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£800m savings identified through better COPD care

NHS commissioners could save more than £800m over the next decade by improving care pathways for patients with chronic obstructive pulmonary disease, analysis available exclusively to HSJ subscribers suggests.

The analysis by health information specialists Sg2 projects how much COPD patients will cost NHS commissioners in each primary care trust area by 2020. It then sets out for each primary care trust the savings possible through better managing the COPD pathway.

The data is timely as COPD exacerbations are common over winter months, creating capacity issues at hospital providers.

The disease accounts for one in eight emergency admissions in the UK and the second highest number of bed days.

The data suggests PCTs could save an average of £5.3m each by 2020 if they implemented programmes to educate patients and help them manage their condition without the need for hospital stays or going to accident and emergency. That could reduce the number of COPD hospital spells by an average of 33 per cent by 2014.

The potential savings were calculated by multiplying the number of spells the research predicts could be avoided by the relevant tariff price, adjusted for market force factors.

Researchers found most potential for savings in parts of the North West, North East and Yorkshire and the Humber, where rates of COPD are high.

With an estimated saving of £3,621 per 1,000 of the population, NHS Knowsley was found to have the biggest potential.

NHS Barking and Dagenham was identified as having the greatest potential for reducing hospital stays, with researchers predicting those could be cut by 41 per cent from 319 spells in 2008-09 to 216 in 2014. Six of the 10 PCTs with the biggest potential for reducing hospital stays were also in London.

NHS Knowsley medical director Chris Mimnagh told HSJ the PCT had introduced many of the actions suggested by Sg2 through a COPD service run by St Helen’s and Knowsley Teaching Hospitals Trust, which had an annual cost of £1.2m.

The service includes a 24/7 helpline, patient action plans and community based clinics staffed by consultants and a dedicated team of COPD nurses.

Dr Mimnagh said: “It’s still early days but it’s showing a drop in A&E attendance and admissions. We are moving in the right direction.”

In 2009-10 the PCT saw 690 fewer A&E attendances, 145 fewer emergency admissions, and 58 fewer emergency readmissions than in 2008-09.

The data

  • See the results for your PCT area here, along with in-depth analysis and information on how to create savings in your organisation: www.hsj.co.uk/5021475.article

Readers' comments (5)

  • £800m savings is all well and good, but they won’t happen by themselves. It seems unlikely that PCTs and SHAs are going to champion this work since they are not much longer for this earth, and GP consortia have yet to materialise. So the only organisations in a position to champion this work are the acutes, and are they really incentivized to keep people out of hospital?

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  • When will people realise that PCT spending less money saves bog-all for the NHS?!

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  • Heavens above, our team did all this analysis 3 years ago and our service no delivers the benefits. Please see www.somersetcopd.co.uk. This is not news.

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  • Dr. More,
    I’m glad to hear that there are other good examples out there where people are seeing tangible benefits from aligning care quality and financial benefits from proactive care pathway redesign. As you say, the ‘news’ here isn’t that there’s a relationship between quality and finance, but that there will be a natural or passive decline in inpatient activity. I’d also argue that to see a model where the service not only breaks even, but starts generating savings within the short space of 3 years is noteworthy. The NHS stands to benefit from hearing about examples and insight from around the country, whether it comes from HSJ, Sg2 or Somerset. Readers should note that additional Sg2 analysis shows similar pathway redesign opportunity across multiple other disease states.
    Meghan Robb, Sg2

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  • IMPRESS, a joint venture to improve and integrate respiratory services in the UK from its two leading respiratory professional bodies, Primary Care Respiratory Society-UK and British Thoracic Society welcomes the attention this report gives to COPD and the burden it places on patients and health services. We support clinicians and commissioners to reduce that burden by offering guidance and case studies that demonstrate the value of integrated care approaches along the pathway; the place of cost-effective treatments such as stop smoking and pulmonary rehabilitation as well as standards for the workforce. The report shows even more clearly that we need to see the COPD National Strategy published to guide improvement across the country in a consistent way. In terms of detail, we would recommend that commissioners double-check any analysis of data with local clinicians. Our knowledge of activity and coding would suggest that if you only look at the first entry on a coding form and if you are NOT using HRG4 you may miss a significant amount of COPD activity in hospitals such as DZ27 Respiratory failure and DZ22 'Unspecified Acute LRTI' that are often incorrectly used. Furthermore HRG version 3.5 still hid a lot of COPD in the 'Complex Elderly' code which may not be included in this analysis. For more free resources and guidance on respiratory care see:
    MORE FOR LESS (guide to quality and productivity in respiratory services)http://www.impressresp.com/LinkClick.aspx?fileticket=xEgv-K-_-F0%3d&tabid=77
    GUIDE TO INFORMATION ABOUT THE USE OF MEDICINES IN THE NHS
    RATIONALISING OXYGEN USE TO IMPROVE PATIENT SAFETY AND TO REDUCE WASTE IN THE NHS
    GUIDE TO RESPIRATORY CODING
    IMPRESS GUIDE TO INFORMATION

    all available on the IMPRESS website www.impressresp.com as listed on the Sg2 report

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