Agenda item: 5.1
SUBJECT
Comparative Clinical Outcomes and Patient Experience for
North Norfolk CCG
PRESENTED BY
Dr Linda Hunter
Mark Taylor, Chief Officer
SUBMITTED TO
Governing Body Meeting - 16 April 2013.
PURPOSE OF PAPER
The Governing Body is asked to:
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Note the contents of the report; and
Agree the recommendations set out in Section 5.
EXECUTIVE SUMMARY
The attached report sets out a range of comparative data on clinical outcomes and patient
experience for people living within the North Norfolk CCG area. It highlights many areas of
good performance but also some areas for improvement. It is proposed to use this type of
comparative clinical data on both outcomes and patient experience to inform commissioning
activity and the performance of providers.
KEY RISKS
Improving outcomes and patient experience is central to the CCG’s role and therefore
regular monitoring of such data is a key function for the Governing Body
IMPACT ASSESSMENT
Over time the CCG would wish to explore whether clinical outcomes and patient experience
varied by different communities.
REFERENCE DOCUMENT(S):
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Norfolk Joint Strategic Needs Assessment (www.norfolkinsight.org.uk)
National Commissioning Board “Outcomes Benchmarking Support Pack for
North Norfolk CCG”, January 2013.( www.england.nhs.uk/la-ccg-data)
Midlands and East SHA Board Papers March 2013
(www.midlandsandeast.nhs.uk)
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1.
PURPOSE
1.1
One of the purposes of clinical commissioning groups is to better focus commissioning on
clinical outcomes and indicators for patients than has historically been the case. For the
past decade or longer the NHS has largely concerned itself on measuring performance in
terms of access times for key services such as elective surgery, cancer referral and
treatment times, and time spent in A & E departments. Whilst these targets have been
and continue to be important in terms of ensuring that patients get timely access to care,
they tell little about the quality and outcomes of the care delivered.
1.2
The purpose of this short paper is to set out for the Governing Body what is currently
known about clinical outcomes for patients using the services which will be commissioned
by the CCG in the future. In essence it sets out the current benchmark which the CCG, in
conjunction with its partners, will seek to improve upon albeit in a time of reducing real
term resources.
2.
DATA SOURCES AND METHODOLOGY
2.1
This report draws upon 3 principle data sources. These are:
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The Norfolk Joint Strategic Needs Assessment
The National Commissioning Board (NCB) Data Pack for North Norfolk CCG
Surveys of Patient Satisfaction
2.2
To a large extent data presented in the abstract, i.e. without a relative comparator, is not
very useful so for the most part the data items contained in this report expresses the
position for North Norfolk against either a comparator group of similar areas, or on the
basis of standardised population rates where such factors as population age profile, and
socio–economic factors are standardised to allow like for like comparison.
2.3
Whilst the data contained in this report is the best available it all has limitations. Virtually
all of the data concerning clinical outcomes and disease prevalence are reliant upon
records and coding maintained by General Practices and hospitals and, whilst there is a
no reason to believe that the data in North Norfolk is any less reliable than elsewhere,
there will always be inconsistencies in how different bodies record and report data.
Similarly the choice of comparator groups is not full proof. The NCB has placed North
Norfolk CCG in a group of Coastal and Countryside CCGs and whilst this will be based on
significant similarities in populations as a CCG we should ensure that we benchmark
ourselves against a wide a comparator group as possible and hence we have, wherever
possible, also included whole England data.
2.4
Data on patient experience though perhaps more subjective than that on clinical
outcomes is absolutely vital to commissioners in terms of ensuring that patients not only
receive care which is safe and effective but crucially that it is delivered with compassion,
dignity and humanity. We know from the recent tragic occurrences at Mid Staffs Hospital
that the absence of such qualities from care can indicate circumstances in which patients
can come to real harm. Over recent years the NHS has begun to run regular surveys on
patient experience which are then compared statistically to similar organisations, or over
time, to seek out areas of good or poor experience. This report includes data drawn from
the Net Promoter Score of hospitals which essentially asks the simple question of whether
people would recommend the hospital to their friends and family, hence its common
name, the “Friends and Family Test”. We also report data on patient satisfaction with
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Primary Care Out of Hours Services and that on GP services for comparison, though
CCGs do not of course commission the latter service.
3.
DISEASE PREVALENCE AND CLINICAL OUTCOMES IN NORTH NORFOLK CCG
3.1
The attached appendices summarise the main headlines within the NCB “Outcomes
Benchmarking Support Pack for North Norfolk CCG”, published in January 2013. The key
messages within each are summarised below:
Appendix 1: Population Profile of Registered Patients
This population pyramid shows the distribution of the North Norfolk population in 5 year
age bands against the average for England. Unsurprisingly this demonstrates that the
CCG area have relatively fewer people in the bandings between ages 20 and 44 than
elsewhere and significantly more people aged 50 and above, with a pronounced
population bulge at age 60-64. Whilst it is a cause of celebration that so many older
people chose to live in the area and bring much richness to the local community, it does
place additional challenges for local health and care services as people tend to consume
far more services later in life.
Appendix 2: Disease Prevalence
This Spine Chart shows the number of people with specific diseases or disabilities based
upon information held on GP information systems. Unsurprisingly it shows that the
prevalence of many conditions more common in later life have a higher prevalence in the
CCG area than the average for England. This includes:
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Coronary Heart Disease
Hypertension
Transient Ischaemic Attacks (mini strokes)
Cancer
Dementia
Chronic Kidney Disease
The high prevalence rates reported also indicates that General Practices in North Norfolk
are effective at identifying and managing these conditions in Primary Care.
Appendix 3: Summary Spine Chart of Outcomes
This chart plots the current outcomes and performance for North Norfolk CCG against
both the rest of England and also the relevant cluster of comparative CCGS.
Overwhelmingly the chart suggests that outcomes achieved by and for the local
community compare favourably with both the national average and cluster. In particular
the indicators below are all significantly better than elsewhere:
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Potential Years of Life lost due to causes considered amenable to healthcare
(treatment)
Under 75 Mortality Rates due to Cardiovascular Disease
Under 75 Mortality Rates due to Respiratory Disease
Under 75 Mortality due to Cancer
Readmission to hospital rates
The NCB data pack contains much greater detail on each of the indicators above and
others and is available at www.england.nhs.uk/la-ccg-data.
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4.
PATIENT EXPERIENCE DATA
4.1
As outlined above the CCG has available to it data collected from a range of patient
surveys. These are not yet comprehensive in covering all the NHS services
commissioned by the CCG and does not as yet routinely include data on patient
experience on services provided by Norfolk Community Health and Care, Norfolk and
Suffolk Foundation Trust, or the East of England Ambulance Services Trust. The CCG
does however have data¹ on patient experience at its main acute providers as set out
below for February 2013:
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1.
NNUH
James Paget Hospital
Queen Elizabeth Hospital
Average for Hospitals
In Midlands & East
Range of Scores in
Midlands & East
65
85
47
71
47-91
Midlands and East SHA Board Papers, March 2013.
4.2
In 2012/13 there were some inconsistencies in how hospitals introduced the test therefore
caution should be exercised in interpreting these results. However it is apparent that the
scores for the Queen Elizabeth Hospital in Kings Lynn are very low and we will be
working through colleagues in West Norfolk CCG as the main commissioner of the
hospital to address the issues identified.
4.3
Appendix 3 also shows that the patient experience score for Primary Care Out of Hours
Services are significantly below the national average at 67%, in contrast to that for GP
services in hours which achieves 92%. Work will be undertaken with the provider EEAST
to better understand the reasons for this rating and what actions can be taken to address
them.
4.4
The CCG will use this type of data, supplemented by other more local sources to inform
commissioning of services, and challenge providers to improve the way in which services
are delivered.
5.
CONCLUSION & RECOMMENDATIONS
5.1
This report highlights the wide range of benchmark data which is now available to support
the CCG in its commissioning activities. It shows an area with an unusually high number
of older people living with conditions generally associated with later life. NHS Services
provided in the area perform very well in terms of outcomes for the majority of indicators.
Though this is a good start point for the CCG, it must not be a reason for complacency or
lack of ambition to deliver further improvement.
5.2
The Governing Body is asked to note the data reported in this paper and agree to utilise
benchmarking of clinical outcome and patient experience data as a part of its ongoing
commissioning role.
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Appendix 1
Population profile (registered patients, April 2011)
The chart below shows the number of people registered with this CCG's practices by sex and 5year age band.
The darker outlines show the profile of the England population
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Appendix 2
Disease prevalence (QOF)
The table below shows the prevalence (number and percentage) of diseases covered by the
QOF for the practices in this CCG in 2010/11. The chart shows the distribution of the CCGs
practices’ prevalence in terms of ranks. Individual practices are shown as vertical bars with the
height of the bar proportional each practice’s population. The blue box shows the range of the
middle 50% of practices in the CCG. The large diamond shows the average rank for the CCG
and the dashed blue line shows the England average
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Appendix 3
NHS North Norfolk CCG
Summary Spine Chart
The chart below shows the distribution of the CCGs on each indicator in terms of ranks. This
CCG is shown as a red diamond. The yellow box shows the interquartile range and median of
CCGs in the same ONS cluster as this CCG. The dotted blue line is the England median. Each
indicator has been orientated so that better outcomes are towards the right (light blue).
This CCG is in the Coastal and Countryside cluster
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