1. Programme • Where are we now?Current PCT performance within SHA • No decision about me, without me: Local patients views • Are there alternative ways of delivering care and achieving QIPP targets? • Round Table Discussion

2. Where are we now?Current PCT performance Colin Gelder & Sandy Walmsley Respiratory Leads West Midlands

3. COPD • COPD causes >25,000 deaths a year in England and Wales (5% all deaths) • 835,000 people in England have been diagnosed with COPD • DoH estimate >3 million people have COPD • Thus 2 million have undiagnosed COPD

4. Key Facts • Approx 9% GP patient population • GP consultation rates x2 angina • Average list will contain 200 COPD patients

7. NHS Costs

8. NHS Costs • COPD is an expensive disease for the NHS when it is not identified and treated early • >75% costs is due to severe/very severe patients • Direct cost of COPD to NHS is £810-930 million a year • Without change this is set to grow

9. Patient Perspective

10. Patient Perspective • COPD is a progressive illness, and the number of people dying as a result of COPD increases with age • COPD is disabling. Although it affects people in different ways, those with COPD often have breathlessness, reduced exercise tolerance, a cough and repeated chest infections

11. COPD Exacerbations & Survival 13.9% of people admitted with an exacerbation of COPD die within 90 days 25% of people admitted with an exacerbation of COPD die within 1 year

13. Social Costs • Quality of life is undermined. • Restricted mobility leads to social isolation and the psychological conditions that go with it. • A British Lung Foundation survey found that 90% of people with severe COPD were unable to participate in socially important activities such as gardening, 66% were unable to take a holiday because of their disease and 33% had disabling breathlessness.

15. Socio-Economic Bias • Smoking is more prevalent in lower socioeconomic groups • 26% of routine and manual workers smoke vs. 15% in managerial & professional occupations • DoH estimates that the routine and manual occupational group represents 50% people with (diagnosed or undiagnosed) COPD in England • Men aged between 20 and 64 employed in unskilled manual occupations are 14 times more likely to die from COPD than men in professional roles, and are around seven times more likely than those in managerial and technical occupations

16. The Disadvantaged • The picture is even worse for smokers from the most disadvantaged sectors of society, where in some cases (e.g. for people with schizophrenia) smoking prevalence can reach 74%

17. Societal Costs • ~25% of people with COPD are prevented from working due to the disease • Leading to 20.4 million lost working days among men and 3.5 million days among women every year • The annual cost of COPD- related lost productivity to employers and the economy has been put at £3.8 billion

18. Current PerformanceinWest Midlands

19. PCT Expenditure on RespiratoryDH 2009-10 Programme Budgeting Benchmark Workbook v1.0 National Average of £8.4m, an SHA average of £8.2m

20. PCT Expenditure on RespiratoryDH 2009-10 Programme Budgeting Benchmark Workbook v1.0

21. Spend per 100,000 of own population on COPDDH 2009-10 Programme Budgeting Benchmark Workbook v1.0 Note Airways Disease does not include Asthma

22. Spend per 100,000 of own population on COPDDH 2009-10 Programme Budgeting Benchmark Workbook v1.0 Note Airways Disease does not include Asthma

23. West Midlands COPD Non-Elective Admissions

24. Prospering Smaller Towns B:COPD Admission Data

25. Prospering Smaller Towns C:COPD Admission Data

26. West Midlands non-elective COPD hospitalisation costs

27. West Midlands non-elective COPD hospitalisation length of stay

28. West Midlands non-elective COPD hospitalisation 28-day readmission rate

29. PCT Cost Saving Potentials for COPD

30. Herefordshire: COPD Admissions Practice Level Data

31. Worcestershire: COPD Admissions Practice Level Data

32. Shropshire: COPD Admissions Practice Level Data

33. West Midlands non-elective Asthma hospitalisation data

34. Prospering Smaller Towns B: Asthma Admission Data

35. Prospering Smaller Towns C: Asthma Admission Data

36. West Midlands non-elective Asthma hospitalisation costs

37. West Midlands non-elective Asthma hospitalisation length of stay

38. West Midlands non-elective Asthma hospitalisation 28-day readmission rate

39. PCT Cost saving Potential for Asthma

40. Herefordshire: Asthma Admissions Practice Level Data

41. Worcestershire: Asthma Admissions Practice Level Data

42. Shropshire Practice Level Asthma Admissions