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Developing together the blueprint for a sustainable health care system for West Kent
Mapping Event – Respiratory LTCs/COPD Case for Change Jun 7, 2013
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COPD/Respiratory Long-‐term condiRons
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COPD is … C
Costly for the NHS in West Kent
£40m resp. care, £35m prod. loss
O
OYen treatable if detected early
>80% due to smoking
P
Prevalent widely
1 in 8 over 35; 3m in UK
Deadly and debilitaRng
1 death every 20min in UK
D
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COPD has mulRple debilitaRng stages
C O P D
• COPD is characterised by limitaRon of airflow in the lungs • However it also has other pulmonary effects such as muscle wasRng and weight loss, pulmonary hypertension, enlargement of the right side of the heart, anxiety and depression • It is a chronic condiRon and has four stages, ranging from Mild airflow limitaRon to Very Severe respiratory failure
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COPD is a debilitaRng disease
C O P D
• COPD is disabling: those with COPD oYen have breathlessness, reduced exercise tolerance, a cough and repeated chest infecRons. The overall quality of life for people with advanced COPD is 4X worse than that for people with severe asthma • A study in 2007 found that 90% of people with severe COPD were unable to parRcipate in socially important acRviRes such as gardening, 66% were unable to take a holiday because of their disease and 33% had disabling breathlessness. For those with the disease in its more severe forms, rouRne daily acRviRes such as geing dressed, washing or climbing stairs become difficult or impossible • Problems with restricted mobility are compounded by social isolaRon and poor self-‐esteem. A significant proporRon of people with COPD suffer from depression, anxiety disorders and other significant social care needs
5 Source: DH Outcomes strategy, 2012; Respiratory Report West Midlands, 2012
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Deaths from COPD are increasing
C O P D
• One person dies from COPD every 20 minutes in England (30,000 deaths a year in England, 276 deaths a year in West Kent) (about 5% of all deaths) • People with severe (stage 4) COPD have a five-‐year survival rate of 24%-‐30%; Death rates from COPD in England are almost double the EU average • 15% of people admined to hospital with COPD die within 3 months and an esRmated 25% will die within a year of admission • Over 70% of paRents who die from COPD die in hospital, with only 20% dying at home • Less that 5% of paRents with COPD have access to palliaRve care • A study in 2005 found that in the last year of life, 40% of people with COPD had breathlessness unrelieved, 68% had low mood unrelieved and 51% had pain unrelieved 6 Source: DH Outcomes strategy, 2012; Yorkshire & Humber Respiratory Programme Report, 2013
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COPD is widespread
C O P D
• In 2009/10 there were 861k paRents on COPD registers in England. However, there are thought to be up to 2 million undiagnosed cases in UK • One in 8 people over age of 35 has COPD that has not been properly diagnosed; over 15% are only diagnosed when they present to hospital as an emergency • Over 50% of people currently diagnosed with COPD are under 65 years of age • There is no single diagnosRc test for COPD; oYen spirometry is performed incorrectly leading to incorrect diagnoses; a naRonal survey revealed that only 12% of nurses undertaking spirometry had received accredited training 7 Source: Kent COPD Health Needs Assessment, 2010
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COPD is frequently missed
• • • •
C O P D
COPD paRents on West Kent GP registers: 8,720 About ~40% of COPD paRents (~4,000) in West Kent are missing from GP registers There are significant differences among GP pracRces, with prevalence varying from 0.5% to over 4% (West Kent average: 1.3%) 10% of acute admissions for COPD are in people without a prior diagnosis of the condiRon 8
Source: Kent COPD Health Needs Assessment, 2010
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C O P D COPD is oYen present alongside other condiRons
Almost all Band 1 (highest risk) paRents with COPD also had some other condiRon
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C O P D
COPD is responsible for a significant proporRon of emergency admissions for ambulatory care sensiRve condiRons
•
Respiratory long term condiRons including COPD accounted for 2,000 admissions and 19,300 bed days in 2011-‐12 for WK paRents over 65 (this makes up 70% of all Respiratory admissions and bed days) 10
C O P D Smoking is the single biggest risk factor for COPD
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• About 85% of deaths due to COPD can be anributed to smoking; In England, smoking causes 35% of all respiratory deaths and 29% of all cancer deaths • Around half of all cigarene smokers develop some airflow obstrucRon; 10%-‐20% develop clinically significant COPD • EsRmated prevalence of COPD in people with lung cancer is between 50% -‐ 65% • Cigarene smoking is also the main preventable cause of lung cancer: lung cancer is twice as common in men with COPD and four Rmes as common in women with COPD 11 Source: ASH Fact Sheet, 2011
C O P D Smoking cessaRon is oYen the most effecRve opRon
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In terms of ‘Value for Money’, the most effecRve intervenRons are: Mild to moderate COPD: Exercise or Smoking cessaRon Severe COPD: Pulmonary rehab Undiagnosed COPD: Smoking cessaRon
12 Source: Commissioning for value, Impress, Winter BTS 2013
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Other treatment opRons do exist
C O P D
NICE defines an intervenRon to be cost-‐ effecRve if it costs less than £20,000-‐£30,000 per quality-‐adjusted life year (QALY) gained
13 Source: Yorkshire & Humber Respiratory Programme Report, 2013
C O P D EffecRve implementaRon can have a significant impact
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• Quiing smoking when COPD symptoms are moderate leads to a decline in symptoms similar to that of healthy never-‐smokers • If all CCGs in England were to achieve the COPD mortality rates of the top 25% best performing CCGs, around 7,800 lives would be saved each year
14 Source: NHS Atlas of VariaRon in Healthcare for People with Respiratory Disease, Sep 2012
C O P D
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COPD has a significant health and societal cost
COPD in West Kent
Asthma in West Kent
221,000 working days lost each year £35m lost from reduced producRvity
£9m in healthcare spend each year 9 deaths in West Kent each year
15 Source: NHS Atlas of VariaRon in Healthcare for People with Respiratory Disease, Sep 2012
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West Kent performance appears good…
C O P D
Spend and outcome relative to all other CCGs in England Higher Spend, Better Outcome
Lower Spend, Better Outcome
2.5 2.0
Health Outcome Z score
1.5 Neo
1.0 Dent
0.5 0.0
CircGastro Mat Inf Canc End,Neuro MH,Resp Vision,Trauma Blood Pois LD,Skin Hear,Soc
-0.5
Musc,GU
-1.0
Hlth
-1.5 -2.0 -2.5 -2.5
-2.0
Lower Spend, Worse Outcome
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0 Spend, 2.5 Higher Worse Outcome
Spend per head Z score
16 Source: Spend and Outcomes Analysis Tool, Public Health England, 2013
C O P D … but not as good as performance of peer regions
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17 Source: Spend and Outcomes Analysis Tool, Public Health England, 2013
C O P D West Kent COPD performance can be improved (1/3)
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NHS West Kent CCG
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C O P D West Kent COPD performance can be improved (2/3)
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Maidstone Hospital
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C O P D West Kent COPD performance can be improved (3/3)
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Tunbridge Wells Hospital
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PracRce benchmarking results
Source: GP PracRce Index 2nd Ed, Dr Foster Intelligence, 2011 Note: this refers to West Kent PCT, not West Kent CCG
C O P D
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Breakdown of spend on respiratory care
C O P D
PCT-‐level expenditure (£m) in 2010-‐11; Total = £4,272.3m 100%
1.3% 3.4% 0.2% 4.4%
PrevenRon & Health PromoRon Primary care 31.1%
Ambulance/A&E/MIU
90% 80% Other
70% 60%
OP
50% Secondary care Community care 54.0%
5.6% Health & social care Non-‐health/social care
40% 30%
Non-‐ elecRve IP
20%
ElecRve IP
10% 0% Secondary care
EsRmate of total cost of COPD in West Kent: £39.3m 22 Source: Impress guide to relaRve value of COPD intervenRons, Impress, 2012
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Working groups Bob Bowes Karen Ponerton Michael Roberts Paul Sigston Ravish Makragod Nikki Clarke George Gammon Derrick Mason
Ian Ayres Stefano SanRni MalR Varshney Paula Parker Syed Arshad Husein Lawrence Sopp Sue Stonbridge Tony Broadrick
Amit Kumar Abraham George James Lampert Steven Kowlessur Kathryn Coleman/Louise Roberson Julie Moore Jennifer Paulson Ellis
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