1. Right Care Deep Dives
NEW Devon CCG
Blood Disorders

2. Contents 1. Introduction 2. Deep Dive Methodology
Right Care Deep Dives, Unwarranted Variation, Using the Evidence
2. Deep Dive Methodology
Data Extraction and Processing, Analysis and Presentation
3. Deep Dive Findings: Blood Disorders
The Challenge, Population, Activity/Spend, Outcomes, Opportunities
Who’s Doing Well? What Does This All Mean?

3. Introduction: Right Care Deep Dives
Commissioning for Value packs help identify Programme Areas in which to look
Analytical Deep Dives form part of phase two: ‘What to Change’
Further, specific analytical requests would also support the ‘How to Change’ phase
Commissioning for Value Packs
Deep Dives
Where to look
What to change
How to change

4. Introduction: Unwarranted Variation
Aim to understand what can’t be explained by patient choice or illness of population
A four-stage process
Identify the variation
Understand if it is warranted
What is driving it?
How do we eliminate it?

5. Introduction: Using the Evidence
Using evidence to move from:
“How can I explain this?” to
“What can I do to improve this?”

6. Methodology: Data Extraction and Processing
Downloaded data for NEW Devon and comparator CCGs from a host of national sources:
Programme Budgeting
HSCIC/iView Prescribing
Quality and Outcomes Framework
Public Health Profiles
Many more!
Process this data into formats which allow ease of comparison and further analysis

7. Methodology: Analysis & Presentation
Where NEW Devon CCG is:
In ‘worst’ quintile
Where a related set of indicators show a tendency toward poor performance
Focus on key areas and/or indicators
National median
Median of national upper quintile
Median of ‘most similar 10 CCGs
Median used instead of mean to reduce impact of extreme outliers
Present comparative data against different scenarios
Against national position and benchmarks
Similar CCGs
Provider
Practice
Review data at a range of levels to better understand variation at a macro and micro level

8. Methodology: Analysis & Presentation
Inquiry approach
Exploring data using key lines of enquiry (KLOEs)
Identify ‘golden threads’ present throughout the data
Working with partners to understand local issues
Identify poorly performing area for KLOE using programme budgeting as a base
Review related indicators from other data sources to refine detail
Analyse provider and practice level data to illustrate local variation
Assess scale of opportunity against various scenarios

9. Blood Disorders Programme

10. Areas for investigation

11. The Challenge
• CCG in second highest quintile for spend in four of the nine areas • Outpatient activity is the largest driver, although picture is complex • In some areas there may be opportunities to negotiate local tariffs with providers to help drive down costs

12. Population Low levels of ‘at-risk’ groups for certain blood disorders
High levels of chronic disease which may increase risk of certain blood disorders

13. Primary Care Prescribing
Spend in second lowest quintile nationally
Opportunity for savings is relatively low and limited detailed information available to support
Addressing practice variation could help deliver the small opportunity in this area
Opportunity = £0 - £107k

14. Community and Integrated Care
Data suggests potential opportunity for savings when compared to similar CCGs
Lack of detail available about what drives this
It could be that high spend in this area is supporting relatively low levels of Non Elective and A&E spend
Community and Integrated Care Opportunity = £1.4M - £3.3M

15. Outpatient Opportunity = £320k - £2.3M
Outpatients (1)
Outpatient costs in second highest quintile
Significant variation across CCGs which may indicate differences in recording practice
Outpatient Opportunity = £320k - £2.3M

16. Outpatients (2)
NEW Devon shows a high proportion of activity recorded under Clinical Haematology attracting a mandatory tariff
Anticoagulant Service are subject to local cost agreements

17. Inpatient Opportunity = £30k - £594k
Inpatients
Non Elective spend benchmarks well
Elective spend within middle quintile showing some opportunity
Some of this could be delivered through changing the setting of care for Day Case activity
Point of delivery
NEW Devon
10 most similar CCGs
England
Ordinary admission 5% 4% 6%
Day Case
94%
90%
83%
Regular Day 0%
11%
Regular Night
Inpatient Opportunity = £30k - £594k

18. Unbundled High Cost Drugs and Devices
CCG spend falls within the highest national quintile
Limited national data available to understand the detail; local analysis recommended
Reduction scenario
Spend per 100,000 (£000s)
Difference with NEW Devon spend per 100,000 (£000s)
Saving opportunity (£000s)
National median
35.8
22.0
199.8
National best quintile median
7.0
50.8
460.2
Similar 10 CCGs median
29.3
28.5
258.3
Unbundled High Cost Drugs and Devices Opportunity = £200k - £460k

19. Overall Blood Disorders opportunity: £1.95M - £6.76M
Opportunities
Primary Care Prescribing: £0k - £107k
Community and Integrated Care: £1.4M - £3.3M
Inpatients: £30k - £594k
Outpatients: £320k - £2.3M
Drugs and Devices: £200k - £460k
Overall Blood Disorders opportunity: £1.95M - £6.76M

20. Community and Integrated Care
Who is doing well?
Outpatients
Gloucestershire CCG
Dorset CCG
Windsor, Ascot & Maidenhead*
Community and Integrated Care
South Derbyshire CCG Nene CCG Mansfield & Ashfield CCG*
CCG performance based on age-sex standardised information
*not a peer CCG, but best-performing CCG in country

21. What does this all mean?
Significant opportunity in Community and Integrated Care  Would need careful consideration as this could be contributing to low Non-elective and A&E spend (*peer CCGs with low Community spend do not have significant Unscheduled Care costs)
Opportunity in Outpatients is wide-ranging and blurred by apparent coding disparities  would require more-detailed review to understand potential
Elective/Daycase opportunity could be realised by shifting setting of care to Regular Day Attender

22. Any Questions?