Commissioning Strategy Lambeth PCT

1
Commissioning Strategy Lambeth PCT

• Burden of Disease
• Strategy Intervention Framework

2
Burden of disease summary and key messages

• Red Box summary
• Life Expectancy
• Improving but gap (worse males)
• Infant deaths
• Reducing and gap appears narrower
• Premature deaths
• CVD gap worse in men and women
• Cancer gap worse in men
• Other areas accdents, infectious disease (HIV),
  cirrhosis of liver, pneumonia and peptic ulcers

• Diseases by ICD chapters (total burden)
• Mental health (includes dementia)
• Other area respiratory, hearing,
  musculoskeletal, accidents
• Programme budget and variations in spend
• Outliers mental health, infectious disease
• Higher spend musculoskeletal, neonates, GU
• Lower spend maternal
• Strategy and intervention framework
• Framework for strategy
• Framework for priorities

3
Hitens red box update 2006/7
Cardiovascular disease mortality (slower
improvement compared for nationally) Cancer
mortality Teenage conceptions Mortality from
infectious and parasitic disease
Lifestyle issues (smoking, obesity, poor diet,
low physical activity) Chronic liver disease
deaths morbidity Chronic renal disease deaths
morbidity Hypertensive disorders HIV
prevalence STIs prevalence Severe mental illness
morbidity Diabetes mortality morbidity
High Burden
Infant mortality Immunisation uptake All cause
mortality in girls under 15 years
Drug misuse All cause mortality in boys under
15 years Mortality from gastric, peptic and
duodenal ulcers
Low Burden
Improving
Worsening
4
Life Expectancy Infant Mortality
5
Life Expectancy in Lambeth
Estimated projections
6
Life Expectancy change in target
7
Infant Mortality
Estimated projections
8
Infant mortality target
9
Premature mortality
10
Premature mortality men SYLL lt 75
11
Premature mortality women SYLL lt 75
12
Trends in premature deaths from all cancers lt 75
years
Estimated projections
13
Trends in premature deaths from all circulatory
diseases lt 75 years
Estimated projections
14
CVD Cancer Targets
15
Disease burden by ICD chapter
16
Years lived with disability (YLD) by ICD chapter
17
Total burden by ICD Chapter in Lambeth 2005Total
Burden YLL YLD
18
DALY Lambeth 2005
19
Programme Budget 2003-5Total spend in Lambeth
2003-5
20
(No Transcript)
21
Programme Budget
22
(No Transcript)
23
(No Transcript)
24
Strategy effective interventions framework
25
Framework for strategic commissioning in Lambeth
OUTCOMES
Client or population groups
School age children young adults
Working adults
Pregnancy and early childhood
Older age
Burden of specific diseases /or risk factors
Interventions and Services
Sustainable Community Strategy
Wider Determinants Self care Primary care/social
care Secondary care Specialist care
Strategic Commissioning Strategy
Shift
26
Which outcome or set of outcomes?

• Prolong life
• Reduce avoidable death
• Improve quality of life
• Reduce suffering
• Reduce harm
• Reduce incidence of disease

• Manage pain
• Improve functioning
• Reduce avoidable hospital admission
• Reduce avoidable emergency admission
• Reduce risk factors
• Increase well-being

27
Which interventions to focus on efficiency of
interventions
Cost-effective interventions used widely
Neglected opportunities
High
Cost-effectiveness
Interventions for which scaling up is inefficient
Low
Interventions to scale back
High
Low
Current coverage
28
Equality, Equity and Health Commissioning
Strategy

• Health Inequality a big issue in Lambeth
• Legal requirement to promote Equality
• Race, gender, disability, sexuality etc
• Reduce discrimination
• Promoting health equity
• Tailoring interventions/services according to
  needs (ability to benefit from an intervention)
• Health Equity Audit as a planning tool
• To measure distribution of outcomes

29
Equal effectiveness for Similar Conditions
Highest offer where Highest needs
Excess Mortality
Offer of Services
Access Of services
effectiveness Of services
Reduced Excess mortality
Highest access where Highest needs