMA, opportunities to move £ around system, method for calculating PB changes each year so can’t compare trends.

5. SPOT http://www.yhpho.org.uk/default.aspx?RID=49488 SPOT tool uses PB and adds outcomes Identifies areas outside the expected range for further investigation Bundles & weights outcomes Compare against peer CCGs +ve: highlights mismatch between spend and outcomes -ve: appropriateness / accuracy of outcome measures

6. Dr Foster http://www.drfoster.com/ Commercial product, widely used by CCGs Provides detailed analysis of hospital use

7. Commissioning for Value & Atlas of Variation CfV http://www.rightcare.nhs.uk/index.php/commissioning-for-value/#commissioningforvalue Collaboration between NHS Right Care, NHS England and Public Health England Commissioning for Value Packs produced for each CCG Pathway compared to peer CCGs & some deep dives Mix of data from PB, PHOF, NHS outcomes, QOF +ve: peer group comparison & pathway useful -ve: interpreting some of the variables cfv-south-gloucestershire.pdf Atlas of Variation http://www.rightcare.nhs.uk/index.php/atlas/atlas-of-variation-2015-opportunity-locator-tool/ http://www.rightcare.nhs.uk/index.php/nhs-atlas/ +ve: extensive, includes variables lacking elsewhere e.g. diagnostic–ve: timeliness & navigation

8. Clinical Benchmarking – some examples Hip fracture database http://www.nhfd.co.uk/ Produced by Clinical Effectiveness and Evaluation Unit & Royal College of Physicians (2007) Hip fracture care & secondary prevention – case-mix, process and outcomes Focused reports on specific topics e.g. anaesthetics, Annual hospital dashboard http://www.nhfd.co.uk/nhfd/2015db/fry.pdf Renal register https://www.renalreg.org/data/ Produced by the UK Renal Registry in collaboration with other organisations All patients receiving renal replacement therapy in UK – process, outcomes, epidemiology Data collected daily from all contributing centres and laboratories Quarterly data collected on all renal patients in UK units Demography, co-morbidity, test results, RRT, medication National Bariatric Register http://nbsr.co.uk/

9. 2014 – the 17 th Annual Renal Register Figure 1.11. Percentage presenting late (2012/2013)

10. 2014 – the 17 th Annual Renal Register Figure 1.1. RRT incidence rates in the countries of the UK 1990–2013