Commissioning for Value
Insight packs
Online Annexes
NHS England Gateway ref: 00525
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Annexes
This file contains the annexes to the CCG
Commissioning for Value Insights packs distributed
to CCGs, including a West Cheshire case-study,
methodology information, the full list of indicators
used to compile the packs.
Annex 1: Why Act – Achieving financial stability in West Cheshire
Achieving financial
stability in West Cheshire
It’s not just about money Right Care in West
Cheshire led to real
quality improvements in
just one annual cycle
Year 1 – “Came from behind” - Implemented system mid year
Year 2 – “Delivered as went along” - Began at year start, achieved by end
Year 3 – “Planned ahead” - Began before year start, over- achieved
Year 4 – “Ahead of the curve” - 20% of QIPP delivered by start
Year 5 – Increased focus on quality!
- A&E attends & admissions, Elective & Nonelective activity, OP Firsts and –
- Follow-ups – all decreased
- Outcomes & Quality – improved
- Integration occurred across health sectors
and with social care
Enabled by, for example :
- Medicines administration training to care
homes
- Personalised care plans (LTC)
- Community endoscopy, optometry,
ophthalmology, neurology & pain
management pathways
- MRI Scanner Direct Access
Other case studies on the above and examples from other CCGs are available from
www.rightcare.nhs.uk/resourcecentre
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Annex 2: Methodology
How have you selected the indicators for inclusion in this pack?
The indicators in this pack have been chosen to reflect the best available representation of spend, drivers of spend
and outcome/quality for the highest spending disease areas. The data in this pack relates to CCG populations not
necessarily just those services the CCG is directly responsible for. CCG level spend by programme is only available
for admissions and prescribing.
Are the data freely available?
Yes, the indicators included in this pack are all derived from publicly available sources. Most of the data comes
from the Health & Social Care Information Centre and Public Health England.
How do you choose the CCGs closest to ours for comparison?
Your CCG has been compared to a cluster group containing 10 CCGs. These are the other 10 CCGs in England which
have the most similar demographic and health characteristics to your own e.g. total population, age profile,
deprivation, ethnicity, and population density.
What are the benchmarks?
For each indicator, the first benchmark in the charts is the average value for the 10 most similar CCGs. The second
benchmark in the charts is the average value for the best 5 of the 10 most similar CCGs. Only this second
benchmark is used in the tables. Only indicators which are worse and statistically significantly different at the 95%
confidence level from the benchmark are shown in the charts or tables.. I.e. effectively they are worse at the
97.5% confidence level.
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Annex 2: Methodology (2)
Which indicators are shown in the improvement opportunities charts and tables?
Only indicators which are significantly different than the benchmark are shown in the pack. I.e. if the 95% confidence intervals for your
CCG’s value do not include the benchmark value then your CCG is an outlier. Furthermore, only indicators were the CCG’s value is
worse than the benchmark are shown as an improvement opportunity. For most indicators (e.g. mortality, spend), if the CCG’s lower
confidence interval is higher than benchmark value then the indicator appears as an improvement opportunity in the pack. E.g. the CCG
could potentially save lives or reduce spend by reducing to the benchmark. For some indicators (e.g. QOF interventions), where a lower
value is a worse outcome then the indicator appears as an improvement opportunity in the pack if the CCG’s upper confidence interval
is lower than the benchmark value. E.g. A CCG with a low % of patients with a disease under control has the improvement opportunity
to increase this.
The charts show the improvement opportunity using both benchmarks, the average value for the 10 most similar CCGs and the average
value for the best 5 of the 10 most similar CCGs. The tables show the improvement opportunity using only the second benchmark, the
average value for the best 5 of the 10 most similar CCGs. The improvement opportunities for every indicator which is worse and
significantly different to the benchmark are shown in the tables. Only the most important improvement opportunities of potential
savings for lives and finance are shown in the charts.
How has the improvement opportunity been calculated?
The improvement opportunity highlights the scale of improvement that would be achieved if the CCG were to change its performance
on that indicator to the benchmark value. It is calculated using the formula:
Improvement Opportunity = (CCG Value – Benchmark Value) * Denominator
The denominator is the most suitable population data for that indicator. E.g. CCG registered population, CCG weighted population, CCG
patients on disease register etc.
The improvement opportunity is only displayed for those indicators where the CCG’s value is statistically significantly different (95%
confidence intervals) and then worse than the benchmark (so effectively 97.5% confidence intervals).
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Annex 3: List of Indicators (1)
Full metadata for these indicators is available online www.rightcare.nhs.uk/commissioningforvalue
Data are 2011/12 unless otherwise stated
Cancer
Circulation
% cancer prevalence 2010/11
Spend on secondary care admissions per 1000 population
Spend on elective and day-case admissions per 1000 population
Spend on non-elective admissions per 1000 population
Spend on FHS prescribing per 1000 population
Secondary care admissions per 1000 population
Elective and day-case admissions per 1000 population
Non-elective admissions per 1000 population
Rate of urgent GP referrals for suspected cancer per 100,000 population
2012/13
% of women aged 50-70 screened for breast cancer in last three years
2010/11-2011/12
Emergency Bed Days for Long Term Conditions per 1000 Population
Mortality from all cancers under 75 years per 100,000 population 2009-11
Mortality from all cancers all ages, per 100,000 population 2009-11
Mortality from colorectal cancer under 75 per 100,000 population 2009-11
Mortality from lung cancer under 75 per 100,000 population 2009-11
Mortality from breast cancer under 75 per 100,000 population 2009-11
% receiving first definitive treatment within two months of urgent referral
from GP 2012/13
Rate of successful quitters at 4-weeks per 100,000 smokers 2009/102011/12
____________________________________________________________
% atrial fibrillation prevalence 2010/11
% stroke or transient Ischaemic Attacks (TIA) prevalence 2010-11
% hypertension prevalence 2010/11
% heart failure due to LVD prevalence 2010/11
Heart failure reported prevalence 2010/11
% coronary heart disease prevalence 2010/11
% cardiovascular disease primary prevention prevalence 2010/11
Spend on secondary care admissions per 1000 population
Spend on elective and day-case admissions per 1000 population
Spend on non-elective admissions per 1000 population
Spend on FHS prescribing per 1000 population
Secondary care admissions per 1000 population
Elective and day-case admissions per 1000 population
Non-elective admissions per 1000 population
% of transient ischaemic attack (TIA) cases with a higher risk who are
treated within 24 hours
% of patients admitted to hospital following a stroke who spend 90% of their
time on a stroke unit 2012/13
Mortality from all circulatory diseases under 75 (DSR) per 100,000
population 2009-11
Mortality from coronary heart disease under 75 (DSR) per 100,000
population 2009-11
Mortality from acute MI under 75 (DSR) per 100,000 population 2009-11
Mortality from stroke under 75 (DSR) per 100,000 population 2009-11
% of patients with CHD whose last blood pressure reading is 150/90 or less
% of patients with CHD whose last measured cholesterol is 5mmol/l or less
Reported prevalence of CHD on GP registers as % of estimated prevalence
Reported prevalence of hypertension on GP registers as a % of estimated
prevalence
Endocrine
% Hypothyroidism prevalence
Diabetes Mellitus (diabetes) (ages 17+) prevalence 2010-11
Spend on secondary care admissions per 1000 population
Spend on elective and day-case admissions per 1000 population
Spend on non-elective admissions per 1000 population
Spend on FHS prescribing per 1000 population
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Annex 3: List of Indicators (2)
Net Ingredient Cost per patient on the QOF diabetes register
Secondary care admissions per 1000 population
Elective and day-case admissions per 1000 population
Non-elective admissions per 1000 population
% of diabetic patients whose last cholesterol was 5mmol or less
% of patients with diabetes in whom the last IFCC-HbA1c is 64mmol/mol or
less
% of patients with diabetes whose last blood pressure was 150/90 or less
Observed vs expected number of emergency bed days for patients with
diabetes
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Gastrointestinal
Spend on secondary care admissions per 1000 population
Spend on elective and day-case admissions per 1000 population
Spend on non-elective admissions per 1000
Spend on FHS prescribing per 1000 population
Secondary care admissions per 1000 population
Elective and day-case admissions per 1000 population
None-elective admissions per 1000 population
Emergency admissions for alcohol related liver disease per 100,000
population
Mortality from gastrointestinal disease under 75 per 100,000 population
Mortality from liver disease under 75 per 100,000 population
_____________________________________________________________
Mental Health
Mental Health - % mental health prevalence 2010/11
Mental Health - % learning disabilities (ages 18+) prevalence 2010/11
Mental Health - % dementia prevalence 2010/11
Mental Health - % depression (ages 18+) prevalence 2010/11
Mental Health - Spend on FHS prescribing per 1000 population
Mental Health - Total bed-days in hospital per 1000 population >74 with a
secondary diagnosis of dementia
Mental Health - Rate of admissions to hospital per 1000 population >74 years
with a secondary diagnosis of dementia
Mental Health - Emergency hospital admissions for self-harm per 100,000
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Genitourinary
% Chronic kidney disease (ages 18+) prevalence
Spend on secondary care admissions per 1000 population
Spend on elective and day-case admissions per 1000 population
Spend on non-elective admissions per 1000 population
Spend on FHS prescribing per 1000 population
Secondary case admissions per 1000 population
Elective and day-case admissions per 1000 population
Non-elective admissions per 1000 population
% of patients on CKD register with hypertension and proteinuria who are
treated with an angiotensin converting enzyme inhibitor or angiotensin
receptor blocker
% of patients on CKD register whose the last blood pressure reading is
140/85 or less
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Maternity
Spend on secondary care admissions per 1000 population
Spend on elective and day-case admissions per 1000 population
Spend on non-elective admissions per 1000 population
Spend on FHS prescribing per 1000 population
Secondary case admissions per 1000 population
Elective and day-case admissions per 1000 population
Non-elective admissions per 1000 population
% of live and still births <2500 grams 2011
Teenage conceptions (aged under 18) rates per 1,000 females aged 15-17
2009 to 2011
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Musculoskeletal
Spend on secondary care admissions per 1000 population
Spend on elective and day-case admissions per 1000 population
Spend on non-elective admissions per 1000 population
Spend on FHS prescribing per 1000 population
Secondary care admissions per 1000 population
Elective and day-case admissions per 1000 population
Non-elective admissions per 1000 population
Hip replacement, EQ-5D, Health Gain (Provisional 2011/12)
Knee replacement, EQ-5D, Health Gain (Provisional 2011/12)
Annex 3: List of Indicators (3)
% of people with mental illness and or disability in settled accommodation
Improving access to psychological therapies - % recovery rate
Reported numbers of admissions on GP registers as a % of estimated
prevalence
Excess under 75 mortality rate in adults with serious mental illness 2010/11
Mortality from suicide and injury undetermined all ages per 100,000
population 2009-11
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Trauma and Injuries
Spend on secondary care admissions per 1000 population
Spend on elective and day-case admissions per 1000 population
Spend on non-elective admissions per 1000 population
Spend on FHS prescribing per 1000 population
Secondary care admissions per 1000 population
Elective and day-case admissions per 1000 population
Non-elective admissions per 1000 population
Mortality from accidental causes all ages per 100,000 population 2009-11
_____________________________________________________________
Hip replacement, Oxford score, Health Gain (Provisional 2011/12)
Knee replacement, Oxford score, Health Gain (Provisional 2011/12)
_____________________________________________________________
Neurological
% epilepsy (ages 18+) prevalence 2010-11
Spend on secondary care admissions per 1000 population
Spend on elective and day-case admissions per 1000 population
Spend on non-elective admissions per 1000 population
Spend on FHS prescribing per 1000 population
Secondary care admissions per 1000 population
Elective and day-case admissions per 1000 population
Non-elective admissions per 1000 population
Emergency admission rate for children with epilepsy per population aged 0–
17 years 2009/10, 2010/11, 2011/12
Mortality from epilepsy under 75 per 100,000 population 2009-11
% of patients with epilepsy on drug treatment and convulsion free 18+
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Respiratory
Overall
% palliative care prevalence 2010/11
% Obesity (ages 16+) prevalence 2010/11
Index of Multiple Deprivation 2010/11
Spend on secondary care admissions per 1000 population
Spend on elective and day-case admissions per 1000 population
Spend on non-elective admissions per 1000 population
Spend on first outpatient appointment following GP referral per 1000
population
Spend on FHS prescribing per 1000 population
Secondary care admissions per 1000 population
Elective and day-case admissions per 1000 population
Non-elective admissions per 1000 population
First outpatient appointment following GP referral per 1000 population
Potential years of life lost (PYLL) FEMALE from causes considered
amenable to healthcare per 100,000 2011
Potential years of life lost (PYLL) MALE from causes considered amenable to
healthcare per 100,000 2011
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% asthma prevalence 2010/11
Chronic obstructive pulmonary disease prevalence 2010/11
Spend on secondary care admissions per 1000 population 2010/11
Spend on elective and day-case admissions per 1000 population
Spend on non-elective admissions per 1000 population
Spend on FHS prescribing per 1000 population
Secondary care admissions per 1000 population
Elective and day-case admissions per 1000 population
Non-elective admissions per 1000 population
Emergency COPD Admissions per 100 Patients on Disease Register
Mortality from asthma under 75 per 100,000 population 2009-11
Mortality from bronchitis, emphysema, and COPD under 75 per 100,000
population 2009-11
Mortality from bronchitis and emphysema under 75 per 100,000 population
2009-11
Reported prevalence of COPD on GP registers as a % of estimated
prevalence