PCT Programme Budgeting fact sheet - 2011/12 Contents Introduction... 2 Methodology and caveats... 3 Key facts... 4 Relative expenditure by programme... 6 Relative expenditure by setting... 7 The biggest programmes... 9 Programmes with relatively high spend compared to the cluster... 18 Programmes with relatively low spend compared to the cluster... 21 Notes... 24 Tom Frost, Public Health Scientist 1 of 25 May 2013
Introduction In order to function optimally commissioners use intelligence and information to better understand current patterns of provision, and to identify opportunities for improving services. Public Health has produced a fact sheet giving an overview of spend by programme budget and a selection of related outcome measures, drawn from publicly available data, namely expenditure data taken from PCT programme budgeting returns to the Department of Health for 2011/12. The data relates to the Primary Care Trust, which ceased to exist on 1 st April 2013. Therefore, this data is not representative of the new commissioning responsibilities of Clinical Commissioning Group. No causal relationship between spend and outcome can be inferred from the data presented here. The limitations of both the programme budget data and outcome data need to be considered. The outcome information available varies between programmes. In addition the coverage of outcome measures varies across programmes; for some outcome measures may encompass the whole programme, for others they may only cover part of a programme. The fact sheets are intended to raise questions which can be investigated further using the quantitative and qualitative outcome data available locally. The Department of Health commissioned the Association of Public Health Observatories (APHO) to develop a tool which helps commissioners to link health outcomes and expenditure. The development of this tool and a Spend and Outcome Factsheet for every PCT in was led by Public Health, Northern and Yorkshire Knowledge and Intelligence Team 1. The SPOT tool uses a different methodology for calculating ONS cluster figures which is based on a straight average of per head spend rather than a population weighted average. This fact sheet adds value to the Public Health work because it goes into greater depth on the Programme Budget areas; benchmarks against a wider range of comparators and contains more and sometimes more up to date outcome information. The outcome information is taken from a variety of sources and is provided to add context to the spending data. It cannot be directly compared as categories and timescales are not always equivalent. The Comparators website 2 contains Programme Budgeting data and allows filtering of reports by Programme Budgeting categories at PCT and GP levels. For further discussion of the uses of programme budgeting and marginal analysis to deliver quality, innovation productivity and prevention please see Commissioning for Health Improvement 3. 1 http://www.yhpho.org.uk/resource/view.aspx?rid=49488 2 https://nww.nhscomparators.nhs.uk/comparators/login.aspx Tom Frost, Public Health Scientist 2 of 25 May 2013
Methodology and caveats Calculating programme budgeting data is complex and not all healthcare activity or services can be classified directly to a programme budgeting category or care setting. When it is not possible to reasonably estimate a programme budgeting category, expenditure is classified as Other. Expenditure on General Medical Services and Personal Medical Services cannot be reasonably estimated at disease specific level, and is separately identified as a subcategory of Other expenditure. The Programme Budgeting data is collated on a price-based method which uses the Secondary User Services (SUS) warehouse to apportion spend. This is robust for Payment by Results (PbR) activity but for non-pbr, SUS does not provide the cost because the price is set locally. The SUS based method has replaced the cost-based method which used reference costs based on returns by providers and a more pragmatic allocation of costs to settings. This is one of the significant changes made to the calculation methodologies in 2010/11 and therefore, it is not possible to make direct comparisons with programme budgeting data from previous years. Programme Budget collection using SUS is still being developed, so can only be used as a starting point for any investigation Estimates of expenditure are calculated using price paid for specific activities and services purchased from healthcare providers. PCTs follow standard guidance, procedures and mappings when calculating programme budgeting data. The Programme Budgeting data is unaudited although the total spend has to match PCT final accounts. The review the data and provide feedback but it is left, in the main, to PCTs to improve accuracy. Not all PCTs invest the same resources into the collection. Comparisons against other PCTs should therefore be made with caution, although comparing against groups of PCTs like the South West or ONS cluster may be more accurate. Differences between PCT and comparators should be investigated and not thought of as potential savings, especially as the data is not representative of the new commissioning responsibilities of Clinical Commissioning Group. The analysis of programme budgeting data by care setting was introduced for the first time in 2010/11. For this reason, programme budgeting data within individual care settings should be interpreted with caution. Due to differences in the level of information available to PCTs on A&E attendances a national split has been applied to PCT total A&E expenditure to apportion it across programme budgeting categories. 3 The Third Annual Population Review: Commissioning for Health Improvement, RightCare. Url: http://www.rightcare.nhs.uk/downloads/third_annual_pop_review.pdf Tom Frost, Public Health Scientist 3 of 25 May 2013
Key facts The data relates to the Primary Care Trust, which ceased to exist on 1 st April 2013. Therefore, this data is not representative of the new commissioning responsibilities of Clinical Commissioning Group. Overall PCT spent 1,675 per head (see note 1) on healthcare in 2011/12. The average for PCTs with similar socio-economic backgrounds (the cluster group see note 2) was 1,725. Out of the 23 programmes, PCT spent the most ( 165 per head) on mental health disorders, followed by problems of circulation ( 126 per head) and problems of the musculo-skeletal system ( 114 per head). Nationally the four programmes with the highest expenditure were mental health, problems of circulation, cancers and tumours and problems of the musculo-skeletal system. PCT s spend is below the cluster average on mental health; circulatory and cancer and tumour programmes, and is a little higher (9%) than the cluster on musculoskeletal problems. PCT spent more on social care needs (+54%), conditions of neonates (+42%); healthy individuals (+33%), problems of learning disability (+24%) and problems of hearing (+20%) than the cluster. However, it spent less on disorders of the blood (-25%); neurological conditions (-14%); mental health disorders (-13%) and problems of the respiratory system (-12%) than the cluster. PCT spent only 4% ( 63 per head) of all spending on prevention and health promotion (see note 5). However, this was a larger percentage and amount than the cluster (2.6%, 45), the South West (2.7%, 46) or (3.0%, 53). PCT spent more on elective and daycase inpatient care (14.7%, 246) and less on non-health and social care settings (0.9%, 16) than the cluster, South West and. Tom Frost, Public Health Scientist 4 of 25 May 2013
Tom Frost, Public Health Scientist 5 of 25 May 2013
Rank Relative expenditure by programme The table below shows relative expenditure (see note 1) by programme ( per head). Rank refers to the relative programme spend position nationally (of 151 PCTs where 1 = highest spending). The programmes are ordered according to variance from the cluster average. Comparative rates are given against the ONS cluster average ( ), the South West and. Expenditure by programme compared to other PCTs ( per head) Variance from Cluster Programme (PCT) South West 38 54% Social Care Needs 73 47 59 54 57 42% Conditions of Neonates 19 13 19 18 58 33% Healthy Individuals 43 33 31 38 30 24% Problems of Learning Disability 41 33 41 31 55 20% Problems of Hearing 10 8 10 9 65 17% Maternity and Reproductive Health 68 58 65 68 28 9% Problems of Musculo Skeletal System 114 105 106 98 41 7% Adverse effects and poisoning 20 19 19 18 61 5% Dental Problems 67 64 62 65 86-5% Problems of Gastro Intestinal System 85 89 88 87 54-5% Problems due to Trauma and Injuries 73 77 70 72 68-6% Problems of Vision 43 46 45 43 118-6% Endocrine, Nutritional and Metabolic 51 54 50 56 82-7% Cancers and Tumours 102 110 109 105 126-8% Problems of Genito Urinary System 79 85 87 88 109-9% Infectious Diseases 19 21 23 28 109-10% Problems of the Skin 34 38 38 40 86-10% Problems of Circulation 126 140 134 131 140-12% Problems of the Respiratory System 72 83 84 84 141-13% Mental Health Disorders 165 190 202 212 112-14% Neurological 71 82 81 81 133-25% Disorders of Blood 14 19 17 22 138 Total 1,675 1,725 1,739 1,755 * Total includes other category expenditure 3 programmes with largest positive variance from the cluster average 3 programmes with largest negative variance from the cluster average Tom Frost, Public Health Scientist 6 of 25 May 2013
Relative expenditure by setting The following table and chart show the spending per head by (PCT) and comparators for 2011/12 the second year this has been provided. Expenditure by setting compared to other PCTs ( per head) (PCT) South West Prevention & Health Promotion 63.03 45.32 46.13 52.81 Primary Care 215.12 217.07 216.85 209.46 Primary prescribing 200.08 207.39 192.37 193.91 Inpatient: Elective and Daycase 245.73 205.33 236.01 196.03 Inpatient: Non elective 259.58 264.02 249.05 269.42 Outpatient 147.53 152.11 146.80 158.39 Other secondary care 200.21 235.68 253.09 257.55 Total Secondary Care 1 853.05 857.14 884.95 881.38 Ambulance 36.84 33.58 36.37 32.94 A&E 25.87 30.29 26.30 32.59 Community Care 134.68 144.68 141.08 149.93 Care provided in other setting 130.72 132.30 145.33 132.59 Non Health and social care 15.72 57.59 49.90 69.56 Total Expenditure 1,675.12 1,725.36 1,739.29 1,755.19 1 This row is the total of inpatient, outpatient and other secondary care Tom Frost, Public Health Scientist 7 of 25 May 2013
spent 50.9% of all spending on secondary care. This was similar to the cluster (49.7%), the South West (50.9%) and (50.2%). However, in monetary terms spent less per head, 853, than the cluster ( 857), the South West ( 885) and ( 881). spent only 4% ( 63 per head) of all spending on prevention and health promotion (see note 5). However, this was a larger percentage and amount than the cluster (2.6%, 45), the South West (2.7%, 46) or (3.0%, 53). spent less on non-health and social care settings (0.9%, 16 per head) than the cluster (3.3%, 58), the South West (2.9%, 50) and (4.0%, 70). spent more on elective and daycase inpatient care (14.7%, 246 per head) than the cluster (11.9%, 205), the South West (13.6%, 236) and (11.2%, 196). Tom Frost, Public Health Scientist 8 of 25 May 2013
The biggest programmes Mental health Expenditure on mental health by sub-programme compared to other PCTs ( per head) Rank Variance from Cluster Programme ONS Cluster: Smaller Towns South West 127-26% Substance Misuse 13.57 18.34 19.61 22.64 151-97% Organic Mental Disorders 0.85 33.32 41.28 29.24 134-66% Psychotic Disorders 12.27 36.34 37.81 41.39 56 19% Child and Adolescent Mental Health Disorders 16.61 13.95 10.93 13.54 49 39% Other Mental Health Disorders 121.41 87.56 92.16 105.17 141-13% All Mental Health Disorders 164.72 189.50 201.80 211.98 Expenditure on mental health by setting compared to other PCTs ( per head) South West Prevention & Health Promotion 10.54 2.66 5.82 4.13 GP, dental & ophthalmic 0.35 0.28 0.38 0.26 Primary prescribing & pharma services 17.30 19.96 18.75 19.24 Inpatient: Elective and Daycase 41.27 7.93 20.78 6.99 Inpatient: Non elective 1.03 3.25 2.99 6.84 Outpatient 5.01 1.92 2.34 4.01 Other secondary care 16.72 67.17 57.68 80.28 Total Secondary Care 1 64.02 80.27 83.78 98.11 Ambulance 0.74 0.53 0.50 0.55 A&E (inc. MIU & WIC) 0.25 0.29 0.25 0.32 Community Care 45.44 41.42 47.20 39.71 Health & social care in other setting 24.33 39.17 40.43 42.30 Non Health and social care 1.75 4.92 4.68 7.37 Total Expenditure 164.72 189.50 201.80 211.98 1 This row is the total of inpatient, outpatient and other secondary care spent 165 per head on mental health problems. This was below the cluster ( 190 per head) and well below the South West and national averages ( 202 and 212 per head respectively). spent much less per head on organic mental disorders and psychotic disorders than other PCTs and also less on substance misuse. However, it spent a significant amount more per head on other mental Tom Frost, Public Health Scientist 9 of 25 May 2013
health disorders. This could mean that other PCTs are able to allocate mental health costs to specific categories whereas is allocating the majority of its costs to the other category. spent more on the prevention and health promotion and inpatient elective and daycase settings than any of the comparators. However, it spent around 50 per head less than any of the comparators on other secondary care and also less on health and social care in other setting. outcomes According to 2011/12 QOF 4 data, the prevalence of mental health problems (people with schizophrenia, bipolar disorder and other psychoses) in was 0.69%, lower than the national average of 0.82%. In 2008 to 2010 had a directly age-standardised mortality rate from suicide and undetermined injury (ICD10 X60-84; Y10-34 exc. Y33.9) of 7.67 per 100,000 which was similar to the national figure of 7.96 and the ONS cluster figure of 7.61 but lower than the South West figure of 8.92. However, none of these differences are statistically significant 5. In 2011/12, had 750 individuals in drug treatment for 3 months or more (a measure for effective treatment engagement) which is a crude rate of 158 per 100,000 population. This compares with 185,428 in which represents a rate of 349 per 100,000 population. In 97% of presenting drug users starting new treatment in this period were retained in treatment after 12 weeks, higher than (94%) 6. An estimated 11% of dependent drinkers (aged 18-75) in are in treatment compared to 13% nationally 7. In 2011/12 s standardised (adjusting for age, sex and deprivation) admissions ratio (SAR) for mental health disorders 8 was 62.1 (which was statistically significantly lower than the baseline of 100). The ONS Cluster SAR was 103.2 which was statistically significantly higher than 9. 4 Copyright 2012, The Health and Social Care Information Centre, Prescribing Support Unit. All rights reserved. 5 http://nww.indicators.ic.nhs.uk/webview/ 6 JSNA Support Pack for Strategic Partners 2013/14 (Adult drug treatment in ), National Treatment Agency for Substance Misuse www.nta.nhs.uk 7 JSNA Support Pack for Strategic Partners 2013/14 (the data for alcohol), National Treatment Agency for Substance Misuse www.nta.nhs.uk 8 ICD10: F00-F99 9 Secondary Uses Services data via Dr Foster (PHM) Tom Frost, Public Health Scientist 10 of 25 May 2013
Problems of circulation Expenditure on problems of circulation by sub-programme compared to other PCTs ( per head) Rank Variance from Cluster Programme South West 55 0% Coronary Heart Disease 38.02 37.87 40.46 35.96 105-24% Cerebrovascular disease 12.75 16.77 15.76 15.35 46-1% Problems of Rhythm 8.34 8.46 8.61 7.63 99-14% Problems of circulation (Other) 66.54 77.15 68.85 72.52 86-10% All problems of Circulation 125.64 140.26 133.68 131.45 Expenditure on problems of circulation by setting compared to other PCTs ( per head) South West Prevention & Health Promotion 1.33 0.17 0.32 0.26 GP, dental & ophthalmic 1.55 1.25 2.20 0.81 Primary prescribing & pharma services 33.52 34.41 32.08 31.40 Inpatient: Elective and Daycase 18.80 16.79 20.61 16.65 Inpatient: Non elective 39.87 39.38 37.31 36.21 Outpatient 9.52 9.00 9.25 9.61 Other secondary care 11.85 17.19 12.16 16.15 Total Secondary Care 1 80.04 82.37 79.34 78.62 Ambulance 6.26 5.36 4.77 5.05 A&E (inc. MIU & WIC) 1.39 1.63 1.41 1.75 Community Care 0.06 7.22 5.62 6.89 Health & social care in other setting 0.03 3.67 4.80 2.28 Non Health and social care 1.46 4.18 3.14 4.39 Total Expenditure 125.64 140.26 133.68 131.45 1 This row is the total of inpatient, outpatient and other secondary care spent 126 per head on this programme. This was less than the cluster ( 140 per head) and also less than the South West and ( 134 and 131 per head respectively). spent slightly less on cerebrovascular disease than its comparators but similar amounts on the other 3 sub-categories of this programme. spent almost 0 on community care settings compared to between 5 and 10 per head by its comparators. Tom Frost, Public Health Scientist 11 of 25 May 2013
outcomes According to 2011/12 QOF 10, the prevalence of stroke and transient ischaemic attack (patients with stroke or TIA) (1.98%) and hypertension (patients with established hypertension) (14.5%) were higher than the national averages (stroke and TIA 1.74% and hypertension 13.6%). However, the prevalence of coronary heart disease (patients with coronary heart disease) (3.28%) was lower than the national average (3.38%) The 2008-10 directly age-standardised mortality rate from cardiovascular (all circulatory) disease (ICD10 I00-99) was 77 per 100,000 under 75s in for males and 30 for females. This was lower for males than the South West and national averages (South West 79.5; * 95 per 100,000). This was also lower for females than the South West and national averages (South West 33; * 41 per 100,000). The cluster averages are 80 for males and 34 for females. (* indicates statistically significant differences) 11. Similar trends exist in the coronary heart disease (under 75) data where the rates are lower than the South West, the cluster and for males and females. s figures are statistically significant lower than the cluster and figures 12. For stroke mortality (under 75) the figures are lower than the averages but higher than the cluster and South West averages for both males and females. The differences are not statistically significantly 13. According to 2011/12 QOF 14 had 91.0% of patients with CHD whose last blood pressure was 150/90 or below compared to 90.2% in the South West and 90.1% in. Additionally, had 81.2% of patients with CHD whose last measured cholesterol (as measured in the last 15 months) was 5 mmol/l or less, slightly higher than the South West (80.6%) and (80.4%). 10 Copyright 2012, The Health and Social Care Information Centre, Prescribing Support Unit. All rights reserved. 11 http://nww.indicators.ic.nhs.uk/webview/ 12 http://nww.indicators.ic.nhs.uk/webview/ 13 http://nww.indicators.ic.nhs.uk/webview/ 14 Copyright 2012, The Health and Social Care Information Centre, Prescribing Support Unit. All rights reserved. Tom Frost, Public Health Scientist 12 of 25 May 2013
Cancers and tumours Expenditure on cancers and tumours by sub-programme compared to other PCTs ( per head) Rank Variance from Cluster Programme South West 135-38% Cancer, Head and Neck 1.50 2.40 2.34 2.51 123-26% Cancer, Upper GI 2.82 3.81 3.12 3.77 87-15% Cancer, Lower GI 6.20 7.25 6.82 6.91 96-11% Cancer, Lung 2.80 3.16 3.33 3.41 50 3% Cancer, Skin 2.52 2.44 2.98 2.23 43-4% Cancer, Breast 10.72 11.14 10.74 10.13 100-21% Cancer, Gynaecological 2.28 2.90 3.21 2.88 38-1% Cancer, Urological 7.47 7.54 7.73 6.73 70-2% Cancer, Haematological 8.66 8.86 9.49 8.99 74-5% Cancers and Tumours (Other) 57.45 60.49 58.75 56.96 82-7% All Cancers and Tumours 102.40 109.99 108.51 104.52 Expenditure on cancers and tumours by setting compared to other PCTs ( per head) South West Prevention & Health Promotion 2.96 3.03 2.82 3.01 GP, dental & ophthalmic 0.03 0.08 0.11 0.08 Primary prescribing & pharma services 8.76 9.41 8.19 7.49 Inpatient: Elective and Daycase 29.04 33.79 37.72 31.61 Inpatient: Non elective 13.13 15.62 12.99 13.38 Outpatient 11.32 10.02 8.54 9.76 Other secondary care 28.41 23.13 24.18 22.61 Total Secondary Care 1 81.90 82.55 83.43 77.36 Ambulance 0.00 0.00 0.04 0.02 A&E (inc. MIU & WIC) 0.00 0.00 0.00 0.00 Community Care 0.07 5.03 4.56 6.74 Health & social care in other setting 7.84 6.84 6.69 6.30 Non Health and social care 0.85 3.06 2.68 3.53 Total Expenditure 102.40 109.99 108.51 104.52 1 This row is the total of inpatient, outpatient and other secondary care spent 102 per head on this programme. This was below the cluster ( 110 per head) and also the South West ( 109) and ( 105). In percentage terms spent furthest below the cluster on head and neck cancer (-38%). The only sub-category it spent more on than the cluster was skin cancer (+3%). Tom Frost, Public Health Scientist 13 of 25 May 2013
spent similar amounts on most settings to its comparators. It spent a little more on other secondary care settings ( 28 per head) compared to the cluster ( 23 per head) and a little less on inpatient: elective and daycase settings ( 29 per head) compared to the cluster ( 34 per head). spent almost 0 on community care settings compared to around 5 per head by its comparators outcomes According to 2011/12 QOF 15 data, the prevalence of cancer (patients with a diagnosis of cancer excluding non-melanotic skin cancers from 1 April 2003) in was 2.16%, higher than the figure of 1.77%. The 2008-10 directly age standardised mortality rate from all cancers was 112 per 100,000 under 75 population in for males and 93 for females. This is statistically significantly lower than the figure for males (122) and lower for females (99). s figures are similar to those for the South West (males 112, females 92) and for the cluster (males 111, females 93) 16. The 2008-10 directly age standardised mortality rate from lung cancer was 23.15 per 100,000 under 75 population in for males and 14.81 for females. This is statistically significantly lower than for males and females (30.7 and 21.0). s figures are also lower for males and females than those for the (South West 25.5/16.1) and for the cluster (24.5 and 16.9). 17 In 2011/12, 94.7% of patients urgently referred by their GP for suspected cancer were seen by a specialist within two weeks 18 compared to 96.3% in and 95.3% in the South West. 99.5% of patients in were treated within 31 days from diagnosis 19 compared to 98.5% in the South West and 98.4% in. 20 In 2011/12 in 1,461 people per 100,000 population aged 16 or over set a quit date and 795 per 100,000 were successful quitters (54%). This compares to the South West figures of 1,635 people per 100,000 15 Copyright 2012, The Health and Social Care Information Centre, Prescribing Support Unit. All rights reserved. 16 http://nww.indicators.ic.nhs.uk/webview/ 17 http://nww.indicators.ic.nhs.uk/webview/ 18 From 2009 the operational standard for this metric was set at 93%, see 20 19 The 31-day standard was introduced in the Cancer Plan (2000) and from January 2009 an operational standard of 96% was set. (See (20). 20 PCT profiles for Cancer 2011/12, National Cancer Intelligence Network. url: https://www.cancertoolkit.co.uk/ (registration required) Tom Frost, Public Health Scientist 14 of 25 May 2013
setting a quit date and 833/100,000 being successful (51%) and to figures of 1,923/100,000 setting a quit date and 944/100,000 being successful (49%) 21. The breast cancer screening programme 22 had a coverage rate (for those aged 53 to 70) of 80.0% within in 2011/12. This was higher than the South West (79.2%) and (7.0%). (Coverage refers to the percentage of eligible population having a test in the last 3 years). 21 Information Centre for health and social care (SSS_annual_tables_2011_12.xls) 22 http://www.cancerscreening.nhs.uk/breastscreen/ Tom Frost, Public Health Scientist 15 of 25 May 2013
Problems of musculo skeletal system Expenditure on problems of musculo skeletal system by setting compared to other PCTs ( per head) South West Prevention & Health Promotion 0.05 0.04 0.15 0.04 GP, dental & ophthalmic 1.33 0.24 0.30 0.13 Primary prescribing & pharma services 8.84 9.35 8.67 8.31 Inpatient: Elective and Daycase 53.12 47.72 49.24 42.85 Inpatient: Non elective 5.05 5.53 6.24 5.30 Outpatient 16.13 15.07 15.97 15.71 Other secondary care 16.96 10.68 15.12 10.56 Total Secondary Care 1 91.26 79.01 86.57 74.42 Ambulance 0.00 0.01 0.14 0.03 A&E (inc. MIU & WIC) 1.48 1.73 1.50 1.86 Community Care 10.02 8.11 4.78 7.80 Health & social care in other setting 0.03 3.60 1.75 2.39 Non Health and social care 1.38 2.84 2.40 3.05 Total Expenditure 114.38 104.92 106.27 98.03 1 This row is the total of inpatient, outpatient and other secondary care spent 114 per head on problems of musculo skeletal system. This was slightly above the cluster ( 105 per head) and the South West ( 106 per head) and well above ( 98 per head). There are no sub-programmes for this indicator. spent more than any of its comparators on inpatient non-elective and total secondary care settings. It did not spend less than its comparators on any setting with average expenditure 10 a head or higher. outcomes In 2011/12 s standardised (adjusting for age, sex and deprivation) admissions ratio (SAR) for hip fractures 23 was 109.0 which was statistically significantly higher than the baseline of 100. The ONS Cluster SAR was 101.3 also compared to ) 24. In 2011/12 s adjusted average health gain 25 for hip replacements was 11.648 compared to 9.925 for. Similarly for knee 23 ICD10: S720-S722 (fractured neck of femur) 24 Secondary Uses Services data via Dr Foster (PHM) 25 Euro-Qol-5D VAS-casemix adjusted health gain measured as part of the Patient Reported Outcome Measures programme, Copyright 2012, The Health and Social Care Information Centre. All Rights Reserved. Tom Frost, Public Health Scientist 16 of 25 May 2013
replacements s adjusted average health gain was 5.098 compared to 4.606 for. However, these were not statistically significant differences. Tom Frost, Public Health Scientist 17 of 25 May 2013
Programmes with relatively high spend compared to the cluster Social care needs Expenditure on social care needs by setting compared to other PCTs ( per head) South West Prevention & Health Promotion 0.00 0.30 0.20 0.75 GP, dental & ophthalmic 0.00 0.04 0.06 0.04 Primary prescribing & pharma services 0.00 0.01 0.00 0.08 Inpatient: Elective and Daycase 0.00 0.03 0.91 0.24 Inpatient: Non elective 0.02 0.09 0.08 0.15 Outpatient 0.00 0.01 0.03 0.01 Other secondary care 0.03 1.22 0.38 1.12 Total Secondary Care 1 0.06 1.33 1.39 1.52 Ambulance 0.00 0.00 0.07 0.01 A&E (inc. MIU & WIC) 0.08 0.10 0.08 0.10 Community Care 0.00 5.67 5.28 7.73 Health & social care in other setting 72.14 34.01 46.41 37.61 Non Health and social care 0.69 5.84 5.01 5.84 Total Expenditure 72.98 47.30 58.50 53.70 1 This row is the total of inpatient, outpatient and other secondary care expenditure for this programme was 73 per head. This is a lot higher than any of the comparators: the cluster figure of 47 per head; the South West figure of 59 and the average of 54. spent 98.9% of its money on this category on health and social care in other setting, compared to 72% for the cluster, 79% for the South West and 70% for. Unlike, some other PCTs spent noteworthy amounts on the non-health and social care setting. There are no sub-programmes for this indicator and no outcomes measures readily available for this indicator for the. Tom Frost, Public Health Scientist 18 of 25 May 2013
Conditions of neonates Expenditure on conditions of neonates by setting compared to other PCTs ( per head) South West Prevention & Health Promotion 0.15 0.33 0.22 0.34 GP, dental & ophthalmic 0.00 0.00 0.00 0.03 Primary prescribing & pharma services 0.00 0.01 0.01 0.03 Inpatient: Elective and Daycase 0.11 0.46 0.29 0.60 Inpatient: Non elective 5.17 4.70 3.26 6.28 Outpatient 0.00 0.11 0.05 0.15 Other secondary care 13.21 6.24 14.41 8.50 Total Secondary Care 1 18.49 11.51 18.01 15.52 Ambulance 0.00 0.00 0.02 0.02 A&E (inc. MIU & WIC) 0.00 0.00 0.00 0.00 Community Care 0.00 0.79 0.02 0.60 Health & social care in other setting 0.00 0.05 0.04 0.58 Non Health and social care 0.09 0.45 0.78 0.66 Total Expenditure 18.73 13.15 19.11 17.79 1 This row is the total of inpatient, outpatient and other secondary care expenditure for this programme was 18.73 per head. This is higher than the cluster average ( 13.15) but more similar to the South West figure of 19.11 and the value of 17.79. There are no sub-programmes for this indicator The majority of the extra money spent on this category compared to the cluster was in the setting of other secondary care. outcomes The 2008-10 crude neonatal mortality rate was 2.2 deaths (of infants under 28 days old) per 1,000 live births in. This is lower than the cluster figure (2.7), South West figure (2.5) and figure (3.0). However, none of these differences are statistically significant 26. The 2008-10 crude infant mortality rate was 4.1 deaths (of children under 1) per 1,000 live births in. This is lower than the figure (4.6) but slightly higher than the South West (3.7) and the cluster (3.8). However, none of these differences are statistically significant 27. 26 http://nww.indicators.ic.nhs.uk/webview/ 27 http://nww.indicators.ic.nhs.uk/webview/ Tom Frost, Public Health Scientist 19 of 25 May 2013
Healthy individuals spent 43 per head on this programme. This was well above the cluster ( 33 per head) and also above the South West and ( 31 and 39 respectively). There are no sub-programmes for this indicator Along with its comparators spent the vast majority of the money on this category on the prevention and health promotion setting and the rest on the non-health and social care setting. outcomes Childhood obesity figures 28 show that 20.3% of children in Reception were overweight or obese in in 2011/12 which is significantly lower than 22.7% in the South West and 22.6% in overall. Similar results are seen in Year 6 where 29.6% of children were found to be overweight or obese. According to 2011/12 QOF 29 data, the prevalence of diabetes mellitus (patients with a diagnosis of diabetes mellitus) in the population aged 17 plus in was 5.2%, lower than the national average of 5.8%. 1.9% of people in live in the 20% most deprived areas of according to the Index of Multiple Deprivation 2010 30. 28 NCMP 2011/12 29 Copyright 2012, The Health and Social Care Information Centre, Prescribing Support Unit. All rights reserved. 30 DCLG Tom Frost, Public Health Scientist 20 of 25 May 2013
Programmes with relatively low spend compared to the cluster Mental health disorders See The Biggest Programmes section. Neurological Expenditure on neurological disorders by sub-programme compared to other PCTs ( per head) Rank Variance from Cluster Programme South West 101-11% Chronic Pain 20.37 22.80 21.43 22.76 106-15% Neurological (Other) 50.64 59.59 59.24 58.26 112-14% All Neurological 71.01 82.39 80.66 81.02 Expenditure on neurological disorders by setting compared to other PCTs ( per head) South West Prevention & Health Promotion 0.00 0.11 0.32 0.05 GP, dental & ophthalmic 0.05 0.06 0.13 0.02 Primary prescribing & pharma services 15.21 15.90 14.24 14.35 Inpatient: Elective and Daycase 9.24 10.84 11.27 10.73 Inpatient: Non elective 21.52 23.21 21.59 23.57 Outpatient 1.79 4.65 3.69 5.49 Other secondary care 16.60 10.76 17.88 10.47 Total Secondary Care 1 49.15 49.46 54.43 50.26 Ambulance 2.22 1.82 2.66 1.90 A&E (inc. MIU & WIC) 0.59 0.69 0.60 0.75 Community Care 3.53 7.81 3.16 7.08 Health & social care in other setting 0.02 4.35 3.14 4.01 Non Health and social care 0.24 2.19 1.98 2.59 Total Expenditure 71.01 82.39 80.66 81.02 1 This row is the total of inpatient, outpatient and other secondary care spent 71 per head on this programme. This was lower than the South West and figures ( 81 per head) and lower than the cluster average ( 82 per head). There are no sub-programmes for this indicator. spent more than the cluster on other secondary care but less on health and social care in other settings and community care. Tom Frost, Public Health Scientist 21 of 25 May 2013
outcomes According to 2011/12 QOF 31 data, the prevalence of epilepsy (patients aged 18 years and over receiving drug treatment for epilepsy) in was 0.78%, the same as the figure and very slightly lower than the South West of 0.81%. In 2008 to 2010 had a directly age-standardised mortality rate from epilepsy (ICD10 G40-41) of 0.75 per 100,000 which was statistically significantly lower than the figure of 1.59; the South West figure of 1.50 and the ONS cluster figure of 1.44 32. 31 Copyright 2012, The Health and Social Care Information Centre, Prescribing Support Unit. All rights reserved. 32 http://nww.indicators.ic.nhs.uk/webview/ Tom Frost, Public Health Scientist 22 of 25 May 2013
Disorders of the blood Expenditure on problems due to disorders of the blood by setting compared to other PCTs ( per head) South West Prevention & Health Promotion 0.00 0.00 0.00 0.02 GP, dental & ophthalmic 1.43 0.04 0.12 0.02 Primary prescribing & pharma services 0.66 0.99 0.63 0.94 Inpatient: Elective and Daycase 1.71 2.26 2.54 2.53 Inpatient: Non elective 1.84 2.62 2.14 3.05 Outpatient 3.01 4.98 4.21 5.73 Other secondary care 5.46 6.00 5.42 7.04 Total Secondary Care 1 12.02 15.86 14.31 18.35 Ambulance 0.00 0.00 0.00 0.02 A&E (inc. MIU & WIC) 0.14 0.16 0.14 0.17 Community Care 0.00 0.63 0.85 0.86 Health & social care in other setting 0.00 0.78 0.20 0.65 Non Health and social care 0.07 0.58 0.40 0.76 Total Expenditure 14.32 19.05 16.66 21.79 1 This row is the total of inpatient, outpatient and other secondary care spent 14.32 per head on this programme. This was lower than the South West ( 16.66 per head) and much lower than the cluster ( 19.05 per head) and ( 21.79 per head) figures. There are no sub-programmes for this indicator. The main setting where spent less than its comparators was on secondary care (total). outcomes No outcomes measures readily available for this indicator. Tom Frost, Public Health Scientist 23 of 25 May 2013
Notes 1. Expenditure is expenditure on own population. This is the net expenditure adjusted to add back expenditure funded from sources outside of the and to deduct expenditure on other PCTs populations incurred though lead commissioning arrangements. Unified weighted population estimates were used. Weighted population figures represent the PCT responsible population adjusted using the national weighted capitation formula, for the age structure of the population, its additional need over and above that accounted for by age, and the unavoidable geographical variations in the costs of providing services. The formula has separate components for hospital and community health services (HCHS), prescribing and primary medical services. This weighting is used to calculate PCT allocations. Detailed information on the resource allocation weighted capitation formula is available at. https://www.gov.uk/government/publications/resource-allocationweighted-capitation-formula Data downloaded on 3 rd April 2013 2011-12 Programme Budgeting PCT Benchmarking Tool Version 1.0.xls (25.01.13). 2. Office of National Statistics (ONS) Clusters. This classification groups health areas into clusters based on similar characteristics. The classification has been constructed by assigning health areas to the local authority classification. The largest cluster is the supergroup there are eight of these. Each supergroup is further split into groups (13 in total) and further into subgroups (24 in total). In this paper we have referred to the13 groups. For further information please see http://www.statistics.gov.uk/about/methodology_by_theme/area_classification/ha/ cluster_summaries.asp 3. Directly age-standardised mortality rates per 100,000 European standard population. Obtained from Information Centre Indicator Portal http://nww.indicators.ic.nhs.uk/webview/. Directly standardised mortality rate is calculated by dividing the number of deaths by the actual local population in a particular age group multiplied by the standard population for that particular age group and summing across the relevant age groups. The rate is usually expressed per 100,000. Tom Frost, Public Health Scientist 24 of 25 May 2013
4. Programme selection. To select programmes with relatively high and low expenditure the 3 that showed the greatest positive variance and the 3 that showed the greatest negative variance were chosen. 5. Care settings Prevention & health promotion Primary care Includes primary & secondary prevention, health promotion, family planning, school health services, national screening programmes, public health programmes for communicable and non-communicable disease, epidemiological surveillance and public health administration. Primary care costs relating services provided by GPs, primary dental services and primary ophthalmic services, excluding those which relate to prevention/health promotion. Primary care activity relating to prescribing or pharmaceutical services, excluding those which relate to prevention/health promotion Admitted patient care activity which takes place in a hospital setting where the admission was elective or as a day-case. Primary prescribing Inpatient: Elective & Daycase Inpatient: Admitted patient care activity which takes place in a hospital setting Non-elective where the admission was as an emergency/non-elective. Outpatient Outpatient attendances or procedures. Other Activity included with this setting will include direct access services, secondary unbundled services (excluding critical care) and secondary care care services which cannot be allocated to more specific settings. Mental Health secondary care services should also be included within this care setting. Ambulance Urgent and emergency transport, i.e. Ambulance activity and 111 expenditure. A&E Activity which takes place within A&E departments and minor injury units. Community care Care provided in other setting Non health / social care Care delivered outside of a hospital and within local communities. Inpatient and outpatient activity carried out within community hospitals should be classified as secondary care activity. All other activity carried out in community hospitals should be classified as community care. All other health and social care services which are not included within the other health settings. Includes prison healthcare, nursing homes, hospice care. Continuing care, intermediate care, respite care, free nursing care should be included within this setting. Social care and learning disability services should be included within this setting unless otherwise specified by the mappings. Expenditure which is not related to the commissioning or provision of health / social care services (e.g. costs relating to facilities & estates). Tom Frost, Public Health Scientist 25 of 25 May 2013