Why Oldham CCG focused on improving its vascular services (part 1)

Oldham CCG first identified its challenges when trying to improve vascular health and use resources effectively, write Dr Anita Sharma and John McEwan.

John McEwan and Dr Anita Sharma: 'Cardiovascular diseases are the main cause of death in the UK.'
John McEwan and Dr Anita Sharma: 'Cardiovascular diseases are the main cause of death in the UK.'

The quality premium will see CCGs incentivised to hit four national and three local targets from April.

Cardiovascular diseases are the main cause of death in the UK causing around 147,300 deaths in England in 2010 (a third of all deaths). Approximately 45% of all deaths from cardiovascular diseases are from coronary artery disease and 27% from stroke.

Oldham lies within the boundaries of the current Greater Manchester and Cheshire Cardiac Network. The population of Oldham is continuing to grow and the next 10 years should see a 4.5% increase to 229,700 by 2022. The early mortality rates from cardiovascular disease (below 75 years), emergency admission rates for CHD and stroke are significantly higher than the national rate. The rates of angiography procedures are significantly lower than nationally.

Vascular vision

The priority should be reducing premature mortality, which is why we in Oldham are thinking about working differently and focusing on premature deaths.

At a time when I and my university friends are reaching an age and stage of our lives when vascular pathologies are common, I felt that the Oldham vascular team needed to prioritise the vascular diseases. Soon it became easier to define the vision: to design pathways for  every vascular problem aiming to deliver a high quality, timely service near to the patient and working with secondary care in an integrated and collaborative fashion.

Our vascular vision is focused on quality care, clinical leadership, collaborative decision making, priority-setting, understanding competing priorities, making decisions about how financial resources could be invested to best improve the health outcomes, quality of life measurement, technical skills, public values, evidenced-based policies and innovation in technologies and service developments.

Objectives

The team decided the objectives should be based on the SMART criteria (specific, measurable, achievable, realistic and time limited)

  • To improve the vascular health of people of Oldham.
  • To improve the vascular care they receive and their experience of it.
  • To deliver the best value for money by using the resources effectively.

To achieve the above objectives, I feel that we must be NICE compliant because that is evidenced based and secondary care compliant because that is knowledge and experienced based.

The agenda

Vascular care is a massive area and covers multiple disease areas - CHD, AF, HF, stroke/TIA, renal, health checks, cardiac rehabilitation, DVT, PAD - all equally important to us in Oldham. To be successful, we needed to be championed by GPs and consultants with shared goals. The decision was made to focus all our energy on HF, AF, stroke/TIA, PAD and health checks for the first six months.

The challenges

  1. Ageing population. Vascular pathology increases with age. The percentage of population aged 40 years and over in Oldham is expected to increase from 22.5% to 23.5% for males and from 24.9% to 25 % for females by 2030.
  2. Deprivation.  In Oldham 41.4% of population lives in the most deprived national quintile and 8.2% of the population in the least deprived quintile.
  3. BME population. The proportion of the population in Oldham which is from black and minority ethnic (BME) groups is estimated at 17.1%. Black people have the highest stroke mortality and South Asian men are more likely to have a higher rate of MI.
  4. Poor lifestyle: It is estimated that Oldham has a significantly higher percentage of smokers, binge drinkers and obese people compared with England.
  5. Complex and multiple vascular pathologies. With increasing age, vascular pathologies become complex.
  6. Lacking proactive high quality care in the community which leads to unnecessary stays in hospital.
  7. Unacceptable variations in the quality of care provided by primary care in Oldham.
  8. High emergency admission rate: Increased number of unplanned admissions and readmissions. In 2010/11 the emergency admission rate for CHD, stroke and HF in Oldham were significantly higher than England. We needed to identify the new ways of meeting the increasing demand for urgent care, to improve self care, end-of-life care and extend preventive care.
  9. Estimated observed prevalence lower than England average. QOF performance 2010/11 showed that the observed prevalence for CHD, stroke and hypertension in Oldham are lower than the national average.
  10. Financial constraints. We are working in challenging financial circumstances and yet we and our patients quite rightly have high expectations of the NHS and the quality of our services. The challenges can not be addressed by tweaking around the edges. We need transformation, innovation and team working. The QIPP (quality, innovation, productivity and prevention) challenge requires the NHS to make up to £20 bn of efficiency savings by 2014/15 and we all have a part to play.
  • Dr Sharma is clinical director for vascular and medicine management at Oldham CCG, Greater Manchester and John McEwan is head of commissioning at Oldham CCG.

Next week: How Oldham CCG is improving its vascular care

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