Commissioning for Value Insight packs Online Annexes

1. Commissioning for Value Insight packsOnline Annexes NHS England Gateway ref: 00525

2. Annexes • This file contains the annexes to the CCG Commissioning for Value Insights packs distributed to CCGs, including a West Cheshire case-study, methodology information, the full list of indicators used to compile the packs.

3. Annex 1: Why Act – Achieving financial stability in West Cheshire Achieving financial stability in West Cheshire Year 1 – “Came from behind” - Implemented system mid year Year 2 – “Delivered as went along” - Began at year start, achieved by end Year 3 – “Planned ahead” - Began before year start, over- achieved Year 4 – “Ahead of the curve” - 20% of QIPP delivered by start Year 5 – Increased focus on quality! Enabled by, for example : - Medicines administration training to care homes - Personalised care plans (LTC) - Community endoscopy, optometry, ophthalmology, neurology & pain management pathways - MRI Scanner Direct Access It’s not just about money - Right Care in West Cheshire led to real quality improvements in just one annual cycle • A&E attends & admissions, Elective & Non-elective activity, OP Firsts and – • Follow-ups – all decreased • - Outcomes & Quality – improved • - Integration occurred across health sectors and with social care Other case studies on the above and examples from other CCGs are available from www.rightcare.nhs.uk/resourcecentre 3

4. Annex 2: Methodology How have you selected the indicators for inclusion in this pack? The indicators in this pack have been chosen to reflect the best available representation of spend, drivers of spend and outcome/quality for the highest spending disease areas. The data in this pack relates to CCG populations not necessarily just those services the CCG is directly responsible for. CCG level spend by programme is only available for admissions and prescribing. Are the data freely available? Yes, the indicators included in this pack are all derived from publicly available sources. Most of the data comes from the Health & Social Care Information Centre and Public Health England. How do you choose the CCGs closest to ours for comparison? Your CCG has been compared to a cluster group containing 10 CCGs. These are the other 10 CCGs in England which have the most similar demographic and health characteristics to your own e.g. total population, age profile, deprivation, ethnicity, and population density. What are the benchmarks? For each indicator, the first benchmark in the charts is the average value for the 10 most similar CCGs. The second benchmark in the charts is the average value for the best 5 of the 10 most similar CCGs. Only this second benchmark is used in the tables. Only indicators which are worse and statistically significantly different at the 95% confidence level from the benchmark are shown in the charts or tables.. I.e. effectively they are worse at the 97.5% confidence level. 4

5. Annex 2: Methodology (2) • Which indicators are shown in the improvement opportunities charts and tables? • Only indicators which are significantly different than the benchmark are shown in the pack. I.e. if the 95% confidence intervals for your CCG’s value do not include the benchmark value then your CCG is an outlier. Furthermore, only indicators were the CCG’s value is worse than the benchmark are shown as an improvement opportunity. For most indicators (e.g. mortality, spend), if the CCG’s lower confidence interval is higher than benchmark value then the indicator appears as an improvement opportunity in the pack. E.g. the CCG could potentially save lives or reduce spend by reducing to the benchmark. For some indicators (e.g. QOF interventions), where a lower value is a worse outcome then the indicator appears as an improvement opportunity in the pack if the CCG’s upper confidence interval is lower than the benchmark value. E.g. A CCG with a low % of patients with a disease under control has the improvement opportunity to increase this. • The charts show the improvement opportunity using both benchmarks, the average value for the 10 most similar CCGs and the average value for the best 5 of the 10 most similar CCGs. The tables show the improvement opportunity using only the second benchmark, the average value for the best 5 of the 10 most similar CCGs. The improvement opportunities for every indicator which is worse and significantly different to the benchmark are shown in the tables. Only the most important improvement opportunities of potential savings for lives and finance are shown in the charts. • How has the improvement opportunity been calculated? • The improvement opportunity highlights the scale of improvement that would be achieved if the CCG were to change its performance on that indicator to the benchmark value. It is calculated using the formula: • Improvement Opportunity = (CCG Value – Benchmark Value) * Denominator • The denominator is the most suitable population data for that indicator. E.g. CCG registered population, CCG weighted population, CCG patients on disease register etc. • The improvement opportunity is only displayed for those indicators where the CCG’s value is statistically significantly different (95% confidence intervals) and then worse than the benchmark (so effectively 97.5% confidence intervals). 5

6. Annex 3: List of Indicators (1) Full metadata for these indicators is available online- www.rightcare.nhs.uk/commissioningforvalue

7. Annex 3: List of Indicators (2)

8. Annex 3: List of Indicators (3)