Southampton - Issues & Answers 2020 · National Variation in Bed Days Average Bed Days for NSTE -ACS Admissions with a Procedure 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 Average Bed

‘National priorities & drivers of best practice’

Huon GrayNational Clinical Director (Cardiac) NHS England, & Consultant Cardiologist, University Hospital Southampton

The CVD Outcomes Strategy Reviewed

Professor Huon GrayNational Clinical Director (Cardiac), NHS England

Consultant Cardiologist, University Hospital of Southampton

East Midlands Conference Centre, Nottingham8th November, 2013

March 5th, 2013

https://www.gov.uk/government/publications/improving-cardiovascular-disease-outcomes-strategy

http://www.kingsfund.org.uk/publications/never-again

Nicholas TimminsJuly 2012

NHS & Social Care Reform (2010-12)

Cardiovascular disease: Still a national priority

Huon GrayNational Clinical Director (Cardiac) NHS England,& Consultant Cardiologist, University Hospital Southampton

6-7 November 2015, EMCC Nottingham

October 2014

http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf

http://www.england.nhs.uk/wp-content/uploads/2014/12/forward-view-plning.pdf

December 2014

Five Year Forward View (2014)

Word Search

• ‘Cardiovascular’ = 0, • ‘Cardiac’ = 1

– “Cardiac outcomes are better”

• ‘Heart’ = 3 – “Early deaths from heart disease are down by

over 40%”– “new biosensor technology” for heart failure– “congenital heart disease”

• ‘Cancer’ = 36

• Prevention (‘Getting Serious about Prevention’, ROI Tool)• Early detection & Risk BP, Cholesterol, AF

(Health Checks, AHSNs, QOF, Heart Age Tool)• Integration of services (New Models of Care, STPs, IC Systems, Networks)• Inherited cardiac conditions

(FH: NICE & Implementation Guidance, Genomics, HCM)• Spec. Commissioning (SCIP & GIRFT, Frailty, National Procurement, CtE)• Congenital Heart Disease (CHD) Review (Implementation of Standards)• RightCare (CVD Prevention, SMI, nSTEMI pathway, Heart Failure)• 7 day working (Cardiac Physiology Review & Working Group)• Improved survival from Out of Hospital Cardiac Arrest

(R2R Document, PAD funding, PAD Database)• 24 x 7 Services (U&E Care Networks, MI, Stroke, Vascular)• Inequalities (Physical & mental health, learning disabilities, older people, social)• Diagnostics (BNP, Echo, CT, MRI) • Information (Clinical Audits, NHSE & HQIP, NHS Digital)

CVD Workstreams (2013-18)

• Prevention (‘Getting Serious about Prevention’, ROI Tool)


https://www.gov.uk/government/publications/cardiovascular-disease-getting-serious-about-prevention

CVD: Getting Serious about Prevention

https://www.gov.uk/government/publications/cardiovascular-disease-getting-serious-about-prevention

https://www.gov.uk/government/news/new-roi-tool-shows-best-ways-to-prevent-cardiovascular-disease


(Health Checks, AHSNs, QOF, Heart Age Tool)



(Health Checks, AHSNs, QOF, Heart Age Tool)• Integration of services (New Models of Care, STPs, IC Systems, Networks)




(FH: NICE & Implementation Guidance, Genomics, HCM)


2nd November, 2017

Up to end of

2009

Up to end of

2013

Up to end of

2016

Up to June 2018

High

Low

KEY

FH Genetic Diagnoses Timeline

5 fold Increase

Since 2010

(in this 50% of UK)

Courtesy: Kate Haralambos

High

Low

England 3757(10 services)

Wales 1113

Scotland1825

Northern Ireland

1256

Total = 7,951

CVD Rare Diseases in 100k Genome Project

Principles for the NHS Genomic Medicine Service 2018/19 to 2020/12

1. To ensure comprehensive and equitable access to genomic medicine as part of routine clinical care for the population of England

2. To improve the quality, value and sustainability of care by providing - prompt and precise diagnosis- personalisation of interventions- a step change in prevention- active participation of patients.

3. To support learning, research & development through new collaborative partnerships between the NHS and with academia and UK life science sector and international collaborators; - new diagnostics, treatments & devices, better patient access to clinical trials.

4. To build the political, ethical and moral trust in genomic medicine- ensuring security of patient data & materials,- appropriateness of care, upholding the values of the NHS Constitution



(FH: NICE & Implementation Guidance, Genomics, HCM)• Spec. Commissioning (SCIP & GIRFT, Frailty, National Procurement, CtE)


The £22bn Challenge

NHSE spends around £15.7billion on Specialised Services each year – but costs growing at a far higher rate than income. Annual cost growth projected at 7.2% over next 5 years.

The 5 Year Forward View projected a 20/21 gap of £30bn. Government committed to increase spend by £8bn by 2020/21. NHS has challenge of achieving £22bn (or 2-3% annual) efficiency improvements.=Switching resources for lower value to higher value activity

Specialised Commissioning Spend (Cardiac)



(FH: NICE & Implementation Guidance, Genomics, HCM)• Spec. Commissioning (SCIP & GIRFT, Frailty, National Procurement, CtE)• Congenital Heart Disease (CHD) Review (Implementation of NHSE Standards)




(FH: NICE & Implementation Guidance, Genomics, HCM)• Spec. Commissioning (SCIP & GIRFT, Frailty, National Procurement, CtE)• Congenital Heart Disease (CHD) Review (Implementation of NHSE Standards)• RightCare (CVD Prevention, SMI, nSTEMI pathway, Heart Failure)


https://www.england.nhs.uk/rightcare/intel/cfv/

NH

“NHS RightCare is a programme committedto reducing unwarranted variation, to improve people’s health & outcomes, and reduce inequalities in health access, experience and outcomes”

https://www.england.nhs.uk/rightcare/intel/cfv/

https://www.england.nhs.uk/rightcare/intel/cfv/pathways/cvd-pathway/

85,123 admissions with

heart attack

33,797 (40%)STEMI

51,326 (60%)nSTEMI

Median LoS 3 days Median LoS 5 days

ID: GB-13673 (Prepared September 2018)

Hospital Episode Statistics (HES): Copyright 2018. Used with permission of NHS Digital NSTE-ACS Admissions without CABG. The Average Bed Days includes bed days from first admission to end of procedural admission i.e. a “super spell” (data excludes repatriation admissions involving Trust transfers)CABG: Coronary Artery Bypass Graft; NSTE-ACS: Non-ST Elevation Acute Coronary Syndromes (non-ST elevation myocardial infarction and unstable angina); NSTEMI: non ST elevation myocardial infarction; UA: unstable angina; Procedure: PCI or angiography (excludes preliminary angiography); PCI: Percutaneous Coronary Intervention; National Level: includes all NHS centres in England providing PCI and/or angiography (excluding centres with <=10 records of procedures)Admissions with record of procedure, admissions with a PCI may also have had angiography, admissions under angiography had no record of PCINational data for the period 1st April 2017 to 31st March 2018

National Variation in Bed DaysAverage Bed Days for NSTE-ACS

Admissions with a Procedure

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

Ave

rag

e B

ed

Da

ys

Trusts in England Performing Procedures for NSTE-ACS

NATIONAL AVERAGE 6.2 BED DAYS


Hospital Episode Statistics (HES): Copyright 2018. Used with permission of NHS Digital NSTE-ACS: Non-ST Elevation Acute Coronary Syndromes (non-ST elevation myocardial infarction and unstable angina); NSTEMI: non ST elevation myocardial infarction; UA: unstable angina; Procedure: PCI or angiography (excludes preliminary angiography); PCI: Percutaneous Coronary Intervention; National Level: includes all NHS centres in England providing PCI and/or angiography (excluding centres with <=10 records of procedures)Admissions with record of procedure, admissions with a PCI may also have had angiography, admissions under angiography had no record of PCINational data for the period 1st April 2017 to 31st March 2018

National Variation in Days to ProcedurePercent of NSTE-ACS Admissions with a Procedure

Within Days 0-3

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

% o

f P

roce

du

res

Wit

hin

Da

ys 0

-3

Trusts in England Performing Procedures for NSTE-ACS

NATIONAL AVERAGE 60%


Hospital Episode Statistics (HES): Copyright 2018. Used with permission of NHS Digital NSTE-ACS: Non-ST Elevation Acute Coronary Syndromes (non-ST elevation myocardial infarction and unstable angina); NSTEMI: non ST elevation myocardial infarction; UA: unstable angina Procedure; Procedure: PCI or angiography (excludes preliminary angiography); PCI: Percutaneous Coronary Intervention; Admissions with record of procedure, admissions with a PCI may also have had angiography, admissions under angiography had no record of PCI

Improvement in the Proportion of Procedures Within 3 Days

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Same Day(Day 0)

1 Day After 2 Days After 3 Days After 4 Days After 5 Days After 6 Days After

% o

f A

dm

issi

on

s w

ith

PC

I or

An

gio

grap

hy

Day of Procedure Relative to Day of AdmissionDec 17 - Mar 18 Dec 16 - Mar 17

56% Within Days 0-3

N=296

23% Within Days 0-3

N=294

Pathway Improvement

PAPWORTH HOSPITAL NHS FOUNDATION TRUSTNSTE-ACS (With a Procedure)


*Values projected from the number of admissions analysed

(Based on the number of admissions in the Dec 17 – Mar 18 analysis, 1000 admissions

would occur over a period of approximately 1.2 years at Papworth

Hospital)

Hospital Episode Statistics (HES): Copyright 2018. Used with permission of NHS Digital NSTE-ACS Admissions without CABG. Includes bed days from first admission to end of procedural admission (excludes repatriation admissions involving Trust transfers)CABG: Coronary Artery Bypass Graft; NSTE-ACS: Non-ST Elevation Acute Coronary Syndromes (non-ST elevation myocardial infarction and unstable angina); NSTEMI: non ST elevation myocardial infarction; UA: unstable angina; Procedure: PCI or angiography (excludes preliminary angiography); PCI: Percutaneous Coronary Intervention; Admissions with record of procedure, admissions with a PCI may also have had angiography, admissions under angiography had no record of PCI

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Before* After*

Tota

l Bed

Da

ys P

er 1

00

0 A

dm

issi

on

s

Reduction of3080

Bed DaysPer 1000

Admissions*

Periods analysed: Dec 16 - Mar 17 (N=266) & Dec 17 - Mar 18 (N=277)

Subsequent Reduction in Bed Days

PAPWORTH HOSPITAL NHS FOUNDATION TRUSTNSTE-ACS (With a Procedure)



(FH: NICE & Implementation Guidance, Genomics, HCM)• Spec. Commissioning (SCIP & GIRFT, Frailty, National Procurement, CtE)• Congenital Heart Disease (CHD) Review (Implementation of Standards)• RightCare (CVD Prevention, SMI, nSTEMI pathway, Heart Failure)• 7 day working (Cardiac Physiology Review & Working Group)





(R2R Document, PAD funding, PAD Database)





(R2R Document, PAD funding, PAD Database)• 24 x 7 Services (U&E Care Networks - MI, Stroke, Vascular)


• Care close to home where possible• Specialist hospital care where necessary• 7-Day consistency in outcomes• Four (out of 10) priority standards

• Standard 2: Time to first consultant review (<14 hours)• Standard 5: Access to diagnostics

(<1 hr [critical], <12 hrs [urgent], <24 hrs non-urgent)• Standard 6: Consultant-directed interventions• Standard 8: Ongoing review (twice daily)











https://www.bhf.org.uk/research/heart-statistics

https://www.bhf.org.uk/research/heart-statistics

Deaths by Disease & Deprivation (England <75 yrs)

Deaths by Disease & Deprivation (England <75 yrs)

Most deprived have 3x the CVD mortality of least

deprived

Richmond Group of CharitiesNovember 2014

UK population2018 = 66.62050 = 75.4m

UK population2018 = 66.62050 = 75.4m

Projected Population

over 65 (England

Local Authorities)

UK population2016 = 65.62039 =>74m

Projected Population

over 65 (England

Local Authorities)

%

England

Due to people living longer, more complex and innovative medicines being developed, and more specialist medicines being used

Growing pressure on NHS drugs bill

0

5,000

10,000

15,000

20,000

Gro

ss sp

end

£m

Primary care

Hospital & community healthsector

Medicines costs at list price (excl. VAT) before any discounts

• Overall spend 2016/17 was £17.4bn, 33.7% increase from £13bn in 2010/11

• Primary care spend rose from £8.6bn in 2010/11 to £9.0bn in 2016/17, a rise of 3.6%

• Hospital spend increased from £4.2bn in 2010/11 to £8.3bn in 2016/17, a rise of 98.3%

UK NHS Spending as % of GDP 1951-2021

2009-21

Largest ever

sustainedreduction

in UK NHS

spendingas a % of

GDP

The NHS in England is to get an extra £20bn a year by 2023 as a 70th "birthday present", Theresa May says.

It means the £114bn budget will rise by an average of 3.4% annually - but that is still less than the 3.7% average rise the NHS has had since 1948.

17th June 2018

5 Priorities at core of NHS Long Term Plan:

• Mental Health (especially children)

• Cancer

• Cardiovascular Disease

• Children’s services (especially prevention & inequalities)

• Reducing health inequalities

18th July 2018

Proposed CVD Priorities for inclusion in NHS Long Term Plan:

1. Prevention2. Heart attack (incl. OHCA) and

stroke pathways 3. Heart failure & Valve disease4. RehabilitationLinked to:

• Primary Care priorities• SCIP, Frailty & SDM• Genomics• Diagnostics & Imaging

18th July 2018

Conclusions• Although not a stated NHSE priority, much

work has been undertaken relevant to CVD.• A range of organisations and ‘levers’ have been

used to promote change including:– PHE, RightCare, Primary Care, QOF, AHSNs, Spec

Comm, NHSI [GIRFT], Genomics, NICE, CQC, Third Sector, Data, Networks [STPs, U&E Care, Clinical]

• Extra investment, & CVD’s inclusion as a policy priority, in the NHS Long Term Plan is welcome and brings future (collaborative) opportunities.

Documents

Southampton - Issues & Answers 2020 · National Variation in Bed Days Average Bed Days for NSTE -ACS Admissions with a Procedure 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 Average Bed