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Wirral Health and Care Commissioning is a strategic partnership between
NHS Wirral Clinical Commissioning Group and Wirral Council 1
Ophthalmology Service Model Redesign Engagement Event
Thursday 9th May 2019
9:30am - 12:30pm
6th Floor, Marriss House
Sue Borrington – Senior Commissioner
Wirral Health and Care Commissioning is a strategic partnership between
NHS Wirral Clinical Commissioning Group and Wirral Council 2
Introduction & Overview of the Morning
• Purpose of the morning
• Agenda
• Housekeeping
3
Ophthalmology in Wirral
• Ageing Population • Mixture of affluent areas and deprived • Overall poor health • Smoking and obesity are prevalent
4
Wirral Health and Care Commissioning is a strategic partnership between
NHS Wirral Clinical Commissioning Group and Wirral Council 5
Wirral - Current Providers
Primary Eyecare Wirral
27 x Community Optometrists
Wirral Health and Care Commissioning is a strategic partnership between
NHS Wirral Clinical Commissioning Group and Wirral Council 6
Wirral University Foundation Teaching Hospital (WUTH)
Wirral Vision
Spa Medica
Wirral Community Foundation Trust
Community Optometrists
Location of CCG commissioned Ophthalmology services
Costs
• Direct Costs £16,700,000pa
• Indirect Costs £31,400,000pa
• Wider Economic Impact £110,000,000pa
7
14/15 15/16 16/17 17/18 18/19
10,503,734 11,794,363 11,410,925 11,297,903 12,104,345
Ophthalmology expenditure year on yearWirral CCG costs are rising by around £1/2 million per annum Main Areas of Growth are: -Phacoemulsification Cataract Extraction and Lens implant -Age Related Macular Degeneration (AMD) -Diagnostic CT Scans
Wirral CCG:
Wirral Health and Care Commissioning is a strategic partnership between
NHS Wirral Clinical Commissioning Group and Wirral Council 8
Expenditure Outpatients 2016/17
Wirral Health and Care Commissioning is a strategic partnership between
NHS Wirral Clinical Commissioning Group and Wirral Council 9
Receipt of Social Care for Visual Impairment 2013/14
Main Causes of Sight Loss on Wirral
10
AMD
• In Wirral, we estimate that:
• 15,600 people are living with the early stages of AMD;
• 1,210 are living with late stage dry AMD;
• 2,480 are living with late stage wet AMD.
• 3,500 combined late stage AMD.
11
Between 2018 and 2030 there is estimated to be an increase of 27% in the number of people living with late
stage AMD in Wirral
• In Wirral, we estimate that 3,860 people are living with cataract
12
Cataract
Between 2018 and 2030 there is estimated to be an increase of 28% in the number of people living
with cataract in Wirral.
Estimated Incidence of Cataract
13
1.40%
1.50%
1.60%
1.70%
1.80%
1.90%
2.00%
2.10%
Chester Warrington Wirral Congleton Crewe &Nantwich
EllesmerePort &Neston
Macclesfield Vale Royal
Series1
Source: NEHEM Population Estimates
Glaucoma
• In Wirral, estimated that 6,890 people are living with ocular hypertension.
• A further 3,750 people are living with glaucoma.
Between 2018 and 2030 there is estimated to be an increase of 19% in the number of people
living with glaucoma in Wirral
14
Diabetic Eye Disease
• In Wirral:
• 21,800 adults have diagnosed diabetes.
• 6,410 people are living with diabetic retinopathy.
• Of these, 590 have severe diabetic retinopathy.
15
Between 2018 and 2030, estimated to be an increase of 1% in the number of people living with diabetic
retinopathy in Wirral.
Uptake of Diabetic Eye Screening 2009/10
16
0
0.005
0.01
0.015
0.02
0.025
0.03
0.035
81
82
83
84
85
86
87
88
England Eastern Cheshire West Cheshire Warrington Wirral Vale Royal South Cheshire
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% of diabetic population receiving screening CVIs as a result of diabetic eye disease (cases per 1,000 population)
Wirral Health and Care Commissioning is a strategic partnership between
NHS Wirral Clinical Commissioning Group and Wirral Council 17
Non-Elective Admissions 2016/17
Falls
In Wirral, it is estimated that: • 1,490 people with sight loss aged over 65 experience a fall per
year
• Of these falls, 700 are directly attributable to sight loss
• 120 people aged over 65 with sight loss experience a severe fall per year
• Of these severe falls, 55 are directly attributable to sight loss
18
Wirral Health and Care Commissioning is a strategic partnership between
NHS Wirral Clinical Commissioning Group and Wirral Council 19
Case for change
• Ageing Population / Rising Incidence • Importance of prevention • Reduce non-elective admissions • Ensure continual quality improvements • Effective use of resources • Requirement to re-procure • Maximise future outcomes for patients
Questions?
20 Wirral Health and Care Commissioning is a strategic partnership between
NHS Wirral Clinical Commissioning Group and Wirral Council
Wirral Health and Care Commissioning is a strategic partnership between
NHS Wirral Clinical Commissioning Group and Wirral Council 21
Exercise 1 – Our Current Model
For your patient: Add to the patient’s pen picture and describe their pathway Identification of: • The good stuff - what works well? • What could be better? • Service gaps / duplication Agree top three priorities for improvement.
Wirral Health and Care Commissioning is a strategic partnership between
NHS Wirral Clinical Commissioning Group and Wirral Council 22
Exercise 2 – The Patient Journey and Expected Outcomes
For your patient: Describe their future ideal pathway How would this differ to the previous pathway? Consider: Service demand / waiting times Urgency of appointment What outcomes would be realised? Patient / Provider / commissioner What works elsewhere Service accessibility
23
Exercise 3 – The Future Model
What might the future model look like? The community offer? Managing demand on acute services? Access points / referral management? What one key change would make a difference? Consider: Ideas from other areas Potential areas of growth What might be the strengths of this model? What might be the limitations? What are the barriers? What contracting model might suit this service?
Wirral Health and Care Commissioning is a strategic partnership between
NHS Wirral Clinical Commissioning Group and Wirral Council 24
Summary of Today
• Next Steps • Questions and Answers
• Feedback forms
Wirral Health and Care Commissioning is a strategic partnership between
NHS Wirral Clinical Commissioning Group and Wirral Council 25
Thank you!