Equality analysis and assessment of outcomes

Mark Youlton

Acute commissioning

Cathy Gardener

01282 644877

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  East Lancashire Hospitals Trust
  
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  Other providers
  
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  GP’s / GP Minor Surgery DES/LES providers
  
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  Public Health
  
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  GP Participation Groups
  
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  Patient Advice Liaison Service (PALS)
  
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  NHS England
  
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  Monthly service review meetings
  
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  Patient Group meetings
  
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  Healthwatch
  

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  The CCG will hold locality communication / engagement events.
  

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  Public involvement – Options of service delivery will be shared and views will be sought to inform the service specification
  

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  Patient focus group feedback analysis
  

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  The CCG’s Integrated Strategic Plan 2013-18 sets out a strategic commitment to deliver more care in the community and in locations closer to patients’ homes.
  

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  The World Health Organisation (WHO) and European Bone and Joint Health Strategies Project identified:
  
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    MSK conditions are the most common reason for repeat consultations with a GP – up to 30% of primary care consultation
    
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    Up to 60% of people on long term sick leave cite MSK problems as a reason
    
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    40% of people over 70 have osteoarthritis of the knee
    
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    It is estimated that 8-10 million people in the UK have arthritis – 1 million are adults under the age of 45
    
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    Low back pain is reported by about 80% of people at some time in their life
    

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  Musculoskeletal conditions are the second most common reason for claiming employment and support allowance in England and this is mirrored in the North West region.
  

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  Using the template provided by Parsons et al (2011), it is estimated that in Lancashire there are approximately 77,168 males and 109,029 females with musculoskeletal conditions (based on 2011 Census population).
  

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  PROMS demonstrates that a significant proportion of patients see little or no improvement post-surgery for joint replacement and would not have had surgery had they been fully aware of the outcomes prior to their surgery.
  

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  Musculoskeletal problems are expected to rise significantly between now and 2030 with the ageing population, increasing rates of obesity and low rates of physical activity. For example, the number of people with arthritis in the UK is expected to rise from 8.5 million to 17 million, causing an increased demand for joint replacement. (Ref: Arthritis Care (2011). Report. Understanding Arthritis
  

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  Commissioning intelligence from Advice & Navigation suggest that 17% of referrals that were intended for 2º care orthopaedic services could be managed in an alternative setting.
  

Community Integrated Assessment Service for MSK, Rheumatology and Chronic Pain Management team offers assessment, treatment and advice plus education to patients on self-management of their condition.

The provider will be expected to use economies of scale and reduction of inefficiencies in patient pathways to provide the service within a reduced financial envelope.

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  The CCG will work within national guidance from Monitor and NHS England in regard to 'below' tariff' pricing. This will include working within the principles of the patients’ best interests, transparency and proactive engagement
  
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  Some procedures such as joint injections & carpal tunnel will be decommissioned from orthopaedic secondary care and will be provided in the new service or primary care.
  
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  The savings are based on efficiencies from Rheumatology and Pain Management in addition to the above reduction in day cases.
  
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  A percentage of these savings will be used by the provider to manage the increased in demand for the integrated service (joint injections/carpel tunnel/patients deflected from secondary care services) and additional costs associated with providing a comprehensive service in all five localities.
  
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  The service will be widely used by East Lancashire GPs as first point of all orthopaedic secondary care referrals to allow triage to take place.
  
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  As a consequence of the new service model it is anticipated that the demand for Orthopaedic referrals will reduce.
  

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  Full Orthopaedic/Rheumatology/Pain & MSK Management budget (minus agreed % to reflect efficiency gains) to one provider who may subcontract other service providers (eg Prime Contract Model)
  
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  Integrated pathways to support patient movement through the whole system
  
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  Allows for greater innovation, service improvements and economies of scale
  
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  Prevents providers competing for patients as it is whole system approach and not funded on an activity basis
  
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  Long term condition support and patient management in the community
  
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  Increase in the number of treatments available within the community
  
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  Provide full range of services within each locality, including the newly built Colne Heath Centre
  
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  Care provided by the most appropriate health professional
  
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  Community referrals to patient support groups and third sector organisations improve holistic support for patients
  

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  MSK service which is led by (GPwSI) providing a restricted range of services in the community at various health centres across East Lancashire
  
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  Comprehensive range of Consultant led services provided by ELHT in an Acute setting for Rheumatology, Orthopaedics and Physiotherapy
  
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  Community Physiotherapy service provided in a range of services across East Lancashire
  
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  MDT - Pain Management service provided by ELHT
  

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  All research evidence base references including nice guidance and publication – please give full reference
  

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  Department of Health Guidelines – MSK Services Framework cites best practice as an integrated MSK service with Rheumatology and Pain Management. This framework is evidence based and has been subject to substantial patient, clinician and stakeholder engagement.
  

The World Health Organisation (WHO) and European Bone and Joint Health Strategies Project identified:

• 
  MSK conditions are the most common reason for repeat consultations with a GP – up to 30% of primary care consultation
  
• 
  Up to 60% of people on long term sick leave cite MSK problems as a reason
  
• 
  40% of people over 70 have osteoarthritis of the knee
  
• 
  It is estimated that 8-10 million people in the UK have arthritis – 1 million are adults under the age of 45
  
• 
  Low back pain is reported by about 80% of people at some time in their life
  

• 
  PROMS demonstrates that a significant proportion of patients see little or no improvement post-surgery for joint replacement and would not have had surgery had they been fully aware of the outcomes prior to their surgery.
  

• 
  Musculoskeletal problems are expected to rise significantly between now and 2030 with the ageing population, increasing rates of obesity and low rates of physical activity. For example, the number of people with arthritis in the UK is expected to rise from 8.5 million to 17 million, causing an increased demand for joint replacement.
  

• 
  Using the template provided by Parsons et al (2011), it is estimated that in Lancashire there are approximately 77,168 males and 109,029 females with musculoskeletal conditions (based on 2011 Census population).
  

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  Patients / Public Sector
  
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  CCG
  
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  Clinicians
  
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  Acute Trust
  

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  Integrated Care delivered closer to home for assessment and treatment improving access for patients.
  
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  Increase in range and level of activity and physical performance
  
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  Increase patient experience
  
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  Facilitation of well supported self-management for those with chronic musculoskeletal conditions
  
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  Patients are able to self-manage their condition
  
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  Improved patient quality of life, and return to work or normal social function where appropriate
  
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  Reduced waiting times
  
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  Improve patient outcomes
  

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  Improve staff skill mix in the community service
  
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  Reduce inappropriate referrals to secondary care services that can be seen and assessed within the community
  
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  Release limited secondary care resources for activity that only they can provide (more acute and complex diagnosis)
  
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  Improve GP satisfaction rates with MSK, Rheumatology and Chronic Pain services
  
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  Increase knowledge and understanding of managing MSK, Rheumatology and Chronic Pain conditions by primary practitioners
  

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  Integrated MSK, Rheumatology and Pain Management community service allowing greater flexibility to design pathways to improve quality outcomes and reduce inefficiencies.
  
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  Economies of scale – reduction in management costs
  
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  Flexible use of alternative contracting models to reduce costs in overall budget and increase value for money
  
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  Reduced waiting times for Community Care
  
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  Management of 2º Care demand reducing 18 week pressures and contract over-performance
  
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  Will provide a single point of access for MSK, Rheumatology and Pain Management referrals, ensuring patients are placed on the most appropriate clinical pathway
  
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  Greater use of primary care and the 3rd sector to promote self-help and provide more holistic support for patients
  
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  Better use of existing community estate (i.e. LIFT centres)
  
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  Increase in the number and types of treatments provided within the community/localities (including the new Colne health centre)
  
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  Care delivered closer to home for assessment and treatment improving access for patients
  

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  The service provider will conduct customer satisfaction surveys on a bi-annual basis
  
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  Patient and referrer feedback is reviewed and acted upon by the provider/s
  
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  Patients to participate in the friends and family test
  
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  The Provider will be required to deliver a performance framework relating to the service, designed to inform the CCG as the commissioner about the performance against the outcomes and KPIs.
  
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  Evaluation of evidence from the service to demonstrate future requirements.
  

Does not impact on any human rights

Cost saving are anticipated from implementing this service

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  Have a positive impact (benefit) on any of the groups?
  
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  Have a negative impact / exclude / discriminate against any person or group?
  
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  Explain how this was identified? Evidence/ Consultation?
  

Low back pain is reported by about 80% of people at some time in their life

Current evidence implies that older people are more susceptible to the experience of pain than any other sector of the population. National UK statistics report approximately 50 per cent of people aged 65 years and older are in some degree of pain or discomfort – nearly 5 million older people. The proportions for the over-75s increases to 56 per cent of men and 65 per cent of women. This equates to over 1 million men and nearly 2 million women, which is illustrative of the gender differences in pain across age.

Y

N

Orthopaedic and MSK related conditions fall into disability therefore having a service which is accessible to more people means that this is a positive impact.

N/A

N/A

Employment Only

N/A

N/A

One of the most significant changes in the demography has been the increase in numbers of different ethnic minorities coming to live and work in the UK especially from Eastern European community’s i. e members of the Polish communities.

Y

N

Y

N

Y

N

There is no local statistics available for this protected group.The IHS data in the survey period April 2011 to March 2012 indicate that:

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  93.9 per cent of adults identified themselves as Heterosexual/Straight,
  
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  1.1 per cent of the surveyed UK population, approximately 545,000 adults, identified themselves as Gay or Lesbian,
  
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  0.4 per cent of the surveyed UK population, approximately 220,000 adults, identified themselves as Bisexual,
  
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  0.3 per cent identified themselves as ‘Other’,
  
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  3.6 per cent of adults stated ‘Don’t know’ or refused to answer the question,
  

Y

N

All staff members will adhere to company policy and will have undertaken the relevant Equality and Diversity training.

From the latest CCG report (Dec13 publication) and results from 5915 GP patient surveys, within East Lancashire there are 5508 heterosexual/straight people, 66 Gay/Lesbians, 43 Bi-sexual, 36 other and 262 preferred not to say.

From the CCG December 13 GP Patient Survey publication, the following category:

Y

(see guidance note below)

The action plan will be monitored in line with the progress of the pilot, regular reviews will take place within the monthly project meetings

July 2014

East Lancashire CCG