Revealed: CCGs with the worst excess bed day rates

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NHS England and NHS Improvement rank CCGs on rates of excess bed days
According to the data City and Hackney CCG had the highest excess bed day rates in 2017
National bodies also published data on excess bed days by medical speciality, which revealed the highest rates were within paediatrics

NHS England and NHS Improvement have compiled a list ranking CCGs across England on their excess bed day rates, HSJ can reveal.

In a letter, sent last week to NHS trusts and clinical commissioning groups, the national bodies asked NHS trusts and CCGs to launch local funding schemes to reduce excess bed days within acute trusts.

Excess bed days refer to an additional fee paid by CCGs to NHS trusts when a patient stays in hospital for longer than a pre-determined length of time- this varies by each speciality.

In the letter, seen by HSJ, Matthew Swindells national director for operations and information at NHS England and Dr Kathy Mclean medical director for NHS Improvement said: ”Whilst for some patients an extended length of stay will be clinically appropriate, there is significant variation access the country - the highest quartile of CCGs have almost three times the rate of excess bed days compared to those in the lowest quartiles.

“This indicates that there are opportunities to reduce the length of stay by transferring these patients to a more appropriate setting, including in the community.”

Attached to the letter the national bodies have complied the rates of excess bed days for every CCG in England, between January for December 2017.

The document also included excess bed day rates by speciality, which revealed the worst rates were in paediatric areas.

List of 50 CCGs with worst excess bed days per 1000 population (full list attached)

CCG Name	Excess bed days	Weighted population	Excess bed days per 1000 weighted population
City and Hackney CCG	26,517	217,080	122.2
Trafford CCG	23,002	255,599	90.0
Manchester CCG	46,861	570,358	82.2
Lewisham CCG	19,781	250,728	78.9
Portsmouth CCG	15,174	203,159	74.7
South Sefton CCG	13,620	189,449	71.9
Dorset CCG	62,622	897,136	69.8
Bath and North East Somerset CCG	13,850	198,603	69.7
Cumbria CCG	26,023	381,336	68.2
West Hampshire CCG	40,777	602,187	67.7
Nene CCG	42,067	651,154	64.6
Lancashire North CCG	28,491	443,878	64.2
Southampton CCG	15,743	264,745	59.5
East Lancashire CCG	25,974	442,508	58.7
Fareham and Gosport CCG	12,521	214,680	58.3
Leeds CCG	47,638	841,070	56.6
Dartford, Gravesham and Swanley CCG	13,854	253,318	54.7
South Eastern Hampshire CCG	12,342	226,776	54.4
North Hampshire CCG	11,913	219,566	54.3
North East Hampshire and Farnham CCG	11,873	219,039	54.2
Oxfordshire CCG	34,264	635,244	53.9
Buckinghamshire CCG	26,687	496,338	53.8
Sutton CCG	9,286	178,215	52.1
Cannock Chase CCG	8,093	155,613	52.0
Corby CCG	3,961	76,311	51.9
Surrey Heath CCG	4,900	95,014	51.6
Doncaster CCG	18,298	361,467	50.6
Stockport CCG	18,131	359,726	50.4
Fylde & Wyre CCG	9,703	196,564	49.4
Swindon CCG	10,431	212,607	49.1
Norwich CCG	10,624	219,904	48.3
Somerset CCG	31,515	652,509	48.3
Tameside and Glossop CCG	13,772	285,253	48.3
Wiltshire CCG	25,080	521,815	48.1
Bexley CCG	10,783	231,344	46.6
Greenwich CCG	11,064	238,883	46.3
Blackburn with Darwen CCG	8,780	190,599	46.1
Herefordshire CCG	9,244	202,417	45.7
North Norfolk CCG	9,653	211,415	45.7
West Leicestershire CCG	17,059	373,722	45.6
West Kent CCG	21,099	466,097	45.3
East Surrey CCG	8,031	177,628	45.2
Eastbourne, Hailsham and Seaford CCG	10,297	229,883	44.8
Surrey Downs CCG	12,813	287,086	44.6
Lambeth CCG	12,333	279,652	44.1
Ealing CCG	14,725	335,225	43.9
Sheffield CCG	25,691	588,192	43.7
Bromley CCG	14,081	325,636	43.2
Newcastle Gateshead CCG	24,591	573,862	42.9
All CCGs	2,220,166	58,719,921	37.8

List of 25 specialities with worst excess bed day rate as a proportion of all inpatient days (full list attached)

Speciality	Total bed days	Excess bed days	Excess bed days as a proportion of all inpatient bed days
Paediatric Immune System Disorders	1,731	1,106	64%
Eyes and Periorbita Procedures and Disorders	96,841	23,429	24%
Pain Management	1,371	274	20%
Paediatric Nervous System Disorders	70,126	13,035	19%
Paediatric Non-Malignant Haematological Disorders	21,982	3,795	17%
Paediatric Rheumatology Disorders	23,642	4,049	17%
Paediatric Gastroenterology Disorders	119,025	19,854	17%
Skin Procedures	60,807	10,112	17%
Ear, Nose, Mouth, Throat and Neck Disorders	346,181	57,235	17%
Paediatric Diabetology, Endocrinology and Metabolic Disorders	26,071	4,200	16%
Paediatric Hepatobiliary Disorders	6,623	937	14%
Spinal Procedures and Disorders	683,256	95,454	14%
Poisoning, Toxic Effects, Special Examinations, Screening and Other Healthcare Contacts	956,443	129,901	14%
Paediatric Cardiology Disorders	26,991	3,478	13%
Paediatric Haematological-Oncology Disorders	67,756	8,104	12%
Musculoskeletal and Rheumatological Disorders	688,994	80,579	12%
Diabetic Medicine	209,172	24,189	12%
Neurological Imaging Interventions	36,156	4,157	11%
Paediatric Medicine	139,142	15,918	11%
Haematological Procedures and Disorders	608,126	61,917	10%
Nervous System Procedures and Disorders	2,991,163	302,863	10%
Paediatric Ear Nose and Throat Disorders	50,630	5,084	10%
Orthopaedic Disorders	833,615	83,338	10%
Ear, Nose, Mouth, Throat and Neck Procedures	176,954	17,354	10%
Paediatric Renal Disorders	24,532	2,392	10%

A spokesman for City and Hackney CCG said: “Closely working with all partners, City and Hackney Clinical Commissioning Group has reduced the numbers of excessive days by over 40% in the last year. This improvement continues through the joined up work of our Integrated Discharge Service and Integrated Independence Team who help ensure our residents transition from hospital to their homes with the right support.”

Story updated 14:17 with comment from City and Hackney CCG.