Back Pain Report Somerset June 2016
Copyright © 2016 Northumberland Tyne and Wear NHS Foundation Trust and South Tees NHS Foundation Trust (on behalf of the North East Quality Observatory Service, NEQOS) BetterKnowledgeBetterCareBetterOutcomes [email protected] Page 1 of 25 www.neqos.nhs.uk NEQOS Back Pain Report
This back pain report contains health intelligence produced by NEQOS to support the implementation of the national pathfinder project to provide better pathways of care for people with low back and radicular pain. The NHS England Pathfinder Projects were established to address high value care pathways which cross commissioning and health care boundaries. Many conditions require a pathway of care which moves from the general practitioner through primary care and community services and into secondary care and sometimes specialised services. Difficulties in commissioning across boundaries, however, can cause artificial interruptions in what should be a seamless care pathway. The Pathfinder Projects are designed for all Stakeholders to work collaboratively to examine in depth these health care interfaces and to develop commissioning structures to commission care across the whole pathway. The Trauma Programme of Care Board selected low back pain and radicular pain as the Pathfinder Project as this is a high value care pathway in view of the very large number of patients involved.
The future of the pathway is that it is designed to be run in primary care (general practice and community physiotherapy) and referral into secondary specialist care is only at the end of the pathway. Key to the success of the pathway are the Triage and Treat practitioners; the highly trained practitioners, either extended scope physiotherapists or nurse specialists who essentially run the pathway and have access to bookable slots for the core therapies, nerve root blocks, spinal surgical clinic appointments or pain clinic appointments. This reduces very significantly the delays in the previous system and also reduces the “pinball” management that is a feature of so many health care systems. Quality care is less expensive by reducing ineffective or repetitive treatment and by reducing conversion into chronic disability
In this profile, the current utilisation of secondary care services for back and radicular pain are shown by CCG and providers, including both NHS Trusts and Independent Sector providers to demonstrate variation in activity regionally and across England. This report is based on the population of patients under the care of CCGs in the South West Region and provides important information about patient flows from these CCGs across all providers within this region. <---- Information on hospital admissions is presented by admission method (elective vs. emergency) and type of procedure (surgery, injections, pain management etc.) undertaken. The aim of this report is to assist both clinicians and commissioners in comparing treatment activity rates between regional providers and against national data to reduce variation and develop evidence based care pathways to improve patient outcomes.
Ongoing monitoring of this secondary care activity will evidence where changes implemented through the national pathfinder project for acute low back and radicular pain to provide timely access to evidence based treatments can improve the quality of patient care, provide community based alternatives to secondary care admissions for back pain and reduce secondary care expenditure.
It is important to note that this report is based on the cohort of patients with back and/or radicular pain but does not include patients who have back pain due to specific diagnosis such as cancer, infection, spinal trauma, inflammatory arthritis, cauda equine syndrome as these patients have very different treatment pathways of care.
Acknowledgements
This work has been funded through the Getting It Right First Time (GIRFT) project that is part of the Department of Health funded Clinically-Led Quality and Efficiency Programme.
Acknowledgements to the Health & Social Care Information Centre (HSCIC) as the source of data used in this report and to Professor Greenough and Mr Ashley Cole for their expert clinical guidance and advice.
[email protected] Page 2 of 25 www.neqos.nhs.uk Introduction and background Low back pain is extremely common and is the largest single cause of loss of disability adjusted life years, and the largest single cause of years lived with disability in England (Global Burden of Disease, 2013). In terms of disability adjusted life years lost per 100,000, low back pain is responsible for 2,313. By contrast the remainder of musculo-skeletal complaints counts for 911, depression 704 and diabetes 337. It should be borne in mind that this is principally occurring in people of working age, or with families. UK specific data shows that LBP was top cause of years lived with disability in both 1990 and 2010 – with a 12% increase over this time. Back pain accounts for 11% of the entire disability burden from all diseases in the UK; furthermore the burden is increasing both absolutely (3.7% increase) and proportionally (7% to 8.5%).
NEQOS have produced CCG and hospital Trust level activity profiles to understand the current position in terms of secondary care activity for back and radicular pain and have worked with a range of key stakeholders from both provider and commissioner organisations to develop the profiles to ensure that the indicators shown are appropriate and relevant to the project. This information needs to be viewed in conjunction with data soon to become available from Arthritis Research UK about the prevalence of back pain and associated risk factors and where possible with locally available data from general practice, including prescribing rates, and onward referrals from primary care (e.g. physiotherapy and radiology).
Technical specification Following a data discovery exercise supported by Professor Charles Greenough (National Clinical Director for Spinal Disorders, South Tees NHS Foundation Trust), definitions for low back and radicular pain were developed based on a combination of diagnosis codes (ICD-10) and relevant secondary care procedures were identified using OPCS 4.7 codes. These codes have been supported by Mr Ashley Cole, Chair of Specialised Spinal Surgery Clinical Reference Group (Consultant Orthopaedic Surgeon, Northern General Hospital and Sheffield Children's Hospital).
Data definitions Data Source: Hospital Episode Statistics (Health & Social Care Information Centre via HDIS). Please note that 2014/15 data is currently classed as provisional.
CCG populations: Health & Social Care Information Centre (Ages 15 & over as at April 2015) (Data was provided in 5 year ages bands, therefore we were unable to use exact figures for Ages 16 & over)
A summary of the data definitions used is shown below:
Time period: April 2011 - March 2015 Primary diagnosis = back pain (specific ICD10 codes) Limited to episode 1 Age 16 years and over Private patients are included unless specified Admission costs are based on the national tariff Directly Age & Sex Standardised Rates use the European Standard Populations
<---- The NHS Trusts included for the South West Region are: • North Bristol NHS Trust University Hospitals • Bristol NHS Foundation Trust • Royal United Hospitals Bath NHS Foundation Trust • Taunton & Somerset NHS Foundation Trust • Northern Devon Healthcare NHS Trust • Royal Devon & Exeter NHS Foundation Trust • South Devon Healthcare NHS Foundation Trust • Plymouth Hospitals NHS Trust • Royal Cornwall Hospitals NHS Trust
The Independent Sector Providers included for the South West Region are: • Spire Bristol Hospital • Circle Bath Hospital • Shepton Mallet NHS Treatment Centre • Nuffield Health, Taunton Hospital • Nuffield Health, Exeter Hospital • Nuffield Health, Plymouth Hospital [email protected] Page 3 of 25 www.neqos.nhs.uk Clinical Commissioning Group (CCG) activity summary
1. Hospital admissions for low back and radicular pain in people aged 16 years and over (April 2014 - March 2015), summary a. Hospital admissions at national level, indicating back pain type and admission method
England Back Radicular Total % Back % Radicular Elective 134,448 102,808 237,256 56.7% 43.3% Emergency 39,331 14,309 53,640 73.3% 26.7% Other 771 951 1,722 44.8% 55.2% Total 174,550 118,068 292,618 59.7% 40.3%
South West CCGs Back Radicular Total % Back % Radicular Elective 3,614 4,333 7,947 45.5% 54.5% Emergency 2,066 861 2,927 70.6% 29.4% Other 76 73 149 51.0% 49.0% Total 5,756 5,267 11,023 52.2% 47.8% b. Hospital admissions at CCG level, indicating proportion of admissions for back pain Table indicates the proportion of admissions for back pain only (and not radicular pain) Somerset 42.0% Bristol 57.2% North Somerset 45.2% Kernow 61.5% Northern, Eastern & Western Devon 47.4% South Devon & Torbay 64.7% South Gloucestershire 54.0% South West CCGs 52.2% England 59.8%
Percentage of Admissions for Back Pain 01/04/2014 - 31/03/2015 All Admission Methods South West CCGs National Average South West CCGs Average 100% Highlighted CCGs: 90% Somerset 80% 70% 60% 50% 40% 30%
Percentage ofAll Admissions Percentage 20% 10% 0% CCG c. Hospital admissions at CCG level, by admission method Table indicates the proportion of admissions for back and radicular pain that is recorded as elective Bristol 59.0% North Somerset 74.8% South Gloucestershire 67.5% Northern, Eastern & Western Devon 76.1% Somerset 69.2% Kernow 77.4% South Devon & Torbay 71.1% South West CCGs 72.1% England 81.1%
Percentage of Admissions that are Elective 01/04/2014 - 31/03/2015 South West CCGs National Average South West CCGs Average 100% Highlighted CCGs: 90% Somerset
80%
70%
60%
50%
40%
30%
Percentage ofAll Admissions Percentage 20%
10%
0% CCG
What is the data telling us? In the 2014/15 financial year period there were almost 300,000 admissions for back and radicular pain in England, with 11,023 (3.8%) of these for patients registered within the South West CCGs. At a national level the proportional split for hospital admissions is 60% for back pain and 40% for radicular pain, and at CCG level in the South West this is variable with the proportion of admissions for back pain ranging from 42% to 65%. Nationally, approximately 81% of back and radicular pain admissions are elective, with the South West having a smaller proportion (72%). At a CCG level in the South West, the proportion of elective admissions for these populations ranges from 59% in Bristol to 77% in Kernow.
[email protected] Page 4 of 25 www.neqos.nhs.uk Clinical Commissioning Group (CCG) activity
2. Hospital admissions for low back and radicular pain in people aged 16 years and over (April 2014 - March 2015) a. Hospital admissions for back pain by CCG (all admission methods), Directly Age & Sex Standardised Admission rate per 100,000 population CCG name All Elective Emergency CCG name All Elective Emergency North Somerset 447.1 332.2 112.7 Somerset 386.8 269.4 113.4 Kernow 426.5 328.4 92.3 Bristol 353.9 219.8 130.9 South Devon & Torbay 417.7 294.0 114.7 South Gloucestershire 330.6 224.2 104.5 Northern, Eastern & Western Devon 413.1 314.7 92.0 South West CCGs 397.0 287.0 104.9 England 645.6 526.5 115.4 b. Hospital admissions for back and radicular pain (all admission methods), Directly Age & Sex Standardised Admission rate per 100,000 population
Directly Age & Sex Standardised Rate of Admissions per 100,000 Population 01/04/2014 - 31/03/2015 All Admission Methods South West CCGs National Average South West CCGs Average 1,800 Highlighted CCGs: 1,600 Somerset 1,400
1,200
1,000
800 per 100,000 per
600
400
200 Directly Age & Sex Standardised Rate of Admissions Admissions of Rate Standardised Sex & Age Directly 0 CCG c. Elective hospital admissions for back and radicular pain, Directly Age & Sex Standardised Admission rate per 100,000 population
Directly Age & Sex Standardised Rate of Admissions per 100,000 Population 01/04/2014 - 31/03/2015 Elective Admissions only South West CCGs National Average South West CCGs Average 1,800 Highlighted CCGs:
1,600 Somerset 1,400 1,200 1,000 800
600 Admissions per 100,000 100,000 per Admissions 400
Directly Age & Sex Standardised Rate of of Rate Standardised Sex & Age Directly 200 0 CCG d. Emergency hospital admissions for back and radicular pain, Directly Age & Sex Standardised Admission rate per 100,000 population
Directly Age & Sex Standardised Rate of Admissions per 100,000 Population 01/04/2014 - 31/03/2015 Emergency Admissions only South West CCGs National Average South West CCGs Average 300 Highlighted CCGs:
Somerset 250
200
150 Admissions per 100,000 per Admissions
100 Directly Age & Sex Standardised Rate of of Rate Standardised Sex & Age Directly 50
0 CCG
What is the data telling us? There is very little variation in elective admission rates across the CCGs within the South West with all 7 CCGs in the lowest quintile nationally. The regional average for elective admissions (287 per 100,000) is almost half (55%) of the national average of 526per 100,000. In contrast, for emergency admissions there is wider variation across the CCGs in the region, ranging from Northern, Eastern & Western Devon CCG in the second lowest quintile to Bristol CCG in the second highest quintile nationally.
[email protected] Page 5 of 25 www.neqos.nhs.uk Clinical Commissioning Group (CCG) activity - GP practice level
3. Hospital admissions for low back and radicular pain in people aged 16 years and over (April 2014 - March 2015) Each symbol represents one GP practice a. Hospital admissions for back pain (Elective admissions), Indirectly Standardised Ratio Somerset
Elective Admissions - Indirectly Standardised Ratios by GP Practice 350 Upper 3SD limit Legend: Upper 2SD limit National Average 300 Somerset Lower 2SD limits Lower 3SD limits
250
200
150 Indirectly standardised Ratio standardised Indirectly 100
50
0 0 20 40 60 80 100 120 Expected events
b. Hospital admissions for back pain (Emergency admissions), Indirectly Standardised Ratio Emergency Admissions - Indirectly Standardised Ratios by GP Practice 500 Upper 3SD limit Legend: Upper 2SD limit 450 National Average Somerset Lower 2SD limits 400 Lower 3SD limits
350
300
250
200
Indirectly standardised Ratio standardised Indirectly 150
100
50
0 0 5 10 15 20 25 30 Expected events
What is the data telling us? The admission rates for elective and emergency admissions for each GP practice within the CCG are expressed as Indirectly Standardised Ratios with 100 representing the national average. This adjustment has been made due to small numbers and in order that comparisons can be made between practices. The upper and lower confidence limits on the funnel charts above are based on national data. Each circle represents the constituent GP Practices for the selected CCG(s). All GP practices within the funnel have admission rates that are not significantly different that the national rates with those above the upper blue funnel having significantly higher rates than the national average.
[email protected] Page 6 of 25 www.neqos.nhs.uk 4. Indirectly Standardised Ratios for Elective & Emergency Admissions for Back & Radicular Pain, by GP Practice Somerset
Indirectly Standardised Ratios that are coloured Red are higher than 3 standard deviations from the mean. Those coloured Yellow are between 2 and 3 higher standard deviations from the mean. Elective Emergency Practice Code Practice Name CCG Population 15+ Observed Expected Ratio Observed Expected Ratio L85001 French Weir Health Centre 11X 13,350 27 69.04 39.11 14 15.33 91.32 L85002 Wells Health Centre 11X 9,816 30 56.56 53.04 6 12.26 48.95 L85003 Exmoor Medical Centre 11X 3,435 6 21.42 28.01 <6 4.36 114.72 L85004 Crewkerne Health Centre, Crewkerne 11X 9,692 21 58.00 36.20 16 12.14 131.82 L85005 Buttercross Health Centre 11X 4,330 23 26.42 87.07 <6 5.62 35.58 L85006 Crown Medical Centre 11X 7,604 28 38.61 72.51 13 8.44 154.12 L85007 Church Street Surgery, Martock 11X 9,500 20 57.32 34.89 14 11.97 116.91 L85008 Frome Medical Centre 11X 23,896 129 125.52 102.77 17 26.90 63.21 L85009 West Somerset Healthcare 11X 8,697 22 53.45 41.16 13 10.91 119.15 L85010 Highbridge Medical Centre 11X 11,333 28 64.87 43.16 <6 13.30 30.09 L85011 Cheddar Medical Centre 11X 6,374 30 37.02 81.04 7 7.83 89.35 L85012 Wellington Medical Centre 11X 12,263 25 68.05 36.74 7 14.74 47.50 L85013 Quantock Medical Centre 11X 2,828 9 17.26 52.16 <6 3.52 113.73 L85014 The Blackbrook Surgery 11X 8,304 22 42.08 52.29 11 9.47 116.21 L85015 Preston Grove Medical Centre, Yeovil 11X 10,524 21 55.96 37.53 16 12.23 130.81 L85016 Burnham Medical Centre 11X 13,979 53 84.78 62.52 27 18.23 148.10 L85017 Penn Hill Surgery, Yeovil 11X 8,251 21 44.72 46.96 10 9.89 101.11 L85018 Cannington Health Centre 11X 4,472 9 25.74 34.96 <6 5.33 75.02 L85019 Harley House Surgery 11X 6,142 17 35.56 47.81 9 7.93 113.45 L85020 Beckington Family Practice 11X 7,689 39 45.15 86.38 <6 9.13 43.83 L85021 College Way Surgery 11X 10,511 35 59.83 58.50 16 13.58 117.80 L85022 Hendford Lodge Medical Centre, Yeovil 11X 9,613 23 52.59 43.74 17 11.42 148.87 L85023 St James Medical Centre 11X 11,336 35 53.93 64.90 16 12.84 124.59 L85024 Polden Medical Practice 11X 6,645 15 39.29 38.18 9 7.89 114.09 L85025 Cranleigh Gardens Medical Centre 11X 7,709 16 38.44 41.62 10 8.65 115.58 L85026 Hamdon Medical Centre, Stoke-Sub-Hamdon 11X 4,360 6 25.10 23.90 7 5.17 135.32 L85027 Wincanton Health Centre 11X 7,126 18 39.60 45.45 6 8.48 70.79 L85028 Springmead Surgery, Chard 11X 5,519 13 31.97 40.66 7 6.93 101.06 L85029 L85029 (Vine Surgery) 11X 6,855 22 37.49 58.68 6 8.21 73.07 L85030 Essex House Medical Centre, Chard 11X 7,798 15 43.23 34.70 13 9.45 137.64 L85031 Milborne Port Surgery 11X 4,721 10 28.00 35.72 9 5.66 159.07 L85032 Bruton Surgery 11X 4,868 9 25.10 35.85 8 5.28 151.59 L85033 Langport Surgery 11X 10,326 20 61.83 32.34 8 12.79 62.55 L85034 Wells City Practice 11X 6,011 19 34.60 54.91 6 7.44 80.65 L85035 East Quay Medical Centre 11X 12,124 25 62.46 40.03 12 13.55 88.54 L85036 Quantock Vale Surgery 11X 4,494 12 26.00 46.15 <6 5.36 93.31 L85037 North Curry 11X 3,332 6 20.10 29.86 <6 4.06 49.28 L85038 Lister House Partnership 11X 5,599 16 34.00 47.06 8 6.88 116.23 L85039 Glastonbury Surgery 11X 11,062 28 57.08 49.05 15 12.33 121.63 L85040 Millbrook Surgery, Castle Cary 11X 4,080 14 23.42 59.79 <6 5.01 79.81 L85041 Irnham Lodge Surgery 11X 5,834 12 34.30 34.99 6 7.70 77.94 L85042 Taunton Road Medical Centre 11X 11,705 31 59.10 52.45 20 12.96 154.36 L85043 Park Medical Practice 11X 8,717 37 46.26 79.99 6 9.87 60.80 L85044 Queen Camel Medical Centre 11X 4,732 13 29.33 44.33 <6 5.87 34.07 L85045 Westlake (C) 11X 1,805 <6 10.51 38.06 <6 2.23 134.60 L85046 Mendip Country Practice 11X 4,353 13 24.69 52.65 <6 4.99 100.19 L85047 Glastonbury Health Centre 11X 5,497 10 29.32 34.11 10 6.02 166.19 L85048 Ryalls Park Medical Centre, Yeovil 11X 4,939 10 25.34 39.46 <6 5.40 92.67 L85050 Luson 11X 4,910 18 27.21 66.14 6 5.82 103.12 L85051 Redgate Medical Centre 11X 5,266 7 25.11 27.88 <6 5.62 35.58 L85052 Warwick House Medical Practice 11X 5,843 11 32.46 33.89 9 6.99 128.67 L85053 Grove House Surgery 11X 5,540 16 29.25 54.70 7 6.21 112.73 L85054 Summervale Surgery 11X 6,117 12 35.40 33.90 <6 7.40 27.01 L85055 Axbridge Surgery 11X 7,244 13 41.53 31.31 10 8.24 121.34 L85056 North Petherton Surgery 11X 4,618 9 25.62 35.13 7 5.44 128.67 L85060 L85060 (Vine Surgery) 11X 3,499 9 19.77 45.53 <6 4.26 117.44 L85061 The Meadows Surgery 11X 2,955 6 16.54 36.27 <6 3.59 83.48 L85062 Lyngford Park 11X 4,655 13 23.08 56.33 <6 5.17 96.64 L85064 Oaklands Surgery, Yeovil 11X 2,773 7 12.68 55.20 <6 2.87 34.81 L85065 Dunster Surgery 11X 1,949 8 12.40 64.50 <6 2.49 40.08 L85066 Ilchester Surgery, Ilchester 11X 2,655 12 14.24 84.27 <6 2.95 135.74 L85601 Brent Area Medical Centre 11X 2,305 8 13.97 57.26 <6 2.76 108.53 L85602 Brendon Hills Surgery 11X 1,516 <6 9.43 21.21 <6 1.78 112.35 L85607 Somerset Bridge Medical Centre 11X 2,974 <6 13.60 14.71 <6 3.09 96.93 L85608 Porlock Medical Centre 11X 1,750 <6 11.55 34.62 <6 2.44 41.03 L85609 Creech 11X 2,844 6 16.42 36.53 9 3.44 261.30 L85611 Oakhill Surgery 11X 2,144 6 10.58 56.72 <6 2.28 87.90 L85612 Victoria Park Medical Centre 11X 3,523 12 16.28 73.69 <6 3.75 26.66 L85616 Victoria Gate Surgery 11X 3,470 6 14.85 40.40 <6 3.54 141.08 L85619 Tawstock Medical Centre, Chard 11X 4,204 7 22.86 30.62 <6 4.81 62.38 L85620 West One Surgery 11X 1,565 6 8.87 67.64 1.80 L85624 Church View Surgery, Illminster 11X 1,912 <6 12.64 7.91 <6 2.64 37.89 Y00189 Abbey Manor Medical Practice 11X 2,203 7 10.45 66.96 <6 2.45 163.08 Y01163 Westlake (S) 11X 1,432 8 8.14 98.33 <6 1.69 59.30 Y02778 Nhs Yeovil Health Centre 11X 4,024 6 13.14 45.68 7 3.63 193.10
[email protected] Page 7 of 25 www.neqos.nhs.uk Hospital Trust activity
5. Hospital admissions for low back and radicular pain in people aged 16 years and over (April 2014 - March 2015) a. Number of hospital admissions for back pain (all admission methods, NHS Trusts only) North Bristol 2,087 Taunton & Somerset 955 Bath 1,837 South Devon 814 Plymouth 1,759 Northern Devon 584 Devon & Exeter 1,706 Bristol 399 Cornwall 1,155 South West NHS Trusts 11,296 England 251,444
Number of Admissions per Provider 01/04/2014 - 31/03/2015 All Admissions South West NHS Trusts 8,000
7,000
6,000
5,000
4,000
3,000 Number ofNumberAdmissions 2,000
1,000
0 Trusts b. Number of admissions per hospital Trust, by admission method (South West Providers only)
Hospital Admissions for Back Pain by Admission Method 01/04/2014 - 31/03/2015 Elective Emergency Other 100% ------258 90% 282 53,640 556 464 290 2,858 326 248 137
80% 70% 60% 297
50% 121 97 133 366 316 122 1,577 1,418 237,256 40% 9,528 415 1,522 1,293 863 626 563
30% Percentage of Admissions Percentage 20% 10% 96 0%
What is the data telling us? The total number of admissions for back pain, rather than a rate, is presented due to the absence of a relevant denominator at hospital Trust level. Activity for the 13 NHS Trusts is to some degree proportional to the size of the Trust and is spread across the quintile chart. The proportion of hospital activity for back pain which is classed as elective care for the South West is slightly lower than the England proportion. However at NHS Trust level the proportion varies between 24% at Bristol to 86% at Bath. All NHS activity at the independent providers is classed as elective.
[email protected] Page 8 of 25 www.neqos.nhs.uk Hospital Trust activity
5. Hospital admissions for low back and radicular pain in people aged 16 years and over (April 2014 - March 2015) c. Elective admissions for back and radicular pain, by treatment specialty (South West Providers only)
Pain Management & Trauma & Spinal Surgery Interventional Provider Name Anaesthetics Orthopaedics Service Radiology Neurosurgery Other Functions Total North Bristol 664 233 282 - 335 8 1,522 Bristol 86 - - - - 10 96 Bath 1,383 134 <6 - - 55 1,572 Taunton & Somerset 129 494 - - - <6 623 Northern Devon 181 233 - - - <6 414 Devon & Exeter 527 880 - <6 - 10 1,417 South Devon 544 - - 11 - 8 563 Plymouth 479 <6 - - 796 17 1,292 Cornwall 836 <6 - - - 26 862 Spire Bristol - 122 - - - - 122 Circle Bath 217 99 - - - - 316 Shepton Mallet 364 <6 - - - - 364 Nuffield Health, Taunton - 31 102 - - - 133 Nuffield Health, Exeter - - 97 - - - 97 Nuffield Health, Plymouth - 12 107 - <6 - 119 Total 5,410 2,238 588 11 1,131 134 9,512 d. Elective admissions for injections for back and radicular pain, by injection type and treatment specialty (national data)
Updated with new codes. Not automatically updated yet.
BUT doesn't need to be updated
What is the data telling us? For elective activity the treatment specialty code indicated within the hospital data varies by hospital trust. Overall the most common specialties are Trauma and Orthopaedics and Pain Management/Anaesthetics. However for the Plymouth Trust approximately 62% of activity is recorded against the Neurosurgery code. It is notable that for Bath Trust 88% of the activity is recorded against the Pain Management/Anaesthetics code. The second table shows the different types of injections being undertaken within each of the treatment function codes and demonstrates that nationally over 62% (104,751) of injections take place within Pain Management/Anaesthetics and 25% of injections are undertaken within Trauma and Orthopaedics. The most common injection type is facet joint injections, which mainly take place within Pain Management/Anaesthetics treatment function, but are also being used in Trauma and Orthopaedics, Spinal Surgery Service and Neurosurgery.
[email protected] Page 9 of 25 www.neqos.nhs.uk Hospital Trust activity from CCGs 6. Patient flows from CCG to Hospital Trust for back and radicular pain in people aged 16 years and over (April 2014 - March 2015) a. Hospital elective admissions by CCG population (percentage of activity)
Elective Admissions by NHS Trust from each CCG 01/04/2014 - 31/03/2015 Other 100% 27 35 43 51 239 33 90% 150 Kernow 24 80% 52 562 South Devon & Torbay
70% 303
60% 1,374 Northern, Eastern & 531 40 50% 860 Western Devon 562 372 538 1,169 40% 60 Somerset
30% Percentage ofadmissions Percentage 678 North Somerset 20%
377 10% 161 Bristol 10 28 0% 25
South Gloucestershire
b. Hospital elective admissions by CCG population (actual activity)
Elective Admissions by NHS Trust from each CCG 01/04/2014 - 31/03/2015 Other 1,800
1,600 Kernow
1,400 239 35 51 South Devon & Torbay 52 150
1,200 303 1,000 562 Northern, Eastern & Western Devon 1,374 800 40 Somerset 538
600 3327 1,169 Number of admissions of Number 860 400 43 North Somerset 678 562 531 200 377 372 161 Bristol 60 - 25 28
South Gloucestershire
What is the data telling us? There is variation between hospital trusts in terms of the number of patients from each of the CCGs that are admitted for back and radicular pain. North Bristol are more likely to take patients from several different CCGs across the region compared to the other Trusts which predominantly admit patients from the CCG where they are located. The data is shown in two ways, indicating both the proportion and number of admissions relating to each CCG.
[email protected] Page 10 of 25 www.neqos.nhs.uk Hospital Trust activity from CCGs 6. Patient flows from CCG to Hospital Trust for back and radicular pain in people aged 16 years and over (April 2014 - March 2015) c. Hospital elective admissions for surgery by CCG population (percentage of activity)
Elective Surgery Admissions by NHS Trust from each CCG 01/04/2014 - 31/03/2015 Other 100% 7 13 16 64 90% 17 6 Kernow 12 80% 52 281
70% 96 South Devon & Torbay
60% 80 Northern, Eastern & 50% Western Devon 68 121 19 40% 161 Somerset 185
30% Percentage ofadmissions Percentage North Somerset 20% 224
10% 96 13 Bristol
0%
South Gloucestershire
d. Hospital elective admissions for surgery by CCG population (actual activity)
Elective Surgery Admissions by NHS Trust from each CCG 01/04/2014 - 31/03/2015 Other 600
7 Kernow 500
South Devon & Torbay
400 64 281 12 Northern, Eastern & 300 96 Western Devon 16 17 19 Somerset 52 200
Number of admissions of Number 161 13 North Somerset 224 100 185 121 96 80 Bristol 68 - 13
South Gloucestershire
What is the data telling us? There is variation between hospital trusts in terms of the number of patients from each of the CCGs that are admitted for surgery for back and radicular pain. In the South West, North Bristol and Plymouth do the highest volume of spinal surgery. North Bristol are more likely to take patients from several different CCGs across the region compared to the other Trusts which predominantly admit patients from the CCG where they are located. The data is shown in two ways, indicating both the proportion and number of admissions relating to each CCG.
[email protected] Page 11 of 25 www.neqos.nhs.uk Hospital Trust activity from CCGs 6. Patient flows from CCG to Hospital Trust for back and radicular pain in people aged 16 years and over (April 2014 - March 2015) e. Hospital elective admissions for injections by CCG population (percentage of activity)
Elective Injections Admissions by NHS Trust from each CCG 01/04/2014 - 31/03/2015 Other 100% 14 13 27 57 24 34 90% 72 22 Kernow 21 163 80% 138 70% South Devon & Torbay 9 60% 1,244 Northern, Eastern & 420 50% 747 Western Devon 246 380 264 820 40% 48 Somerset 334
30% Percentage ofadmissions Percentage North Somerset 20% 187 10% Bristol 9 144 25 0% 22
South Gloucestershire
f. Hospital elective admissions for injections by CCG population (actual activity)
Elective Injections Admissions by NHS Trust from each CCG 01/04/2014 - 31/03/2015 Other 1,600
1,400 Kernow
1,200
South Devon & Torbay
1,000 27 Northern, Eastern & 72 800 1,244 Western Devon
57 Somerset 600 22
138 Number of admissions of Number 820 163 400 24 747 North Somerset 246 34 420 200 380 334 264 187 144 Bristol - 48 22 25
South Gloucestershire
What is the data telling us? There is variation between hospital trusts in terms of the number of patients from each of the CCGs that are admitted for injections for back and radicular pain. Bath and Devon & Exeter have the highest volume of activity for injections. North Bristol are more likely to take patients from several different CCGs across the region compared to the other Trusts which predominantly admit patients from the CCG where they are located. The data is shown in two ways, indicating both the proportion and number of admissions relating to each CCG.
[email protected] Page 12 of 25 www.neqos.nhs.uk CCG activity to Hospital Trust
7. Patient flows to Hospital Trusts from CCGs for back pain in people aged 16 years and over (April 2014 - March 2015) a. Hospital elective admissions by CCG population (percentage of activity)
Elective Admissions by CCG to each Provider 01/04/2014 - 31/03/2015 Other
100% 39 15 Independent Sector 105 56 70 65 109 Providers 90% 40 25 9 Cornwall 80% 10 60 474 678 280 Plymouth 70% 28 860 60% South Devon 531 50% 24 Devon & Exeter 40% 1,169 377 538 562 Northern Devon 30% Percentage ofadmissions Percentage 303 562 20% Taunton & Somerset
10% 161 372 150 51 Bath 0% 52 43
Bristol
Bristol
Kernow
Somerset
South
Torbay Eastern & Eastern
Northern, North Bristol
South Devon & Devon South
Western Devon Western
Gloucestershire North Somerset North b. Hospital elective admissions from each CCG (actual activity)
Elective Admissions by CCG to each Provider 01/04/2014 - 31/03/2015 Other 3,000 Independent Sector Providers
2,500 Cornwall 105
Plymouth 2,000 678 South Devon 28 1,500 70 39 Devon & Exeter 860 1,000 474 1,169
Northern Devon Number of admissionsofNumber 56 109 60 Taunton & Somerset 500 65 280 562 531 562 538 372 377 303 Bath 161 150 - 52
Bristol
Bristol
Kernow
Somerset
South Torbay
North Bristol
South Devon &
Gloucestershire
NorthSomerset
& Western Devon &Western Northern, Eastern Northern,
What is the data telling us? There is variation between CCGs in terms of the number of hospital trusts to which their patients are admitted. Activity is highest for Northern, Eastern and Western Devon CCG. Patients were admitted to at least three acute hospital trusts as well as independent sector providers compared to South Gloucestershire CCG which almost solely used the north Bristol Trust. Bristol, North Somerset and Somerset CCGs are the highest users of Independent Sector activity in the South West. The data is shown in two ways, indicating both the proportion and amount of activity relating to each provider.
[email protected] Page 13 of 25 www.neqos.nhs.uk CCG activity to Hospital Trust
7. Patient flows to Hospital Trusts from CCGs for back pain in people aged 16 years and over (April 2014 - March 2015) c. Hospital elective admissions for surgery by CCG population (percentage of activity)
Elective Surgery Admissions by CCG to each Provider 01/04/2014 - 31/03/2015 Independent Sector 100% Providers 19 50 90% 20 21 88
Plymouth 80% 103 55
70% 224 60% Devon & Exeter
50% 19 161 281 40% 96 96 Northern Devon
30% 121 185 Percentage of admissions of Percentage 20% 52
10% Taunton & Somerset 68 12 17
0% Bristol
Kernow North Bristol
Somerset
South
Torbay
Eastern & Eastern
Northern,
South Devon & Devon South
Western Devon Western
Gloucestershire North Somerset North d. Hospital elective admissions for surgery from each CCG (actual activity)
Elective Surgery Admissions by CCG to each Provider 01/04/2014 - 31/03/2015 Independent Sector 700 Providers
600 Plymouth 88
500
400 Devon & Exeter 224 50 300
Northern Devon
Numberofadmissions 200 103 19 185 281
100 20 21 55 161 121 19 96 96 Taunton & Somerset 68 52
- 12 17
Bristol Kernow
Somerset North Bristol
South
Torbay
SouthDevon &
Gloucestershire
NorthSomerset
&Devon Western Northern, Eastern Northern,
What is the data telling us? There is variation between CCGs in terms of the number of hospital trusts to which their patients are admitted for spinal surgery. Activity is highest for Northern, Eastern and Western Devon CCG. Patients were admitted to at least three acute hospital trusts as well as independent sector providers compared to South Gloucestershire CCG which almost solely used the north Bristol Trust. Somerset CCGs is the highest users of Independent Sector activity in the South West. The data is shown in two ways, indicating both the proportion and amount of activity relating to each provider.
[email protected] Page 14 of 25 www.neqos.nhs.uk CCG activity to Hospital Trust
7. Patient flows to Hospital Trusts from CCGs for back pain in people aged 16 years and over (April 2014 - March 2015) e. Hospital elective admissions for injections by CCG population (percentage of activity)
Elective Injections Admissions by CCG to each Provider 01/04/2014 - 31/03/2015 Other
100% 17 9 Independent Sector Providers 44 90% 86 334 Cornwall 80% 22 348 8 25 9 Plymouth 70% 48 250
60% 747 South Devon 420 50% 820 Devon & Exeter 40% 6 380 187 21 Northern Devon
30% 246 Percentage ofadmissions Percentage 20% Taunton & Somerset 138 163 10% 144 264 72 27 Bath 0% 22 24 34
Bristol
Bristol
Kernow
Somerset
South
Torbay Eastern & Eastern
Northern, North Bristol
South Devon & Devon South
Western Devon Western
Gloucestershire North Somerset North f. Hospital elective admissions for injections from each CCG (actual activity)
Elective Injections Admissions by CCG to each Provider 01/04/2014 - 31/03/2015 Other 1,600 Independent Sector Providers 1,400 334 Cornwall 1,200 Plymouth 25 1,000 17 South Devon 800 348 820 Devon & Exeter 600 747 Northern Devon Number of admissionsofNumber 400 86 380 250 420 Taunton & Somerset 44 48 200 264 246 163 187 138 144 Bath - 22 24 72 34
Bristol
Bristol
Kernow
Somerset
South Torbay
North Bristol
South Devon &
Gloucestershire
NorthSomerset
& Western Devon Northern,Eastern
What is the data telling us? There is variation between CCGs in terms of the number of hospital trusts to which their patients are admitted for injections. Activity is highest for Northern, Eastern and Western Devon CCG. Patients were admitted to at least three acute hospital trusts as compared to South Gloucestershire CCG which almost solely used the North Bristol Trust. Bristol, North Somerset and Somerset CCGs are the highest users of Independent Sector activity in the South West for injections. The data is shown in two ways, indicating both the proportion and amount of activity relating to each preovider.
[email protected] Page 15 of 25 www.neqos.nhs.uk Hospital Trust activity (national level) 8. Hospital admissions for low back and radicular pain in people aged 16 years and over (1st April 2011 - 31st March 2015) a. Hospital admissions by procedure type over time (all admission types)
Total Number of Admissions by Procedure Type & Year 100,000 Radicular pain injection 90,000
80,000 Back pain injections
70,000 No procedure done 60,000 Surgery 50,000
40,000 Procedure not linked to back pain
Number of admissions of Number 30,000 Pain management 20,000 excluding injections
10,000 Imaging
- 2011/12 2012/13 2013/14 2014/15 b. Elective hospital admissions by surgery procedure type over time
Elective Admissions by Surgery Group & Year 16,000
14,000 Decompression
12,000
Discectomy 10,000
Posterior lumbar fusion 8,000
6,000 Revision decompression Number of admissions of Number 4,000 All other surgery
2,000
- 2011/12 2012/13 2013/14 2014/15 c. Hospital admissions by injection procedure type over time
Elective Admissions by Injection Group & Year 70,000 Injection facet joint 60,000 Epidural sacral
50,000
Spinal nerve root 40,000 injection
Epidural lumbar 30,000
Numberofadmissions 20,000 Other back injection
10,000 Epidural (not specified) - 2011/12 2012/13 2013/14 2014/15
What is the data telling us? These charts show national trends in the types of procedures undertaken during elective admissions including a group where no procedure was undertaken during their admission. There is also a category listed as 'procedure not linked to back pain' which reports admission activity where there is a primary diagnosis of back pain but with a procedure not linked to back pain. The main procedure type relating to elective admissions are for back and radicular pain injections which has increased from a combined total of just under 140,000 to 170,000 episodes over the four year period. This is in stark contrast to number of admissions related to surgery which has remained relatively constant at 30,000 admissions per year. The proportion of admissions with no procedure reported has remained at approximately 15-16% of all activity. The charts in sections b and c show the elective admissions over time specifically for different groups of surgery procedures and injections.
[email protected] Page 16 of 25 www.neqos.nhs.uk Hospital Trust activity
9. Elective hospital admissions for low back and radicular pain in people aged 16 years and over (April 2014 - March 2015) a. Elective hospital admissions by procedure type (national level including all providers)
b. Number of elective admissions per hospital Trust, by procedure type (percentage of activity) (South West Providers only)
Elective Admissions for Back Pain by Procedure Type, 01/04/2014 - 31/03/2015
Back pain Injections Radicular Pain Injections Surgery No procedure done Procedure not linked to Back Pain Pain Management excluding Injections Imaging 100% 32 14 7 464 40 26 107 89 59 6 8 16,797 184 9 95 65 448 90% 24 11 40 33 18 12,765 55 20 408 30 141 10,552 161 73 20 79 80% 141 273 1,925 27,668
83 70% 343 180 82 60% 44 531 433 144 50% 341 93,605 1,280 96 100 598 94 167 4,301 40% 333
30% 339 Percentage of admissions Percentage 268 395 407 20% 35 154 35 74,701 10% 314 341 1,957 87 51 146 116 9 20 9 8 0%
c. Number of elective admissions per hospital Trust, by procedure type (actual activity) (South West Providers only)
Elective Admissions for Back Pain by Procedure Type, 01/04/2014 - 31/03/2015 Back pain Injections Radicular Pain Injections Surgery No procedure done Procedure not linked to Back Pain Pain Management excluding Injections Imaging 1,800
1,600 32 95 1,400 184
107
161 40 14 1,200 55 89 83 273 141 1,000
433 59 800 1,280 531 33
600 40 598
Number of admissions of Number 343 65 339 141 30 400 180 73 395 333 79 200 144 407 341 314 341 268 167 82 44 146 87 154 116 94 96 100 - 35 51 20
What is the data telling us? The table shows the number of procedures done in the latest 12 month period, by procedure type, with injections being the most common elective procedure. Nationally only 4.4% of elective admissions have no procedure recorded indicating that there are relatively few elective admissions where no procedure is undertaken but this is more likely to occur in Plymouth Trust. Seven of the South West providers have a higher proportion of elective activity for injections than the England rate (approx. 70%) and it is possible that the variation is due to differences in the point of delivery of care across hospital Trusts (for example it is possible that activity may also take place as outpatient procedures). The data is shown in two ways, indicating both the proportion and amount of activity relating to each procedure. [email protected] Page 17 of 25 www.neqos.nhs.uk Hospital Trust activity
9. Elective hospital admissions for low back and radicular pain in people aged 16 years and over (April 2014 - March 2015) d. Number of elective admissions for injections per hospital Trust, by injection type (percentage of activity) (South West Providers only)
Elective Admissions for Back Pain for Injections, by Injection Type, 01/04/2014 - 31/03/2015 Epidurals Spinal nerve root injection Injection facet joint Other back injections 100% 27 57 27 19 18 225 6 138 20 54 9 13,238 90% 84 53 97 50 8 1,732 80% 284
287 29 61,463 70% 134 241 353 139 60% 73 238 1,698 50% 257 8 13 93 30 32,458 18 1,227 40% 155 442 82
30% 97
Percentage of admissions of Percentage 256 20% 131 94 2,603 26 261 61,147 184 103 10% 76 156 83 0%
e. Number of elective admissions for injections per hospital Trust, by injection type (actual activity) (South West Providers only)
Elective Admissions for Back Pain for Injections, by Injection Type, 01/04/2014 - 31/03/2015
Epidurals Spinal nerve root injection Injection facet joint Other back injections 1,600
1,400 138 53 1,200
1,000 57 800 284 54 27 600 1,227 353 287 27 97 400 84 442 Number of admissions of Number 18 241 139 82 155 20 200 257 134 50 238 97 256 261 73 184 156 29 76 131 83 93 94 103 - 30 8
f. Proportion of elective admissions for lumbar facet joint injections, by hospital trust
Proportion of Elective Admissions for Injections which relate to Facet Joint Injections, 01/04/2014 - 31/03/2015
Injection facet joint % South West Providers Average England Average
60%
50%
40% From FT4b Data
30%
20%
10%
0% Proportion of injections which were for facet joint facet for were which injections of Proportion
What is the data telling us? Epidurals are those most frequently done within the South West, constituting almost 42% of injection activity which is higher than the England proportion (36%). Compared to national data, South West providers overall do slightly higher rates of spinal nerve injections (27% vs. 19% nationally) and slightly lower rates of lumbar facet joint injections (28% vs. 37% nationally). The data is shown in two ways, indicating both the proportion of overall activity and number of episodes for each Provider. Bath Trust does a markedly higher number of epidurals compared to all of the other providers. The proportion of facet joint injections done at Trust level ranges from 5% (Shepton Mallet) to 54% (South Devon) compared to the England figure of 37%. [email protected] Page 18 of 25 www.neqos.nhs.uk Hospital Trust activity
9. Elective hospital admissions for low back and radicular pain in people aged 16 years and over (April 2014 - March 2015) g. Number of elective admissions for surgery per hospital Trust, by surgery type (percentage of activity) (South West Providers only)
Elective admissions for back pain for surgery, by surgery type, 01/04/2014 - 31/03/2015 Decompression Discectomy Revision decompression Decompression + fusion Posterior lumbar fusion All Other Surgery 100% 30 31 6 8 154 2,516 15 90% 64 63 9 229 3,115 19 21 80% 24 17 121 19 50 883 16 46 102 1,631
70% 10 44 36 6 13 394 5,014 60% 17 34 127
50% 80 16 40% 62 74 94 56 30% 47 143 996 14,509
Percentage of admissions of Percentage 43 247 20% 172 42
10%
0%
h. Number of elective admissions for surgery per hospital Trust, by surgery type (actual activity) (South West Providers only) Elective admissions for back pain for surgery, by surgery type, 01/04/2014 - 31/03/2015 Decompression Discectomy Revision decompression Decompression + fusion Posterior lumbar fusion All Other Surgery 600
500 31 63 30 17 400 46 121 300 127 13 17 64 200 80 16 10 6 34
Numberofadmissions 15 247 100 19 172 21 36 24 143 19 44 94 74 43 47 56 62 42 - 16
What is the data telling us? The charts above show the range in activity relating specifically to elective admissions for surgery, by type of surgery, for the South West providers. Although the profile for the South West overall is relatively similar to the England profile, there are wide variations at provider level. Decompression is the most common surgical procedure for back pain at all providers but there are notably higher numbers of spinal fusions at North Bristol compared to the other South West providers. The data is shown in two ways, indicating both the proportion and amount of activity relating to each surgery type.
[email protected] Page 19 of 25 www.neqos.nhs.uk CCG activity by back pain procedure group
10. Elective hospital admissions for low back and radicular pain in people aged 16 years and over (April 2014 - March 2015) a. Number of elective admissions for surgery per CCG, by surgery type (South West only)
Elective Admissions for Back Pain for Surgery, by Surgery Type, 01/04/2014 - 31/03/2015 Decompression Discectomy Revision decompression Decompression + fusion Posterior lumbar fusion All Other Surgery 90
80 7 70 9 6 6 18 60 8 6 10 6 17 7 50 13 20 7 9 13 14 40 12 17 14 30 11
20 38 43 39 36 35 33 28 10 24 25
-
Number of admissions per 100,000population per admissionsofNumber
Bristol
Kernow
England
Somerset
South
Torbay
SouthWest
Eastern & Eastern
Northern,
South Devon &
Western Devon Western
Gloucestershire North SomersetNorth b. Number of elective admissions for injections per CCG, by injection type (South West only) Elective Admissions for Back Pain for Injections, by Injection Type, 01/04/2014 - 31/03/2015 Epidurals Spinal nerve root injection Injection facet joint Other back injections
400
350 28
300 131 250 7 13 13 200 62 11 32 8 62 69 150 100 86 59 6 111 98 100 46 66 35 30 62 59 130 50 38 34 77 56 67 59 55 35 29 39
-
Number of admissions per 100,000 population 100,000 per admissions of Number
Bristol
North
Kernow
re
England
Devon
Western
Somerset Somerset
South
Eastern & Eastern
Northern,
& Torbay &
South West South
South Devon South Gloucestershi c. Number of elective admissions for lumbar facet joint injections, by CCG (South West only) Proportion of Elective Admissions for Injections which relate to Facet Joint Injections 01/04/2014 - 31/03/2015 Injection facet joint % South West Average England Average 50% 45% 40% 35%
30% From CCG3 Data 25% 20% 15% 10% 5%
0%
Proportion of injections which were for facet joint facet for were whichinjectionsof Proportion
Bristol
North
Kernow
e
Devon
Western
Somerset Somerset
Eastern&
Northern,
South
Torbay
Gloucestershir SouthDevon &
What is the data telling us? Chart 9a shows the range in the activity rate relating specifically to elective admissions for surgery, by type of surgery, for the South West CCGs, with chart 9b showing the same for injections. North Somerset CCG have a notably higher rate of posterior lumbar fusions compared to the England rates (18 vs. 7 per 100,000) and most CCGs have consistently lower rates for all types of injections compared to England rates. The only exceptions are Somerset and North Somerset rates of spinal nerve root injections which are higher than national rates (98 & 111 vs. 69 per 100,000).
[email protected] Page 20 of 25 www.neqos.nhs.uk Hospital Trust activity
11. Hospital admissions for low back and radicular pain in people aged 16 years and over (April 2014 - March 2015) a. Elective admissions for back pain by patient classification and type, all providers
Other Patient Types are Amenity patients and Category II patients, and where the Administrative Category is unknown. b. Elective admissions for back pain, average length of stay by provider 67% of elective admissions for back pain are day cases, therefore the range in length of stay has not been calculated. c. Emergency admissions for back pain, average length of stay by provider (South West Trusts only)
Variation in length of stay Emergency Admissions only 01/04/2014 - 31/03/2015 2nd Quartile 3rd Quartile Median 9 8 7
6 5 4
3 Length ofstay Length 2 1 -
What is the data telling us? Over 98% of elective admissions for back pain in the current data extraction relate to NHS patients, with just over 0.5% relating to private patients. The boxplot indicates the variation in length of stay for emergency admissions to the South West Trusts and shows that all Trusts have a higher median length of stay (ranging from 1 to 4 days), compared to the England rate of zero days.
[email protected] Page 21 of 25 www.neqos.nhs.uk Hospital Trust Activity Total Costs 12. Total costs to the commissioner for hospital admissions for low back and radicular pain in people aged 16 years and over (April 2014 - March 2015) a. Total Costs by Admission Method Type (South West FTs only)
Provider Name Elective Emergency Other Total North Bristol £ 4,326,634 £ 1,153,461 £ 55,832 £ 5,535,926 Plymouth £ 3,197,415 £ 716,477 £ 10,718 £ 3,924,610 Devon & Exeter £ 2,372,485 £ 462,171 £ 11,569 £ 2,846,225 Taunton & Somerset £ 1,064,867 £ 414,850 £ 9,767 £ 1,489,484 Northern Devon £ 491,491 £ 270,181 £ 146,555 £ 908,228 Bath £ 496,774 £ 366,399 £ 943 £ 864,117 Cornwall £ 517,087 £ 258,666 £ 22,882 £ 798,634 South Devon £ 312,058 £ 256,969 £ 4,319 £ 573,346 Bristol £ 65,166 £ 313,237 £ 13,750 £ 392,153 Total £ 12,843,978 £ 4,212,409 £ 276,335 £ 17,332,722 b. Total Costs by Procedure Type (South West FTs only)
Pain Procedure not Management Radicular pain Back pain No procedure linked to back excluding Other Non- Provider Name Surgery Injections Injections done pain Imaging Injections Surgical Total North Bristol £ 3,141,899 £ 256,323 £ 205,938 £ 391,748 £ 1,117,416 £ 154,405 £ 268,197 £ - £ 5,535,926 Plymouth £ 2,695,621 £ 247,257 £ 71,067 £ 364,324 £ 350,423 £ 175,668 £ 20,248 £ - £ 3,924,610 Devon & Exeter £ 1,510,778 £ 375,682 £ 198,315 £ 245,427 £ 300,192 £ 114,608 £ 101,222 £ - £ 2,846,225 Taunton & Somerset £ 671,338 £ 233,074 £ 57,268 £ 194,876 £ 201,780 £ 131,147 £ - £ - £ 1,489,484 Northern Devon £ 297,512 £ 90,979 £ 81,050 £ 315,010 £ 37,412 £ 71,572 £ 14,693 £ - £ 908,228 Bath £ 462,733 £ 55,197 £ 5,636 £ 184,481 £ 51,160 £ 101,244 £ 1,204 £ 2,462 £ 864,117 Cornwall £ - £ 205,757 £ 222,326 £ 229,733 £ 38,409 £ 36,663 £ 65,747 £ - £ 798,634 South Devon £ - £ 120,135 £ 152,053 £ 138,688 £ 41,237 £ 87,980 £ 33,252 £ - £ 573,346 Bristol £ - £ 31,508 £ 23,520 £ 181,532 £ 35,628 £ 119,966 £ - £ - £ 392,153 Total £ 8,779,881 £ 1,615,914 £ 1,017,174 £ 2,245,820 £ 2,173,655 £ 993,253 £ 504,563 £ 2,462 £ 17,332,722
What is the data telling us? Across all South West Trusts in 2014/15 the total cost to commissioners for back and radicular pain admissions was approximately £17 million, with 74% of the costs attributed to elective activity. Note that these costs are by provider Trust and will include activity for CCGs outside of the South West region. The surgery procedures group accounts for over 50% of the total cost of all procedures, and the cost of injections is an additional 15% of the total.
[email protected] Page 22 of 25 www.neqos.nhs.uk CCG Activity Total Costs
13. Hospital admissions Total Cost for low back and radicular pain in people aged 16 years and over (April 2014 - March 2015) a. All Admission Methods - Table All Admissions Elective Admissions Emergency Admissions Registered Cost per head Cost per head Cost per head Population Responsible CCG Name of Population Total Cost of Population Total Cost of Population Total Cost (Ages 15+) Somerset £ 5.80 £ 2,716,164 £ 4.09 £ 1,914,816 £ 1.57 £ 735,805 468,040 Bristol £ 5.81 £ 2,386,844 £ 3.95 £ 1,621,473 £ 1.76 £ 722,063 410,912 South Devon & Torbay £ 6.20 £ 1,501,160 £ 4.47 £ 1,081,414 £ 1.51 £ 364,792 242,116 South Gloucestershire £ 6.46 £ 1,403,611 £ 4.71 £ 1,023,655 £ 1.70 £ 369,814 217,289 Kernow £ 6.83 £ 3,206,457 £ 5.40 £ 2,532,375 £ 1.15 £ 538,787 469,126 Northern, Eastern & Western Devon £ 7.23 £ 5,469,665 £ 5.41 £ 4,098,758 £ 1.53 £ 1,156,709 757,011 North Somerset £ 8.11 £ 1,456,597 £ 6.15 £ 1,103,705 £ 1.90 £ 341,483 179,503 South West Total £ 6.61 £ 18,140,499 £ 4.87 £ 13,376,196 £ 1.54 £ 4,229,453 2,743,997 b. All Admission Methods - Quintile Chart Cost of Back Pain Admissions per head of Population 01/04/2014 - 31/03/2015 All Admission Methods South West CCGs National Average South West CCGs Average £16 Highlighted CCGs:
£14 Somerset
£12
£10
£8
£6 Cost per head of population of head per Cost £4
£2
£0 CCG c. Elective Admissions only, by Procedure Type Pain Procedure not Management Total Cost Radicular pain Back pain No procedure linked to back excluding Other Non- Responsible CCG Name Surgery Injections Injections done pain Imaging Injections Surgical Northern, Eastern & Western Devon £ 2,688,992 £ 585,396 £ 313,954 £ 17,311 £ 353,882 £ 11,622 £ 127,602 £ - £ 4,098,758 Kernow £ 1,661,727 £ 314,460 £ 253,164 £ 19,864 £ 201,634 £ 2,272 £ 79,253 £ - £ 2,532,375 Somerset £ 1,140,685 £ 405,674 £ 82,135 £ 17,511 £ 244,594 £ 4,153 £ 20,065 £ - £ 1,914,816 Bristol £ 1,043,638 £ 160,101 £ 81,634 £ 4,120 £ 272,297 £ 8,400 £ 51,283 £ - £ 1,621,473 North Somerset £ 680,353 £ 176,439 £ 72,524 £ 1,227 £ 153,153 £ - £ 20,010 £ - £ 1,103,705 South Devon & Torbay £ 647,064 £ 143,313 £ 153,830 £ 1,937 £ 95,569 £ - £ 39,700 £ - £ 1,081,414 South Gloucestershire £ 643,155 £ 86,457 £ 63,527 £ 3,760 £ 178,362 £ 868 £ 47,527 £ - £ 1,023,655
What is the data telling us? There is wide variation across the CCGs in the South West in cost per head of population for admissions related to back and radicular pain.
North Somerset CCG has the highest spend per head of population regionally (£8.11) driven mainly by high costs for elective admissions. The neighbouring Somerset CCG has the lowest costs per head for both emergency and elective admissions (£5.80). Despite all South West CCGs having considerably lower elective admission rates, this is not reflected cost per head indicating that costs per admission for these CCGs were higher.
The final table shows the total spend for elective admissions for each CCG for 2014/15 (based on national tariff) and includes a breakdown of this spend by procedure type. Surgery generally accounts for the majority of spend, and this is consistently seen across all CCGs where there is considerably greater spend on admissions for surgery.
[email protected] Page 23 of 25 www.neqos.nhs.uk 14. Back & Radicular Pain Admissions Breakdown for the South West Region Highlighted Provider Data is included in this report (Red=Complex Spinal Provider, Blue=NHS Trust & Green=Independent Sector Provider) Elective Admissions Emergency Other Admission Code Provider Name Surgery Injections Other Admissions Types Total RVJ NORTH BRISTOL NHS TRUST 369 596 318 503 6 1,792 RK9 PLYMOUTH HOSPITALS NHS TRUST 524 506 250 447 <6 1,729 RH8 ROYAL DEVON AND EXETER NHS FOUNDATION TRUST 257 925 201 271 6 1,660 REF ROYAL CORNWALL HOSPITALS NHS TRUST - 749 113 277 <6 1,141 RBA TAUNTON AND SOMERSET NHS FOUNDATION TRUST 128 407 64 318 <6 920 RA9 SOUTH DEVON HEALTHCARE NHS FOUNDATION TRUST - 448 115 245 <6 811 RBZ NORTHERN DEVON HEALTHCARE NHS TRUST 73 298 44 134 32 581 RA7 UNIVERSITY HOSPITALS BRISTOL NHS FOUNDATION TRUST - 79 16 282 6 383 NTPH1 SHEPTON MALLET NHS TREATMENT CENTRE <6 358 <6 - - 363 RD1 ROYAL UNITED HOSPITALS BATH NHS FOUNDATION TRUST 15 182 6 58 - 261 RA3 WESTON AREA HEALTH NHS TRUST - - <6 138 <6 145 RA4 YEOVIL DISTRICT HOSPITAL NHS FOUNDATION TRUST - - <6 133 <6 139 NT238 NUFFIELD HEALTH, TAUNTON HOSPITAL 81 43 7 - - 131 NV302 CIRCLE BATH HOSPITAL 40 77 7 - - 124 NT233 NUFFIELD HEALTH, PLYMOUTH HOSPITAL 97 8 13 - - 118 NT302 SPIRE BRISTOL HOSPITAL 18 98 <6 - - 117 NT215 NUFFIELD HEALTH, EXETER HOSPITAL 96 - <6 - - 97 NT206 NUFFIELD HEALTH, BRISTOL HOSPITAL (CHESTERFIELD) <6 50 6 - - 59 NT402 BMI - BATH CLINIC 9 47 - - - 56 RH5 SOMERSET PARTNERSHIP NHS FOUNDATION TRUST - - <6 32 17 50 R1G TORBAY AND SOUTHERN DEVON HEALTH AND CARE NHS TRUST - - 6 14 28 48 NLL01 PENINSULA COMMUNITY HEALTH C.I.C - - <6 17 27 48 NFH01 SOMERSET SURGICAL SERVICES 6 34 <6 - - 41 NVC09 NEW HALL HOSPITAL <6 18 - - - 19 RJ1 GUY'S AND ST THOMAS' NHS FOUNDATION TRUST <6 6 6 - - 13 NTC01 SHEPTON MALLET NHS TREATMENT CENTRE - - 11 - - 11 RET THE WALTON CENTRE NHS FOUNDATION TRUST - - 10 - - 10 RNZ SALISBURY NHS FOUNDATION TRUST - <6 <6 <6 <6 10 RTE GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST <6 <6 - <6 - 7 NR501 PLYMOUTH COMMUNITY HEALTHCARE (CIC) - 7 7 RDU FRIMLEY HEALTH NHS FOUNDATION TRUST - <6 <6 - - 6 RTH OXFORD UNIVERSITY HOSPITALS NHS TRUST <6 - <6 <6 - 6 RAN ROYAL NATIONAL ORTHOPAEDIC HOSPITAL NHS TRUST - <6 <6 - - <6 RHM UNIVERSITY HOSPITAL SOUTHAMPTON NHS FOUNDATION TRUST <6 <6 - <6 - <6 RD3 POOLE HOSPITAL NHS FOUNDATION TRUST <6 - <6 RN3 GREAT WESTERN HOSPITALS NHS FOUNDATION TRUST - <6 - <6 - <6 RRJ THE ROYAL ORTHOPAEDIC HOSPITAL NHS FOUNDATION TRUST <6 <6 <6 - - <6 AAH #N/A - <6 <6 - - <6 RKB UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUST - - <6 <6 - <6 RR1 HEART OF ENGLAND NHS FOUNDATION TRUST <6 - <6 RRV UNIVERSITY COLLEGE LONDON HOSPITALS NHS FOUNDATION TRUST <6 <6 - - <6 <6 RVV EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST <6 - <6 RYJ IMPERIAL COLLEGE HEALTHCARE NHS TRUST - <6 - <6 - <6 NT202 NUFFIELD HEALTH, BOURNEMOUTH HOSPITAL - <6 - - - <6 NT433 BMI - SARUM ROAD HOSPITAL - <6 <6 - - <6 NVC04 DUCHY HOSPITAL - - <6 - - <6 R1H BARTS HEALTH NHS TRUST <6 - <6 R1K LONDON NORTH WEST HEALTHCARE NHS TRUST <6 - <6 RDY DORSET HEALTHCARE UNIVERSITY NHS FOUNDATION TRUST - <6 - - - <6 RDZ THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALS NHS FOUNDATION TRUST <6 - <6 RF4 BARKING, HAVERING AND REDBRIDGE UNIVERSITY HOSPITALS NHS TRUST - <6 - <6 - <6 RHW ROYAL BERKSHIRE NHS FOUNDATION TRUST <6 - <6 - - <6 RJ7 ST GEORGE'S UNIVERSITY HOSPITALS NHS FOUNDATION TRUST <6 - <6 RJZ KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUST - - <6 <6 - <6 RKE THE WHITTINGTON HOSPITAL NHS TRUST <6 <6 - - - <6 RL1 THE ROBERT JONES AND AGNES HUNT ORTHOPAEDIC HOSPITAL NHS FOUNDATION TRUST - <6 - - <6 <6 RLQ WYE VALLEY NHS TRUST <6 - <6 RM3 SALFORD ROYAL NHS FOUNDATION TRUST - <6 - - - <6 RN5 HAMPSHIRE HOSPITALS NHS FOUNDATION TRUST - <6 - <6 - <6 RRK UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUST - <6 - <6 - <6 RTK ASHFORD AND ST PETER'S HOSPITALS NHS FOUNDATION TRUST <6 - <6 RVR EPSOM AND ST HELIER UNIVERSITY HOSPITALS NHS TRUST - <6 - - - <6 RXK SANDWELL AND WEST BIRMINGHAM HOSPITALS NHS TRUST <6 - <6 RXW SHREWSBURY AND TELFORD HOSPITAL NHS TRUST <6 - <6 NT304 SPIRE SOUTHAMPTON HOSPITAL - <6 - - - <6 NTPH4 CIRENCESTER NHS TREATMENT CENTRE - <6 - - - <6 R1C SOLENT NHS TRUST <6 - <6 RA2 ROYAL SURREY COUNTY HOSPITAL NHS FOUNDATION TRUST - <6 - - - <6 RAP NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST <6 - <6 RAX KINGSTON HOSPITAL NHS FOUNDATION TRUST - <6 - - - <6 RCD HARROGATE AND DISTRICT NHS FOUNDATION TRUST <6 - <6 RJ2 LEWISHAM AND GREENWICH NHS TRUST <6 - <6 RJE UNIVERSITY HOSPITALS OF NORTH MIDLANDS NHS TRUST <6 - <6 RN7 DARTFORD AND GRAVESHAM NHS TRUST <6 - <6 RNS NORTHAMPTON GENERAL HOSPITAL NHS TRUST <6 - <6 RP5 DONCASTER AND BASSETLAW HOSPITALS NHS FOUNDATION TRUST <6 - <6 RQ6 ROYAL LIVERPOOL AND BROADGREEN UNIVERSITY HOSPITALS NHS TRUST <6 - <6 RQM CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST - - <6 - - <6 RTF NORTHUMBRIA HEALTHCARE NHS FOUNDATION TRUST <6 - <6 RTG DERBY TEACHING HOSPITALS NHS FOUNDATION TRUST <6 - <6 RTP SURREY AND SUSSEX HEALTHCARE NHS TRUST - <6 - - - <6 RTR SOUTH TEES HOSPITALS NHS FOUNDATION TRUST <6 - <6 RTX UNIVERSITY HOSPITALS OF MORECAMBE BAY NHS FOUNDATION TRUST <6 - <6 RWF MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST <6 - <6 RWG WEST HERTFORDSHIRE HOSPITALS NHS TRUST - <6 - - - <6 RWH EAST AND NORTH HERTFORDSHIRE NHS TRUST <6 - <6 RWP WORCESTERSHIRE ACUTE HOSPITALS NHS TRUST <6 - <6 RWW WARRINGTON AND HALTON HOSPITALS NHS FOUNDATION TRUST <6 - <6 RXF MID YORKSHIRE HOSPITALS NHS TRUST - <6 - - - <6 RXN LANCASHIRE TEACHING HOSPITALS NHS FOUNDATION TRUST <6 - <6 RXP COUNTY DURHAM AND DARLINGTON NHS FOUNDATION TRUST <6 - <6 RXQ BUCKINGHAMSHIRE HEALTHCARE NHS TRUST - <6 - - - <6 NLX22 THORNBURY HOSPITAL - <6 <6 NN801 THE SPENCER WING (RAMSGATE ROAD) - - <6 - - <6 NR527 MOUNT GOULD HOSPITAL - <6 <6 NT418 BMI - THE HAMPSHIRE CLINIC - - <6 - - <6 NVC22 WINFIELD HOSPITAL <6 - - - - <6 Total 1,733 4,981 1,233 2,927 149 11,023
[email protected] Page 24 of 25 www.neqos.nhs.uk DOCUMENT GOVERNANCE Document name Back Pain Report Document type Final Version 0.6 Date 17/06/2016 Document Classification Confidential Prepared on behalf of GIRFT Created by Adam Fearing, Andrea Brown & Liz Lingard Approved by Epidemiologist Liz Lingard Approved by Project Director Helen Ridley Peer Reviewed by (if appropriate) Originating organisation NEQOS Website of originating organisation www.neqos.nhs.uk - Please contact the NEQOS advisory service through this web link for further information or to enquire about NEQOS undertaking similar work. Contact email address [email protected] Public file location N/A Internal file location G:\Project Management\Project Mgt 15-16\Back Pain
VERSION CONTROL Version Document Type Date Amendments By Adam Fearing, 0.1 First Draft 10/03/2016 --- Liz Lingard Adam Fearing, 0.2 Draft V2 15/03/2016 Amendments & Final QA Kayoung Goffe Adam Fearing, 0.3 Draft V3 15/04/2016 Further minor amendments Kayoung Goffe 0.4 Draft V4 03/05/2016 Further minor amendments Adam Fearing 0.5 Draft V5 11/05/2016 Further minor amendments Adam Fearing 0.6 Draft V6 17/06/2016 Narrative & formatting Liz Lingard
CONFIDENTIALITY CHECKLIST – FOR COMPLETION PRIOR TO ANY DRAFTS SENT TO CLIENTS Does the report include any small numbers? Yes Yes, the small numbers in this report have been suppressed. Observed events less than 6 have been replaced by "<6". Rates where the If yes, can we produce a meaningful suppressed numerator or denominator are less than 6 have been shown, although version? to calculate that small number would not be possible from the data shown here. If not, the Epidemiologist AND Director must justify why not here, highlight, and agree the need for an NDA Have Lightfoot/HSCIC approved use of NDA in order to disclose small numbers?
Has the recipient of the report signed the NDA?
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