Thames Valley SCN Workshop Charles Rendell June 20 2014 Affiliate: - - PowerPoint PPT Presentation

Affiliate:

Thames Valley SCN Workshop

Charles Rendell June 20 2014

DRAFT - NOT FOR CIRCULATION

Agenda

• Service Mapping overview
• High level findings
• Data background
• Definitions
• High level data
• Way forward

NCS… what we do

• Experts in neurology solutions
• Improve outcomes and drive down cost
• Support for all health economy partners
• Unique voluntary sector not for profit partnership
• Service users at the heart of neurology commissioning
• DH Innovation funding 2011-2014
• CSU functions

15 million people in England (of which 7 million are migraine) – more than 1:4 have a neurological condition. Over half a million people are newly diagnosed each year

• 38% Real-term increase in

annual spending between 2006-7 & 2009-10

• 31% Increase in neurological

inpatient admissions between 2004-5 & 2009-10, compared to 20% for the NHS as a whole

• 32% Increase in emergency

neurological admissions to hospital between 2004-05 & 2009-10, compared to 17% for the NHS as a whole.

Project Background

• The aim of the project was to give an overview of

neurological service provision across the Thames Valley SCN area:

• Process

– Interviews with key stakeholders – Document reviews – Development and analysis of data across nine conditions (selected by the SCN) – Development of report and recommendations

NB: Should be recognised that the data is an indicator of performance and accuracy is dependent on coding and other variables

.

Conditions reviewed

Disease area

Epilepsy Headache and Migraine MS and demyelinating diseases Motor Neurone Disease Movement disorders (including Parkinson’s and tremor) Muscle disorders (including Myasthenia Gravis) Neuropathy Sub arachnoid haemorrhage Acquired Brain Injury

ICD codes ( as requested by SCN)

G40 and G41 G93, G43 and R51X G35X,G36, G37 G12 G20X, G21, G23, G25, G26 G70, G71, G72, G73 G61, G62 I60 S06

.

High level findings

• There is evidence of services and highly committed staff to manage

neurological conditions across the area across statutory and the voluntary sector but a more coordinated and informed approach is needed.

• Neurology is not routinely being highlighted in Joint Strategic Needs

Assessments across all the CCGs

• Integration of health and social care services is poorly developed

across the region

• Community service provision is patchy across the area and there is

a lack of data for community services

• There is an element of historical confusion around how services are

commissioned and by whom. Work is ongoing to by the SCN and Specialised Commissioning to rectify this situation.

.

High level findings

• There is a lack of informed neurological

commissioning

– Although there is strong leadership for many long-term neurological conditions there is no formalised integrated care pathways – Services have evolved overtime driven by individual staff rather than in a coordinated fashion – Data is not being routinely used to inform service planning and provision across the pathway of care – There is minimal specific attention given to neurology across new CCG Operating Plans ( due for sign off late June) although strategies are being developed which will have positive

• utcomes for the neurology community

DRAFT - NOT FOR CIRCULATION

High level findings

• Comorbidity data indicates that a number of emergency

admissions are potentially avoidable e.g. admissions due to urinary tract infections or lobar pneumonia

• There is anecdotal evidence that due to lack of capacity

and under resourced services, staff are unable to focus

• n the necessary ongoing improvements for their service

area

• Specialist nurses report that there are working with high

caseloads

.

High level findings

• Specialist staff and patients report that knowledge of

neurological conditions is poor among non specialist staff

• Voluntary sector provision across the region is well

established , driving high level of patient and carer engagement through the Regional Neurological Alliances

.

Data

High level data presentation across agreed disease areas – Further investigation of data bases covering

• Admissions
• Readmissions
• LOS
• Excess Bed days
• Zero Bed days
• Costs
• Comorbids
• Out Patients
• Patient flows through local hospitals

Definitions

• Primary admission– the diagnosis considered to be the main

reason for an admission

• Secondary admission– the secondary reason for an admission

– For example Primary: Urinary Tract Infection. Secondary: MS

• Non elective – an unplanned admission, usually an emergency
• Elective – patient is given a date to attend hospital

Data background

• Hospital Episode Statistics is from the same source as SUS

(secondary usage service) data apart from the patient’s ID and address are removed

• All data provided through a commercial reuse licence from the NHS

Health and Social Care Information Centre via NHS

• Data has also been sourced for the Health and Social Care

Information Centre

Patient populations across TVSCN

CCG 2009-10 2010-11 2011-12 2012-13 NHS Aylesbury Vale CCG 195,246 196,588 198,019 200,597 NHS Bracknell and Ascot CCG 131,352 134,545 136,117 136,865 NHS Chiltern CCG 323,114 325,403 322,894 327,820 NHS Newbury and District CCG 113,215 113,295 113,978 114,847 NHS North & West Reading CCG 106,593 105,758 107,019 107,951 NHS Oxfordshire CCG 687,169 684,189 694,252 693,515 NHS Slough CCG 135,548 137,106 143,386 146,685 NHS South Reading CCG 125,757 124,409 126,989 132,560 NHS Windsor, Ascot and Maidenhead CCG 149,094 149,156 150,550 152,712 NHS Wokingham CCG 154,161 153,259 154,220 155,927

With the exception of Oxford CCG local populations have increased between 2009/10 and 2012/13

Affiliate:

Epilepsy

Admission rate per 100,000 – Total elective and non- elective admissions with a primary or secondary diagnosis of Epilepsy 2009/10 to 2012/13 by CCG

The highest admissions per 100,000 for Epilepsy is NHS Sough CCG 50 100 150 200 250 300 350 400 450 500

Admissions per 100,000 population by CCG

2009/2010 2010/2011 2011/2012 2012/2013

Total admission costs – Total elective and non- elective admissions with a primary or secondary diagnosis of Epilepsy 2009/10 to 2012/13

Total admission costs for Epilepsy across the SCN area are increasing year on year

$8,524,993 $8,546,154 $9,182,260 $11,812,360

2009/10 2010/11 2011/12 2012/13

Thames Valley SCN total costs

Thames Valley SCN Linear (Thames Valley SCN)

Admission cost per 100,000 – Total elective and non- elective admissions with a primary or secondary diagnosis of Epilepsy 2009/10 to 2012/13 by CCG

Highest costs per 100,000 were incurred by Slough CCG $0 $100,000 $200,000 $300,000 $400,000 $500,000 $600,000 $700,000 $800,000

Costs per 100,000 population

2009/2010 2010/2011 2011/2012 2012/2013

Affiliate:

Headache and Migraine

Admission rate per 100,000 – Total elective and non- elective admissions with a primary or secondary diagnosis of Headache and Migraine 2009/10 to 2012/13 by CCG

The highest admissions per 100,000 for Headache and Migraine is NHS Slough CCG 50 100 150 200 250 300 350 400 450

Admissions per 100,000 population by CCG

2009/10 2010/11 2011/12 2012/13

Total admission costs – Total elective and non- elective admissions with a primary or secondary diagnosis of Headache and Migraine 2009/10 to 2012/13

Total admission costs for Headache and Migraine across the SCN were increasing year on year but dipped in 2012/13

$6,255,424 $6,566,809 $7,407,416 $6,933,603

2009/10 2010/11 2011/12 2012/13

Thames Valley SCN total costs

Costs Linear (Costs)

Admission cost per 100,000 – Total elective and non- elective admissions with a primary or secondary diagnosis of Headache and Migraine 2009/10 to 2012/13 by CCG

Highest costs per 100,000 were incurred by NHS Aylesbury Vale CCG $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 $450,000 $500,000

Costs per 100,000 population

2009/2010 2010/2011 2011/2012 2012/2013

Affiliate:

Multiple Sclerosis and Demyelinating disease

Admission rate per 100,000 – Total elective and non- elective admissions with a primary or secondary diagnosis of MS 2009/10 to 2012/13 by CCG

The highest admissions per 100,000 for MS is NHS Windsor and Ascot CCG 50 100 150 200 250 300

Admissions per 100,000 population by CCG

2009/2010 2010/2011 2011/2012 2012/2013

Total admission costs – Total elective and non- elective admissions with a primary or secondary diagnosis of MS 2009/10 to 2012/13

Total admission costs for MS across the SCN area are increasing year on year

$3,155,423 $3,578,875 $2,914,027 $3,808,721

2009/10 2010/11 2011/12 2012/13

Thames Valley SCN total costs

Total costs Linear (Total costs)

Admission cost per 100,000 – Total elective and non- elective admissions with a primary or secondary diagnosis of MS 2009/10 to 2012/13 by CCG

Highest costs per 100,000 were incurred by NHS Windsor, Ascot and & Maidenhead CCG $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000

Costs per 100,000 population

2009/2010 2010/2011 2011/2012 2012/2013

Affiliate:

Motor Neurone disease

Admission rate per 100,000 – Total elective and non- elective admissions with a primary or secondary diagnosis of MND 2009/10 to 2012/13 by CCG

The highest admissions rate per 100,000 for MND is NHS Bracknell and Ascot CCG 5 10 15 20 25

Admissions per 100,000 population by CCG

2009/2010 2010/2011 2011/2012 2012/2013

Total admission costs – Total elective and non- elective admissions with a primary or secondary diagnosis of MND 2009/10 to 2012/13

Total admission costs for MND across the SCN have decreased 2012/13

$985,584 $993,100 $1,019,046 $965,803

2009/10 2010/11 2011/12 2012/13

Thames Valley SCN total costs

Total costs Linear (Total costs)

Admission cost per 100,000 – Total elective and non- elective admissions with a primary or secondary diagnosis of MND 2009/10 to 2012/13 by CCG

Highest costs per 100,000 were incurred by NHS North & West Reading CCG $0 $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000

Costs per 100,000 population

2009/2010 2010/2011 2011/2012 2012/2013

Affiliate:

Movement Disorders (Including Parkinson’s and Tremor)

Admission rate per 100,000 – Total elective and non- elective admissions with a primary or secondary diagnosis of Movement Disorder 2009/10 to 2012/13 by CCG

The highest admissions per 100,000 for Movement Disorder is NHS Wokingham CCG 20 40 60 80 100 120 140 160 180

Admission per 100,000 population by CCG

2009/2010 2010/2011 2011/2012 2012/2013

Total admission costs – Total elective and non- elective admissions with a primary or secondary diagnosis of Movement Disorder 2009/10 to 2012/13

Total admission costs for Movement Disorder across the SCN have increased in 2012/13 to just over £7 million.

$5,874,271 $5,397,383 $5,736,579 $7,104,541

2009/10 2010/11 2011/12 2012/13

Thames Valley SCN total costs

Total costs Linear (Total costs)

Admission cost per 100,000 – Total elective and non- elective admissions with a primary or secondary diagnosis of Movement Disorder 2009/10 to 2012/13 by CCG

Highest costs per 100,000 were incurred by NHS Wokingham $0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 $450,000

Costs per 100,000 population

2009/2010 2010/2011 2011/2012 2012/2013

Affiliate:

Muscle disorders (including Myasthenia Gravis)

Admission rate per 100,000 – Total elective and non- elective admissions with a primary or secondary diagnosis of Muscle Disorder 2009/10 to 2012/13 by CCG

The highest admissions per 100,000 for Movement Disorder is NHS Oxfordshire CCG 200 400 600 800 1,000 1,200

Admissions per 100,000 population by CCG

2009/2010 2010/2011 2011/2012 2012/2013

Total admission costs – Total elective and non- elective admissions with a primary or secondary diagnosis of Muscle Disorder 2009/10 to 2012/13

Total admission costs for Muscle Disorder across the SCN have increased in 2012/13 to just over £1.3 million.

$1,011,542 $790,503 $847,936 $1,307,347

2009/10 2010/11 2011/12 2012/13

Thames Valley SCN Total costs

Total costs Linear (Total costs)

Admission cost per 100,000 – Total elective and non- elective admissions with a primary or secondary diagnosis of Muscle Disorder 2009/10 to 2012/13 by CCG

Highest costs per 100,000 were incurred by NHS North & West Reading CCG $0 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000

Costs per 100,000 population

2009/2010 2010/2011 2011/2012 2012/2013

Affiliate:

Acquired Brain Injury

Admission rate per 100,000 – Total elective and non- elective admissions with a primary or secondary diagnosis of ABI 2009/10 to 2012/13 by CCG

The highest admission rate per 100,000 for ABI is NHS Chiltern CCG at 133 per 100,000 5 10 15 20 25 30 35 40 45 50

Admissions per 100,000 population by CCG

2009/2010 2010/2011 2011/2012 2012/2013

Total admission costs – Total elective and non- elective admissions with a primary or secondary diagnosis of AIB 2009/10 to 2012/13

Total admission costs for AIB across the SCN have risen year on year with a slight dip 2012/13

£1,395,210 £1,633,179 £2,542,110 £2,375,895

2009/10 2010/11 2011/12 2012/13

Total costs

Total costs Linear (Total costs)

Admission cost per 100,000 – Total elective and non- elective admissions with a primary or secondary diagnosis of ABI 2009/10 to 2012/13 by CCG

Highest costs per 100,000 were incurred by NHS Newbury and District CCG £- £20,000 £40,000 £60,000 £80,000 £100,000 £120,000 £140,000 £160,000 £180,000 £200,000

Cost per 100,000 population

2009/2010 2010/2011 2011/2012 2012/2013

Admissions and Costs

.

Admission rate per 100,000 – Total elective and non- elective admissions with a primary or secondary diagnosis across conditions 2009/10 to 2012/13 across TVSCN

Highest admissions across the area are for Epilepsy 225 202 104 11 113 23 25 252 209 120 11 129 24 25 275 238 129 12 138 25 34 268 246 127 12 130 25 34 50 100 150 200 250 300 Epilepsy Headache and Migraine MS MND Movement Disorders Muscle Disorders ABI

Admissions per 100,000 across TVSCN

2009/10 2010/11 2011/12 2012/13

Total elective and non elective costs 2009/10- 2012/13

Costs across elective were just under £42 million for elective admissions across these 7 conditions and just under £75 million for non elective admissions equating to overall costs of £ 116,710,689 over four years in Thames Valley. $0 $5,000,000 $10,000,000 $15,000,000 $20,000,000 $25,000,000 $30,000,000 Epilepsy Headache and Migraine MS MND Movement disorders Muscle disorders ABI

Costs of admissions across 2009/10-2012/13

Elective Non Elective

Top co-morbidities by disease category

Disease Indicator Top Categories Total Spend Epilepsy Infections (UTI, RTI) £2,548,922 Headache & Migraine Pregancy related, syncope & UTI £1,125,214 Multiple Sclerosis Infections (UTI, RTI) £1,172,160 MND Infections (UTI, RTI) £203,082 Movement Disorders Infections (UTI) NoF & Senility £3,839,907 Muscle disorders Infections (UTI, RTI) £249,059 Neuropathy Infections (UTI), Ulcers (ll) £360,144 ABI Subdural Haemorrhage, SAH, Diffuse Brain Injury £1,291,356

The majority of comorbidities involve UTI

The way forward

• There are a range of recommendations in the report including:

– Commissioners and providers routinely examine and interpret neurology data to inform practice – Commissioners agree a minimum data set for the community services – The provision of local specialist nurses in neurology is reviewed – Review co-morbidities across neurology to identify area where interventions could be introduced to reduce avoidable admissions – Raise awareness of neurological conditions – Review examples of integrated care pathways for those with neurological conditions – Consider joint commission arrangements – Develop local disease registers

.

The way forward

• Information by area and condition is further detailed in

the report

• Data is available in the appendix and can be reviewed if

required

• Further data is available in the report on Referral to

Treatment, Outpatients and Workforce.

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0207 5818419 www.ncssupport.org.uk charles.rendell@csupport.org.uk https://twitter.com/@NCS

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