Download CCG Outcomes Indicator Set - June 2016

CCG Outcomes Indicator Set
England, June 2016: Quarterly publication
Published 23 June 2016
CCG Outcomes Indicator Set: June 2016 publication
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Author:
Clinical Indicators Team
Health and Social Care Information Centre
Responsible statistician:
Chris Dew,
Information Analysis Lead Manager
2
Version:
V1.0
Date of publication:
23 June 2016
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CCG Outcomes Indicator Set: March 2016 publication
Contents
Summary of release
4
CCG OIS background
6
Cancer stage indicators
7
Summary of changes
7
1.19 Record of lung cancer stage at decision to treat
7
Analysis of cancer staging indicators
11
1.17 Record of stage of cancer at diagnosis
11
1.18 Percentage of cancers detected at stage 1 and 2
14
1.19 Record of lung cancer stage at decision to treat
16
Further uses for the CCG OIS indicators
17
Feedback
17
Appendix 1 – Indicator update summary
18
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3
CCG Outcomes Indicator Set: June 2016 publication
Summary of release
The following indicators aim to provide clear, comparative information for Clinical
Commissioning Groups (CCGs) and Health and Wellbeing Boards (HWBs) in England about
the quality of health services commissioned by CCGs and, as far as possible, the associated
health outcomes. They therefore help CCGs and HWBs to understand where they may need
to focus their efforts to improve services and outcomes. The timescales of the indicators vary
according to the data source but the most recently available data is used in all cases. A full
list of the time periods and updates for each indicator in this release is available in
Appendix 1.
New data periods have been added for the following existing indicators:
1.8
Emergency admissions for alcohol related liver disease
1.14
Maternal smoking at delivery
1.17
Record of stage of cancer at diagnosis
1.18
Percentage of cancers detected at stage 1 and 2
1.19
Record of lung cancer stage at decision to treat
1.22
Hip fracture: incidence
2.5
People with diabetes diagnosed less than a year who are referred to
structured education
2.6
Unplanned hospitalisation for chronic ambulatory care sensitive
conditions
2.7
Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s
2.11a
The percentage of referrals to IAPT services which indicated a reliable
recovery following completion of treatment
2.11b
The percentage of referrals to IAPT services which indicated a reliable
improvement following completion of treatment
2.11c
The percentage of referrals to IAPT services which indicated a reliable
deterioration following completion of treatment
3.1
Emergency admissions for acute conditions that should not usually
require hospital admission
3.4
Emergency admissions for children with lower respiratory
tract infections
3.14
Alcohol-specific hospital admissions
3.15
Emergency alcohol-specific readmission to any hospital within 30 days of
discharge following an alcohol-specific admission
5.3
Incidence of Healthcare Associated Infection (HCAI) – Methicillin-resistant
Staphylococcus aureus (MRSA)
5.4
Incidence of Healthcare Associated Infection (HCAI) – C. difficile
4
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CCG Outcomes Indicator Set: March 2016 publication
This commentary includes: Description of the change of the data source owners for cancer
staging indicators “1.17 Record of stage of cancer at diagnosis” and “1.18 Percentage of
cancers detected at stage 1 and 2” and a change to the data source for “1.19 Record of lung
cancer stage at decision to treat” with analysis of the effect on figures for 2013 which have
been restated.
Further analysis of all cancer stage indicators is included, with a set of CCG level maps for
“1.17 Record of stage of cancer at diagnosis”, and top and bottom five performing CCG
tables for both “1.18 Percentage of cancers detected at stage 1 and 2” and “1.19 Record of
lung cancer stage at decision to treat”.
Data, along with indicator specifications providing details of indicator construction, data
quality, statistical methods and interpretation considerations, can be accessed by visiting the
Health and Social Care Information Centre (HSCIC) Indicator Portal at:
https://indicators.hscic.gov.uk.
This information can be found towards the top of the navigation tree on the left-hand side of
the page under ‘CCG Outcomes Indicator Set’ where there are individual sections for each
domain. A publication schedule for planned future updates for all indicators in the CCG OIS
can be found on the HSCIC website: http://www.hscic.gov.uk/ccgois.
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5
CCG Outcomes Indicator Set: June 2016 publication
CCG OIS background
The various indicators within the CCG OIS help CCGs to gain an understanding of the
health-related outcomes within their area and how these outcomes compare to other CCGs.
As of April 2015 there were 209 CCGs in England. This follows the merger of three CCGs;
NHS Gateshead CCG, NHS Newcastle North and East CCG and NHS Newcastle West CCG
which became NHS Newcastle Gateshead CCG. There is wide variation in the size of these
organisations; as of 01 January 2016 the largest CCG, NHS Cambridgeshire and
Peterborough, had 929,926 registered patients and the smallest CCG, with 74,913
registered patients, was NHS Corby1. Where possible, indicator values are standardised by
age and sex to account for differences in the age and sex profile of each CCG, ensuring
CCG values are comparable with each other.
Within the CCG OIS, values are published at ‘All registered patients in England’ (National)
level where possible. This ‘National’ figure includes only data from the 209 CCGs, excluding
data from NHS Commissioning Hubs2 i.e. the number of observed admissions at a ‘National
level’ is the sum of admissions across the 209 CCGs (211 pre April 2015). Most of the
indicators in this release report on 209 CCGs as the data relates to the 2014/15 year. Those
indicators including data from 2015/16 and those where the data supplier aggregated data to
the new merged CCG ahead of the organisational change are reported for 209 CCGs.
Additionally, it is important to note that due to differences in data sources and methods,
these figures are not comparable to England level figures in NHS Outcomes Framework
indicators. For many of the indicators the methodology is consistent across the frameworks,
but due to the fact the two frameworks serve different purposes, different data sources and
methods are used. CCG OIS aims to support local commissioning functions and therefore
uses registered patient counts as the subject population for calculating indicators3. The NHS
Outcomes Framework focuses on national-level accountability and uses Office for National
Statistics (ONS) mid-year resident population estimates as a denominator base.
1
HSCIC publishes GP patient counts on a quarterly basis, which are available on our website. Quoted January 2016 figures are available
at: http://www.hscic.gov.uk/catalogue/PUB19775
2
Specialised commissioning hubs are responsible for leading the commissioning of specialised services in the NHS in England (i.e. for rare
conditions and low volume treatments) including the direct commissioning of military and prison health services.
3
Where the use of registered patients is not possible, the resident population from ONS mid-year estimates has been used; this is clearly
stated in the indicator description.
6
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CCG Outcomes Indicator Set: March 2016 publication
Cancer stage indicators
Summary of changes
The CCG OIS contains three indicators that focus on the recording of the stage of cancer,
either at diagnosis (Indicator 1.17 Record of stage of cancer at diagnosis), whether detection
was at stage 1 or 2 (Indicator 1.18 Percentage of cancers detected at stage 1 and 2) or if the
stage was recorded at the decision to treat the specific cancer (1.19 Record of lung cancer
stage at decision to treat).
For the first two indicators the responsibility for the source data, the Cancer Analysis System
(CAS), moved with the National Cancer Intelligence Network (NCIN) when it became part of
Public Health England (PHE) on 01 April 2013. NCIN is now part of the National Cancer
Registration and Analysis Service (NCRAS) within PHE. The NCIN website is still being
maintained until further notice at time of publication and is available here:
http://www.ncin.org.uk/home
This change has no effect on the data for these two indicators.
The final indicator, “1.19 Record of lung cancer stage at decision to treat”, has had a more
fundamental change. For the first time, the source of the cancer data has moved to a register
from an audit, which aligns it with the other two cancer stage indicators. Previously, the data
was taken from the National Lung Cancer Audit (NLCA) maintained by the HSCIC and now
the data are from the National Cancer Registration and Analysis Service (NCRAS). The new
data source is available to the public at the following website: http://www.ncr.nhs.uk .
The data for CCG OIS indicator 1.19 that was previously published have been restated for
the same period (2013) using the new data source, and updated with data for 2014. An
archived file of the previous NLCA values is available on the HSCIC Portal.
1.19 Record of lung cancer stage at decision to treat
The overall effect of changing data sources from an audit to a register has been a large
increase in the number of patients recorded, and a smaller increase in the number with stage
of cancer recorded at decision to treat lung cancer.
The total number of eligible patients (denominator) increased by 22.2 per cent from 30,503
to 37,260 in 2013, whereas the number of patients with their stage recorded at decision to
treat lung cancer (numerator) increased by 13.1 per cent from 28,285 to 31,983. This results
in an overall drop of 6.9 percentage points for the indicator for 2013 when comparing the
NLCA and NCRAS data. Figure 1. presents the percentage point change in the indicator
value by CCG for 2013.
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CCG Outcomes Indicator Set: June 2016 publication
Figure 1. Indicator 1.19 Record of lung cancer stage at decision to treat
Percentage point change from 2013 NLCA to 2013 NCRAS data sources
60
50
P
e
r
c
e
n
t
a
g
e
p
o
i
n
t
40
30
c 20
h
a
10
n
g
e 0
-10
England average
-20
-30
-40
CCGs
It is reasonable to expect that a register would result in a more comprehensive and larger
patient base, there are a few CCGs which returned unexpected results during comparison.
For example, NHS Rushcliffe CCG had a reduction in eligible patients (denominator) for
2013, down from 66 to 57 patients, while 24 CCGs (see Table 1) showed a reduction in the
number of patients with stage recorded at decision to treat lung cancer (numerator) for 2013.
The reason for these unexpected changes is not known and may be partly attributable to
data quality changes.
8
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CCG Outcomes Indicator Set: March 2016 publication
Table 1. Indicator 1.19 Record of lung cancer stage at decision to treat
CCGs with a reduction in numerator from NLCA to NCRAS in 2013
NLCA
numerator
NCRAS
numerator
Difference
Percentage
change
NHS East Staffordshire CCG
46
27
19
-41%
NHS Warwickshire North CCG
114
87
27
-24%
NHS Thanet CCG
125
102
23
-18%
NHS Aylesbury Vale CCG
92
77
15
-16%
NHS Canterbury and Coastal CCG
114
101
13
-11%
NHS South Devon and Torbay CCG
202
179
23
-11%
NHS South Kent Coast CCG
123
110
13
-11%
NHS Blackpool CCG
142
129
13
-9%
NHS Rushcliffe CCG
55
50
5
-9%
NHS Hillingdon CCG
111
101
10
-9%
NHS Lincolnshire West CCG
52
48
4
-8%
NHS North West Surrey CCG
140
132
8
-6%
NHS Hastings and Rother CCG
119
113
6
-5%
NHS Kingston CCG
64
61
3
-5%
NHS Islington CCG
110
105
5
-5%
NHS Corby CCG
47
45
2
-4%
NHS Southampton CCG
120
115
5
-4%
NHS Herefordshire CCG
101
97
4
-4%
NHS Haringey CCG
80
77
3
-4%
NHS Gloucestershire CCG
271
261
10
-4%
NHS South West Lincolnshire CCG
56
54
2
-4%
NHS Walsall CCG
171
165
6
-4%
NHS Wyre Forest CCG
63
61
2
-3%
NHS Bromley CCG
143
140
3
-2%
CCG
A list of the CCGs most affected by the change in data source is presented in Table 2, based
on the percentage point difference in indicator value when moving from the NLCA to the
NCRAS data sources for 2013.
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CCG Outcomes Indicator Set: June 2016 publication
Table 2. Indicator 1.19 Record of lung cancer stage at decision to treat
CCG indicator value percentage point change from NLCA to NCRAS in 2013
NCLA
2013
NCRAS
2013
Percentage
point change
Improved
NHS Herts Valleys CCG
NHS Dudley CCG
NHS Milton Keynes CCG
NHS Luton CCG
NHS Sutton CCG
37.0
58.8
54.5
72.8
72.6
85.0
91.0
85.8
93.4
89.1
48.0
32.2
31.3
20.6
16.5
Worsened
NHS Southampton CCG
NHS East Staffordshire CCG
NHS West London CCG
NHS North West Surrey CCG
NHS Bassetlaw CCG
100
69.7
100
99.3
94.3
65.3
37.5
68.7
68.0
64.0
-34.7
-32.2
-31.3
-31.3
-30.3
Change
10
CCG
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CCG Outcomes Indicator Set: March 2016 publication
Analysis of cancer staging indicators
1.17 Record of stage of cancer at diagnosis
This indicator reports the percentage of new cases of cancer for which a valid stage is
recorded at the time of diagnosis. This has increased over the time series to 75.9 per cent in
England for 2014.
There has been a reduction in the year on year increase from the first reported year for the
England total, 59.4 per cent in 2012, (168,496 out of 283,448 patients) to 70.8 per cent in
2013 (206,379 out of 291,298) to 75.9 per cent in 2014 (225,016 out of 296,606). Despite
this slow down, there has still been a 16.5 percentage point increase over the last three
years.
Figure 2. Indicator 1.17 Record of stage of cancer at diagnosis
Annual national (England) total indicator value, 2012-2014
80
70
P
e
r
60
50
40
c
e
n
t
30
20
10
0
2012
2013
2014
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11
CCG Outcomes Indicator Set: June 2016 publication
Figures 3 to 5 highlight this large improvement in national indicator values between 2012 and
2014 by presenting the indicator value by CCG for each year.
Figure 3. Indicator 1.17 Record of stage of cancer at diagnosis
Indicator value by CCG, 2012
Percentage
20 - 33.9
34 - 47.9
48 - 61.9
62 - 75.9
76 - 90
Count of CCGs
9
40
82
53
25
London
Ordnance Survey License Number 100044406. ©Crown Copyright and database right, 2016.
Figure 4. Indicator 1.17 Record of stage of cancer at diagnosis
Indicator value by CCG, 2013
Percentage
20 - 33.9
34 - 47.9
48 - 61.9
62 - 75.9
76 - 90
Count of CCGs
0
15
26
100
68
London
Ordnance Survey License Number 100044406. ©Crown Copyright and database right, 2016.
12
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CCG Outcomes Indicator Set: March 2016 publication
Figure 5. Indicator 1.17 Record of stage of cancer at diagnosis
Indicator value by CCG, 2014
Percentage
20 - 33.9
34 - 47.9
48 - 61.9
62 - 75.9
76 - 90
Count of CCGs
0
1
12
84
112
London
Ordnance Survey License Number 100044406. ©Crown Copyright and database right, 2016.
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13
CCG Outcomes Indicator Set: June 2016 publication
1.18 Percentage of cancers detected at stage 1 and 2
This indicator reports the percentage of new cases of cancer which were diagnosed at stage
1 or 2 for the following specific cancer sites, morphologies and behaviour: invasive
malignancies of breast, prostate, colorectal, lung, bladder, kidney, ovary, uterus, nonHodgkin lymphoma and invasive melanomas of skin. It forms a subset of those cancers
covered in indicator 1.17.
Stage is a measure of how much a cancer has grown and spread, with later stages having
poorer outcomes.4 The stage of a cancer describes the size of a tumour and how far it has
spread from where it originated. Stage 1 and 2 relate to cancers that are small and remain in
the organ where they started.
For more information on the various staging definitions, please visit the NHS Choices
website at: http://www.nhs.uk/chq/Pages/3169.aspx?CategoryID=96
When compared to indicator 1.17, this indicator has a slower rate of change between 2012
and 2014 for the England figure, rising from 41.6 per cent (84,178 out of 202,348 patients) in
2012 to 45.7 per cent (95,426 out of 209,005) in 2013, and to 50.7 per cent in 2014 (107,979
out of 213,161).
The nature of the indicators is different, indicator 1.17 capturing whether any stage is
recorded at diagnosis and indicator 1.18 noting of those diagnosed, which records reported
the stage as being either stage 1 or 2. The larger improvement in stage recording is not
reflected in the number of diagnoses at an early stage, indicating that whilst more patients
are having a stage recorded at diagnosis, relatively fewer are being diagnosed at an early
stage according to the figures.
4
NCIN cancer staging definition: http://www.ncin.org.uk/publications/survival_by_stage
14
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CCG Outcomes Indicator Set: March 2016 publication
Figure 6 presents the distribution of values for 2014 by CCG against the England average
value for record of stage of cancer at diagnosis.
Figure 6. Indicator 1.18 Record of stage of cancer at diagnosis
Indicator value by CCG in 2014, highest to lowest, with England average
70
60
P
e
r
50
c
e
n
t
30
40
2014
England
20
10
0
CCGs
There is a large variation in values over the three years, so the top and bottom five indicator
values by CCG are presented in Table 3. Certain CCGs appear consistently in either the top
or bottom five CCGs for the three years reported. As indicator 1.18 represents a subset of
the same patients captured by indicator 1.17, a low or high value in indicator 1.17 is likely to
result in a similar value in indicator 1.18 provided the CCG in question has a standard mix of
patients with the cancers used to calculate the indicator value.
Table 3. Indicator 1.18 Record of stage of cancer at diagnosis
Top and bottom five CCGs by indicator value 2012, 2013 and 2014
Top five CCGs
Bottom five CCGs
NHS West Suffolk CCG
NHS Solihull CCG
NHS Cambridgeshire and Peterborough CCG
NHS Bedfordshire CCG
NHS West Norfolk CCG
2014
61.0
59.7
59.2
58.5
58.0
NHS West Suffolk CCG
NHS Rushcliffe CCG
NHS Cambridgeshire and Peterborough CCG
NHS Mid Essex CCG
NHS South Norfolk CCG
2013
60.6
58.3
57.5
56.8
56.1
NHS West Suffolk CCG
NHS Bath and North East Somerset CCG
NHS Cambridgeshire and Peterborough CCG
NHS Norwich CCG
NHS South Norfolk CCG
2012
59.6
57.1
56.8
56.4
56.0
NHS Lincolnshire West CCG
NHS Slough CCG
NHS Rotherham CCG
NHS Lincolnshire East CCG
NHS Bassetlaw CCG
2014
33.3
36.3
36.5
36.5
36.7
NHS Slough CCG
NHS Windsor, Ascot and Maidenhead CCG
NHS South West Lincolnshire CCG
NHS East Staffordshire CCG
NHS Lincolnshire West CCG
2013
21.3
26.5
26.8
27.1
27.2
NHS Slough CCG
NHS Chiltern CCG
NHS North West Surrey CCG
NHS Windsor, Ascot and Maidenhead CCG
NHS Bracknell and Ascot CCG
2012
17.7
18.1
18.1
20.1
20.5
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CCG Outcomes Indicator Set: June 2016 publication
1.19 Record of lung cancer stage at decision to treat
When comparing the restated 2013 figures with the newly published 2014 figures for this
indicator, we see that overall rates improve from an already high 85.8 per cent to 90.1 per
cent, a 4.3 percentage point increase.
Within this improved figure, there has been a lot of movement amongst CCGs. The top and
bottom five CCGs by indicator value changed sequence and membership, although more
CCGs remained in the bottom five than the top five, as seen in Table 4.
Table 4. Indicator CCG OIS Indicator 1.19 Record of lung cancer stage at decision to treat
Top and bottom five CCGs by indicator value, 2013 and 2014
Top five CCGs
Bottom five CCGs
2014
100.0
NHS Lincolnshire West CCG
2014
41.6
NHS North Norfolk CCG
98.0
NHS Lincolnshire East CCG
56.3
NHS Leeds West CCG
97.9
NHS Harrow CCG
68.5
NHS North Kirklees CCG
97.8
NHS Bassetlaw CCG
72.5
NHS West Suffolk CCG
97.6
NHS South West Lincolnshire CCG
73.3
NHS Leeds West CCG
2013
97.7
NHS Lincolnshire West CCG
2013
33.6
NHS Hartlepool and Stockton-On-Tees CCG
96.8
NHS East Staffordshire CCG
37.5
NHS Leeds South and East CCG
96.7
NHS South West Lincolnshire CCG
62.8
NHS North Kirklees CCG
96.7
NHS Bassetlaw CCG
64.0
NHS North Lincolnshire CCG
96.3
NHS Warwickshire North CCG
64.4
NHS Corby CCG
While the overall indicator value increased by 4.3 percentage points, there was variation in
the change at CCG level. Table 5 highlights the top and bottom five CCGs based on
percentage point difference from their respective indicator values in 2013 to 2014.
Table 5. Indicator CCG OIS Indicator 1.19 Record of lung cancer stage at decision to treat
Five most improved and reduced CCGs by indicator value 2013 to 2014
Five most improved CCGs
NHS East Staffordshire CCG
Percentage
point change
43.0
2013
per cent
37.5
2014
per cent
80.5
NHS Warwickshire North CCG
30.2
64.4
94.6
NHS Gloucestershire CCG
26.8
68.7
95.5
NHS Southampton CCG
23.6
65.3
88.9
NHS South Devon and Torbay CCG
20.8
72.5
93.3
Five most reduced CCGs
NHS Vale Royal CCG
Percentage
point change
-14.5
2013
per cent
92.8
2014
per cent
78.3
NHS Barking and Dagenham CCG
-10.6
87.7
77.1
NHS Lincolnshire East CCG
-9.7
66.0
56.3
NHS Havering CCG
-9.5
86.2
76.7
NHS Hastings and Rother CCG
-8.5
86.3
77.8
16
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CCG Outcomes Indicator Set: March 2016 publication
Further uses for the CCG OIS indicators
This document gives an overview of selected indicators within this CCG OIS release.
Examples of further work that these data will allow are given below:



To identify areas with poor outcomes that require further detailed investigation
The data allow CCGs to identify how outcomes compare with peers and neighbouring
CCGs
As new data periods are published, CCGs will be able to use the indicators to monitor
indicator trends over time.
Feedback
If there are any other topics within the CCG OIS that you find interesting and would like
further analysis of in a future report, please contact us at [email protected] .
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17
CCG Outcomes Indicator Set: June 2016 publication
Appendix 1 – Indicator update summary
Table 1: Time periods and updates for indicators within the June 2016 publication
Indicator number and name
Time period
Update
1.8 Emergency admissions for
alcohol related liver disease
January 2015 to December 2015
(Data from April 2015 is provisional)
CCG, National
1.14 Maternal smoking at delivery
Q3 2015/16
CCG
1.17 Cancer: record of stage at
diagnosis
2014
CCG, National
1.18 Cancer: early detection
2014
CCG, National
1.19 Lung cancer: record of stage at
diagnosis
2013 (revised), 2014
CCG, National
1.22 Hip fracture: incidence
January 2015 to December 2015
(Data from April 2015 is provisional)
CCG, National
2.5 People with diabetes diagnosed
less than a year who are
2013/14, 2014/15,
CCG
referred to structured education
GP practice participation added for
2012/13
2.6 Unplanned hospitalisation for
chronic ambulatory care sensitive
conditions
January 2015 to December 2015
(Data from April 2015 is provisional)
CCG, National
2.7 Unplanned hospitalisation for
asthma, diabetes and epilepsy in
under 19s
January 2015 to December 2015
(Data from April 2015 is provisional)
CCG, National
2.11a The percentage of referrals to
IAPT services which indicated a
reliable recovery following
completion of treatment
January 2015 to December 2015
(Provisional)
CCG, National
2.11b The percentage of referrals to
IAPT services which indicated a
reliable improvement following
completion of treatment
January 2015 to December 2015
(Provisional)
CCG, National
2.11c The percentage of referrals to
IAPT services which indicated a
reliable deterioration following
completion of treatment
January 2015 to December 2015
(Provisional)
CCG, National
3.1 Emergency admissions for acute
conditions that should not usually
require hospital admission
January 2015 to December 2015
(Data from April 2015 is provisional)
CCG, National
3.4 Emergency admissions to
hospital of children with lower
respiratory tract infections (LRTIs)
January 2015 to December 2015
(Data from April 2015 is provisional)
CCG, National
3.14 Alcohol-specific hospital
admissions
January 2015 to December 2015
(Provisional)
CCG, National
18
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CCG Outcomes Indicator Set: March 2016 publication
Indicator number and name
Time period
Update
3.15 Emergency alcohol-specific
readmissions to any hospital within
30 days of discharge following an
alcohol-specific admission
January 2013 to December 2015
(Provisional)
CCG, National
5.3 Incidence of Healthcare
Associated Infection (HCAI) Methicillin-resistant Staphylococcus
aureus (MRSA)
March 2015 to March 2016
CCG
5.4 Incidence of Healthcare
Associated Infection (HCAI) – C.
difficile
March 2015 to March 2016
CCG
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CCG Outcomes Indicator Set: June 2016 publication
Published by the Health and Social Care Information Centre
Part of the Government Statistical Service
Responsible Statistician
Chris Dew, Information Analysis Lead Manager
ISBN 978-1-78386-737-0
This publication may be requested in large print or
other formats.
For further information
www.hscic.gov.uk
0300 303 5678
[email protected]
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This work remains the sole and exclusive property of the Health and Social Care
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This work may be re-used by NHS and government organisations without permission.