074 20 20PCT 20Strategic 20Plan 202

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					                                                                                   Agenda Item:2.3
                                                                                   Ref:W08-09/074
                                  Wirral Primary Care Trust

                                  Wirral PCT Strategic Plan

Introduction

     The




2.   Wirral PCT is well placed to produce the strategic plan building on the “Health for All’ draft
     Strategic Commissioning Plan 2008-2013, which the Board considered at its meeting in June.



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Implementation

6.   A project lead has been appointed to develop the SP, supported by a core team with
     representatives from Public Health, Finance, Information and Corporate Services who are
     managing production of the document reporting to Corporate Directors weekly on their
     progress. Both The Board and PEC will be actively involved and consulted prior to the final
     SP submission to the DH in October this year. This will be a main agenda item for the
     informal Board in August.

7.   To aid preparation of SPs DH produced for each PCT a data set of their performance
     benchmarked against PCTs of similar profile in England and cluster PCTs. The first stage of
     the SP project has been an analysis of Wirral’s data set alongside a review of information

Wirral PCT Strategic Plan: Board Meeting 8 July 2008

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      used to inform ‘Health for All’ Strategic Commissioning Plan 2008-2013, ensuring all priority
      health needs have been taken into account and considered.

8.    Table one shows the health needs of the population identified from all source.

9.    Looking at key demographic and socio-economic trends there will be a marked increase in
      the proportion of older people in Wirral. It is predicted that the over 65 population will increase
      by 19% over the next ten years, with the sharpest increase being in the over 85s. This ageing
      population is also likely to lead to a larger number of older people living alone.

10.   Between 1988 and 2001 Wirral experienced declining birth rates. Since 2001 fertility rates
      have been increasing overall in Wirral, this mirrors the national picture. There are currently
      around 3,500 live births in Wirral each year. Wirral has a high number of looked after children.

11.   We will address key health needs for all and the needs of older people (OP) and children and
      young people (CYP) within our strategic plan

      Table 1
       PCT Commissioning Strategic Plan (JSNA 1)
       Life expectancy
       Health Inequalities
            Smoking
            Alcohol*
            Obesity
            Sexually Transmitted Infections (STI’s)
            Mental Health
            Cancer* & Palliative Care
            Heart Failure
            Cardiovascular Disease*
       Demographic and Socioeconomic Focus
            Children and Young People
               (particularly for looked after children and those living in deprived circumstances
            Older people


       Health Local Area Agreements

          Alcohol
          Childhood Obesity
          Teenage Pregnancy
          Life Expectancy
          Smoking
          Mental Health (Self-harm)
          Dementia
          Older People (Falls)


       DH Data Pack
       81st-100 percentile
        Cancer
        CHD
        COPD
        Stroke
        Mental Health**

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                      Breast Cancer Mortality
                      Lung Cancer Incidence
                      Lung Cancer Mortality
                     Top 10%
                      Hospital Admissions caused by unintended and deliberate harm
                      Deaths from Chronic Liver Disease
                      HIV Prevalence***
                      Suicide and injury undetermined intent mortality rate
                      Rate of hospital admissions per 100,000 for alcohol related harm

                    *Contributors to gap in life expectancy as well as Cardiopulmonary Disease, Suicide and external causes (includes violence,
                    accidents)
                     **Not benchmarked but high morbidity compared with SHA peers
                    ***Small Numbers-analysis of change over time under preparation

12.                 Further analysis was undertaken to identify and prioritise the key health needs for our
                    population. This work included looking at Wirral performance compared to National
                    performance, Wirral spend versus national spend on specific disease groups and Wirral life
                    years lost versus England years of life lost. An example is shown in Figure 2.

          Figure 2
        2 x 2 Matrix (Wirral Years of Life Lost v England Years of Life Lost)


                    250




                    200



                                                                                                                      b

                    150
      England YLL




                                                                                       c
                    100




                      50

                                                       a

                           f       d          g
                       0
                               e
                           0                      50                  100                    150                    200                     250
                                                                            Wirral YLL




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   Key    Area                                       Wirral Years of Life Lost Rate (Crude       England Years of
                                                               per 10,000 <=75)                   Life Lost Rate
                                                                                                    (Crude per
                                                                                                   10,000 <=75)


    A     Accidents                                                    49                                 38.25
    B     Cancers                                                      194                            161.35
    C     Circulatory Diseases                                         128                            106.14
    D     Bronchitis, emphysema and other COPD                         16                                 11.36
    E     Diabetes                                                      4                                 4.39
    F     Infectious & Parasitic Disease                                6                                 7.37
    G     Suicide & Injury Undetermined                                38                                 27.34


    13.    Reviewing the existing information and DH dataset did not highlight any major health needs
           not already considered by the PCT and approved by the Board.

    14.    The next stage of the SP development is to select the PCT local outcomes. Each PCT is
           asked to select up to 10 outcomes; 2 national mandatory outcomes, life expectancy and
           health inequalities, as well as up to 8 outcomes determined locally for evaluation as part of
           WCC. World Class Commissioning Assurance will look at the fit of the outcomes with the SP
           and health needs of the population as well as assessment of the PCT position on each of the
           metrics relative to national performance and other PCTs.

    15.    Appendix 1 shows the full list of nationally defined options for local selection. PCTs may also
           select a local outcome if it provides a better fit with their strategic priorities. CDG considered
           all options for the local outcomes; the following describes the options proposed with
           supporting rationale.

Key health needs for          WCC                                            Rationale for Local outcome
Wirral population             Proposed Local Outcomes                        selection
Life Expectancy               Life expectancy at time of birth years         Mandatory

Health Inequalities           Average IMD (Deprivation index) score          Mandatory

Sexually transmitted          Under 18 conception rate                       Links to LAA, current poor
Infections (STI’s)                                                           performance
Cardiovascular Disease        Percentage of stroke admissions given          Desire to continue to improve
                              a brain scan within 24 hours                   the care pathway for stroke
                                                                             patients
Smoking                       Smoking quitters                               Major issue affecting health-
                                                                             prevention into the mainstream
Alcohol                       Rate of hospital admissions per                Major health issue for our
                              100,000 for alcohol related harm               population

Mental Health                 Hospital admissions caused by                  Major health issue for our
                              unintended and deliberate injuries.            population

Cardiopulmonary               Uptake on pnemococcus vaccinations             Growing elderly population
Disease                       by over 65s                                    and COPD an issue for our
                                                                             population- prevent hospital
                                                                             admission and excaberations
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Key health needs for       WCC                                       Rationale for Local outcome
Wirral population          Proposed Local Outcomes                   selection
Obesity                    Diabetes controlled blood sugar           Major issue for our population,
                                                                     links to LAA. Circulatory
                                                                     diseases are a major issue for
                                                                     our population; interventions
                                                                     focus primary care, prevention
                                                                     into the mainstream
Cancer                     Option 1 Breast cancer mortality-Local    Cancer key health issue and
                           proposed indicator                        cause of premature death,
                                                                     breast cancer mortality poor,
                           Option 2 Lung cancer mortality-Local      lung cancer poor mortality
                           proposed indicator



         Analysis re: the cancer target options

         Rate of years life lost (<=75) 2004/06:
                                 Breast Cancer            Lung Cancer
         England                     39.39                   31.27
         NW                          38.64                   40.26
         ONS Peer                    42.87                   46.57
         Wirral                      48.32                   42.31

         There is not a great deal of difference between the 2 Cancer target options.
         For Breast cancer there is a greater variance from SHA & Peer rate.
         For Lung cancer there is greater impact in terms of potential numbers.

   16.   The Board is asked to select a Cancer target.

   17.   The next steps of the project are alignment of the initiatives we have commissioned to
         strategic direction and ensuring we have clarity concerning their impact and predicted
         outcomes that will deliver the vision of the PCT.




   Wirral PCT Strategic Plan: Board Meeting 8 July 2008

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                                                                                                  Agenda Item:2.3
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       Overview of Various Components of Strategy

                                                                                       Aspirations against each criteria
                                                                                       would have to be specified


Health needs                                                                       Locally defined Measurable goals
   Life expectancy                                                                For example
   Health inequality                                                              Establishment of Obesity Family/
   Smoking                                                                        childhood weight management services
   Alcohol                                                                        Impact-Achieve a 1% reduction in the
   Obesity                                                                        number of year 10 children that are
   Sexually transmitted infections                                                obese by 2012 Achieve a 2% reduction
    (STI)                                                                          in the number of reception aged children
   Mental Health                                                                  that are obese by 2012 (Reference
   Cancer                                                                         Strategic commissioning Plan p 41)
   Cardio Pulmonary Disease
   CVD

                                       Vision
Demographic and socioeconomic          To organise services around patients in
focus                                  order to identify and address health
   Children & young peoples           needs, reduce inequalities and improve      Outcome targets – WCC scorecards
    services                           the health and well being of the                Under 18 conception rate.
   Older people                       population                                      Percentage of stroke admissions
                                                                                        given a brain scan within 24
                                                                                        hours
                                                                                       Smoking quitters
                                                                                       Uptake on pnemococcus
                                                                                        vaccinations by over 65s
                                       Prioritised initiatives                         Diabetes controlled blood sugar.
Other needs / delivery objectives
                                       A set of programmes that will deliver the       Rate of hospital admissions per
   Prevention
                                       vision with the maximum impact at most           100,000 for alcohol related harm
   Closer to home
                                       efficient cost                                  Hospital admissions caused by
   Modernising services
                                                                                        unintended and deliberate
                                                                                        injuries
                                                           Designed to Improve         Option 1 Breast cancer mortality-
                                                           Outcomes                     Local proposed indicator
                                                                                       Option 2 Lung cancer mortality-
                                                                                        Local proposed indicator




       Conclusion

       18.    The Board is asked to note the progress in the production of the SP.

       19.    The Board is asked to consider the options proposed for the 8 local outcome targets.



       Geraldine Murphy-Walkden
       Divisional Head of Commissioning and Contracts
       26 June 2008




       Wirral PCT Strategic Plan: Board Meeting 8 July 2008

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Appendix 1


                ID         Ref   Metric              Selection     Metric definition
                                                     (please
                                                     set 1 to 8)
 FOR ALL               1         Health              ALL PCTs      Average IMD (deprivation index) score
   PCTs                          inequalities
                       2         Life expectancy     ALL PCTs      Life expectancy at time of birth, Years
   BIRTH               3     1   Infant mortality                  Mortality rate per 1,000 live births, under one years old
                       4     2   Caesarean                         Percentage of live births delivered by caesarean section
                                 section
                       5     3   Low birth weight:                 Number of live and stil births where babies have weighed less than 2500grams
                                 Births under
                                 2500grams
                       6     4   Under 18                          Teenage conception rate per 1000 females, aged 15-17
                                 conception rate
                       7     5   Infants breastfed                 Percentage of infants breastfed at 6-8 weeks
                       8     6   Smoking during                    Actual percentage of women known to be smokers at the time of delivery
                                 pregnancy
                       9     7   Downs                             Percentage of parents who chose to have Downs Syndrome screening
                                 syndrome
                                 screening
 CHILDREN            10      8   Hospital                          Proportion of deliberate or unintented injuries to children or young people (per
                                 admissions                        10,000 aged under 19)
                                 caused by
                                 unintended and
                                 deliberate
                                 injuries
                     11      9   Proportion of                     Proportion of children aged 2 who complete immunisation for Measles, Mumps and
                                 children who                      Rubella (MMR)
                                 complete MMR
                                 immunisation by
                                 2nd Birthday




Wirral PCT Strategic Plan: Board Meeting 8 July 2008                                                                                                      7/13
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                ID        Ref    Metric             Selection     Metric definition
                                                    (please
                                                    set 1 to 8)
                     12     10   Proportion of                    Proportion of children aged 5 who complete immunisation for MMR (1st and 2nd
                                 children who                     doses)
                                 complete MMR
                                 immunisation
                                 (1st and 2nd
                                 dose) by their
                                 5th Birthday
                     13     11   Proportion of                    Proportion of children aged 5 who complete immunisation for Diptheria, Polio,
                                 children who                     Tetanus (DTP)
                                 complete DTP
                                 immunisation by
                                 their 5th
                                 Birthday
 STAYING             14     12   Life expectancy:                 Life expectancy at time of birth, Years
 HEALTHY                         Males
                     15     13   Life expectancy:                 Life expectancy at time of birth, Years
                                 Females
                     16     14   Deaths from                      Directly standardised rates from chronic liver disease, including cirrhosis (ICD-10
                                 Chronic liver                    K70, K73-K74) per 100,000, all ages
                                 disease
                     17     15   HIV prevalence                   Rate per 100,000 of Diagnosed HIV infected patients
                     18     16   Smoking quitters                 Rate per 100,000 population aged 16 and over
                     19     17   Hypertension                     Unadjusted hypertension prevalence
                                 prevalence
                     20     18   Uptake of                        PPV Uptake in the 65 years and over and GP response rate by PCT for 2006/07
                                 pnemococcus                      presented as total % uptake
                                 vaccinations by
                                 over 65s
                     21     19   Uptake of                        Percentage uptake of influenza vaccinations by over 65s
                                 influenza
                                 vaccinations by
                                 over 65s
                     22     20   GUM access                       % of all patients seen at a GUM clinic who were seen within 48 hours of contacting
                                 within 48 hours                  the service


Wirral PCT Strategic Plan: Board Meeting 8 July 2008                                                                                                        8/13
                                                                                                                                                             Agenda Item:2.3
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                ID        Ref    Metric              Selection     Metric definition
                                                     (please
                                                     set 1 to 8)
 PLANNED             23     21   Cancer mortality                  Directly standardised rates from all malignant neoplasms (ICD-10 C00-C97)
   CARE                          rate                              Premature mortality (under 75 years)
                     24     22   Proportion of                     Coverage of women aged 53-64 by PCO (less than 3 years since last test)
                                 women aged 53-
                                 64 offered
                                 screening for
                                 breast cancer
                     25     23   Proportion of                     Coverage of women aged 25-64 (less than 3.5 years since last adequate test)
                                 women aged 25-
                                 64 screened for
                                 cervical cancer
                     26     24   Percentage of                     Percentage of patients first seen by a specialist within two weeks when urgently
                                 patients first                    referred by their GP or dentist with suspected cancer
                                 seen by a
                                 specialist within
                                 two weeks when
                                 urgently referred
                     27     25   Proportion of                     Percentage of patients with diagnosis to treatment time less than or equals to one
                                 patients waiting                  month
                                 no more than 31
                                 days for cancer
                                 treatment
                     28     26   Percentage of                     The number of patients receiving their first definitive treatment for cancer within two
                                 patients                          months (62 days) of GP or dentist urgent referral for suspected cancer.
                                 receiving their
                                 first definitive
                                 treatment for
                                 cancer within
                                 two months of
                                 urgent referral
                                 for suspected
                                 cancer.




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                                                                                                                                                        Agenda Item:2.3
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                ID        Ref    Metric             Selection     Metric definition
                                                    (please
                                                    set 1 to 8)
                     29     27   Percentage of                    RTT admitted pathways
                                 patients seen
                                 within 18 weeks
                                 for admitted
                                 pathways
                     30     28   Percentage of                    RTT non admitted pathwats
                                 patients seen
                                 within 18 weeks
                                 for non-admitted
                                 pathways
                     31     29   Self reported                    Quality of care received
                                 experience of
                                 patients & users
                     32     30   Patient and user                 Percentage of patients who felt they were treated with respect and dignity while in
                                 reported                         the hospital?
                                 measure of
                                 respect and
                                 dignity in their
                                 treatment
   ACUTE             33     31   Mortality rate                   Directly age-standardised rates (DSR) per 100,000 European Standard population
                                 from causes
                                 considered
                                 amenable to
                                 healthcare
                     34     32   Stroke deaths                    Deaths in hospital and after discharge between 0 and 29 days (inclusive) of an
                                 within 30 days                   emergency admission to hospital with a stroke. Indirectly age and sex standardised
                                                                  rates per 100,000 persons
                     35     33   Percentage of                    Percentage of stroke admissions given a brain scan within 24 hours
                                 stroke
                                 admissions
                                 given a brain
                                 scan within 24
                                 hours



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                                                                                                                                                           Agenda Item:2.3
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                ID        Ref    Metric                Selection     Metric definition
                                                       (please
                                                       set 1 to 8)
                     36     34   Percentage of                       Percentage of stroke admissions given a physiotherapist assessment within 72
                                 stroke                              hours
                                 admissions
                                 given a
                                 physiotherapist
                                 assessment
                                 within 72 hours
                     37     35   Delayed                             Percent of cases delayed of delayed transder of care per 100,000 population (age 18
                                 transfers of care                   and over)
                     38     36   4-hour A&E                          Percentage of patients who spent less than 4 hours in A&E
                                 waiting time
                                 target
                     39     37   MRSA infection                      MRSA rate per 10,000 bed days
                                 rate
                     40     38   Clostridium                         Clostridium difficile rate per 1000 for patients aged over 65 years
                                 Difficile infection
                                 rate
MENTAL               41     39   Suicide & Injury                    Directly standardised rates per 100,000 European standard population from
HEALTH                           Undetermined                        intentional self-harm and injury undetermined whether accidentally or purposely
                                 Intent Mortality                    inflicted (ICD-10 X60-X84, Y10-Y34 exc Y33.9)
                                 Rate
                     42     40   Drug treatment                      Drug treatment average waiting times in weeks of all treatments eg. Rehab, GP
                                 waiting times                       specialist, outpatient etc
                     43     41   Percent drug                        Percent of drug misusers sustained in treatment
                                 users recorded
                                 as being in
                                 effective
                                 treatment
                     44     42   Rate of hospital                    Rate of alcohol-related admissions per 100,000 population (EASR)
                                 admissions per
                                 100,000 for
                                 alcohol related
                                 harm



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                                                                                                                                                           Agenda Item:2.3
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                ID        Ref    Metric               Selection     Metric definition
                                                      (please
                                                      set 1 to 8)
LONG TERM            45     43   Mortality rate per                 Mortality from all ages and all causes presented as DSR per 100,000 European
CONDITIONS                       100,000                            Standard population
                     46     44   COPD mortality                     Directly standardised rates per 100,000 European standard population from
                                                                    bronchitis, emphysema and other chronic obstructive pulmonary disease (ICD10
                                                                    J40-J44), all ages
                     47     45   Diabetes                           Directly standardised rates per 100,000 standard European population for diabetes
                                 mortality                          (ICD-10 E10-E14), all ages
                     48     46   CVD mortality                      Directly standardised rates per 100,000 standard European population for all CVD
                                                                    mortality, (ICD10 I00-I99). Premature mortality (under 75 years)

                     49     47   CHD mortality                      Directly standardised rates per 100,000 standard European population for all CHD
                                                                    mortality, (ICD10 I20-I25), all ages
                     50     48   COPD                               Percentage of all patients with COPD in a GP registered population
                                 prevalence
                     51     49   Diabetes                           The percentage of patients with diabetes in who have an HbA1c of 7.5 or less
                                 controlled blood
                                 sugar
                     52     50   CHD controlled                     The percentage of patients with coronary heart disease, in
                                 blood pressure                     whom the last blood pressure reading (measured in the last 15 months) is 150/90 or
                                                                    less
                     53     51   CHD controlled                     The percentage of patients with coronary heart disease whose
                                 cholesterol                        last measured total cholesterol (measured in the last 15 months) is 5 mmol/l or less

                     54     52   Percentage of                      Percentage of diabetics screened for diabetic retinopathy
                                 people screened
                                 for diabetic
                                 retinopathy
END OF LIFE          55     53   Palliative care                    Palliative care, unadjusted prevelance percent
                                 prevelance
                     56     54   Percentage of all                  Percentage of all deaths that occur at home as reported by Primary Care
                                 deaths that                        Organisation
                                 occur at home



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                ID        Ref    Metric            Selection     Metric definition
                                                   (please
                                                   set 1 to 8)
   OTHER             57     55   Other <please                   <please provide definition>
                                 specify>
                     58     56   Other <please                   <please provide definition>
                                 specify>
                     59     57   Other <please                   <please provide definition>
                                 specify>




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