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 and a full listing of
Programme Budget categories.
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. 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
Respiratory - % asthma prevalence
Circulation - % atrial fibrillation prevalence
Cancer - % cancer prevalence
Circulation - % cardiovascular disease primary prevention prevalence
Genito Urinary - % chronic kidney disease (ages 18+) prevalence
Respiratory - % chronic obstructive pulmonary disease prevalence
Circulation - % coronary heart disease prevalence
Mental health - % dementia prevalence
Mental health - % depression (ages 18+) prevalence
Endocrine - % diabetes mellitus (diabetes) (ages 17+) prevalence
Neurological - % epilepsy (ages 18+) prevalence
Circulation - % heart failure prevalence
Circulation - % heart failure due to LVD prevalence
Circulation - % hypertension prevalence
Endocrine - % hypothyroidism prevalence
Learning Disability - % learning disabilities (ages 18+) prevalence
Mental Health - % mental health prevalence
Overall - % obesity (ages 16+) prevalence
Overall - % palliative care prevalence
Circulation - % stroke or transient ischaemic attacks (TIA) prevalence
Overall - Index of mutiple deprivation (2010)
Overall - Spend on secondary care admissions per 1000 population
Overall - Spend on elective and day-case admissions per 1000 population
Overall - Spend on non-elective admissions per 1000 population
Overall - Spend on first outpatient appointment following GP referral per 1000 population
Annex 3: List of Indicators (2)
Overall - Spend on FHS prescribing per 1000 population
Overall - Secondary care admissions per 1000 population
Overall - Elective and day-case admissions per 1000 population
Overall - Non-elective admissions per 1000 population
Overall - First outpatient appointments following GP referral per 1000 population
Overall - Potential years of life lost (PYLL) FEMALE from causes considered amenable to healthcare. Directly age and sex standardise
Overall - Potential years of life lost (PYLL) MALE from causes considered amenable to healthcare. Directly age and sex standardised
Cancer - Spend on secondary care admissions per 1000 population
Cancer - Spend on elective and day-case admissions per 1000 population
Cancer - Spend on non-elective admissions per 1000 population
Cancer - Spend on FHS prescribing per 1000 population
Cancer - Secondary care admissions per 1000 population
Cancer - Elective and day-case admissions per 1000 population
Cancer - Non-elective admissions per 1000 population
Cancer - % of females aged 50-70 screened for breast cancer in last 36 months
Cancer - Mortality from all cancers under 75 years per 100,000 population (Directly age-standardised)
Cancer - Mortality from all cancers all ages per 100,000 population (Directly age-standardised)
Cancer - Mortality from colorectal cancer under 75 years per 100,000 population (Directly age-standardised)
Cancer - Mortality from lung cancer under 75 years per 100,000 population (Directly age-standardised)
Cancer - Mortality from breast cancer under 75 years per 100,000 population (Directly age-standardised)
Cancer - % receiving first definitive treatment within two months of urgent referral from GP
Cancer - Rate of successful quitters at 4-weeks per 100,000 smokers
Endocrine - Spend on secondary care admissions per 1000 population
Endocrine - Spend on elective and day-case admissions per 1000 population
Endocrine - Spend on non-elective admissions per 1000 population
Annex 3: List of Indicators (3)
Endocrine - Spend on FHS prescribing per 1000 population
Endocrine - Net ingredient cost per patient on the QOF diabetes register
Endocrine - Secondary care admissions per 1000 population
Endocrine - Elective and day-case admissions per 1000 population
Endocrine - Non-elective admissions per 1000 population
Endocrine - % of diabetic patients whose last cholesterol was 5mmol or less (DM 17)
Endocrine - % of patients with diabetes in whom the last IFCC-HbA1c is 64 mmol/mol or less (DM 27)
Endocrine - % of patients with diabetes in whom last blood pressure was 150/90 or less (DM 30)
Mental Health - Spend on secondary care admissions per 1000 population
Mental Health - Spend on elective and day-case admissions per 1000 population
Mental Health - Spend on non-elective admissions per 1000 population
Mental Health - Spend on FHS prescribing per 1000 population
Mental Health - Secondary care admissions per 1000 population
Mental Health - Elective and day-case admissions per 1000 population
Mental Health - Non-elective admissions per 1000 population
Mental Health - Mortality from suicide and injury undetermined all ages per 100,000 population (Directly age-standardised)
Neurological - Spend on secondary care admissions per 1000 population
Neurological - Spend on elective and day-case admissions per 1000 population
Neurological - Spend on non-elective admissions per 1000 population
Neurological - Spend on FHS prescribing per 1000 population
Neurological - Secondary care admissions per 1000 population
Neurological - Elective and day-case admissions per 1000 population
Neurological - Non-elective admissions per 1000 population
Neurological - Mortality from epilepsy under 75 years per 100,000 population (Directly age-standardised)
Neurological - % of patients with epilepsy on drug treatment and convulsion free, 18+ yrs (Epilepsy 08)
Annex 3: List of Indicators (4)
Circulation - Spend on secondary care admissions per 1000 population
Circulation - Spend on elective and day-case admissions per 1000 population
Circulation - Spend on non-elective admissions per 1000 population
Circulation - Spend on FHS prescribing per 1000 population
Circulation - Secondary care admissions per 1000 population
Circulation - Elective and day-case admissions per 1000 population
Circulation - Non-elective admissions per 1000 population
Circulation - Mortality from all circulatory diseases under 75 years per 100,000 population (Directly age-standardised)
Circulation - Mortality from coronary heart disease under 75 years per 100,000 population (Directly age-standardised)
Circulation - Mortality from acute MI under 75 years per 100,000 population (Directly age-standardised)
Circulation - Mortality from stroke under 75 years per 100,000 population (Directly age-standardised)
Circulation - % of patients with CHD whose last blood pressure reading is 150/90 or less (CHD 06)
Circulation - % of patients with CHD whose last measured cholesterol is 5 mmol/l or less (CHD 08)
Circulation - Reported prevalence of CHD on GP registers as % of estimated prevalence
Circulation - Reported prevalence of hypertension on GP registers as % of estimated prevalence
Respiratory - Spend on secondary care admissions per 1000 population
Respiratory - Spend on elective and day-case admissions per 1000 population
Respiratory - Spend on non-elective admissions per 1000 population
Respiratory - Spend on FHS prescribing per 1000 population
Respiratory - Secondary care admissions per 1000 population
Respiratory - Elective and day-case admissions per 1000 population
Respiratory - Non-elective admissions per 1000 population
Respiratory - Mortality from asthma under 75 years per 100,000 population (Directly age-standardised)
Respiratory - Mortality from bronchitis and emphysema and COPD under 75 years per 100,000 population (Directly age-standardised
Respiratory - Mortality from bronchitis and emphysema under 75 years per 100,000 population (Directly age-standardised)
Annex 3: List of Indicators (5)
Respiratory - Reported prevalence of COPD on GP registers as % of estimated prevalence
Gastro-intestinal - Spend on secondary care admissions per 1000 population
Gastro-intestinal - Spend on elective and day-case admissions per 1000 population
Gastro-intestinal - Spend on non-elective admissions per 1000 population
Gastro-intestinal - Spend on FHS prescribing per 1000 population
Gastro-intestinal - Secondary care admissions per 1000 population
Gastro-intestinal - Elective and day-case admissions per 1000 population
Gastro-intestinal - Non-elective admissions per 1000 population
Gastro-intestinal - Emergency admissions for alcohol related liver disease per 100,000 population
Gastro-intestinal - Mortality from gastrointestinal disease under 75 years per 100,000 population (Directly age-standardised)
Gastro-intestinal - Mortality from liver disease under 75 years per 100,000 population (Directly age-standardised)
Musculoskeletal - Spend on secondary care admissions per 1000 population
Musculoskeletal - Spend on elective and day-case admissions per 1000 population
Musculoskeletal - Spend on non-elective admissions per 1000 population
Musculoskeletal - Spend on FHS prescribing per 1000 population
Musculoskeletal - Secondary care admissions per 1000 population
Musculoskeletal - Elective and day-case admissions per 1000 population
Musculoskeletal - Non-elective admissions per 1000 population
Trauma and Injuries - Spend on secondary care admissions per 1000 population
Trauma and Injuries - Spend on elective and day-case admissions per 1000 population
Trauma and Injuries - Spend on non-elective admissions per 1000 population
Trauma and Injuries - Spend on FHS prescribing per 1000 population
Trauma and Injuries - Secondary care admissions per 1000 population
Trauma and Injuries - Elective and day-case admissions per 1000 population
Trauma and Injuries - Non-elective admissions per 1000 population
Annex 3: List of Indicators (6)
Genito Urinary - Spend on secondary care admissions per 1000 population
Genito Urinary - Spend on elective and day-case admissions per 1000 population
Genito Urinary - Spend on non-elective admissions per 1000 population
Genito Urinary - Spend on FHS prescribing per 1000 population
Genito Urinary - Secondary care admissions per 1000 population
Genito Urinary - Elective and day-case admissions per 1000 population
Genito Urinary - Non-elective admissions per 1000 population
Genito Urinary - % of patients on CKD register with hypertension and proteinuria who are treated with an ACE inhibitor or angioten
Genito Urinary - % of patients on CKD register whose last blood pressure reading is 140/85 or less (CKD03)
Maternity - Spend on secondary care admissions per 1000 population
Maternity - Spend on elective and day-case admissions per 1000 population
Maternity - Spend on non-elective admissions per 1000 population
Maternity - Spend on FHS prescribing per 1000 population
Maternity - Secondary care admissions per 1000 population
Maternity - Elective and day-case admissions per 1000 population
Maternity - Non-elective admissions per 1000 population
Cancer - Rate of urgent GP referrals for suspected cancer per 100,000 population
Cancer - Emergency bed days for long-term conditions per 1000 population
Mental Health - Total bed-days in hospital per 1000 population >74 years 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 - Reported numbers of dementia on GP registers as a % of estimated prevalence
Neurological - Emergency admission rate for children with epilepsy per 1000 population aged 0–17 years
Circulation - % of transient ischaemic attack (TIA) cases with a higher risk who are treated within 24 hours
Circulation - % of patients admitted to hospital following a stroke who spend 90% of their time on a stroke unit
Respiratory - Emergency COPD admissions per 100 patients on disease register
Annex 3: List of Indicators (7)
Musculoskeletal - Hip replacement, EQ-5D, average health gain (provisional 2011/12)
Musculoskeletal - Knee replacement, EQ-5D, average health gain (provisional 2011/12)
Musculoskeletal - Hip replacement, Oxford score, average health gain (provisional 2011/12)
Musculoskeletal - Knee replacement, Oxford score, average health gain (provisional 2011/12)
Mental Health - Emergency hospital admissions for self harm per 100,000 2011/12 (Directly standardised)
Mental Health - % of people with mental illness and or disability in settled accommodation, 2011/12
Mental Health - Improving access to psychological therapies - % recovery rate 2011/12
Mental health - Excess under 75 mortality rate in adults with serious mental illness, 2010/11 (Directly age-sex standardised)
Maternity - % of live and still births <2500 grams, 2011
Maternity - Teenage conceptions (aged under 18): rates per 1,000 females aged 15-17, 2009 to 2011
Trauma and Injuries - Mortality from all accidental causes all ages per 100,000 population (Directly age-standardised)
Endocrine - Observed vs expected number of emergency bed days for patients with diabetes
Programme budgeting categories
Programme budgeting is the analysis of expenditure in healthcare programmes, such as cancer, mental health and coronary heart disease. There are
23 programmes which are based on the World Health Organisation’s international classification of diseases. Programme budgeting allows PCTs to
examine the health gain that can be obtained from investment, through linking their programme objectives, activities and outcomes to estimates of
expenditure.
The following table outlines the 23 programme budget categories and subcategories:
Cod Main Category
e
01 Infectious diseases
02
03
04
05
Cancers and
Tumours
Sub
Subcategories
code
A
HIV and AIDS
X
Infectious diseases
A
Cancer, Head and Neck
B
C
D
E
F
G
H
I
X
Disorders of Blood
X
Endocrine, Nutritional A
and Metabolic
problems
B
X
Mental Health
Disorders
A
B
C
D
06
07
08
09
10
X
Problems of Learning X
Disability
Neurological
A
X
Problems of Vision
X
Problems of Hearing X
Problems of
A
circulation
B
C
X
Cancer, Upper GI
Cancer, Lower GI
Cancer, Lung
Cancer, Skin
Cancer, Breast
Cancer, Gynaecological
Cancer, Urological
Cancer, Haematological
Cancers and Tumours
Disorders of Blood
Diabetes
Endocrine
Endocrine, Nutritional and Metabolic
problems
Substance Misuse
Organic Mental Disorders
Psychotic Disorders
Child and Adolescent Mental Health
Disorders
Other Mental Health Disorders
Problems of Learning Disability
Chronic Pain
Neurological
Problems of Vision
Problems of Hearing
Coronary Heart Disease
Cerebrovascular disease
Problems of Rhythm
Problems of circulation
Code Main Category
11
12
13
Problems of the
respiratory system
Dental problems
Problems of The gastro
intestinal system
14
Problems of the Skin
15
Problems of the Musculo
skeletal system
Problems due to Trauma
and Injuries
Problems of Genito
Urinary system
16
17
18
19
20
21
22
23
Maternity and
Reproductive Health
Conditions of neonates
Adverse effects and
poisoning
Healthy Individuals
Social Care Needs
Other
Sub
code
A
Subcategories
Obstructive Airways Disease
B
X
Asthma
Problems of the respiratory system
X
A
Dental problems
Upper GI
B
C
X
Lower GI
HepatoBiliary
Problems of the gastro intestinal system
A
X
X
Burns
Problems of the Skin
Problems of the Musculo skeletal system
X
Problems due to Trauma and Injuries
A
Genital tract problems
B
C
X
Renal problems
STD
Problems of Genito Urinary system
X
Maternity and Reproductive Health
X
A
Conditions of neonates
Unintended consequences of treatment
B
C
X
X
X
A
X
Poisoning
Violence
Poisoning and adverse effects
Healthy Individuals
Social Care Needs
GMS/PMS contract expenditure
Other Miscellaneous