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 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, 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 Increase in emergency admissions for self-harm (specifically in young people) - ranked upper quintile nationally 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? Musculoskeletal (MSK) Value Opportunities 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)