QIPP Right Care. NHS Milton Keynes Health investment slide pack. July 2010

Transcription

1 NHS Milton Keynes Health investment slide pack July 2010

2 About this health investment pack Purpose / Objectives to highlight the scale of variation in healthcare at PCT and GP Practice level and demonstrate how Programme Budgeting tools can help the search for unwarranted variation and support the health investment process The analysis presented provides a high level narrative in terms of expenditure, expenditure drivers, and the resulting outcomes for one disease area per PCT By triangulating data from a variety of sources, the analysis draws on a wide evidence base to provide consistent messages and therefore minimises opportunities to highlight data quality issues This pack cannot draw comprehensive conclusions but provides a summary of readily available and free to use national level information sets for local organisations to raise questions and investigate further PCTs who want to explore these variations in more detail should take this forward through their DPH and Public Health Observatories and Quality Observatories As the NHS moves towards commissioning by GP Consortia it is imperative that PCTs establish a clear framework and evidence base for making and evaluating health investment decisions 2

3 Overview Programme Budgeting Tools show that Milton Keynes has; Higher spend and worse outcome for Neurological problems when compared to similar PCTs Lowest prevalence of Epilepsy when compared to similar PCTs Low number of patients on convulsion free drugs when compared to similar PCTs Lowest FHS prescribing expenditure when compared to similar PCTs High spend on Elective admissions for Neurological problems when compared to similar PCTs High spend on Emergency admissions for Neurological problems when compared to similar PCTs 3

4 What is Programme Budgeting? 23 Programme Budgeting Categories 1 Infectious Diseases 2 Cancer & Tumours 3 Blood Disorders 4 Endocrine, Nutritional and Metabolic Problems 5 Mental Health Problems 6 Learning Disability Problems 7 Neurological System Problems 8 Eye/Vision Problems 9 Hearing Problems 10 Circulation Problems (CVD) 11 Respiratory System Problems 12 Dental Problems 13 Gastro Intestinal System Problems 14 Skin Problems 15 Musculo Skeletal System Problems (excludes Trauma) 16 Trauma & Injuries 17 Genito Urinary System Disorders (except infertility) 18 Maternity & Reproductive Health 19 Neonates 20 Poisoning 21 Healthy Individuals 22 Social Care Needs 23 Other Conditions 4

5 2007/08 and 2008/09 Programme Level Expenditure for England 5

6 Information Available for PCTs This pack will provide an update on the products available to commissioners including: Programme Budgeting Spreadsheet; SPOT (Spend & Outcome Tool); Programme Budgeting Atlas; NHS Comparators. Inpatient Variation Expenditure Tool (IVET) These tools allow commissioners to compare expenditure and outcomes at disease level. To access these tools visit; These tools are a starting point for the process of making health investment decisions. 6

7 Programme Budgeting Spreadsheet Milton Keynes PCT Expenditure Programme Budgeting Category Milton Keynes PCT Expenditure on own population ( 000s) % change from Infectious Diseases 3,673 3,155 4,613 46% 02 Cancers and Tumours 13,408 15,644 16,385 5% 03 Disorders of Blood 3,817 2,929 3,827 31% 04 Endocrine, Nutritional and Metabolic 7,596 7,591 8,792 16% 05 Mental Health Disorders 28,763 32,836 34,208 4% 06 Problems of Learning Disability 8,409 9,893 10,233 3% 07 Neurological 11,293 13,210 14,711 11% 08 Problems of Vision 3,515 7,289 6,707-8% 09 Problems of Hearing 1,279 1,720 1,953 14% 10 Problems of Circulation 21,884 20,167 23,120 15% 11 Problems of the Respiratory System 12,652 11,544 14,638 27% 12 Dental Problems 12,372 12,996 14,332 10% 13 Problems of Gastro Intestinal System 16,011 16,464 15,981-3% 14 Problems of the Skin 5,409 6,673 6,719 1% 15 Problems of Musculo Skeletal System 14,770 23,346 14,635-37% 16 Problems due to Trauma and Injuries 14,801 14,345 10,874-24% 17 Problems of Genito Urinary System 9,836 9,893 12,128 23% 18 Maternity and Reproductive Health 15,739 17,367 16,930-3% 19 Conditions of Neonates 2,984 1,619 2,850 76% 20 Adverse effects and poisoning 2,769 2,722 3,667 35% 21 Healthy Individuals 9,311 9,551 10,989 15% 22 Social Care Needs 6,789 7,684 5,275-31% 23 Other 37,819 48,568 54,357 12% All Total 264, , ,924 4% 7

8 Programme Budgeting Spreadsheet Expenditure per 100,000 population (weighted by age, sex and need) Milton Keynes has high expenditure for Maternity, Dental and Neurological Categories adjusting for age, sex and need of population PCT Selected Milton Keynes PCT Selected Cluster details 2 GROUP (12 groups) New and Growing Towns Population (as per Allocations) Dist from Target '000 (Under/Over) Dist from Target % (Under/Over) Programme Budgeting Category 2006/ /08 199, , ,563 (13,141) (10,080) (10,631) -5.05% -3.50% 2008/ % EXPENDITURE ON OWN POPULATION per 100,000 population Rank Rank Rank % Change 01 Infectious Diseases 1,837, ,558, ,255, % 02 Cancers and Tumours 6,707, ,726, ,009, % 03 Disorders of Blood 1,909, ,446, ,870, % 04 Endocrine, Nutritional and Metabolic 3,800, ,749, ,297, % 05 Mental Health Disorders 14,389, ,217, ,722, % 06 Problems of Learning Disability 4,206, ,886, ,002, % 07 Neurological 5,649, ,524, ,191, % 08 Problems of Vision 1,758, ,600, ,278, % 09 Problems of Hearing 639, , , % 10 Problems of Circulation 10,948, ,960, ,302, % 11 Problems of the Respiratory System 6,329, ,701, ,155, % 12 Dental Problems 6,189, ,418, ,006, % 13 Problems of Gastro Intestinal System 8,010, ,131, ,812, % 14 Problems of the Skin 2,706, ,295, ,284, % 15 Problems of Musculo Skeletal System 7,389, ,530, ,154, % 16 Problems due to Trauma and Injuries 7,404, ,085, ,315, % 17 Problems of Genito Urinary System 4,920, ,886, ,928, % 18 Maternity and Reproductive Health 7,873, ,577, ,276, % 19 Conditions of Neonates 1,492, , ,393, % 20 Adverse effects and poisoning 1,385, ,344, ,792, % 21 Healthy Individuals 4,658, ,717, ,371, % 22 Social Care Needs 3,396, ,795, ,578, % 23 Other 18,920, ,988, ,572, % All Total 132,524, ,791, ,528,061 3% 8

9 2008/2009 Programme Budgeting Spreadsheet Neurological Expenditure per 100,000 population (weighted by age, sex and need) Green circle shows Milton Keynes PCT has high Neurological Expenditure compared to PCTs nationally (blue dots) and the highest Neurological Expenditure compared to similar PCTs (purple triangles) 9

10 APHO Spend and Outcomes tool (SPOT) The Spend and Outcomes tool has been developed by the Association of Public Health Observatories. The tool allows PCTs to compare their expenditure and outcome data for each of the 23 Programme Budget disease categories on a single page. The tool is interactive and allows PCTs to select different outcome measures and different views of the data including a comparison with any other selected PCT. A very useful tool that quickly allows PCTs to identify areas of expenditure that warrant further investigation. 10

11 2008/2009 APHO Spend and Outcomes Tool Each diamond represents a disease category and shows spend and outcomes compared to the national average Milton Keynes has a slightly higher spend and worse outcome for Neurological when compared to PCTs nationally. Mortality from all Epilepsy, under 75 11

12 2008/2009 APHO Spend and Outcomes Tool - ONS Cluster Average Each diamond represents a disease category and shows spend and outcomes compared to the ONS Cluster average Milton Keynes has higher spend and a worse outcome for Neurological when compared to similar PCTs Mortality from all Epilepsy, under 75 12

13 Programme Budgeting Atlases The Programme Budgeting Atlases are provided on our behalf by the National Centre for Health Outcomes Development, under contract to the Information Centre for Health and Social as part of the Compendium of Public Health Indicators. The Atlas links programme budgeting expenditure data, as presented in the programme budgeting spreadsheet with an array of outcome data. By using mapping software, bar charts and correlation plots, the Atlases provides an illuminating and user-friendly way of analysing and presenting data. Atlases available via an NHS Net connection from: nww.nchod.nhs.uk 13

14 Years of life lost due to mortality from epilepsy, Directly age-standardised rate per 10,000 population, less than 75 years, all persons Milton Keynes has high years of life lost due to Epilepsy when compared to similar PCTs 14

15 Patients with epilepsy on drug treatment and convulsion free: Percent, 18+ years, FY 2007/8 Milton Keynes has a low number of patients on drug/convulsion free treatments when compared to similar PCTs 15

16 FHS Prescription expenditure: Neurological problems: Thousand pounds per 100,000 population (weighted for age, sex and need) FY 2007/8 Milton Keynes has the lowest FHS Prescribing Expenditure on Neurological Problems when compared to similar PCTs 16

17 Prevalence of all Epilepsy (QOF); Percent, 17+ years: FY 2007/8 Milton Keynes has the lowest prevalence of Epilepsy when compared to similar PCTs 17

18 Emergency Readmissions to hospital within 28 days of discharge: All Neurological Problems: Admissions excluding day cases, indirectly age standardised, percent all ages FY 2007/2008 Milton Keynes has an above average number of Emergency Readmissions when compared to similar PCTs 18

19 Deaths within 30 days of admission: All Neurological problems: Admissions excluding day cases, indirectly age standardised, percent all ages FY 2007/2008 Milton Keynes has a below average number of deaths within 30 days of admission when compared to similar PCTs 19

20 Programme Budgeting Atlases Indices of deprivation 2007:IMD Average score, 2005 vs FHS Prescription Expenditure; Neurological problems: Thousands pounds per 100,000 unified weighted population FHS Prescription expenditure on neurological problems is negatively correlated to indices of deprivation. Milton Keynes PCT has a lower FHS prescription expenditure than PCTs with a similar indices of deprivation 20

21 NHS Comparators NHS Comparators provided by the IC on the NHS net; nww.nhscomparators.nhs.uk Holds data at England, SHA, PCT and Practice level; Data are timely and frequent every quarter up to Q3 2009/10 Various sources of data including: total admissions activity and expenditure; non-elective admissions activity and expenditure elective admissions activity and expenditure prescribing items and expenditure better care better value metrics including low cost statin prescribing Very powerful for showing variation, and time series which allows to track change over time Outpatient referrals by GP 21

22 NHS Comparators - Expenditure on all Neurological admissions covered by PBR tariff (age and sex adjusted rate) - Comparison with other PCTs Milton Keynes has the highest spend on total admissions for Neurological problems when compared to similar PCTs Table shows activity, expected activity based on national averages, and the resulting % difference, for PCT and SHA 22

23 NHS Comparators - Expenditure on Neurological Elective admissions covered by PBR tariff (age and sex adjusted rate) - Comparison with other PCTs Milton Keynes has high spend on elective admissions for Neurological problems when compared to similar PCTs Drill down to disease level 23

24 NHS Comparators - Expenditure on Neurological Elective admissions covered by PBR tariff (age and sex adjusted rate) GP Practice Level Large variation in spend on elective admissions for Neurological problems at GP Practice Level Drill down to disease level Easy to identify high and low spending practices. Can compare practices within groups based on need of population 24

25 NHS Comparators GP Practice Level Comparison of Expenditure on Emergency Admissions Milton Keynes has high spend on emergency admissions for Neurological problems when compared to similar PCTs 25

26 NHS Comparators - Expenditure on Neurological Emergency admissions covered by PBR tariff (age and sex adjusted rate) GP Practice Level Large variation in spend on emergency admissions for Neurological problems at GP Practice Level Drill down to disease level Easy to identify high and low spending practices. Can compare practices within groups based on need of population 26

27 NHS Comparators Breakdown of Actual and Expected Expenditure on admissions by Programme Budget or Disease Category Also available for FHS Prescribing Expenditure NHS Comparators Breakdown of Actual and Expected Expenditure on admissions by Programme Budget or Disease Category for Milton Keynes PCT Also available for FHS Prescribing Expenditure This table is available at SHA, PCT, and Practice level, on a quarterly or annual basis. The table shows for inpatient admissions in each disease area, actual spend, expected based on national averages, and expenditure differences in absolute and % terms. Because expenditure is calculated as activity multiplied by tariff, the table is less useful where tariff is less well developed e.g. Mental Health. 27

28 Inpatient Variation Expenditure Tool (IVET) The tool provides PCTs with: inpatient expenditure data (2008/9) on different diseases and interventions; Inpatient expenditure per 1000 population, standardising for age, sex and need; The change in inpatient expenditure and activity required to meet a userdefined benchmark for each disease and intervention; Comparative data to other PCTs allowing variation between PCTs to be seen. A novel feature of this tool is that the standardisation accounts for age, sex and needs - with needs (e.g. deprivation) built up to PCT level from the Person Based Resource Allocation at practice level 28

29 IVET: PCT inpatient expenditure above or below the benchmark for diseases in The recently launched Inpatient Variation Tool (IVET) allows PCTs to compare inpatient expenditure at Disease and Procedure level with a user defined benchmark. Further diseases and interventions will be added subsequent to feedback from PCTs 29

30 IVET: PCT inpatient expenditure for selected disease/intervention compared to a user defined benchmark. The Inpatient Variation Tool allows PCTs to select a high cost disease or procedure, choose a benchmark level (e.g. median, lowest 10%) and view potential savings. 30

31 Conclusion We have used Programme Budgeting Tools to show that Milton Keynes has; Higher spend and worse outcome for Neurological problems when compared to similar PCTs Lowest prevalence of Epilepsy when compared to similar PCTs Low number of patients on convulsion free drugs when compared to similar PCTs Lowest FHS prescribing expenditure when compared to similar PCTs High spend on Elective admissions for Neurological problems when compared to similar PCTs High spend on Emergency admissions for Neurological problems when compared to similar PCTs 31

32 Next Steps Visit the Health Investment Network website: Use the E guides to understand how the tools use in this slidepack work and to gain a better understanding of expenditure and associated outputs and outcomes. Produce versions of this slidepack for other programme budgeting categories. Download the annual population value review which provides a contextual guide to the health investment process. Access a video learning module that explores the definitions, tools and practical application of Programme Budgeting Marginal Analysis (PBMA) Find Useful links to other tools, data sources, reports and guidance. Further information regarding can be found at: 32