Appendix G: Calderdale CCG 5 Year Strategy Value Opportunities
Cardiovascular Disease (CVD) Value Opportunities
Governing Body Clinical Lead: Dr Steven Cleasby
Governing Body Associate Clinician: Dr Fred Mayland
Case for Change in Calderdale
 Mortality rate circulatory disease (under 75’s) is in the upper quintile nationally
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Observed prevalence does not match expected prevalence (potential for unmet need) for example
CHD prevalence is 4% vs 6.3% estimated prevalence
Smoking prevalence in people with long-term conditions is 4.5% higher than benchmark
Binge drinking is 11.8% higher than CCG benchmark (YHPHO)
Variation in primary and secondary prevention (QOF)
Variation in CVD QOF indicators e.g.% patients with MI treated with ace inhibitor (447 more people
should be on ace inhibitors) (YHPHO)
Potential to save 39 lives per year, £1.3m on non-elective care (Right care)
Non elective activity in the upper quintile nationally - 568 extra non elective admission rates against
benchmark
Non elective admission rates higher than benchmark for Heart failure in males 43.8% higher (YHPHO)
Non elective angioplasty rate higher than benchmark (45 extra)
Average Length of Stay (LOS) for Coronary Heart Failure (CHD) and Stroke is between 83.1% to
112.4% higher than benchmark (4,477 extra bed days)
Potential to save £680k in prescribing (Right Care)
Mental Health Value Opportunities
Governing Body Clinical Lead: Dr John Taylor,
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Clinical Associate: Dr Peter Davie
Case for change in Calderdale
Information captured from our JSNA identifies the demographic challenges and relative prevalence of the
main risk factors for mental ill-health in Calderdale:
Increase seen in mortality rates from suicide and self-injury - ranked upper quintile nationally
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Increase in emergency admissions for self-harm (specifically in young people) - ranked upper quintile
nationally
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The percentage of adults 18+ with depression is significantly worse than the national average (England:
11.88 – Calderdale: 14.89) This indicator estimates the prevalence of depression from GP records
Dementia diagnosis rates are lower than the recommended level. The number of people in Calderdale
estimated to have dementia in 2012 was 2,355, however, data from the GP registers shows actual number
was 1,171. This means approx. 1,300 people with dementia (53%) were not diagnosed
There is a high length of stay for people in hospital suffering from dementia
Improving Access to Psychological Therapies for recovered patients is lower than expected for both
recovery and access
Approximately 10% of the population describe themselves as lonely all or most of the time
There are strong links between social isolation and loneliness with poorer mental and physical health. The
impact on health includes increasing self-harming behaviours such as over eating, greater alcohol
consumption, smoking and increased exposure to stress.
Loneliness affects the immune and cardiovascular systems and can result in sleeping difficulties which in
turn have negative effects on metabolic, neural and hormonal regulations.
CQUINS for mental health – equates to £1m – how effective is this being used?
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Musculoskeletal (MSK) Value Opportunities
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Governing Body Clinical Lead: Dr Majid Azeb
Governing Body Associate: TBC
Case for change in Calderdale
Greatest increase in our population over the next 10 years is children and older people. National data as the number of elderly people in the community increase, so has the number of people with MSK
conditions.
Affects more women than men for all age groups, with MSK pain prevalence higher in ethnic groups
63% to 85%.
MSK conditions account for 7% of all reported disabilities among children aged 10-15; it is the reason
for 1 in 8 sick notes (average length off sick is 10 weeks).
Average cost to society £7.4 billon p/year and 50% of people on benefits suffer from MSK conditions.
Potential savings for non-elective admissions £150k – ranked in the upper quintile nationally for activity
and statistically significantly different from our comparators
Some increase on non-elective and day case
Overtrade in non-elective procedures in T&O at Leeds costing £100k.
Potential saving for elective and day case is £1.4million
Nationally - MSK conditions account for 30% of GP consultations and most common for repeat
consultations in primary care
Poor access to physiotherapy– Practice visits.
No community model for broad range of MSK condition related activity – including pain management
Significant increased spend on elective cases
Performance as at Dec 13 noted an overtrade on the CHFT contract for T&O (£153k), with
performance breached in T&O at 88%.
Overtrade at the Spire on elective procedures costing £109k and out-patient procedures of £15k
PROMS data placed Calderdale in lower quartile of orthopaedic procedures and participant rates are
below average for hips and knees in Calderdale. However, of those who participate we are a positive
outlier
Opportunities
o Prescribing opportunity for MSK conditions within top 5 in value pack
o Potential saving for prescribing - £150,000
o Elective and day-case admissions activity opportunity - 441
o Non-elective admissions opportunity - 292
o Hip replacement, average health gain expressed in QALYs (119)
o Knee replacement, average health gain expressed in QALYs (61)