“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Programme Budgeting for supporting commissioning and clinical standards

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Overview Programme Budgeting information National Centre for Health Outcomes Development Atlas Next steps

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Overview Annual return from PCTs to DH Spend on care (across all sectors) broken down by 23 Programme Budget Categories. Based on ICD Chapters, but in general uses asterisk (manifestation) codes rather than dagger (cause).

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Complementary to HRG tariff/PBR PB Categories are condition based PB spend is population based

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Uses Interventions ConditionsConditions HRG1HRG2HRG3HRG4 PB1 xxx PB2xx PB3 xx PB4 Etc. xxx

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Overview Programme Budgeting information National Centre for Health Outcomes Development Atlas Next steps

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” What spend

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Comparisons

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Population or Incidence?

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” HRGS for Coronary Heart Disease E12 Acute Myocardial Infarction w/o cc 29% E22 Ischaemic Heart Disease without intervention >69 or w cc 11% E11 Acute Myocardial Infarction w cc 15% E04 Coronary Bypass 4% E15 Percutaneous Coronary Intervention 4% E23 Ischaemic Heart Disease without intervention <70 w/o cc 8% E14 Cardiac Catheterisation and Angiography without complications 6% E99 Complex Elderly with a Cardiac Primary Diagnosis 15% E29 Arrhythmia or Conduction Disorders >69 or w cc 2% E03 Cardiac Valve Procedures 0% E08 Pacemaker Implant except for AMI, Heart Failure or Shock 1% E40 Other Cardiothoracic or Circulatory Procedures >18 0% E18 Heart Failure or Shock >69 or w cc 1% E38 Electrophysiological and other Percutaneous Cardiac Procedures >18 0% E30 Arrhythmia or Conduction Disorders <70 w/o cc 0%

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

Overview Programme Budgeting information National Centre for Health Outcomes Development Atlas Next steps

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” The National Centre for Health Outcomes Development: Interactive atlas of PCTs linking: Indicators of need, activity and outcome GP Quality and Outcomes framework Programme Budgeting spend

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

Programme Budget Spend

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

Quality and Outcomes framework: Estimate of the prevalence of coronary disease

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight”

New Forest: high prevalence, high spend

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Isle of Wight: High prevalence, low spend

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Outcome: Years of life lost

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Overview Programme Budgeting information National Centre for Health Outcomes Development Atlas Next steps

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Data submissions for 2006/7---- sign off by PCT Chief exec. Increased number of sub Programme Budget Categories (cancers, CHD, MH etc) Revisions to PB Categories mean that 2005/6 and 2006/7 are NOT comparable. Better identification of prevention spend scheduled for 2007/8.

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Summary Programme budget data available from ?Mid November. NCHOD atlases will be available later. HRG analysis can be made available.

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Next Steps ‘ Programme budget- - a verb not a noun ’ South Central workshop in late November to: –Explore and understand data –Identify issues for further analysis –Consider development of Marginal Analysis –Speakers? Topics? Programme?