first understand your data!
TRANSCRIPT
First understand your data!
Sue Thomas CEO NHiS Commissioning Excellence
Neuro numbers
• The • The NHS spent £4.4 billion on
neurology in 2013
• 4.2% of overall NHS expenditure
• 700,000 emergency admissions costing over £750 million
• Overall NHS expenditure on neuro rose by over 200% between 2003/4 & 2012/13
• 1.3 million hospital admissions in 2012/13 an increase of 500,000 over a 5 year period
Neurological Alliance 2014
Neurology is not really on the national agenda
• Only 14.7% of CCGs have assessed local costs relating to the provision of their neurology services
• Only 20.4% and 26.2% of CCGs respectively have assessed the number of people using neurological services and the prevalence of neurological conditions within their area
• Only 33% of CCGs obtain vital feedback from patients in regards to the neurological services they commission
• These issues have a significant impact on patients’ care, with 58.1% of patients having experienced problems in accessing the services or treatment they need.
Neurological Alliance (2015) The Invisible Patients
Neurologists Is an independent review required?
• Future hospital commission (2013) 24/7 specialist care in hospital or care close to home
• Shape of Training Review proposes Specialist neurology specialists with extra generalist training
We need new ways of working to manage!
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The aim of the NIN is to use information to improve outcomes and reduce inequality in
neurological care in England.
It will do this by:
Identifying and collecting data concerning neurological care
Providing a single open-access store of high quality data, with expert analysis
Using information to support service design and to monitor change
Supporting the development of evidence-based clinical care pathways
Where data indicate, to encourage a resource shift towards primary and secondary prevention
The Neurology Intelligence Network (NIN) What is it?
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Funding: Jointly sponsored by PHE and NHS England.
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WHERE DOES ALL THIS INFORMATION COME FROM?
Sources include:
Hospital Episode Statistics (HES)
Diagnostic Imaging Dataset (DID)
Referral To Treatment (RTT)
HSCIC Compendium of Population Health Indicators
Local Basket of Inequalities Indicators (LBOI)
GP Practice data
Social Care data
The Adult Social Care Outcomes Framework
Quality Accounts
NHS Outcomes Framework
Summary Hospital-level Mortality Indicator (SHMI)
NHS Comparators (over 200 comparators including GP demographics, and QOF)
Workforce statistics compiled from data supplied by around 400 NHS
organisations, and on behalf of around 8,000 GP practices
NHS England Atlas data
Prescribing Data
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1. Neurology Fingertips Tool
Neurology profiles: http://fingertips.phe.org.uk/profile-group/mental-
health/profile/neurology/data
Compare figures for 18 different measures of epilepsy care in 4 Clinical Commissioning
Regions, 12 Strategic Clinical Networks and 211 Clinical Commissioning Areas in England.
Compare 21 different measures concerning emergency admission to hospital with a neurological
condition
For example: How headache and migraine admissions vary by deprivation and CCG
2. Compendium of Neurological Data. England 2012-3
http://www.hscic.gov.uk/catalogue/PUB13776
Download and examine hundreds more tables concerning neurological care in hospitals
and the community.
What can it do for you? – Find it and see
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How neurology fits 5 year forward view
• Prevention of crisis through Improved management (cross boundary working)
• Multi-specialist community providers
• Primary, community & acute care systems
• Urgent & emergency Care (rapid access to support)
• Smaller local hospitals
• Specialised Care – outreach/hub and spoke models
• Transforming health and social care
Changes to neurology commissioning
• All neurology related outpatient activity will be repatriated to CCGs (GP referrals to neurology centres or neuroscience centres) from April 2015. Funding will be transferred from NHSE to CCGs to cover the expected costs of these additional services
• Only consultant to consultant referrals will be funded by NHSE
• Need to consider what this will mean for CCGs who have previously had services funded by NHSE
Collaborative commissioning
• The new collaborative arrangements will be co-designed with CCGs;
• CCGs will be able to choose how much involvement they have in collaborative arrangements;
• It is not expected that CCGs will be required to invest additional resource in setting up or delivering the new arrangements;
• NHS England will provide a range of development support for CCGs to implement the arrangements; and
• National standards, policies and specifications will be utilised within locally designed service models and pathways.
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100,000
200,000
300,000
400,000
500,000
600,000
Motor neurone diseaseSpinal cord injury Migraine CNS infections Hydrocephalus Acquired brain injury Multiple sclerosis Parkinson’s Neuropathies Epilepsy
£
Top 10 neurological conditions requiring hospital admission
(data from 9 Clinical Networks)
Data source NHiS 2014
What does the local data in West Midlands look like?
• Overall spend on 10 conditions with a primary and secondary diagnosis across in 2012/13 = £94.5m
• Epilepsy had the highest cost followed by Parkinson’s and MS
• Cost of non-elective admissions across WMSCN 2012/13 = over £58mm
What does the local data in West Midlands look like?
• When looking at the following indicators, all showed an increased in activity and cost between 2009/10 and 2012/13
• Total admissions
• Non-elective admissions
• Length of stay
• Re-admissions
• Although across the majority of conditions Excess Bed Days had decreased over this period
What does the local data in West Midlands look like?
• Data Intelligence Report for WMSCN in 2014, analysing HES data over a 4 year period (2009/10 – 2012/13) for top 10 condition • Parkinson’s
• Acquired brain injury
• Migraine
• Multiple sclerosis
• Epilepsy
• Motor neurone disease
• Spinal cord injury
• Cerebral palsy
• Hydrocephalus
• Dystonia
• Looked at trends in activity and costs
What does the local data in West Midlands look like?
Highest co-morbidity spend across the 10 conditions – 2009/10 – 2012/13
• Respiratory and related problems = 20.6m
• UTIs = £14.8m
• Falls = £3.9m
These costs highlight a need for robust respiratory and UTI pathways
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Case History Wessex SCN
• 2.8M population (5% NHS England, £4.8bn)
2.8M population (5% NHS England, £4.8bn)
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Neurosciences
Neurology
DGH
Salisbury
Wessex SCN:
ACKNOWLEDGEMENTS
These figures show the ways in which data concerning local neurology services can be
extracted and presented.
HSCIC data commissioned by Wessex SCN and provided by NCS/NHiS with analysis by Dr
C Kipps
Some figures showing the ways in which data concerning local neurology services can be extracted and presented. HSCIC data
commissioned by Wessex SCN and provided by NHiS with analysis by Dr C Kipps
© Crown
copyright
Numbers increasing (normalised) Elective and Non-Elective But rates per condition very different
Readmissions in Wessex 2013/14
0
50
100
150
200
250
Epilepsy Headache Movement Disorders MS and Inflammatory Neuromuscular
No
. Re
adm
issi
on
s
Wessex Average Length of Stay
0
1
2
3
4
5
6
7
Epilepsy Headache Movement Disorders MS and Inflammatory Neuromuscular
Len
gth
of
Stay
(D
ays)
2009/2010
2010/2011
2011/2012
2012/2013
2013/2014
324,055 Parkinson's disease admissions in 182,859 patients over 4 years which
included 72% non-elective admissions and an expenditure of £907 million (£777 million for non-elective admissions).
The main reasons for admission were pneumonia (13.5%), motor
decline (9.4%), urinary tract infection (9.2%), and hip fractures (4.3%).
Comorbidity Movement Disorders
….target interventions more effectively
Comorbidity Multiple Sclerosis
High admission rates shorter length of stay (LOS) High zero bed day rates (ZBD) low excess bed days (EBD) high readmission rates
Lower admission rates longer length of stay Low zero bed days High excess bed days Low readmission rates
HEADACHE, EPILEPSY
MOV DISORDERS, MS, NEUROMUSCULAR
Put effort into • front door emergency
presentations • education referrers &
emergency staff • rapid review (neurology)
Put effort into • early supported discharge • admission prevention • enhanced primary care
management of prominent neuro LTC co-morbidities
Avoiding hospital admissions
• Identify which admissions are avoidable and which interventions are effective.
• Lower socio-economic groups more likely to be admitted (but not in MS)
• Higher continuity of GP care helps
• Self-management helps
• Early review by senior clinician in emergency department may help
Sarah Purdy, Kings Fund, 2010
UCL Partners
The CCG’s
• NHS Barnet
• NHS Camden
• NHS Islington
• NHS Enfield
• NHS East and North Herts
• NHS Haringey
• NHS City and Hackney
• NHS Tower Hamlets
• NHS Newham
• NHS Waltham Forest
• NHS Barking and Dagenham
• NHS Redbridge
• NHS Havering
• NHS Herts Valley
The Hospitals
• University College London Hospitals NHS FT (Queen Square)
• Royal Free London NHS FT (& Barnet &Chase Farm Hospital)
• Bart’s Health NHS Trust (& Whipps Cross and Newham hospitals)
• Barking, Havering & Redbridge NHS Trust
• Homerton Hospital NHS FT
• Whittington Hospital NHS Trust
• North Middlesex University Hospital NHS Trust
See UCL partners UTI pathway Spend a penny save a pound
• http://www.londonscn.nhs.uk/wp-content/uploads/2015/03/neuro-porter-032015.pdf
Service redesign
• Reducing OPA and admissions
• Reducing demand on services
• Self management
• Integrated care
• Referral support system – GP training
• Neuro directory
• Neuro advisers and one stop shop
• Renew exercise programme
• Patient pathways
Parkinson’s integrated care pathway
Summary
• We cannot change pathways, or develop strategy without data – we need to use it, AND we need to collect it
• Commissioning without robust clinical input is an engine without a track; clinical activity without sustainable commissioning is a track without an engine
• We need to address both emergency and LTC – but the approach required is different, and needs to take into account clinical
wisdom as well as business transactional data
• You can’t do much of this without friends – Collaborative commissioning with GPs, CCGs, nursing & AHP, PPI and voluntary
sector
Acknowledgement
• Dr Chris Kipps Wessex SCN
Sue Thomas
Twitter @Sue_nhis