Getting serious about prevention
Our plans focus on improving peoples’ ability to make better lifestyle choices – both the population of Northumberland and the NHS’s own employees.
Commissioning services to improve health
During 2014/15, we have reduced the incidence of falls in the elderly, using the Fallsafe care bundle to reduce inpatient falls. We have also increased our scrutiny of healthcare acquired infections in the community through support in community settings, care and nursing home providers as well as through a targeted programme to increase the quality of prescribing.
The physical activity strategy for the county is a priority for the CCG and we continue to promote healthy lifestyles through our commissioning plan and through our work place programme to improve the lifestyles of our staff.
The local authority appointed a Director of Public Health in the local authority and previous vacancies are now being recruited, so we expect to be able to drive forward our prevention agenda during 2015. We are developing measures to capture our ambition for improving healthy lifestyles in preparation for April 2015.
Our priorities for 2015/16 are:
- Promoting well-being and reducing the impact of ill health in those people living in residential and nursing homes. This relates to a number of initiatives outlined in some of our other clinical domains, however, we are also supporting the ongoing development of knowledge and skills for care home staff
- Increasing the uptake of screening for major cancers. We will roll out the GP reminder letter for bowel screening and the ‘pink letter’ for cervical screening – both of which were developed in North Northumberland
- Encouraging and supporting employees in their health lifestyle choices to promote their health and well-being. We recognise that health and care employees in Northumberland are also usually Northumberland residents with families and lives outside of work. By encouraging our employees to make healthy lifestyle choices, we aim to impact on the wellbeing of their families and communities. As part of this work we will be working towards a Healthy Business award
- Including health gain priorities in all our main contracts, new guidelines and newly commissioned services. For example, the COPD guideline and associated pulmonary rehabilitation services prioritise stop smoking programmes. We have include patient reported outcome measures (a measure of health gain before and after the intervention) included in our major contracts where appropriate
Financial recovery in already achieved unplanned care
Northumberland has consistently experienced pressures in unplanned care. Benchmarking data has been used to both quantify and prioritise the unplanned care work over the last two years and into the future. For example, the CCG ‘Quality profile’ (see below) shows there is a higher use of A&E across all the patients cared for in Northumberland and there was a particularly high conversion rate of A&E patients being admitted into a hospital bed for a day case and released home without procedure (IP25). These were concentrated within the Northumbria Healthcare and in particular in Wansbeck General Hospital
CCG Quality Profile 2014/15
The relatively high volume of activity translates into high cost too. The November 2014 “commissioning for value pack” shows our spend on non-elective care is 35% higher than our 10 most similar CCGs.
The CCG recognised it’s historically high spend in unplanned care and developed a number of programmes at its inception, to reduce this spend. For example, in partnership with Northumbria Healthcare and Northumberland County Council, the CCG developed a high risk patient pathway initiative aimed at integrating health and social care across the county to provide a seamless service for frail and elderly patients which aimed to:
- Enable patient-centred joint working across the health and social care system for over 26,000 older people.
- Successfully involve patients, their families and key stakeholders in developing the pathway.
- Improve health and wellbeing through a consistent evidence-based approach across the health and social care system.
- Significantly reduce unnecessary admissions to hospital and residential care.
- Support more people with very complex needs to live at home for longer.
- Improve access to specialists.
In 2013/14 the CCG saw a significant reduction in urgent admissions to hospitals from the community and from care homes and found that the patient experience has improved significantly.
The CCG has experienced significant pressure in non-elective activity in 2014/15, due to a number of factors. For example, the national high risk patient care DES shifted practices’ focus from identifying and monitoring patients at high risk of an emergency admission to completing the necessary paperwork to meet the requirements of the DES. The CCG has also experienced significant pressures during the winter, along with the rest of the country, which has increased emergency admissions.
Activity remains lower than the trend line, as shown in the following two tables, and actions are agreed with partners including primary care to drive out further efficiencies in 2015/16.
Non Elective Admissions 2009-2014 (Activity) – showing a reduction in admissions since the CCG implemented its unplanned care work.
Table X – non elective admissions 2009 – 2014 (cost) – showing a reduction in cost of admissions since the CCG implemented its unplanned care work.
Financial recovery planned for 2015/16
We are working with our providers – secondary, community and primary care – to design and implement non elective pathways that are better value for money and cost effective for the CCG, whilst delivering quality outcomes. This includes refining the delivery of ambulatory care and preparing for the opening of the new emergency care hospital; whilst also managing same day primary urgent care demand through new ways of working with community nursing services and releasing time to care for complex and vulnerable patients.
The Better Care Fund programmes capture our plans to reduce unplanned care activity by £4m, through improved joint working between the health and care sector. We recognise that a large volume of unplanned care work is a result of patients being admitted to hospital, in the last days of their life – often from care home settings.
Of the 1603 Northumberland CCG patients who died in hospital, 548 (34.2%) were on either the high risk patient pathway or the end of life pathway. The following chart shows the emergency admission frequency in the last 100 days of life for patients who are on one or both of these pathways, including the admission in which they died, relating to the period November 2013 – October 2014. Compared to the all patient group, the emergency admission pattern has less of a peak towards 0 days and there is more hospital activity with the last 7 days. Patients spent on average 22.5 emergency days in hospital in the last 100 days and the length of stay ranged from 0 days to 82 days. The average number of admissions per patient was 1.75. The chart below shows the volume of activity being targeted.