Introduction

We hope that you find this comparative overview useful in relation to the STP area Birmingham and Solihull. To help to put this information into further context, we are providing you with the following summary which we hope will get you thinking and support you in future planning and prioritisation of health and social care services.

The summary is split into three sections:

  • Section 1 – Lifestyle indicators
  • Section 2 – Prevalence and activity / cost indicators
  • Section 3 – Summary of suggested areas of prioritisation

A Commissioning for Value (CFV) Long Term Condition (LTC) pack (December 16) is available for each CGG and we will therefore also be making reference to the information in the various Sections within this summary narrative as applicable. To view the CFV packs, please follow the following link: . Another useful CFV pack is the ‘Where to Look’ pack which is also focused on value in relation to the 10 highest spending programmes of care and reducing unwarranted variation. We include some highlights from that pack in Section 3.

Please be aware that CCGs in an STP may have different population demographics and therefore caution should be used if trying to compare between these CCGs.

You will also notice that not all indicators in the pack are colour coded. This will relate to indicators where colour coding is not available via the Fingertips tool, any reported prevalence indicators and any indicators prior to 2012.

Section 1 – Lifestyle indicators

Data is included relating to lifestyle indicators including smoking, obesity and physical activity. These are important considerations in understanding the health and risk factors of your local populations. The colour coding for these indicators has been based on benchmarking each of the CCGs against the CCGs nationally.

You’ll see that Solihull CCG has a lower population that are physically inactive compared to CCGs nationally however Birmingham South and Central (Birmingham SC) and Birmingham Cross City (Birmingham CC) CCGs are within the CCGs where higher numbers of patients are recorded as physically inactive. It may be useful to understand what exercise and activity programmes are available within the local area and how referrals may be increased to ensure that the population is becoming more active. The prevalence of the population who are smokers is, on the whole similar than national benchmarked CCGs except for Solihull CCG which is lower. Smoking cessation support and treatment is within the top quartile for Birmingham SC, Solihull is within quartiles 2 and 3 but Birmingham CC is within the lower quartile. It therefore may be useful to understand what services are available within this CCG to support patients to stop smoking.

Prevalence rates for hypertension and obesity are in line with the average when benchmarked nationally for Birmingham SC and Birmingham CC CCGs. Solihull CCG has higher than average hypertension prevalence and lower than average obesity prevalence. When reviewing the CFV packs, there may be an opportunity in Birmingham CC and Solihull to identify and record patients who are obese or overweight as their recorded rates are lower when benchmarked for this indicator (64.4% for both CCGs).

Section 2 – Prevalence and activity/cost indicators

It is important that patients are identified onto a register if they have been diagnosed with a long term condition to ensure that they get the care and management that they need.

A number of long term conditions are identified within this pack and display the number of reported patients on each of the registers (for each CCG), the national average as well as the number of expected patients with those conditions based on a varying number of factors such as particular demographics (e.g. age, sex). Colour coding is displayed against national benchmarking where this is available and within appendix 1, the colour coding is based on the CCG’s position against the 10 most similar CCGs in England.

Diabetes prevalence for all 3 CCGs are higher than CCGs when nationally benchmarked and detection against expected prevalence rates is high when reviewing the CFV pack data.

All 3 CCGs have good participation in the national diabetes audit although there is still an opportunity to increase uptake to 100%. The national diabetes audit indicators should therefore be interpreted with caution and should be viewed in comparison with the number of practices who have participated as the indicators are calculated against the participating practices and not overall practices.

The chronic kidney disease (CKD) indicators within the pack are taken from the Quality and Outcomes Framework (QOF) 2014/15 and it should be noted that these indicators have now been retired and are not being monitored via the QOF. However at the time of this information being published, blood pressure management for patients with CKD is in the lower quartile for two of the CCGs (Birmingham CC and Solihull CCGs), Solihull is also in the lower quartile for a record of an albumin-creatinine ratio test and Birmingham SC CCG for treatment with an ACE-I or ARB. Therefore CKD management may be an opportunity for further review across all of the CCGs.

Dementia prevalence for over 65 years is lower Solihull CCG but slightly higher for Birmingham SC and Birmingham CC CCGs. When comparing this with the numbers expected within the CFV packs, Solihull CCG are within the lower half of CCGs as is Birmingham CC CCG. Birmingham SC CCGhas a detection ratio of 97.2% placing the CCG as one of the highest nationally. There may be an opportunity to understand how the CCG have detected the majority of their expected patients and share learning across the other 2 CCGs.

For the respiratory indicators (asthma and COPD), Birmingham SC and Birmingham CC CCGs were in the worse CCGs for emergency adults and children’s admissions in 2012/13 (utilising the most up to date data available). In terms of the QOF indicators within the management of COPD, Solihull CCG is within the lower quartile for diagnosis by Spirometry whereas the other 2 CCGs are within the mid quartiles. Birmingham SC are within the upper quartiles for FEV1 recording and assessed using MRC Dyspnoea whereas Birmingham CC and Solihull CCGs are within the mid quartiles. Therefore there is scope to improve within these areas.

There is strong evidence that stroke risk can be substantially reduced by prescribing anticoagulation (e.g. warfarin) and warfarin in particular is underutilised for stroke prevention in AF (Health and Social Care Information Centre). Both Birmingham SC and Solihull CCGsare in the lower quartile of CCGs for the treatment of anticoagulants/anti-platelet therapy and therefore this may be an area for further review.

Section 3 - Section 3 - Summary of suggested areas of prioritisation

The CFV ‘Where to look’ packs were updated in January 2017 and are CCG specific to support local discussion about prioritisation to improve both the utilisation of resources and value to the population utilising the Rightcare methodology. CCGs should in theory then be able to ensure that their plans focus on the opportunities which have the biggest potential on health outcomes, resource allocations and reducing inequalities (Introduction, CFV where to look packs, January 2017).

We have taken the time to summarise some of the areas for the CCGs within your STP taken directly from the where to look packs to use in conjunction with the information we have presented you with within these STP packs. The table below illustrates the quantified opportunity for some of these indicators.

Disease area / Quality / CCGs this relates to / Quantified opportunity
Respiratory / Reported vs. expected prevalence COPD / Birmingham CC
Solihull
Birmingham SC / 3598
1181
2136
Respiratory / % of patients diagnosed using Spirometry / Birmingham CC
Solihull / 109
77
Diabetes / % of diabetic patients receiving all three treatment targets / Birmingham CC
Solihull / 129
344
Dementia / Dementia diagnosis rate >65 years / Birmingham CC
Solihull / 1281
71

In addition the CFV ‘where to look’ packs illustrate spending opportunities in relation to admissions and primary care prescribing including the values attached to that.

  • Improvement in ensuring patients are more physically active – Birmingham South Central and Birmingham Cross City CCGs
  • Increase identification of patients who are obese or overweight – Birmingham Cross City and Solihull CCGs
  • Greater participation in the national diabetes audit – All 3 CCGs
  • The management of patients with CKD (blood pressure control/treatment/albumin-creatinine testing) – All 3 CCGs
  • Increase identification of patients over 65 years with dementia – Solihull CCG and Birmingham Cross City CCG
  • Understand the high proportion of detected patients with dementia (over 65 years) to share learning – Birmingham South Central CCG
  • Improvement in the number of adults and children with asthma admitted as an emergency –Birmingham South Central and Birmingham Cross City CCGs
  • Increase COPD diagnosis confirmed by spirometry – Solihull CCGs
  • Increase identification of patients with COPD – All CCGs
  • Increase in the anticoagulation and anti-platelet prescribing for AF patients to reduce stroke risk –Birmingham South Central and Solihull CCGs.

WMAHSN Long Term Conditions Network Tracey Cox, Dr Ruth Chambers,

Birmingham and Solihull STP data pack narrative

Version 1 – Jan 2018 (updated)