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Stoke on Trent PCT COPD & Asthma Benchmarking Data

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Stoke on Trent PCT COPD & Asthma Benchmarking Data Dr Colin Gelder*, Sandy Walmsley*, Paul Dodd^, Dr Matthew Coates+ *Respiratory Leads NHS West Midlands ^Programme Specialist NHS West Midlands +NHS Strategic Analyst, Novartis Pharmaceuticals UK Limited May 2011 West Midlands SHA report Page | 1 1.0 Purpose of Report We present a report on COPD and Asthma for Stoke PCT. The purpose of the report is to provide up to date data illustrating the current costs to the PCT of COPD and Asthma, the variations in practice between (1) the PCT and other PCT in England, (2) between the PCT and other PCT in the West Midlands, (3) between the PCT and other PCT with a similar level of deprivation, and (4) to demonstrate the variation on admission rates between individual practices. The report is intended to stimulate discussions around service improvement and QIPP alignment. The savings that would be achieved by QIPP alignment have been calculated, as have the number of Practices that would have to be supported to reduce admissions to the QIPP target. 2.0 Methods i. Data sources The prevalence data used in this report were obtained from the NHS Information Centre, QOF practices and prevalence 2009/10. The hospitalisation data were obtained from Dr Foster and HRG4 codings were used throughout. All data refer to financial year 2009/10. ii. Calculation method Hospitalisation parameters were calculated on a per 1000 population basis throughout this report to allow a relative comparison to SHA and National means. The per population basis was chosen ahead of a per register size basis to eliminate variations in the reported disease prevalence, which are expected to fall well below the real prevalence figures. West Midlands SHA report Page | 2 3.0 Executive Summary When compared to other SHAs Stoke PCT spends 10% more than average on Respiratory Disease. When compared to other PCTs Stoke has an above average spend and poor outcome for COPD. Stoke PCT has a high admission rate for both COPD and Asthma. Stoke has a higher than average admission cost for both COPD and Asthma. If the hospitalisation rate for COPD was reduced to the national average, a total of 321 admissions could be avoided equating to savings of £701k, and if the hospitalisation rate for COPD were reduced by 20% (the QIPP target), the associated savings would be £399k. If the hospitalisation rate for Asthma were reduced to the national average, a total of 125 admissions could be avoided equating to savings of £117k, and if the hospitalisation rate for Asthma were reduced by 20%, the associated savings would be £84k. There is 15 fold variation between practices in the unplanned COPD admission rate (from 0.5 to 7.5 per 1000 registered individuals), and 13 fold variation in Asthma unplanned admission rate (from 0.5/1000 to 5.6/1000). Stoke PCT could reduce their COPD hospital admissions by 172 spells (the QIPP target of 20% equates to 180 spells), if 25 GP practices reduced their hospitalisation rate to the PCT average. Stoke on Trent PCT could reduce their asthma hospital admissions by 70% of the QIPP target (20% reduction = 80 spells), if the 21 practices with an admission rate above the current PCT mean reduced their admissions to the PCT average hospitalisation rate. West Midlands SHA report Page | 3 4.0 Spending on Health Stoke PCT spent £161.7 million per 100,000 of the population on health in 2009-10. This represents an increase of 4.5% from the £154m spent on health in 2008-9 and an increase of 16% from the £138m spent in 2007-8. The total expenditure on Respiratory Disease in 2009-10 was £9.3m/100,000 population, compared to a National Average of £8.4m, an SHA average of £8.2m and a cluster average of £9.2m. This means that Stoke PCT’s expenditure on Respiratory Disease is 10% more than the National and Cluster average and 13% more than the West Midlands SHA average. Stoke is ranked 31/152 in terms of its spending on Respiratory Disease when compared to other PCT in England, and 2/17 when compared to other PCT in the SHA. A full breakdown of Health spending by disease area for Stoke PCT is given in Appendix 1. West Midlands SHA report Page | 4 5.0 Spend & Outcome Department of Health Data prepared by the Yorkshire and Humber Public Health Authority show that Stoke has a higher spend and worse outcome for COPD than the average for PCT in England. Stoke PCT has a marginally lower spend and average outcomes compared to other PCT within its ONS cluster. West Midlands SHA report Page | 5 6.0 COPD Hospitalisation data for Stoke on Trent PCT 6.1 COPD non-elective hospitalisations per 1000 population Stoke on Trent PCT’s non-elective COPD hospitalisation rate for COPD was higher in 2009/10, 2008/09 and 2007/8 than the national and SHA averages, and below the industrial hinterlands cluster of PCT average (Figure 6.1). The hospital admissions have increased over the past three years from 3.0 per 1000 population in 2007/08 to 3.3/1000 in 2009/10. The 2009/10 hospitalisation rate was ranked 17/17 (with rank 17 being worst) in the West Midlands, and ranked 133/152 nationally, (see Appendix 5) The 2009/10 hospitalisation rate was ranked 7 of 15 in the industrial hinterlands social sub-group, down from rank 2 in 2008/09 and rank 3 in 2007/08 (Appendix 15) Figure 6.1: COPD non-elective hospitalisations per 1000 population 4 3.8 3.8 3.4 3.5 3.3 3 3 3 2.5 2.3 2.2 2.2 2.2 2.1 2 2 1.5 1 0.5 0 2007/08 2008/09 2009/10 National SHA Stoke on Trent Sub group West Midlands SHA report Page | 6 6.2 COPD non-elective hospitalisation costs per 1000 population Stoke PCT’s non-elective COPD hospitalisation costs were higher than the National average, the SHA average, and lower than the industrial hinterlands PCT cluster average in 2009/10, 2008/09, and 2007/08 (Figure 6.2). The hospital admission costs have increased steadily over the past three years from £5,500 per 1000 population in 2007/08 to £6,000 in 2008/09 and £7,200 in 2009/10. The 2009/10 hospitalisation costs was ranked 17/17 in the West Midlands, and ranked 127/152 nationally, down from rank 116 in 2008/09 and rank 115 in 2007/08 (see Appendix 6) The 2009/10 hospitalisation costs was ranked 4 out of 15 in industrial hinterlands A social sub-group (see Appendix 16) Figure 6.2: COPD non-elective hospitalisations costs (£k) per 1000 population 7.5 7.5 8 7.2 6.8 7 6 5.5 6 5.1 5.1 4.6 4.6 5 4.2 4.1 4 3 2 1 0 2007/08 2008/09 2009/10 National SHA Stoke on Trent Sub group West Midlands SHA report Page | 7 6.3 COPD non-elective hospitalisation length of stay Stoke on Trent PCT’s non-elective COPD length of stay was shorter than both the national and SHA averages in the last three years (Figure 6.3) The average length of stay has varied little over the past three years from 7.4 days in 2007/08 to 7.1 days in 2008/09 and 7.3 days in 2009/10. The 2009/10 average length of stay was ranked 4/17 in the West Midlands, and ranked 51st nationally. (see Appendix 7) The 2009/10 length of stay was ranked 8 out of 15 in the industrial hinterlands A social sub-group, down from rank 5 in 2007/08 (see Appendix 17) Figure 6.3: COPD non-elective hospitalisations length of stay 8.5 8.3 8.4 8.2 8 7.9 8 7.7 7.7 7.4 7.5 7.3 7.3 7.2 7.1 7 6.5 6 2007/08 2008/09 2009/10 National SHA Stoke on Trent Sub group West Midlands SHA report Page | 8 6.4 COPD non-elective hospitalisation 28-day readmission rate Stoke on Trent PCT’s non-elective COPD 28-day readmission rate was the same as the national averages in 2007/08, 2008/09 and 2009/10 (Figure 6.4), and very similar to the SHA average. However it was below the average for industrial hinterlands cluster of PCT in all three years. The 28-day readmission rate has seen small increases since 2007/08 The 2009/10 28-day readmission rate was ranked 11/17 in the West Midlands, and ranked 83/152 nationally (see Appendix 8) The 2009/10 28-day readmission rate was ranked 4 out of 15 in industrial hinterlands A social sub-group, up from rank 7 in 2007/08 (see Appendix 18) Figure 6.4: COPD non-elective hospitalisations 28-day readmission rate 0.3 0.24 0.25 0.23 0.21 0.210.210.21 0.220.220.22 0.2 0.19 0.2 0.2 0.15 0.1 0.05 0 2007/08 2008/09 2009/10 National SHA Stoke on Trent Sub group West Midlands SHA report Page | 9 6.5 COPD non-elective hospitalisation excess bed days Stoke on Trent PCT’s non-elective COPD excess bed days was lower than both the national and SHA averages in 2009/10, having been higher in 2007/08 (Figure 6.5) The excess bed days have reduced steadily from 0.9 days per spell in 2007/08 to 0.7 days per spell in 2008/09 & 0.4 days per spell in 2009/10.
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