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. The 2009/10 excess bed days was ranked 3/17 in the West Midlands, and ranked 42/152 nationally, up from rank 106 in 2008/09 and rank 109 in 2007/08 (see Appendix 9) The 2009/10 excess bed days was ranked 7 out of 15 in the industrial hinterlands A social sub-group, up from rank 12 in 2008/09 and 13 in 2007/08 (see Appendix 19)
Figure 6.5: COPD non-elective hospitalisations excess bed days
1 0.9 0.9 0.8 0.8 0.8 0.8 0.7 0.7 0.7 0.7 0.7 0.7 0.6 0.6 0.5 0.5 0.5 0.4 0.3 0.2 0.1 0 2007/08 2008/09 2009/10
National SHA Stoke on Trent Sub group
West Midlands SHA report Page | 10
6.6 COPD hospitalisation savings potential
Stoke on Trent PCT’s 2009/10 non-elective COPD hospitalisation rate was 3.3 per 1000 population, compared with the national average of 2.2 per 1000 population
If the hospitalisation rate were reduced to the national average, a total of 321 admissions could be avoided equating to savings of £701k (see Appendix 25)
If the hospitalisation rate were reduced by 10% or 20% (the QIPP target), the associated savings would be £199k and £399k, respectively (see Appendix 25)
West Midlands SHA report Page | 11
7.0 Asthma
7.1 Asthma non-elective hospitalisations per 1000 patients
Stoke PCT’s non-elective Asthma hospitalisation rate was higher than both the national and SHA averages in 2007/08, 2008/09 and 2009/10
The hospital admissions have reduced from 1.9 per 1000 population in 2007/08 to 1.8 in 2008/09 and 1.6 in 2009/10
The 2009/10 hospitalisation rate was ranked 13/17 in the West Midlands, and ranked 132/152 nationally, down from rank 137 in 2008/09 and rank 142 in 2007/08 (see Appendix 10)
The 2009/10 & 2008/09 hospitalisation rates were ranked 12 out of 15 in the Industrial Hinterlands A social sub-group (see Appendix 20) Figure 7.1: Asthma non-elective hospitalisations per 1000 patients
1.9 2 1.8 1.8 1.6 1.6 1.6 1.5 1.5 1.6 1.4 1.3 1.3 1.4 1.2 1.2 1.2 1 0.8 0.6 0.4 0.2 0 2007/08 2008/09 2009/10
National SHA Stoke on Trent Sub group
West Midlands SHA report Page | 12
7.2 Asthma non-elective hospitalisation costs per 1000 patients
Stoke on Trent PCT’s non-elective Asthma hospitalisation costs was higher than both the national and SHA averages in 2007/08, 2008/09 and 2009/10 (Figure 7.2) The hospital admission costs per 1000 patients has decreased from 1.6k per 1000 patients to 1.5k over the past three years The 2009/10 hospitalisation costs was ranked 12/17 in the West Midlands, and ranked 127/152 nationally, down from rank 134 in 2008/09 and rank 141 in 2007/08 (see Appendix 11) The 2009/10 & 2008/09 hospitalisation costs was ranked 11 out of 15 in the industrial hinterlands A social sub-group, (see Appendix 21)
Figure 7.2: Asthma non-elective hospitalisations costs (£k) per 1000 patients
1.8 1.7 1.6 1.6 1.5 1.5 1.4 1.4 1.4 1.4 1.3 1.2 1.2 1.2 1.1 1.1 1 0.8 0.6 0.4 0.2 0 2007/08 2008/09 2009/10
National SHA Stoke on Trent Sub group
West Midlands SHA report Page | 13
7.3 Asthma non-elective hospitalisation length of stay
Stoke on Trent PCT’s non-elective Asthma length of stay was lower than both the national and SHA averages in 2007/08 and 2009/10, having been higher in 2008/09 (Figure 7.3) The average length of stay increased in 2008/09 and returned to close to the 2007/08 level in 2009/10. The 2009/10 average length of stay was ranked 5 in the West Midlands compared with rank 13 in 2008/09, and ranked 30 nationally, down from rank 86 in 2008/09 (see Appendix 12) The 2009/10 length of stay was ranked 5 out of 15 in the industrial hinterlands A social sub-group, up from rank 10 in 2008/09 but down from rank 3 in 2007/08 (see Appendix 22)
Figure 7.3: Asthma non-elective hospitalisations length of stay
3 2.8 2.8 2.8 2.7 2.8 2.7 2.5 2.6 2.6 2.5 2.5 2.2 2.3
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 | 14
7.4 Asthma non-elective hospitalisation 28-day readmission rate
Stoke on Trent PCT’s non-elective Asthma 28-day readmission rate was higher than both the national and SHA averages in the 2008/09 and 2009/10 (Figure 4.1.9) The 28-day readmission rate has however increased 0.11 readmissions per spell in 2007/08 to 0.13 readmissions per spell in 2009/10. The 2009/10 28-day readmission rate was ranked 10/17 in the West Midlands compared with rank 4 in 2007/08, and ranked 83/152 nationally, from rank 93 in 2008/09 and rank 27 in 2007/08 (see Appendix13 ) The 2009/10 28-day readmission rate was 10 out of 15 in the industrial hinterlands A social sub-group, up from rank 13 in 2008/09, down from rank 7 in 2007/08 (see Appendix 23)
Figure 7.4: Asthma non-elective hospitalisations 28-day readmission rate
0.14 0.13 0.13 0.12 0.12 0.12 0.110.110.11 0.110.11 0.11 0.11 0.1 0.1
0.08
0.06
0.04
0.02
0 2007/08 2008/09 2009/10
National SHA Stoke on Trent Sub group
West Midlands SHA report Page | 15
7.5 Asthma non-elective hospitalisation excess bed days
Stoke on Trent PCT’s number of non-elective Asthma excess bed days was lower than the national and SHA averages in 2007/08 and 2009/10, having been similar to these averages in 2007/08 (Figure 7.5) The excess bed days have are at the same level as they were in 2007/08 (0.2 days per spell) The 2009/10 excess bed days rate was ranked 10 in the West Midlands, from rank 4 in 2007/08, and ranked 83 nationally, down from rank 27 in 2007/08 (see Appendix 14) The 2009/10 excess bed days was ranked 10 out of 15 in the industrial hinterlands A social sub-group, up from rank 13 in 2008/09 but down from rank 3 in 2007/08 (see Appendix 24)
Figure 7.5: Asthma non-elective hospitalisations excess bed days
0.35 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3
0.25 0.2 0.2 0.2 0.2 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 | 16
7.6 Asthma hospitalisation savings potential
Stoke on Trent PCT’s 2009/10 non-elective COPD hospitalisation rate was 3.3 per 1000 population, compared with the national average of 1.2 per 1000 population
If the hospitalisation rate were reduced to the national average, a total of 321 admissions could be avoided equating to savings of £701k (see Appendix 26)
If the hospitalisation rate were reduced by 10% and 20%, the associated savings would be £199k and £399k, respectively (see Appendix 26)
West Midlands SHA report Page | 17
8.0 Individual GP practice data for COPD
Figure 8.1 shows the variation in COPD non-elective hospitalisation rate by GP practice in Stoke PCT. Where no value is presented for a practice, hospitalisation data was not available. Table 8.2 shows the 2009/10 spells, tariff and length of stay data for the GP practices in Stoke PCT, along with the PCT averages for those performance indicators. The number of admissions that could be avoided if each practice’s admission rate was reduced to the PCT average hospitalisation rate is also presented. 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.
West Midlands SHA report Page | 18
Figure 8.1: COPD non-elective hospitalisations per 1000 population by GP practice
14.0
12.0
10.0
8.0
6.0
4.0
2.0
0.0
Y00592 Y00303
M83624 M83625 M83695 M83620 M83725 M83623 M83682 M83082 M83683 M83127 M83094 M83004 M83146 M83627 M83047 M83669 M83631 M83711 M83650 M83038 M83619 M83709 M83143 M83126 M83661 M83068 M83014 M83622 M83739 M83028 M83134 M83713 M83629 M83708 M83021 M83075 M83133 M83061 M83102 M83090 M83632 M83714 M83128 M83100 M83712 M83066 M83678 M83690 M83076 M83700 M83138 M83123 M83601 PCT average
West Midlands SHA report Page | 19
Table 8.2: GP practice level COPD data for Stoke on Trent PCT
Cumulative hosps Spells per 1000 Rank Tariff per 1000 Rank Average Spells reduced if Practice Code Population Spells reduced if PCT population spells population tariff LoS PCT average rate average rate PCT average 5512 901 3.3 6.0 7.3 M83028 3866 29 7.5 55 19.1 55 9.4 16 16 M83134 3881 28 7.2 54 16.5 53 7.4 15 31 M83713 3181 21 6.6 53 9.2 42 3.4 10 41 M83624 2749 17 6.2 52 14.7 52 9.5 8 49 M83625 6652 37 5.6 51 12.3 50 6.9 15 64 M83695 1512 8 5.3 50 12.0 48 5.8 3 67 M83629 3250 17 5.2 49 8.9 39 2.8 6 73 M83708 1620 8 4.9 48 13.5 51 10 3 76 M83620 5544 27 4.9 47 9.2 41 6 9 85 M83725 3091 15 4.9 46 17.6 54 17.9 5 90 M83623 4480 21 4.7 45 10.4 46 6.4 6 96 M83021 10614 48 4.5 44 8.7 38 3.8 13 109 M83075 7336 32 4.4 43 8.2 35 4.8 8 117 M83682 6923 30 4.3 42 8.1 33 5.3 7 124 M83082 11908 51 4.3 41 10.1 45 6.4 12 136 M83683 2834 12 4.2 40 9.1 40 8.7 3 139 M83133 2615 11 4.2 39 12.2 49 10.4 2 141 M83061 7897 33 4.2 38 9.4 43 7.1 7 148 M83127 2505 10 4.0 37 10.4 47 5.7 2 150 M83094 13990 55 3.9 36 9.8 44 8 9 159 M83004 12569 48 3.8 35 8.5 37 5.9 6 165 M83102 3935 15 3.8 34 8.4 36 6.1 2 167 M83090 4355 16 3.7 33 8.1 34 4.3 2 169
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M83632 4141 15 3.6 32 7.8 31 7.6 1 170 M83146 7602 27 3.6 31 7.5 28 5.2 2 172 M83627 6070 20 3.3 30 7.4 27 5.6 - - Y00592 5475 18 3.3 29 8.0 32 7.2 - - M83714 1591 5 3.1 28 4.9 19 4 - - M83128 4159 13 3.1 27 5.9 22 5.1 - - M83047 5265 16 3.0 26 7.5 29 8.9 - - M83669 2883 8 2.8 25 6.9 26 10.1 - - M83631 2907 8 2.8 24 6.4 25 8.5 - - M83100 3750 10 2.7 23 6.4 24 7.2 - - M83712 3026 8 2.6 22 5.2 21 3.4 - - M83711 3121 8 2.6 21 7.8 30 8.5 - - M83650 2050 5 2.4 20 3.3 11 4.4 - - M83038 10412 25 2.4 19 5.1 20 7 - - M83066 6111 14 2.3 18 4.5 17 7.6 - - M83678 2265 5 2.2 17 5.9 23 7.2 - - M83619 1828 4 2.2 16 4.0 12 3 - - M83709 4774 10 2.1 15 4.1 14 6.4 - - M83143 3687 7 1.9 14 4.6 18 9.9 - - M83690 3394 6 1.8 13 3.2 10 5.5 - - M83076 11358 20 1.8 12 4.3 15 6.7 - - M83126 5690 9 1.6 11 4.1 13 6 - - M83661 2044 3 1.5 10 4.3 16 1.5 - - M83068 10881 14 1.3 9 2.5 9 6.6 - - M83700 2452 3 1.2 8 1.8 6 2.3 - - M83138 8195 9 1.1 7 2.1 7 3.2 - - Y00303 2829 3 1.1 6 1.2 3 4 - - M83014 8520 9 1.1 5 2.3 8 3 - -
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M83622 2428 2 0.8 4 1.0 1 9 - - M83739 2686 2 0.7 3 1.1 2 4.5 - - M83123 6132 4 0.7 2 1.7 5 7.3 - - M83601 3819 2 0.5 1 1.3 4 3 - -
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9.0 GP practice Asthma data
Figure 9.1 shows the variation in Asthma non-elective hospitalisation rate by GP practice in Stoke PCT. Where no value is presented, hospitalisation data was not available for that practice.
Table 9.2 shows the 2009/10 spells, tariff and length of stay data for the GP practices in Stoke PCT, along with the PCT averages for those performance indicators. The spells that could be reduced if each practice were at the PCT average hospitalisation rate is also presented. 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 | 23
Figure 9.1: Asthma non-elective hospitalisations per 1000 population by GP practice
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0.0
Y00592 Y00303
M83712 M83700 M83622 M83127 M83625 M83066 M83068 M83021 M83623 M83076 M83004 M83146 M83038 M83094 M83739 M83126 M83629 M83143 M83028 M83102 M83128 M83709 M83123 M83708 M83714 M83650 M83661 M83631 M83100 M83725 M83624 M83075 M83713 M83682 M83082 M83619 M83138 M83047 M83014 M83061 M83620 M83711 M83690 M83601 M83134 M83632 M83090 M83627 M83695 M83683 M83133 M83669 M83678 PCT PCT average
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Table 9.2: GP practice level Asthma data for Stoke on Trent PCT
Cumulative hosps Spells per 1000 Rank Tariff per 1000 Rank Average Spells reduced if Practice Code Population Spells reduced if PCT population spells population tariff LoS PCT average rate average rate PCT average 276018 401 1.6 1.7 2.3 M83712 3026 17 5.6 46 4.0 45 1.3 12 12 M83631 2907 11 3.8 45 3.6 44 2.1 6 18 M83700 2452 8 3.3 44 2.4 39 1.4 4 22 Y00303 2829 7 2.5 43 1.9 34 0.9 2 25 M83622 2428 6 2.5 42 3.3 43 4.8 2 27 M83100 3750 9 2.4 41 2.2 38 2.2 3 30 M83127 2505 6 2.4 40 2.8 41 3.8 2 32 M83725 3091 7 2.3 39 1.9 36 1.9 2 34 M83625 6652 15 2.3 38 2.0 37 1.5 4 38 M83624 2749 6 2.2 37 2.9 42 4.3 2 39 M83066 6111 13 2.1 36 1.8 33 1.8 3 42 M83075 7336 15 2.0 35 2.8 40 4.5 3 45 M83068 10881 21 1.9 34 1.6 31 1.8 3 49 M83713 3181 6 1.9 33 1.9 35 2.7 1 49 M83021 10614 20 1.9 32 1.7 32 2.4 3 52 M83682 6923 13 1.9 31 1.4 22 0.7 2 54 Y00592 5475 10 1.8 30 1.3 21 1.3 1 55 M83623 4480 8 1.8 29 1.3 20 1 1 56 M83082 11908 21 1.8 28 1.5 27 1.6 2 57 M83076 11358 20 1.8 27 1.6 29 2.3 1 59 M83619 1828 3 1.6 26 0.8 11 0.5 0 59 M83004 12569 20 1.6 25 1.5 28 1.7 - -
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M83138 8195 13 1.6 24 1.4 23 1.8 - - M83146 7602 12 1.6 23 1.4 25 2.3 - - M83047 5265 8 1.5 22 1.2 19 2 - - M83038 10412 14 1.3 21 1.5 26 4 - - M83014 8520 10 1.2 20 1.6 30 4.1 - - M83094 13990 16 1.1 19 1.1 18 2.4 - - M83061 7897 9 1.1 18 1.4 24 5.6 - - M83739 2686 3 1.1 17 0.8 10 0.8 - - M83620 5544 6 1.1 16 0.9 15 0.7 - - M83126 5690 6 1.1 15 1.0 17 2.3 - - M83711 3121 3 1.0 14 7.7 46 56 - - M83629 3250 3 0.9 13 0.9 13 1.3 - - M83690 3394 3 0.9 12 1.0 16 7 - - M83143 3687 3 0.8 11 0.8 9 1 - - M83601 3819 3 0.8 10 0.5 2 0.5 - - M83028 3866 3 0.8 9 0.8 12 4.5 - - M83134 3881 3 0.8 8 0.6 7 1 - - M83102 3935 3 0.8 7 0.7 8 1.4 - - M83632 4141 3 0.7 6 0.6 6 0 - - M83128 4159 3 0.7 5 0.5 3 0 - - M83090 4355 3 0.7 4 0.5 5 1.3 - - M83709 4774 3 0.6 3 0.9 14 2 - - M83627 6070 3 0.5 2 0.3 1 0.5 - - M83123 6132 3 0.5 1 0.5 4 1.3 - - M83695 1512 - 0.0 ------M83708 1620 - 0.0 ------M83683 2834 - 0.0 ------M83133 2615 - 0.0 ------
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M83714 1591 - 0.0 ------M83669 2883 - 0.0 ------M83650 2050 - 0.0 ------M83678 2265 - 0.0 ------M83661 2044 - 0.0 ------
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10 Comparisons of COPD & Asthma Admission Rates
Figure 10.1: COPD and Asthma non-elective hospitalisations per 1000 population by GP practice 8.0 COPD
7.0 Asthma
6.0
5.0
4.0
3.0
2.0
1.0
0.0
Y00592 Y00303
M83028 M83713 M83695 M83708 M83725 M83021 M83082 M83133 M83127 M83004 M83632 M83627 M83714 M83047 M83100 M83711 M83038 M83678 M83143 M83076 M83661 M83700 M83014 M83739 M83601 M83134 M83624 M83625 M83629 M83620 M83623 M83075 M83682 M83683 M83061 M83094 M83102 M83090 M83146 M83128 M83669 M83631 M83712 M83650 M83066 M83619 M83709 M83690 M83126 M83068 M83138 M83622 M83123 PCT average
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11.0 COPD & Asthma Prevalence Data
Figure 11.1 Stoke on Trent COPD Prevalence from QOFF Register 2008/9
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Figure 11.2 Stoke on Trent Asthma Prevalence from QOFF register 2008/9
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Figure 11.3 Combined Asthma and COPD Prevalence Stoke on Trent PCT 2008/9
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Appendix 1: Stoke PCT Health Expenditure
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Appendix 2: Stoke on Trent PCT Spend on Respiratory versus other PCT in SHA
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Appendix 3: Stoke Spend Versus Outcome, Right Care Analysis
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Appendix 4: Stoke on Tent QOF Data 2009/10
Indicators
The light grey bar shows the range of values found in England. The dark grey sections mark out the range within which the middle-half of the observed values lie (25th to 75th percentile). The red line shows where the England average is. The position of the dot shows the practice value, a diamond the PCT value, a triangle the cluster value in relation to this scale. The corresponding numbers can be found in the cells next to the chart.Note: This type of chart requires a value judgement if high is good or bad. Not for all indicators it is possible to do this in an indisputable and meaningful way. The practice values are colour- coded: Significantly worse than regional average Not significantly different from regional average Significantly better than regional average o Significance level not calculated PCT value Cluster value
West Midlands SHA report Page | 37
Appendix 5: West Midlands non-elective COPD hospitalisation data
COPD admissions per 1000 population COPD admissions per 1000 registered pts Rank within SHA National rank PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 2.1 2.3 2.2 146 155 140 ------SHA 2.0 2.2 2.2 147 154 143 ------Herefordshire PCT 1.5 1.5 1.4 117 109 98 1 1 1 23 16 22 Heart Of Birmingham Teaching PCT 1.6 1.6 1.5 229 237 215 4 2 2 31 23 27 Warwickshire PCT 1.6 1.6 1.6 133 126 119 5 3 3 35 30 36 Shropshire County PCT 1.7 1.8 1.7 110 118 108 6 5 4 45 44 42 Telford and Wrekin PCT 2.0 2.3 1.8 127 134 101 9 9 5 74 79 49 Worcestershire PCT 1.5 1.9 1.8 122 147 130 3 6 6 30 54 52 South Staffordshire PCT 1.5 1.7 1.8 109 121 127 2 4 7 24 36 55 North Staffordshire PCT 2.1 2.1 2.0 128 122 108 10 8 8 82 73 70 Solihull Care Trust 2.0 2.4 2.1 139 164 136 8 12 9 73 89 77 Dudley PCT 2.1 2.4 2.2 160 169 149 11 11 10 83 87 86 Wolverhampton City PCT 2.1 2.3 2.2 156 162 149 12 10 11 84 84 88 South Birmingham PCT 2.3 2.6 2.4 151 167 150 13 13 12 94 100 96 Coventry Teaching PCT 1.9 2.1 2.4 135 142 156 7 7 13 71 72 98 Sandwell PCT 2.8 3.0 2.7 170 176 157 14 14 14 119 117 115 Walsall Teaching PCT 3.0 3.0 2.7 194 181 153 17 16 15 129 119 116 Birmingham East and North PCT 2.9 3.1 3.0 212 226 210 15 17 16 122 123 124 Stoke On Trent PCT 3.0 3.0 3.3 163 162 166 16 15 17 125 118 133
Ranking based on per 1000 population data
West Midlands SHA report Page | 38
Appendix 6: West Midlands non-elective COPD hospitalisation costs
COPD tariff per 1000 population COPD tariff per 1000 registered pts Rank within SHA National rank PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 4.2 4.6 5.1 297 314 329 ------SHA 4.1 4.6 5.1 297 315 336 ------Heart Of Birmingham Teaching PCT 3.4 3.3 3.5 495 500 491 6 2 1 43 23 25 Herefordshire PCT 3.1 3.1 3.5 241 227 238 3 1 2 27 15 26 Shropshire County PCT 3.3 3.4 3.8 212 220 239 5 3 3 36 27 31 Warwickshire PCT 3.3 3.6 4.1 272 271 297 4 6 4 35 39 41 Worcestershire PCT 2.8 3.5 4.2 219 268 301 1 5 5 13 38 45 Telford and Wrekin PCT 3.9 4.6 4.2 244 271 238 7 9 6 61 76 46 North Staffordshire PCT 4.4 4.0 4.4 263 231 239 11 7 7 87 58 55 South Staffordshire PCT 2.9 3.5 4.6 212 245 320 2 4 8 18 32 66 Solihull Care Trust 4.1 5.1 4.8 286 349 311 10 12 9 77 100 72 Dudley PCT 4.0 4.3 5.0 298 303 334 8 8 10 68 67 73 Wolverhampton City PCT 4.6 4.8 5.2 334 331 348 12 11 11 93 84 83 Coventry Teaching PCT 4.0 4.6 5.7 279 308 366 9 10 12 73 79 100 South Birmingham PCT 4.9 5.7 5.8 328 367 369 13 13 13 104 109 106 Sandwell PCT 5.5 5.7 6.2 332 332 358 15 14 14 116 111 110 Walsall Teaching PCT 6.5 6.8 6.8 426 407 381 17 16 15 133 131 119 Birmingham East and North PCT 6.2 6.9 7.0 452 501 493 16 17 16 129 132 124 Stoke On Trent PCT 5.5 6.0 7.2 304 320 362 14 15 17 115 116 127
Ranking based on per 1000 population data
West Midlands SHA report Page | 39
Appendix 7: West Midlands non-elective COPD hospitalisation length of stay
COPD Length of stay Rank within SHA National rank PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 8.3 8.0 7.7 ------SHA 8.4 8.2 7.9 ------Solihull Care Trust 8.2 8.5 6.7 7 11 1 62 98 23 North Staffordshire PCT 8.7 7.2 6.8 10 4 2 101 34 27 Heart Of Birmingham Teaching PCT 8.7 7.8 7.2 11 9 3 102 62 46 Stoke On Trent PCT 7.4 7.1 7.3 5 3 4 30 29 51 Herefordshire PCT 8.4 7.7 7.4 8 7 5 73 58 55 Birmingham East and North PCT 9.5 9.1 7.6 14 13 6 130 130 65 Telford and Wrekin PCT 6.9 7.5 7.7 1 6 7 17 49 74 Dudley PCT 7.3 6.9 7.8 4 2 8 28 26 77 Sandwell PCT 7.2 6.6 7.9 3 1 9 23 21 91 Walsall Teaching PCT 8.6 9.7 8.1 9 17 10 87 142 97 Wolverhampton City PCT 9.3 8.3 8.1 13 10 11 123 93 100 Shropshire County PCT 9.7 9.4 8.2 17 16 12 139 138 102 South Staffordshire PCT 7.5 7.3 8.2 6 5 13 37 38 104 Worcestershire PCT 7.1 7.7 8.2 2 7 14 22 58 105 Coventry Teaching PCT 9.6 9.1 8.3 16 12 15 136 129 109 Warwickshire PCT 9.1 9.2 8.9 12 14 16 117 134 132 South Birmingham PCT 9.6 9.4 9.4 15 15 17 133 136 144
West Midlands SHA report Page | 40
Appendix 8: West Midlands non-elective COPD hospitalisation 28-day readmission rate
COPD readmissions per spell Rank within SHA National rank PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 0.20 0.21 0.22 ------SHA 0.19 0.21 0.22 ------Herefordshire PCT 0.18 0.16 0.14 5 1 1 38 4 2 Solihull Care Trust 0.20 0.26 0.18 14 17 2 92 145 17 South Staffordshire PCT 0.18 0.18 0.19 6 5 3 39 18 21 North Staffordshire PCT 0.21 0.19 0.19 17 7 4 107 34 22 Heart Of Birmingham Teaching PCT 0.20 0.21 0.19 10 9 5 80 72 27 Telford and Wrekin PCT 0.20 0.22 0.20 9 11 6 76 80 42 Worcestershire PCT 0.15 0.22 0.20 3 12 7 17 87 47 Wolverhampton City PCT 0.14 0.18 0.21 1 6 8 5 27 54 Walsall Teaching PCT 0.20 0.22 0.21 11 14 9 81 100 55 Dudley PCT 0.15 0.16 0.22 4 2 10 18 7 66 Stoke On Trent PCT 0.20 0.21 0.22 12 10 11 84 78 83 Warwickshire PCT 0.19 0.20 0.23 8 8 12 73 54 86 Shropshire County PCT 0.15 0.16 0.23 2 3 13 12 8 88 Coventry Teaching PCT 0.20 0.17 0.24 13 4 14 91 14 104 Sandwell PCT 0.19 0.22 0.24 7 13 15 62 93 106 Birmingham East and North PCT 0.21 0.23 0.25 16 15 16 106 111 110 South Birmingham PCT 0.21 0.23 0.25 15 16 17 97 112 118
West Midlands SHA report Page | 41
Appendix 9: West Midlands non-elective COPD hospitalisation excess bed days per spell
COPD excess bed days per spell Rank within SHA National rank PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 0.8 0.6 0.7 ------SHA 0.8 0.7 0.8 ------Solihull Care Trust 0.6 1.0 0.2 8 15 1 51 141 5 North Staffordshire PCT 1.1 0.7 0.4 13 10 2 136 100 27 Stoke On Trent PCT 0.9 0.7 0.4 12 12 3 109 106 42 Herefordshire PCT 0.4 0.5 0.5 4 5 4 22 58 56 Shropshire County PCT 0.6 0.7 0.5 7 11 5 50 105 63 Coventry Teaching PCT 1.3 1.1 0.6 16 16 6 141 145 73 Walsall Teaching PCT 0.5 0.6 0.6 5 6 7 33 70 74 Wolverhampton City PCT 0.9 0.8 0.6 11 13 8 105 117 77 Birmingham East and North PCT 1.3 1.3 0.7 17 17 9 144 150 81 Worcestershire PCT 0.3 0.5 0.7 2 4 10 14 50 91 Warwickshire PCT 0.8 0.6 0.7 10 7 11 89 89 95 Dudley PCT 0.5 0.2 0.8 6 1 12 38 8 110 Heart Of Birmingham Teaching PCT 1.2 0.6 0.8 14 9 13 138 93 113 Telford and Wrekin PCT 0.3 0.6 0.9 1 8 14 10 91 120 South Birmingham PCT 1.2 0.9 1.1 15 14 15 139 132 135 South Staffordshire PCT 0.6 0.5 1.2 9 3 16 53 46 139
Sandwell PCT 0.4 0.3 1.3 3 2 17 21 26 140
West Midlands SHA report Page | 42
Appendix 10: West Midlands non-elective asthma hospitalisation data
Asthma admissions per 1000 population Asthma admissions per 1000 registered pts Rank within SHA National rank PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 1.2 1.3 1.2 81 86 77 ------SHA 1.3 1.5 1.4 93 103 96 ------Shropshire County PCT 0.7 0.9 0.8 47 60 51 2 2 1 6 23 14 Herefordshire PCT 0.6 0.8 0.8 50 55 55 1 1 2 2 3 17 Warwickshire PCT 0.7 1.0 0.9 60 75 67 3 3 3 7 33 35 Worcestershire PCT 1.0 1.2 1.0 82 88 72 6 6 4 60 57 48 Dudley PCT 1.0 1.0 1.1 76 72 71 5 4 5 52 36 60 North Staffordshire PCT 1.2 1.2 1.1 74 68 59 10 8 6 91 65 67 South Staffordshire PCT 1.0 1.2 1.2 72 82 81 4 7 7 47 60 75 Walsall Teaching PCT 1.3 1.4 1.3 84 84 72 11 9 8 101 96 97 Telford and Wrekin PCT 1.1 1.2 1.3 68 68 76 7 5 9 67 56 101 Solihull Care Trust 1.2 1.5 1.5 86 104 94 9 10 10 88 114 108 Coventry Teaching PCT 1.2 1.6 1.5 81 105 99 8 11 11 78 119 121 South Birmingham PCT 1.6 1.7 1.6 104 110 102 12 13 12 126 127 131 Stoke On Trent PCT 1.9 1.8 1.6 104 99 82 16 14 13 146 137 132 Wolverhampton City PCT 1.6 1.7 1.7 119 117 113 13 12 14 130 126 136 Sandwell PCT 1.8 2.0 1.9 106 115 108 15 15 15 140 142 143 Birmingham East and North PCT 1.8 2.2 2.2 129 160 156 14 16 16 139 147 148 Heart Of Birmingham Teaching PCT 2.7 3.1 3.3 397 471 470 17 17 17 151 151 151
Ranking based on per 1000 population data
West Midlands SHA report Page | 43
Appendix 11: West Midlands non-elective asthma hospitalisation costs
Asthma tariff per 1000 population Asthma tariff per 1000 registered pts Rank within SHA National rank PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 1.1 1.2 1.1 74 79 74 ------SHA 1.2 1.4 1.4 86 94 92 ------Herefordshire PCT 0.6 0.7 0.8 44 49 52 1 1 1 2 3 9 Shropshire County PCT 0.6 0.8 0.8 40 51 49 2 3 2 4 13 12 Worcestershire PCT 0.9 1.1 0.9 73 81 66 6 7 3 50 61 39 Warwickshire PCT 0.8 1.0 1.0 63 77 69 3 4 4 20 46 45 Dudley PCT 0.8 0.8 1.0 61 56 66 4 2 5 26 12 49 North Staffordshire PCT 1.2 1.1 1.0 71 63 57 10 8 6 100 65 63 South Staffordshire PCT 0.8 1.0 1.1 61 72 78 5 6 7 34 52 73 Telford and Wrekin PCT 1.0 1.0 1.2 61 60 70 7 5 8 63 49 93 Walsall Teaching PCT 1.4 1.4 1.3 93 84 74 11 10 9 125 114 104 Solihull Care Trust 1.1 1.3 1.4 75 86 90 9 9 10 79 91 114 South Birmingham PCT 1.7 1.7 1.5 111 112 96 15 14 11 144 137 122 Stoke On Trent PCT 1.6 1.7 1.5 89 90 77 13 13 12 141 134 127 Wolverhampton City PCT 1.5 1.5 1.6 109 101 107 12 11 13 133 116 132 Coventry Teaching PCT 1.0 1.6 1.6 72 103 105 8 12 14 73 127 137 Sandwell PCT 1.6 1.8 1.7 97 104 100 14 15 15 142 141 142 Birmingham East and North PCT 1.7 2.0 2.0 124 145 139 16 16 16 145 149 148 Heart Of Birmingham Teaching PCT 2.4 2.8 3.4 355 416 476 17 17 17 151 151 151
Ranking based on per 1000 population data
West Midlands SHA report Page | 44
Appendix 12: West Midlands non-elective asthma hospitalisation length of stay
Asthma Length of stay Rank within SHA National rank PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 2.8 2.8 2.7 ------SHA 2.8 2.7 2.6 ------Solihull Care Trust 2.2 1.9 2.5 2 1 8 15 3 56 North Staffordshire PCT 2.9 2.8 2.6 12 12 10 88 80 58 Heart Of Birmingham Teaching PCT 2.5 2.2 2.6 7 3 11 39 12 62 Stoke On Trent PCT 2.2 2.8 2.3 3 13 5 18 86 30 Herefordshire PCT 2.0 2.7 2.5 1 9 7 9 69 50 Birmingham East and North PCT 3.2 2.6 2.1 14 6 1 115 52 15 Telford and Wrekin PCT 3.0 2.7 2.6 13 10 12 94 71 66 Dudley PCT 2.3 2.0 2.3 5 2 2 23 5 23 Sandwell PCT 2.6 2.7 2.3 8 8 2 56 67 23 Walsall Teaching PCT 4.1 3.7 2.9 17 17 15 147 143 105 Wolverhampton City PCT 2.8 2.5 2.5 11 5 6 77 47 44 Shropshire County PCT 2.4 2.7 2.8 6 7 14 35 65 94 South Staffordshire PCT 2.3 2.4 2.5 4 4 8 20 30 56 Worcestershire PCT 2.6 2.7 2.3 8 11 4 56 74 29 Coventry Teaching PCT 2.7 3.6 3.6 10 16 16 69 139 142 Warwickshire PCT 3.9 3.2 3.6 16 14 17 141 125 144 South Birmingham PCT 3.7 3.3 2.6 15 15 12 138 130 66
West Midlands SHA report Page | 45
Appendix 13: West Midlands non-elective asthma hospitalisation 28-day readmission rate
Asthma readmissions per spell Rank within SHA National rank PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 0.10 0.11 0.11 ------SHA 0.11 0.11 0.12 ------Dudley PCT 0.10 0.07 0.09 9 2 1 81 12 33 South Birmingham PCT 0.09 0.13 0.10 5 14 2 55 123 46 Shropshire County PCT 0.11 0.09 0.10 13 4 3 105 35 58 North Staffordshire PCT 0.09 0.12 0.11 3 13 4 46 114 74 Coventry Teaching PCT 0.08 0.10 0.11 2 8 5 27 62 78 Heart Of Birmingham Teaching PCT 0.11 0.10 0.11 11 7 6 85 59 81 South Staffordshire PCT 0.11 0.10 0.11 15 9 7 113 71 93 Sandwell PCT 0.13 0.09 0.12 16 6 8 138 39 97 Walsall Teaching PCT 0.07 0.09 0.12 1 4 9 12 35 99 Birmingham East and North PCT 0.10 0.12 0.12 7 12 10 66 111 110 Warwickshire PCT 0.11 0.11 0.13 14 10 11 106 81 117 Stoke On Trent PCT 0.11 0.13 0.13 12 16 12 89 140 119 Telford and Wrekin PCT 0.09 0.08 0.13 4 3 13 54 20 122 Wolverhampton City PCT 0.10 0.11 0.14 8 11 14 75 82 130 Herefordshire PCT 0.10 0.07 0.14 10 1 15 82 8 131 Solihull Care Trust 0.10 0.13 0.14 6 15 16 63 127 133 Worcestershire PCT 0.17 0.17 0.18 17 17 17 149 149 149
West Midlands SHA report Page | 46
Appendix 14: West Midlands non-elective asthma hospitalisation excess bed days per spell
Asthma excess bed days per spell Rank within SHA National rank PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 0.3 0.3 0.2 ------SHA 0.3 0.3 0.3 ------Telford and Wrekin PCT 0.2 0.2 0.1 6 4 1 40 30 14 Herefordshire PCT 0.1 0.3 0.1 2 9 2 11 66 35 Birmingham East and North PCT 0.7 0.4 0.1 16 16 3 146 118 39 Worcestershire PCT 0.2 0.2 0.1 5 6 4 37 42 44 Shropshire County PCT 0.1 0.2 0.1 3 5 5 20 31 52 Sandwell PCT 0.3 0.2 0.1 11 7 6 78 45 60 Wolverhampton City PCT 0.2 0.2 0.2 10 3 7 75 29 67 Dudley PCT 0.1 0.1 0.2 1 2 8 6 7 74 Walsall Teaching PCT 0.4 0.3 0.2 13 11 9 126 76 76 Stoke On Trent PCT 0.2 0.3 0.2 4 13 10 27 93 83 North Staffordshire PCT 0.7 0.3 0.2 17 12 11 147 92 102 South Staffordshire PCT 0.2 0.3 0.3 8 10 12 50 69 109 Warwickshire PCT 0.6 0.4 0.3 14 14 13 142 111 114 South Birmingham PCT 0.7 0.6 0.3 15 17 14 145 136 115 Coventry Teaching PCT 0.2 0.4 0.4 7 15 15 44 117 130 Solihull Care Trust 0.3 0.1 0.4 12 1 16 81 6 139 Heart Of Birmingham Teaching PCT 0.2 0.2 0.7 9 8 17 65 48 146
Ranking based on per 1000 population data
West Midlands SHA report Page | 47
Appendix 15: Industrial Hinterlands (A) non-elective COPD hospitalisation data
COPD admissions per 1000 population COPD admissions per 1000 registered pts Rank within sub-group PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 2.1 2.3 2.2 146 155 140 - - - SHA 2.0 2.2 2.2 147 154 143 - - - Darlington PCT 2.3 3.1 2.5 129 159 119 1 3 1 Wirral PCT 3.2 2.8 2.8 142 129 128 6 1 2 Sefton PCT 3.7 3.9 3.2 173 179 139 11 10 3 County Durham PCT 3.1 3.6 3.2 136 152 130 4 6 4 Halton and St Helens PCT 3.2 3.5 3.3 143 149 137 8 5 5 Tameside and Glossop PCT 2.4 3.3 3.3 114 144 141 2 4 6 Stoke On Trent PCT 3.0 3.0 3.3 163 162 166 3 2 7 Sunderland Teaching PCT 3.2 3.8 3.7 114 135 129 5 7 8 Redcar and Cleveland PCT 3.2 3.8 3.7 134 154 147 7 9 9 Middlesbrough PCT 3.2 4.2 3.8 133 173 157 9 13 10 Hull Teaching PCT 3.7 4.4 4.0 217 247 216 13 14 11 South Tyneside PCT 3.7 3.9 4.2 130 132 131 12 11 12 Hartlepool PCT 3.6 3.8 4.2 164 162 167 10 8 13 Gateshead PCT 4.1 4.1 4.2 184 184 177 14 12 14 Knowsley PCT 5.4 5.9 4.9 192 201 153 15 15 15
Ranking based on per 1000 population data
West Midlands SHA report Page | 48
Appendix 16: Industrial Hinterlands (A) non-elective COPD hospitalisation costs
COPD tariff per 1000 population COPD tariff per 1000 registered pts Rank within sub-group PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 4.2 4.6 5.1 297 314 329 - - - SHA 4.1 4.6 5.1 297 315 336 - - - Wirral PCT 5.6 5.3 5.5 252 239 250 4 1 1 Darlington PCT 4.5 6.2 5.8 256 322 282 1 4 2 Sefton PCT 7.3 7.9 7.0 341 359 306 12 10 3 Stoke On Trent PCT 5.5 6.0 7.2 304 320 362 3 2 4 Tameside and Glossop PCT 4.8 6.2 7.4 224 273 317 2 3 5 Halton and St Helens PCT 6.9 7.2 7.7 307 309 323 8 7 6 Redcar and Cleveland PCT 6.2 7.0 7.9 262 285 310 6 5 7 County Durham PCT 6.7 7.7 7.9 292 325 320 7 9 8 Middlesbrough PCT 5.9 7.1 8.0 243 292 327 5 6 9 Hull Teaching PCT 7.1 8.9 8.8 416 498 478 10 14 10 Hartlepool PCT 7.2 7.2 9.2 336 312 365 11 8 11 Sunderland Teaching PCT 6.9 8.0 9.4 249 288 330 9 11 12 Gateshead PCT 8.9 8.2 9.8 403 367 411 14 12 13 South Tyneside PCT 8.3 8.5 10.0 291 283 315 13 13 14 Knowsley PCT 10.6 11.3 10.7 376 383 335 15 15 15
Ranking based on per 1000 population data
West Midlands SHA report Page | 49
Appendix 17: Industrial Hinterlands (A) non-elective COPD hospitalisation length of stay
COPD Length of stay Rank within sub-group PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 8.3 8.0 7.7 - - - SHA 8.4 8.2 7.9 - - - Middlesbrough PCT 6.1 5.6 5.8 1 1 1 Wirral PCT 6.5 6.2 6.3 2 3 2 Hartlepool PCT 7.3 6.7 6.7 4 6 3 Gateshead PCT 8.0 5.9 6.8 10 2 4 Knowsley PCT 7.7 7.2 6.9 9 9 5 Redcar and Cleveland PCT 7.3 6.6 7.0 3 5 6 County Durham PCT 7.5 7.6 7.3 7 10 7 Stoke On Trent PCT 7.4 7.1 7.3 5 7 8 Tameside and Glossop PCT 7.7 6.4 7.3 8 4 8 Sefton PCT 8.1 8.2 7.5 11 12 10 Hull Teaching PCT 8.1 9.0 7.5 12 14 11 Darlington PCT 7.4 7.1 7.5 6 7 12 Halton and St Helens PCT 9.1 8.1 7.6 14 11 13 Sunderland Teaching PCT 8.7 8.6 7.9 13 13 14 South Tyneside PCT 9.6 9.3 8.6 15 15 15
West Midlands SHA report Page | 50
Appendix 18: Industrial Hinterlands (A) non-elective COPD hospitalisation 28-day readmission rate
COPD readmissions per spell Rank within sub-group PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 0.20 0.21 0.22 - - - SHA 0.19 0.21 0.22 - - - Redcar and Cleveland PCT 0.19 0.21 0.19 5 5 1 Middlesbrough PCT 0.18 0.26 0.21 2 14 2 County Durham PCT 0.21 0.22 0.21 8 6 3 Stoke On Trent PCT 0.20 0.21 0.22 7 4 4 Halton and St Helens PCT 0.22 0.23 0.22 10 10 5 Knowsley PCT 0.22 0.25 0.23 12 13 6 Gateshead PCT 0.20 0.21 0.23 6 3 7 South Tyneside PCT 0.19 0.19 0.23 4 1 8 Tameside and Glossop PCT 0.19 0.23 0.24 3 9 9 Sunderland Teaching PCT 0.18 0.22 0.25 1 7 10 Wirral PCT 0.25 0.20 0.25 14 2 11 Hartlepool PCT 0.21 0.23 0.26 9 11 12 Hull Teaching PCT 0.22 0.24 0.26 11 12 13 Sefton PCT 0.26 0.26 0.28 15 15 14 Darlington PCT 0.23 0.22 0.28 13 8 15
West Midlands SHA report Page | 51
Appendix 19: Industrial Hinterlands (A) non-elective COPD hospitalisation excess bed days per spell
COPD excess bed days per spell Rank within sub-group PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 0.8 0.6 0.7 - - - SHA 0.8 0.7 0.8 - - - Hartlepool PCT 0.5 0.5 0.3 5 10 1 Sunderland Teaching PCT 0.8 0.5 0.3 12 9 2 Middlesbrough PCT 0.4 0.2 0.3 4 2 3 Knowsley PCT 0.4 0.3 0.4 3 6 4 County Durham PCT 0.4 0.3 0.4 2 5 5 Sefton PCT 0.7 0.4 0.4 9 8 6 Stoke On Trent PCT 0.9 0.7 0.4 13 12 7 Gateshead PCT 1.0 0.2 0.5 14 1 8 Darlington PCT 0.2 0.4 0.5 1 7 9 Halton and St Helens PCT 0.8 0.6 0.5 10 11 10 Hull Teaching PCT 0.5 0.8 0.7 7 14 11 Wirral PCT 0.5 1.0 0.7 6 15 12 Tameside and Glossop PCT 0.6 0.3 0.9 8 3 13 South Tyneside PCT 1.6 0.8 0.9 15 13 14
Redcar and Cleveland PCT 0.8 0.3 1.2 11 4 15
West Midlands SHA report Page | 52
Appendix 20: Industrial Hinterlands (A) non-elective asthma hospitalisation data
Asthma admissions per 1000 population Asthma admissions per 1000 registered pts Rank within sub-group PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 1.2 1.3 1.2 81 86 77 - - - SHA 1.3 1.5 1.4 93 103 96 - - - Redcar and Cleveland PCT 1.2 1.4 1.0 50 59 40 6 5 1 Darlington PCT 1.2 1.3 1.1 66 70 53 3 2 2 County Durham PCT 1.0 1.3 1.2 46 53 49 1 1 3 South Tyneside PCT 1.1 1.4 1.3 38 47 39 2 4 4 Hull Teaching PCT 1.6 1.7 1.3 93 93 72 11 10 5 Sunderland Teaching PCT 1.2 1.3 1.5 43 48 51 4 3 6 Wirral PCT 1.5 1.5 1.5 66 69 70 9 7 7 Gateshead PCT 1.4 1.7 1.5 63 77 64 7 11 8 Middlesbrough PCT 1.7 1.6 1.6 69 66 64 12 9 9 Halton and St Helens PCT 1.5 1.8 1.6 68 79 67 10 13 10 Tameside and Glossop PCT 1.4 1.4 1.6 68 64 68 8 6 11 Stoke On Trent PCT 1.9 1.8 1.6 104 99 82 13 12 12 Hartlepool PCT 1.2 1.6 1.7 55 69 67 5 8 13 Sefton PCT 2.1 1.9 1.8 98 88 77 14 14 14 Knowsley PCT 2.7 2.8 2.5 95 96 78 15 15 15
Ranking based on per 1000 population data
West Midlands SHA report Page | 53
Appendix 21: Industrial Hinterlands (A) non-elective asthma hospitalisation costs
Asthma tariff per 1000 population Asthma tariff per 1000 registered pts Rank within sub-group PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 1.1 1.2 1.1 74 79 74 - - - SHA 1.2 1.4 1.4 86 94 92 - - - Redcar and Cleveland PCT 1.1 1.4 1.0 46 56 39 5 8 1 Darlington PCT 1.1 1.3 1.0 61 65 49 4 3 2 County Durham PCT 0.9 1.1 1.1 41 46 46 1 1 3 South Tyneside PCT 1.0 1.3 1.2 34 42 38 2 4 4 Hull Teaching PCT 1.5 1.7 1.3 87 97 69 12 13 5 Gateshead PCT 1.1 1.5 1.3 50 68 55 6 10 6 Wirral PCT 1.3 1.4 1.4 58 61 62 9 7 7 Tameside and Glossop PCT 1.3 1.3 1.4 61 55 59 8 2 8 Middlesbrough PCT 1.5 1.3 1.4 61 54 57 11 6 9 Sunderland Teaching PCT 1.0 1.3 1.5 37 46 54 3 5 10 Stoke On Trent PCT 1.6 1.7 1.5 89 90 77 13 11 11 Halton and St Helens PCT 1.3 1.8 1.6 58 77 65 10 14 12 Hartlepool PCT 1.2 1.5 1.6 54 63 63 7 9 13 Sefton PCT 1.8 1.7 1.6 83 77 72 14 12 14 Knowsley PCT 2.2 2.3 2.3 78 78 73 15 15 15
Ranking based on per 1000 population data
West Midlands SHA report Page | 54
Appendix 22: Industrial Hinterlands (A) non-elective asthma hospitalisation length of stay
Asthma Length of stay Rank within sub-group PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 2.8 2.8 2.7 - - - SHA 2.8 2.7 2.6 - - - Gateshead PCT 1.8 2.1 1.6 1 3 1 Tameside and Glossop PCT 2.7 2.3 1.9 10 5 2 Middlesbrough PCT 2.4 2.0 2.2 6 1 3 Halton and St Helens PCT 2.7 3.0 2.3 11 13 4 Stoke On Trent PCT 2.2 2.8 2.3 3 10 5 County Durham PCT 2.5 2.2 2.4 7 4 6 Hartlepool PCT 2.9 3.1 2.4 13 14 7 Darlington PCT 3.1 2.6 2.5 14 8 8 Sefton PCT 2.2 2.5 2.6 2 7 9 Knowsley PCT 2.4 2.0 2.6 4 2 10 Wirral PCT 2.4 2.5 2.7 4 6 11 Redcar and Cleveland PCT 2.5 2.9 2.7 9 11 12 Hull Teaching PCT 3.1 3.8 2.8 15 15 13 South Tyneside PCT 2.8 2.6 2.8 12 9 14 Sunderland Teaching PCT 2.5 3.0 3.7 8 12 15
West Midlands SHA report Page | 55
Appendix 23: Industrial Hinterlands (A) non-elective asthma hospitalisation 28-day readmission rate
Asthma readmissions per spell Rank within sub-group PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 0.10 0.11 0.11 - - - SHA 0.11 0.11 0.12 - - - Gateshead PCT 0.12 0.11 0.08 10 7 1 Knowsley PCT 0.11 0.11 0.08 8 9 2 County Durham PCT 0.08 0.09 0.08 2 3 3 Hull Teaching PCT 0.09 0.11 0.09 4 10 4 South Tyneside PCT 0.09 0.05 0.10 3 1 5 Wirral PCT 0.12 0.08 0.10 11 2 6 Darlington PCT 0.12 0.09 0.10 9 5 7 Sefton PCT 0.10 0.13 0.11 6 12 8 Sunderland Teaching PCT 0.08 0.12 0.12 1 11 9 Stoke On Trent PCT 0.11 0.13 0.13 7 13 10 Tameside and Glossop PCT 0.12 0.15 0.14 12 15 11 Halton and St Helens PCT 0.10 0.13 0.15 5 14 12 Redcar and Cleveland PCT 0.14 0.11 0.15 14 8 13 Middlesbrough PCT 0.19 0.11 0.18 15 6 14 Hartlepool PCT 0.13 0.09 0.21 13 4 15
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Appendix 24: Industrial Hinterlands (A) non-elective asthma hospitalisation excess bed days per spell
Asthma excess bed days per spell Rank within sub-group PCT 2007/08 2008/09 2009/10 2007/08 2008/09 2009/10 National 0.3 0.3 0.2 - - - SHA 0.3 0.3 0.3 - - - Gateshead PCT 0.1 0.1 0.0 2 1 1 Darlington PCT 0.4 0.3 0.1 15 10 2 County Durham PCT 0.2 0.2 0.1 4 2 3 Middlesbrough PCT 0.2 0.2 0.1 11 3 4 Hull Teaching PCT 0.3 0.7 0.1 12 15 5 Hartlepool PCT 0.2 0.3 0.1 5 12 6 Redcar and Cleveland PCT 0.1 0.2 0.1 1 8 7 Knowsley PCT 0.2 0.2 0.2 8 7 8 Tameside and Glossop PCT 0.2 0.3 0.2 7 11 9 Stoke On Trent PCT 0.2 0.3 0.2 3 13 10 Sunderland Teaching PCT 0.2 0.3 0.2 6 9 11 Sefton PCT 0.4 0.2 0.2 14 4 12 Wirral PCT 0.2 0.4 0.3 9 14 13 Halton and St Helens PCT 0.2 0.2 0.4 10 5 14 South Tyneside PCT 0.3 0.2 0.4 13 6 15
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Appendix 25: COPD hospitalisation savings potential
COPD COPD COPD admissions Cost per Admissions reduced Savings if average Savings if Savings if PCT Population Register admissions per 1000 population spell (£) if average admissions (£) admissions -10% (£) admissions -20% (£) National 54,003,337 829,767 116,130 2.2 2,350 0 0 27,286,400 54,572,800 SHA 5,707,214 86,020 12,299 2.2 2,350 26 61,292 2,890,700 5,781,400 Herefordshire PCT 180,142 2,649 259 1.4 2,436 0 0 63,100 126,200 Heart Of Birmingham Teaching PCT 313,934 2,218 476 1.5 2,288 0 0 108,900 217,800 Warwickshire PCT 546,003 7,527 899 1.6 2,488 0 0 223,700 447,400 Shropshire County PCT 295,342 4,688 504 1.7 2,222 0 0 112,000 224,000 Telford and Wrekin PCT 169,429 2,996 304 1.8 2,342 0 0 71,200 142,400 Worcestershire PCT 572,989 7,993 1,038 1.8 2,318 0 0 240,600 481,200 South Staffordshire PCT 605,435 8,726 1,112 1.8 2,511 0 0 279,200 558,400 North Staffordshire PCT 208,582 3,846 414 2.0 2,222 0 0 92,000 184,000 Solihull Care Trust 220,953 3,400 463 2.1 2,281 0 0 105,600 211,200 Dudley PCT 312,366 4,631 692 2.2 2,238 20 45,398 154,900 309,800 Wolverhampton City PCT 256,543 3,848 575 2.2 2,329 23 54,315 133,900 267,800 South Birmingham PCT 386,532 6,122 918 2.4 2,461 87 213,578 225,900 451,800 Coventry Teaching PCT 349,333 5,420 846 2.4 2,346 95 222,401 198,500 397,000 Sandwell PCT 322,378 5,612 883 2.7 2,277 190 432,151 201,100 402,200 Walsall Teaching PCT 266,448 4,773 731 2.7 2,488 158 393,223 181,900 363,800 Birmingham East and North PCT 424,787 6,059 1,270 3.0 2,350 357 837,982 298,500 597,000 Stoke On Trent PCT 276,018 5,512 915 3.3 2,183 321 701,557 199,700 399,400
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Appendix 26: Asthma hospitalisation savings potential
Asthma Asthma Asthma admissions Cost per Admissions reduced Savings if average Savings if Savings if PCT Population Register admissions per 1000 population spell (£) if average admissions (£) admissions -10% (£) admissions -20% (£) National 54,003,337 3,180,080 63,590 1.2 967 0 0 6,149,600 12,299,200 SHA 5,707,214 348,023 8,268 1.4 959 0 0 793,200 1,586,400 Shropshire County PCT 295,342 19,203 239 0.8 958 0 0 22,900 45,800 Herefordshire PCT 180,142 11,634 147 0.8 932 0 0 13,700 27,400 Warwickshire PCT 546,003 34,752 506 0.9 1,030 0 0 52,100 104,200 Worcestershire PCT 572,989 34,768 575 1.0 915 0 0 52,600 105,200 Dudley PCT 312,366 18,417 330 1.1 924 0 0 30,500 61,000 North Staffordshire PCT 208,582 13,647 227 1.1 960 0 0 21,800 43,600 South Staffordshire PCT 605,435 34,509 708 1.2 958 0 0 67,800 135,600 Walsall Teaching PCT 266,448 16,027 346 1.3 1,014 32 32,718 35,100 70,200 Telford and Wrekin PCT 169,429 10,557 227 1.3 930 27 25,556 21,100 42,200 Solihull Care Trust 220,953 13,206 321 1.5 956 61 58,171 30,700 61,400 Coventry Teaching PCT 349,333 20,658 539 1.5 1,059 128 135,232 57,100 114,200 South Birmingham PCT 386,532 24,110 627 1.6 933 172 160,339 58,500 117,000 Stoke On Trent PCT 276,018 17,741 450 1.6 942 125 117,762 42,400 84,800 Wolverhampton City PCT 256,543 14,973 436 1.7 940 134 125,930 41,000 82,000 Sandwell PCT 322,378 20,397 604 1.9 929 224 208,418 56,100 112,200 Birmingham East and North PCT 424,787 25,479 944 2.2 892 444 395,851 84,200 168,400 Heart Of Birmingham Teaching PCT 313,934 17,945 1,042 3.3 1,013 672 681,370 105,600 211,200
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