RSS 1.0Research and Policy
Browse by
Recent Submissions
-
How Does Access to Community Health Services for Older People Vary Across the Midlands?Community health services provide invaluable support for older people with a range of health care needs. These services also keep local health systems working efficiently. Despite this importance, comparatively little is known about the scale and distribution of community services. The NHS may consequently fall short when it comes to monitoring and planning these services. Integrated Care Boards (ICBs) in the Midlands therefore commissioned this report, through the Midlands Decision Support Network, to better understand how access to community services varies across the region. We were asked to focus on services for older people (taken to be those aged 65 and over). We set out to investigate what could be said of community services in terms of their: Scale and concentration. How much care is provided? How has this changed over time? To what extent is care concentrated or distributed? Socio-economic distribution. Which population groups receive the most care? Effect on demand. (How) have changes in community services provision affected pressures in urgent care? The nature of these analyses was exploratory. Lack of existing knowledge, and expected problems with data quality, meant that we focused more on the question of what could be said, than on generating definitive answers and recommendations. Nonetheless, we see several implications of this work for Midlands ICBs.
-
GP Practice productivity, efficiency, and continuity of careIn the previous two reports in this series, we showed that crude GP practice consultation rates, the average number of consultations per person per year, has been falling since 2012, whilst the need for consultations has been increasing. A substantial gap between need and supply has opened up, with significant consequences for patients and the wider health system. Almost half of patients now report difficulty getting through to their GP practice by telephone. Attendances at over-stretched emergency departments for conditions treatable in GP practices have increased. And there has been a rise in the number of emergency admissions to hospitals for ambulatory care sensitive conditions. The scale of the gap between need and supply is such that substantial GP recruitment must be the mainstay of any solution. But large-scale, national efforts to increase the numbers of clinical staff take time, and despite considerable efforts, the number of fully qualified, permanent GPs, the core of the primary care workforce, has fallen since 2015. Resolving this recruitment problem remains a key feature of national strategies for primary medical services. But given the pressing consequences of an under-supply of GP practice consultations and the intractability of the GP recruitment challenge, efforts to close the gap between need and supply have increasingly focused on productivity solutions. In this report, we explore the issue of GP practice productivity and efficiency; how it might be measured, how it has changed over time, the degree of geographic variation, and the relationship between productivity, efficiency, and continuity of care for patients. We draw heavily on three pieces of research carried out recently by the University of York, by the Strategy Unit in conjunction with the University of Birmingham and by the University of Cambridge and the INSEAD business school. Key Findings Analysis by the University of York suggests that cost-weighted productivity of primary medical services increased rapidly, by 2.3% per annum between 2004 and 2012. Since 2012 productivity growth has stalled. A cross-sectional analysis of GP practice productivity in 2019 and 2020, carried out by the Strategy Unit, suggests that there is little headroom for productivity growth within the service model that was prevalent at the time. The benefits of care continuity to patients, staff and health systems have been widely reported. But recent research by the University of Cambridge finds a positive relationship between continuity of care and the efficiency of a GP practice consultation. The time to a patient’s next appointment is increased if they are seen by their usual GP. As efforts to increase the number of GPs have faltered, attention has turned to reducing the gap between need and supply of GP practice consultations by improving input-output productivity. These efforts take many forms including division of labour and the delegation of duties to nurses and other healthcare professionals, remote consultations, extended hours, the diversion of low acuity cases to pharmacies, and the merging and federating of GP practices. These efforts to improve input-output productivity may be undermined by the absence of financial incentives to increase supply. They may also lead to unintended reductions in continuity of care which increases need and reduces supply. An alternative approach to closing the gap between need and supply of GP practice consultations would make continuity of care the primary objective. A strategy based on this priority would be a radical departure from current policy.
-
The gap between need and supply of GP practice consultationsThis is the second in a series of three analyses of GP practice service provision. In the previous paper in this series, we showed that GP consultation rates, the average number of consultations per person, increased between 1995 and 2012, before falling steadily to 2019. Trends beyond this point become more difficult to interpret and the available evidence is not consistent. This is important contextual information for those keen to address patients’ concerns about access to GP services, but additional insight is needed before a grounded policy response can be settled on. Interpreting trends in supply, would ideally take place alongside data on trends in patients’ needs. In this paper we seek to answer two related questions. How have consultation rates changed over time relative to need? Are patients with a given level of need, more or less likely to receive a GP practice consultation now than they were in the past? and, If gaps between need and supply of GP consultations exist, do we see any evidence of displaced demand and failure demand elsewhere in the healthcare system? Our analysis covers the period from 2008 to 2019, and uses the primary care research database, CPRD Gold. Over this period there is close agreement between the various available data sources about trends in consultation rates. Supplementary analysis draws on data from the GP Patient Survey, the Emergency Care Dataset (ECDS) and Hospital Episode Statistics (HES) for admitted patient care. The final paper in this series considers GP practice productivity, efficiency, and continuity of care. Key findings The use of GP practice consultations increases with age and with levels of morbidity. Since 2008, the population has aged and age-specific morbidity levels have increased. This suggests that need for GP practice consultations has grown, whilst the average number of consultations per person has reduced. We estimate that in 2019, a patient was 12.2% less likely to receive a consultation than a patient with similar needs in 2012. An additional 36.6 million consultations (+13.9%) would have been required to meet needs in 2019 as they were in 2012. Patients are finding it increasingly difficult to contact and make a convenient appointment with their GP practice. It has become more common for patients to use emergency departments and urgent care centres to access care that would normally be delivered by GP practices. Hospital admissions for acute, and to a lesser extent, chronic ambulatory care sensitive conditions, had been rising prior to the pandemic.
-
Long-term trends in GP practice consultation ratesGP practice consultations are, by some distance, the most common interaction between the NHS and the population it serves. During these consultations, patient’s acute conditions are diagnosed and treated, their long-term conditions are managed, preventative interventions are delivered, and referrals to secondary care are made. Patient satisfaction with access to GP practice consultations is a long-standing problem, but this issue has become more acute since the COVID-19 pandemic. Most consultation appointments are booked by telephone, but in a recent survey, 50% of patients reported difficulties getting through to their GP practice by telephone, up from 30% in 2018. One might expect that the NHS would have a detailed and comprehensive understanding of the levels, types, and distribution of this important service. Whilst there have been many advances in recent years, there remain important gaps in our knowledge. In this paper we explore the long-term trends in GP practice consultation rates. We use two research databases, Clinical Practice Research Datalink (CPRD) Gold and Aurum, to estimate consultation rates between 1995 and 2022. We consider all interactions between a patient and a healthcare professional: face-to-face consultations in the GP practice, consultations conducted by telephone, or using digital technologies, and visits made to the patient. We set our results alongside (1) estimates from other studies, (2) new data on GP appointment rates, (3) GP patient survey results, (4) information about the GP practice workforce and its workload, and (5) data on other important forms of GP Practice activity. Key findings Practice consultation rates, the average number of consultations per patient per year, increased steadily and for many years until 2012, corroborating results from earlier studies. Between 2012 and 2019, consultation rates fell, reversing the gains seen since 2008. As far as we are aware, this is the first study that highlights a fall in GP practice service levels over this period. From 2020, the two sources of data that we used to estimate consultation rates, produce substantially different results, with one showing continued reductions and the other showing rapid increases in consultation rates. Analysis of other sources of information fails to resolve the matter. Experimental data from NHS Digital suggests GP practice appointments have increased, but responses to the GP Patient Survey, and data on prescription and referral rates imply that consultation rates have decreased. That no clear consensus emerges from these analyses of post-pandemic trends, may indicate an issue with the primary unit of activity of GP practices, a patient consultation. For many years, this unit of activity had a clear and consistent meaning. Between 2008 and 2019, counts of consultations from different systems and sources provide similar results and similar trends. But the widespread adoption of remote consultations and digital technologies, the emergence of Primary Care Networks, and the rapid expansion of the allied healthcare professional workforce, have led to radical changes in service models. Future analyses of activity trends and equity of access may require the development of new activity units that better reflect the operations of modern general practice. This analysis, the first in a series of three, considers changes in the rate of consultations per patient per year. The remaining papers in the series will explore how rates of consultations have changed relative to patient need, the consequences of these changes on hospital activity, and changes in the productivity and continuity of GP practice service provision.
-
How is growth in diagnostic testing affecting the hospital system?Our latest report published for The Midlands Decision Support Network presents a systems analysis that suggests, alongside benefits, the recent growth in diagnostic testing has had a substantial and adverse effect on the flow of patients through hospitals and on the timeliness of care that patients receive. MDSN Diagnostic Growth Report We find that growth in diagnostic testing has led to: Longer waits and overcrowding in emergency departments. A longer waiting list (and longer waits) for elective treatment. Longer stays in hospital and decreases in bed availability. These effects are sizeable; they are felt in both elective and emergency pathways; and, unaddressed, they will undermine patient safety. The key message of this report is that trade-offs are inevitable in our health system. All else being equal, an NHS that increases testing as fast as capacity allows will be more perceptive but less responsive than one offering minimal testing. The question is, what is the correct balance? What rate of diagnostic growth will secure the best overall outcomes for the population? It may be that the NHS will have to grow diagnostic services more slowly than it might wish, so that the growth is sustainable and better balances risks and benefits across the system.
-
ICS intelligence functions – a toolkit to support the implementation of NHSE guidanceIn 2020, NHSE announced the expectation that ICSs should develop “shared cross-system intelligence and analytical functions that use information to improve decision-making at every level.” This expectation has been followed by more detailed guidance for health and care systems setting out: What an intelligence function is National enablers that can support their development How intelligence functions can help with decision-making; and What a good intelligence function looks like. Alongside this work, the Strategy Unit, with input from the Nuffield Trust, were commissioned by NHSE to create a toolkit to help ICSs introduce intelligence functions into their system plans. This toolkit provides a curated set of materials offering ideas, inspiration, and practical advice for getting started with an intelligence function that can be tailored to local contexts. The toolkit provides systems with: A clear description of different types of analyses systems can undertake, and the skills and resources they will need to execute them A set of actionable ‘tips for getting started’ with an intelligence function Available resources that can address some of the essential questions that will need to be explored as intelligence functions are developed; and A set of case studies describing how ICSs have already made progress in establishing their intelligence functions. This toolkit is another example of the Strategy Unit’s ongoing commitment to furthering the use of high-quality analysis across the NHS. For example, it should be considered alongside our recommendations for advancing the analytical capability of the NHS and its ICS partners. It is also clearly linked to our work with Decision Support Networks. The Strategy Unit is also organising the first national Health and Care Analytics Conference (HACA 2023) to celebrate and advance analysis as delivered by the NHS and local government across the UK.
-
Strategies to reduce inequities in access to planned care: an Ethics Review for Integrated Care BoardsWe are delighted to present a report on inequities in access to elective care for the Midlands Decision Support Network (MDSN). Produced by Angie Hobbs - the world’s first Professor in the Public Understanding of Philosophy – this paper examines the ethical questions raised by our report outlining strategies for reducing inequity. Professor Hobbs looks at our suggested strategies with the eye of a professional philosopher, asking: what ethical tensions and issues might arise by following these strategies? How can they be overcome? Her headline finding is that all the strategies suggested in our work are viable from an ethical perspective. And she goes further, outlining a process for decision-making which – if followed with care, thoughtfulness and humility – should give Integrated Care Boards (ICBs) and hospital trusts confidence in making ethically thorny choices. This ethics review is a further significant addition to the case for addressing inequities. It follows: Our May 2021 report outlining the nature and scale of the problem of inequities in access to elective care. Our May 2022 report suggesting strategies for addressing the problem. The legal review from Hill Dickinson examining these strategies from a legal perspective. Work by University Hospitals Coventry & Warwickshire NHS Trust, who have shown that it is practically possible to implement approaches to addressing inequities. Research by our partners Ipsos demonstrating that it is possible to engage people in the sophisticated and tricky choices involved. Analysis cannot change practice. This requires others – ICBs, hospital trusts, policy makers – to act. But analysis can guide action and reduce barriers to it; and we believe the work outlined above presents a compelling case with some clear routes forward. The NHS is committed to addressing health inequalities. We see our work as an important element in helping it to do so, with Professor Hobbs’ ethics review offering a unique contribution to this conversation.
-
Strategies to reduce inequalities in access to planned hospital proceduresOur new report guides Integrated Care Boards through the process of developing a credible strategy to reduce inequalities in access to planned hospital procedures. In our 2021 report for the Midlands Decision Support Network, we described how people living in more deprived areas have poorer access to planned hospital care than their more affluent counterparts. These deficits are widespread, substantial, and worsening. In this report, we move beyond describing and explaining the problem, providing practical support for those keen to address it. We start from the premise that inequities are not immutable. Tackling the issue will not be easy, but it is essential if the NHS is to be true to its founding principles. Efforts to date have clearly not been sufficient. Bolder action and more potent interventions are required. The report is primarily aimed at integrated care board (ICB) members. Is addressing inequities in planned hospital care a priority for your organisation? If it is, then we hope this report will help. How much additional care, and of what type, would be required to ‘level-up’ access to planned hospital procedures? Is levelling-up the only solution? What interventions exist that might help reduce inequities? How might an ICB go about setting its strategy? And once set, how should the strategy be monitored? These are the questions addressed by this report. Update 10th August 2022: To help ICBs and others, in taking the insights from this report into action, we have commissioned some further perspectives on the possible strategies described. The first of these is a publication from colleagues at Hill Dickinson which provides an up-to-date overview of the legal duties placed upon ICB decision makers in relation to reducing inequalities and then considers the range of possible strategies proposed in our report from that legal perspective. This paper will be followed later in the year by one that addresses the ethical dimensions of developing strategies to address socioeconomic inequalities in planned care.
-
Scoping the Future (CRUK)The Strategy Unit was a partner in this project, led by the Health Services Management Centre at the University of Birmingham. The project was commissioned by Cancer Research UK to understand the capacity of endoscopy services to meet growing demand. The work included evidence collation, qualitative interviews with staff managing and delivering endoscopy services across England, quantitative modelling and analysis and triangulation of all the findings to make a series of recommendations. The findings were shared with the Independent Cancer Taskforce to inform the recently published cancer strategy.
-
Making the Case for Integrating Mental and Physical Health Care - Full Report.The Strategy Unit, inspired by earlier research published by the Nuffield Trust, has created a ground breaking report for all STPs which investigates in detail the interaction between mental and physical health. The work describes and unpacks the gap between the physical health and life expectancy of those in contact with specialist mental health services and the rest of the population, and examines levels of variation in health care utilisation. ‘Making the Case for Integrating Physical and Mental Health Care’ has been designed to inform greater partnership working within local health economies to drive better health outcomes for patients and improved levels of efficiency. The Black Country STP were the pilot area for this work, and subsequently NHS England commissioned a version of the report for all 44 STPs in England. These STP reports were published via STP leads in May 2017 and have received wide-spread acclaim for their quality, depth and real-world practical relevance. We are particularly enthused by the positive reaction from the clinical community, with lots of examples where our work has helped to catalyse clinically- led service improvement initiatives The reports give STPs bespoke data and analysis, setting out the scope to improve patient care by better integrating mental and physical health services, in line with the ambition set out in the Five Year Forward View for the NHS. They also model potential benefits and opportunities for financial reinvestment from reduced pressure on acute care and elsewhere. Director of the Strategy Unit, Peter Spilsbury, said: “This report is important. Using newly linked national data and novel analysis, it can unpack for each STP area one of the biggest yet least spoken about health gaps facing our society - the gap between the physical health and life expectancy of those in contact with mental health services and the rest of the population.” "Some of the differentials in both health outcomes and health service utilisation are eye opening but we have been able to use these findings (and the summary of the evidence base provided) to begin building a broad coalition of local partners to identify and implement practical changes. I commend it enthusiastically to colleagues as a catalyst for much needed change.” According to the study, men with mental health disorders in England are estimated to live 19 years less than those without. For women this gap is around 16 years and the figures for both can vary substantially between STP localities.
-
Evaluation of an Integrated Mental Health Liaison Service (Rapid Assessment Interface and Discharge Service) in Northern IrelandA high proportion of patients treated for physical health conditions also have co-morbid mental health problems; and there is growing acceptance of a need to raise awareness of mental health issues in acute hospitals and improve the experience of care and treatment for this group. In response to such challenges, the Northern Health and Social Care Trust, one of five health and social care trusts in Northern Ireland, introduced a specialised multidisciplinary mental health liaison team—known as Rapid Assessment Interface and Discharge service[1]. The Rapid Assessment Interface and Discharge model involves rapid assessment of patients presenting to the ED with mental health, self-harm or substance misuse needs and those admitted to general hospital wards so that they can receive appropriate interventions for their physical and mental health, either in the community or in hospital. The Trust wanted to understand the effectiveness of the Rapid Assessment Interface and Discharge service and be sufficiently confident in the conclusions to make decisions about long-term funding for the service. We worked with the Trust to design a quantitative evaluation study capable of providing reliable inference about the effectiveness of the new service. A retrospective matched cohort study design was used to compare likelihood of admission from the emergency department and average length of stay for patients treated by 'Rapid Assessment Interface and Discharge' with a matched comparison group of similar patients treated in other acute hospitals in the region. All research into cause-and-effect relationships, faces the challenge of maximising similarity of groups being compared to ensure fairness of the comparison and unbiasedness of the findings. We applied a novel matching algorithm—genetic matching[2]— to select a group of comparison patients. Simulation studies have shown genetic matching achieves better covariate balance and produces more stable and unbiased treatment effect estimates[3]. Our study found, for patients treated by the Rapid Assessment Interface and Discharge service in the ED their average risk (or chance) of admission was 18.7% lower (95% confidence interval –9.3% to –27.3%). Average length of stay for a wider group of patients treated on general wards (including those benefitting indirectly from the presence of 'Rapid Assessment Interface and Discharge' Service) was 10.8% lower (95% confidence interval –9.2% to –12.4%). Both findings were statistically highly significant (P <0.001). The findings from our evaluation were instrumental in decisions that have led to the Rapid Assessment Interface and Discharge service in the Northern HSC Trust moving to a more sustainable footing
-
Estimating the impact of the proposed reforms to the Mental Health Act on the workload of psychiatristsIn January 2021, the Government published a White Paper, setting out its plans to reform the Mental Health Act. The Government invited views on the paper and in July 2021, it published a summary of the consultation responses and its plans to address the issues raised. The proposed reforms aim to ensure mental health service users have choice and autonomy wherever possible, that restrictions on service users’ freedoms are minimised and that opportunities for therapeutic benefit whilst detained are maximised. The reforms seek to deliver these objectives by altering the rights and responsibilities described in the 1983 Act or by introducing new rights and responsibilities. This analysis, conducted for the Royal College of Psychiatrists, estimates the likely impacts of Mental Health Act reforms on the workload of psychiatrists and the number of additional psychiatrists that would be required to meet these new obligations. Estimating the impact of the reforms is a prerequisite to adequately resourcing them. Failure to do so will create implementation risks and may inadvertently displace or interfere with other important aspects of a psychiatrist’s role. This issue is particularly important at present when demand for mental health services is high and rising rapidly.
-
Making the case for integrating physical and mental health services in England - National overviewThis is a national overview report of our Making the case for integrating physical and mental health services reporting which took place in July 2017. The original reports looked at the physical health of people who use mental health services; life expectancy, acute hospital use and opportunities to improve service quality and efficiency.
-
Socio-economic inequalities in access to planned hospital care: causes and consequencesTacking inequalities in health is a long-standing NHS policy objective. Variation in the experiences and outcomes of different communities during the COVID-19 pandemic served to bring this issue back into focus. In the Summer and Autumn of 2020, as the first wave of the pandemic subsided, concern grew about reduced access to routine hospital care: diagnostics, outpatient care and planned surgery. Waiting lists and waiting times began to grow. The network of Decision Support Units in the Midlands recognised the potential for this issue to exacerbate existing inequalities. They jointly commissioned this analysis to explore the extent, causes and consequences of socio-economic inequalities in access to planned hospital care. The recent NHS Planning Guidance emphasises the importance of identifying and tackling these inequalities. The report has four objectives: To describe socio-economic inequalities in access to planned hospital care To identify where in the patient pathways these, inequalities in planned care emerge To explore potential drivers of these inequalities To explore whether poor access to planned care in some communities leads to increased demand for unplanned care. The report builds on earlier research, advancing our understanding in some key areas. Although further analysis may certainly add benefit, this report is sufficient to support some immediate and targeted actions. We look forward to working with the network of Decision Support Units in the Midlands to improve the outcomes for people living in the most deprived parts of the region.
-
Measuring the effect of the coronavirus pandemic on population healthOne feature of the pandemic has been the fast-flowing stream of facts and numbers about the impact of Covid-19. At the same time, we’ve had to absorb the meaning of terms that were previously the preserve of epidemiologists and public health professionals. This has made it hard to see the ‘real’ story. There has been so much information – some of it seemingly contradictory – that, at times, we have all found ourselves struggling to understand why advice has changed or numbers differ. And now, as we (hopefully) move out of the pandemic itself, there is an important societal and political process of reckoning. In approaching this, the task of explanation will be aided by a solid, factual foundation. So this report examines some basic questions: How many people have died from Covid-19? How many more people have died from the wider impact of the pandemic, including policy responses? How many years of life have been lost to Covid-19? Were most victims of Covid-19 going to die of other causes within a short timeframe? What has been the effect of the pandemic on life expectancy? We walk carefully and neutrally through these questions, using data to help provide answers. In each case, we explain the strengths and limitations of the different sources of data, and how choice of methods might lead to different results, before implementing a set of public health and actuarial techniques to deliver a rounded assessment of the pandemic’s effect on population health. Initiated as part of the Analytical Collaboration, this report is our contribution to establishing a solid, empirical basis for learning from the pandemic:
-
Risk and Reward Sharing for NHS Integrated Care SystemsRisk and reward sharing is a simple and attractive concept, offering a commissioner the opportunity to co-opt and incentivise a provider to moderate growth in healthcare demand by sharing in the savings or cost over-runs. The Centers for Medicare and Medicaid Services (CMS), a US government agency, has established a comprehensive approach to risk and reward sharing for US Accountable Care Organisations: the Shared Savings Program. This paper draws out the central themes from the Shared Savings Program and translates these into an NHS context. The rationale that underpins the development of Accountable Care Organisations in the US and Integrated Care Systems in England is similar: to moderate healthcare costs through service coordination and integration. However, US ACOs and English ICSs are vastly different in scale (on average, US ACOs provide services to c. 19,000 enrolled patients) and operate in radically different political, financial and cultural contexts. In the US, ACOs are required to sign up to one of three risk-sharing ‘tracks’. Track 1 is a one-sided risk-sharing model where providers have the potential to share in savings if priced activity falls below expected levels, but are not required to pay a share of any cost over-runs. Tracks 2 and 3 are two-sided models, exposing providers to an increasing proportion of upside and downside risks. Six years since the first ACOs were established more than 90% of ACOs remain on track 1. This suggests that to date, providers have a limited appetite for risk. It also offers some insight into the level of confidence that US ACOs have in their ability to moderate demand growth. Complexity is a key feature of any robust risk-reward sharing arrangement and is likely to increase transaction costs above those associated with fee-for-service arrangements. The complexity arises as the commissioner or system designer attempts to ensure that the incentives accurately reflect the policy intention, and do not instead reward cost shunting, quality reductions or chance variations in costs. It is possible to extend risk-reward sharing to multiple partners within an Integrated Care System and to organisations outside the scope of an ICS. But these extensions add further complexity. The notion of a ‘counterfactual’ is central to risk-reward sharing. In this context a counterfactual is the price of healthcare activity that might be expected under normal circumstances. It is the benchmark against which priced activity levels are assessed at year end. If priced activity falls below this level, then the provider may be entitled to a reward payment. If it exceeds this level, then a penalty may be applied. There are many approaches to calculating and agreeing counterfactuals, but none are simple. These calculations determine the allocation of significant sums of money. If the NHS is to make best use of risk and reward sharing, then it must be aware of the complexities and hazards inherent in these arrangements as well as the potential benefits.
-
Palliative and End of Life Care Report for Children and Young PeopleCommissioned by NHS England, this report describes the the characteristics and levels of resource required by children and young people (CYP) (0-25 years) with life limiting conditions and/or life threatening conditions (LLC). The scope of this report does not attempt to explain or address the complexity of life threatening conditions and palliative end of life care for children and young people; it does however highlight a new and emerging population of significance for the NHS in England. People aged 0-25 span both paediatric and adult services, Clinical Commissioning Groups and Specialised and Direct Commissioning. It is much reported that there is a broad and complex age transition period in this cohort and this report therefore covers this whole period. This report draws on information from a range of primary sources including Hospital Episode Statistics (HES), Secondary Users Service (SUS) and ONS population projections and death registrations to provide intelligence on the prevalence, acute utilisation and characteristics of these complex patients. Also available is a companion report commissioned by NHS England describing the status and context of palliative and end of life care services in the West Midlands, it may be helpful and provide additional context to read these two reports in conjunction. The main chapters of the report focus on; Chapter 2 – Prevalence analyses – Identifies CYP with an LLC registered with a GP practice in the West Midlands who have been in contact with hospital services since April 2006. The chapter examines how prevalence has changed over the past decade and summarises the cohorts by demographics and condition characteristics. Chapter 3 - Acute healthcare utilisation – Identifies and summarises all acute hospital activity in HES for the cohort including A&E, Inpatients and Outpatients. Activity is identified whether it is related to the LLC or not, and is described in terms of overall trends and demographic and condition characteristics between 2011/12 and 2015/16. The cost of activity by CCG, STP and provider is also summarised in this section. Activity in the 12 months prior to death has been examined at each point of delivery for those who died in 2015/16. Chapter 4 – Historical deaths and forecasts - Examines the trend in deaths for all CYP in the West Midlands (0-25 years) over the past decade and compares this to deaths in our cohort. Deaths for all CYP are forecasted until 2022/23.
-
Palliative and End of Life Care in the West MidlandsCommissioned by NHS England, this report describes the status and context of palliative and end of life care services in the six Sustainability and Transformation Partnerships in the West Midlands. The report contains data on trends and forecast numbers of deaths, place of death, palliative care registers, acute healthcare use prior to death, availability of specialist-level palliative care and summarises the results of recent palliative care reviews and audits. The number of deaths in England has reduced year on year since the early 1980’s despite increases in population size. In 2011 there were four hundred and fifty thousand deaths in England, lower than at any point since the NHS was founded, but since 2011 the number of deaths per annum has increased and ONS forecast that this upward trend will continue for the foreseeable future with a 25% increase in annual deaths by 2039. This implies that demand for end of life care has been comparatively low in recent years but will rise considerably in the years ahead. Hospital remains the most common place of death, although all parts of the West Midlands have seen decreases in the proportion of deaths in this setting. There are now five thousand fewer deaths per year in hospital than in 2006. A very large proportion of deaths from frailty and degenerative conditions occur in either a hospital or care home setting. Without service redesign, we might expect these settings to experience most demand pressure as frailty deaths increase rapidly. Palliative care registers are intended to assist GP practices to manage the care of patients in their last 12 months of life and evidence suggests that patients on palliative care registers are more likely to receive well-coordinated care. Despite significant improvements in recent years, the number of patients on palliative care registers in the West Midlands falls well short of the expected number. Acute hospital utilisation increases significantly in the last 12 months of life. Despite unprecedented pressure on hospital beds, patients continue to receive non-beneficial treatments in hospitals in the last months of life. A&E attendances and emergency admissions rise sharply in the last year of life, often peaking in the month of death. In May 2017, there were 52 Consultants in Palliative Medicine working a total of 450 (half-day) sessions per week. One fifth of these sessions were delivered as part of a community palliative care team with the remaining sessions shared between hospitals and hospices. In their most recent CQC inspection,6 12 hospitals in the West Midlands received ‘Good’ ratings for end of life care. A further 6 were assessed as ‘requiring improvement’ and one was assessed as ‘inadequate’. All of the hospices in the West Midlands received a ‘good’ or ‘’outstanding’ rating in their most recent CQC inspection.
-
The Effect of Demographic Change on Acute Hospital UtilisationRecognising that the effect of population ageing can be overstated, we set out to ask what effect an older population will have on demand for health and care services. Here, we explain why typical approaches ‘overlook the fact that rising life expectancy makes … older people “younger”, healthier, and fitter than their peers in earlier cohorts’. This report is the first in a set of three reports produced by the Strategy Unit that each address a crucial aspect of commissioner planning for acute services. As a collective, these three reports provide a useful and robust framework on which local commissioning organisations can base their strategic planning.
-
Changes to Admission ThresholdsThis analysis builds on a paper, Changes in Admission Thresholds in English Emergency Departments, which explores changes in the casemix of patients attending emergency departments (EDs) and the propensity of EDs to admit patients. The report incorporates additional analysis commissioned by NHS England, extending the scope of the analysis and refining the methodology.
