Calderdale and Huddersfield NHS Trust
Demonstrating quality of life and cost benefits: the impact of self
management on five patients living with Chronic Pain
Summary
By using the Co-Creating Health approach, of running programmes for patients that
build people’s knowledge, skills and confidence to better manage their own
condition, offering clinicians Practitioner development, that builds practitioners’
skills and techniques to proactively support self management) and utilising service
improvement tools so that the systems and processes the healthcare service uses
are designed to support self management, Calderdale and Huddersfield NHS Trust
have been able to demonstrate a positive impact on both the quality of life of
people with chronic pain and on the cost of care.
The financial analysis of five patients demonstrates a potential saving of £5310
based on reduction in drugs, interventions and hospital and GP follow ups, with
further potential savings through reduced usage of other services such as
substance misuse and mental health.
Improvements in quality of life and cost savings
Patient feedback obtained from questionnaires of those going on the patient skills
programme indicates that as a result of the programme patients:
 Feel more in control
 Have increased confidence about their condition and able to ask questions
 Have an improved quality of life
 Have increased knowledge about their health
The Trust has also presented numerous patient stories at both local and national
events, demonstrating:
 Reduced reliance on medication
 Reduced contracts with health professionals
 A feeling of being in control
 The creation of a network of friends for support
Created by Calderdale and Huddersfield NHS Trust, 2012
as part of the Health Foundation’s Co-creating Health programme
Clinicians who have gone through the Practitioner Development Programme have
reported more productive consultants in which the patient has been able to relay
what they want and decisions about future management have been made on a
partnership basis. There have been improved patient outcomes as a result of the
shared agenda and goal setting.
Calderdale and Huddersfield NHS Trust collected data on 5 patients that
demonstrates both improvements in the quality of patient life and the potential cost
savings:
Patient 1
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Medication before attending the patient skills programme – Before
attending the programme, the patient was taking: Gabapentin 300mgs 68/day. Co-codamol 500/30 8tabs/day, Amitryptylline - 50mgs at night,
Citalopram 2 tabs, Ibuprofen 400mgs three times.
Interventions before attending the patient skills programme - Before
attending the programme, the patient was Spinal injections, day case
Medication and interventions after attending the patient skills
programme - No medication. The patient has been discharged from the
pain service and has not been to the GP either..
Quality of Life improvement- Positive, confident to manage condition,
sleeps better without medication, Alcohol consumption and addiction to it
stopped. Looking into getting employment
Potential cost saving as a result –
 Drugs approximate
 Spinal injections
 Outpatient appointment
 Gp appointment
£150 - £200 / year
£1000/ year based on 6 monthly injection
£140 based on 2 follow up visits
£200 based on 4 appointments per year
Total financial saving to health services = £1540 (based on approximate prices)
Patient 2
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Medication before attending the patient skills programme - Gabapentin
300mgs 6-8/day, Diazepam three times/day, Dihydrocodiene, Zimovan,
Baclofen
Depressed, isolated and suicidal before SMP
Post attending the patient skills programme - stopped Gabapentin,
Zimovan and Baclofen.
Quality of life improvement - Exercising, swimming walking and started
back on photography. Depression much better managed and not suicidal
anymore.
Potential cost saving as a result –
Created by Calderdale and Huddersfield NHS Trust, 2012
as part of the Health Foundation’s Co-creating Health programme
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Drugs approximate
Outpatient appointment
Gp appointment
£200 / year
£140 based on 2 follow up visits
£200 based on 4 appointments per year
Total financial saving to health services = £540 (based on approximate prices)
Patient 3
Medication before attending the patient skills programme - Diclofenac 50mgs TDS,
Paracetamol 8/day and more, Codiene 8/day, Gabapentin 600mgs 4times/day
Amitryptilline - 50mgs/day
 Interventions before attending the patient skills programme - Spinal
injection 3times/year,
 Quality of life before attending the patient skills programme - feeling
suicidal and debilitated when injection not given on time, isolated and
drugged up, alcoholic
 Medication after attending the patient skills programme - Stopped
Diclofenac, Paracetamol, Codiene, Amitryptilline down to 25mgs and
Gabapentin down to 600mgs twice a day
 Quality of life attending the patient skills programme – Spinal injection
only once a year, sees GP only once in 6 months as opposed to once a
month now. Alcohol stopped ,depression gone, enjoying life feels he/she is
giving something back to society now.
Potential cost saving as a result –
 Drugs approximate
 Outpatient appointment
 Injection
 Gp appointment
£300 / year
£210 based on 3 follow up visits
£1000 based on 2 injections / year
£500 based on 12 appointments per year
Total financial saving to health services = £2010 (based on approximate prices)
Patient 4
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Medication - not changed after attending the patient skills programme
Interventions - F/u appointments with consultant reduced, now only once in
6 months to see nurse and continuing to improve
Quality of life - Confident to self manage, improved exercise regime now
and mobility, walks a lot and fantastic social support from the group she
attended
Potential cost saving as a result –
 Outpatient appointment
£140 based on 2 follow up visits
Total financial saving to health services = £140 (based on approximate prices)
Created by Calderdale and Huddersfield NHS Trust, 2012
as part of the Health Foundation’s Co-creating Health programme
Patient 5
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Medication - Gabapentin and Amitryptilline
Post SMP - patient discharged from hospital
Quality of Life - Now confident and supporting family member through
addiction problems and has become an excellent self manager.
Potential cost saving as a result
 Drugs approximate
 Outpatient appointment
 Gp appointment
£300 / year
£280 based on 4 follow up visits
£500 based on 12 appointments per year
Total financial saving to health services = £1080 (based on approximate prices)
Learning
The financial analysis of five patients alone demonstrates a potential saving of
£5,310 based on reduction in drugs, interventions and hospital and GP follow ups.
This does not take into account any potential savings which will be demonstrable
as a result of reduced reliance upon other services such as substance misuse or
indeed mental health service.
Apart from listing the social benefits this case study made no attempt to quantify
the potential savings associated with improvements in the patients’ quality of life
and their ability to return to work.
These case studies demonstrate that the Co-creating Health approach, based on
the three inter-linked activities of a Patient Skills Programme for People with Long
Term Conditions, Practitioner Development and Service Improvement, can deliver
real benefits for patients living with long term conditions. The case studies also
provide a starting point for demonstrating the benefits of embedding the approach
into the ‘mainstream’.
Calderdale and Huddersfield will further explore these issues across a greater
number of patients as part of our local project evaluation.
Created by Calderdale and Huddersfield NHS Trust, 2012
as part of the Health Foundation’s Co-creating Health programme
Find out more
Read more about Co-Creating Health on the Health Foundation’s Self
Management Support Resource Centre at http://www.health.org.uk/resourcecentre/new-sms/.
Read more about NHS Arran & Ayrshire’s experiences implementing the Cocreating Health programme on the Health Foundation’s Self Management Support
Resource Centre, at http://www.health.org.uk/resource-centre/new-sms/realstories/calderdale-and-huddersfield-nhs-foundation-trust/.
Created by Calderdale and Huddersfield NHS Trust, 2012
as part of the Health Foundation’s Co-creating Health programme