Ophthalmology Service Model Redesign Engagement Event Thursday 9th May 2019 9:30am - 12:30pm 6 th Floor, Marriss House Sue Borrington – Senior Commissioner Wirral Health and Care Commissioning is a strategic partnership between 1 NHS Wirral Clinical Commissioning Group and Wirral Council
Introduction & Overview of the Morning • Purpose of the morning • Agenda • Housekeeping Wirral Health and Care Commissioning is a strategic partnership between 2 NHS Wirral Clinical Commissioning Group and Wirral Council
Ophthalmology in Wirral • Ageing Population • Mixture of affluent areas and deprived • Overall poor health • Smoking and obesity are prevalent 3
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Wirral - Current Providers Primary Eyecare Wirral 27 x Community Optometrists Wirral Health and Care Commissioning is a strategic partnership between 5 NHS Wirral Clinical Commissioning Group and Wirral Council
Location of CCG commissioned Ophthalmology services Wirral University Foundation Teaching Hospital (WUTH) Wirral Vision Spa Medica Wirral Community Foundation Trust Community Optometrists Wirral Health and Care Commissioning is a strategic partnership between 6 NHS Wirral Clinical Commissioning Group and Wirral Council
Costs • Direct Costs £16,700,000pa • Indirect Costs £31,400,000pa • Wider Economic Impact £110,000,000pa Wirral CCG: Ophthalmology expenditure year on year Wirral CCG costs are rising 14/15 15/16 16/17 17/18 18/19 by around £1/2 million per 10,503,734 11,794,363 11,410,925 11,297,903 12,104,345 annum Main Areas of Growth are: -Phacoemulsification Cataract Extraction and Lens implant -Age Related Macular Degeneration (AMD) -Diagnostic CT Scans 7
Expenditure Outpatients 2016/17 Wirral Health and Care Commissioning is a strategic partnership between 8 NHS Wirral Clinical Commissioning Group and Wirral Council
Receipt of Social Care for Visual Impairment 2013/14 Wirral Health and Care Commissioning is a strategic partnership between 9 NHS Wirral Clinical Commissioning Group and Wirral Council
Main Causes of Sight Loss on Wirral 10
AMD • In Wirral, we estimate that: • 15,600 people are living with the early stages of AMD; • 1,210 are living with late stage dry AMD; • 2,480 are living with late stage wet AMD. • 3,500 combined late stage AMD. Between 2018 and 2030 there is estimated to be an increase of 27% in the number of people living with late stage AMD in Wirral 11
Cataract • In Wirral, we estimate that 3,860 people are living with cataract Between 2018 and 2030 there is estimated to be an increase of 28% in the number of people living with cataract in Wirral. 12
Estimated Incidence of Cataract 2.10% 2.00% 1.90% 1.80% 1.70% 1.60% Series1 1.50% 1.40% Chester Warrington Wirral Congleton Crewe & Ellesmere Macclesfield Vale Royal Nantwich Port & Neston Source: NEHEM Population Estimates 13
Glaucoma • In Wirral, estimated that 6,890 people are living with ocular hypertension. • A further 3,750 people are living with glaucoma. Between 2018 and 2030 there is estimated to be an increase of 19% in the number of people living with glaucoma in Wirral 14
Diabetic Eye Disease • In Wirral: • 21,800 adults have diagnosed diabetes. • 6,410 people are living with diabetic retinopathy. • Of these, 590 have severe diabetic retinopathy. Between 2018 and 2030, estimated to be an increase of 1% in the number of people living with diabetic retinopathy in Wirral. 15
Uptake of Diabetic Eye Screening 2009/10 88 0.035 CVIs for diabetic eye disease per 1,000 population 87 0.03 % uptake of diabetic retinopathy screening 86 0.025 85 0.02 84 0.015 83 0.01 82 0.005 81 0 England Eastern Cheshire West Cheshire Warrington Wirral Vale Royal South Cheshire % of diabetic population receiving screening CVIs as a result of diabetic eye disease (cases per 1,000 population) 16
Non-Elective Admissions 2016/17 Wirral Health and Care Commissioning is a strategic partnership between 17 NHS Wirral Clinical Commissioning Group and Wirral Council
Falls In Wirral, it is estimated that: • 1,490 people with sight loss aged over 65 experience a fall per year • Of these falls, 700 are directly attributable to sight loss • 120 people aged over 65 with sight loss experience a severe fall per year • Of these severe falls, 55 are directly attributable to sight loss 18
Case for change • Ageing Population / Rising Incidence • Importance of prevention • Reduce non-elective admissions • Ensure continual quality improvements • Effective use of resources • Requirement to re-procure • Maximise future outcomes for patients Wirral Health and Care Commissioning is a strategic partnership between 19 NHS Wirral Clinical Commissioning Group and Wirral Council
Questions? Wirral Health and Care Commissioning is a strategic partnership between 20 NHS Wirral Clinical Commissioning Group and Wirral Council
Exercise 1 – Our Current Model For your patient: Add to the patient’s pen picture and describe their pathway Identification of: • The good stuff - what works well? • What could be better? • Service gaps / duplication Agree top three priorities for improvement. Wirral Health and Care Commissioning is a strategic partnership between 21 NHS Wirral Clinical Commissioning Group and Wirral Council
Exercise 2 – The Patient Journey and Expected Outcomes For your patient: Describe their future ideal pathway How would this differ to the previous pathway? Consider: Service demand / waiting times Urgency of appointment What outcomes would be realised? Patient / Provider / commissioner What works elsewhere Service accessibility Wirral Health and Care Commissioning is a strategic partnership between 22 NHS Wirral Clinical Commissioning Group and Wirral Council
Exercise 3 – The Future Model What might the future model look like? The community offer? Managing demand on acute services? Access points / referral management? What one key change would make a difference? Consider: Ideas from other areas Potential areas of growth What might be the strengths of this model? What might be the limitations? What are the barriers? What contracting model might suit this service? 23
Summary of Today • Next Steps • Questions and Answers • Feedback forms Wirral Health and Care Commissioning is a strategic partnership between 24 NHS Wirral Clinical Commissioning Group and Wirral Council
Thank you! Wirral Health and Care Commissioning is a strategic partnership between 25 NHS Wirral Clinical Commissioning Group and Wirral Council
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