Read more about what information is available to help you and your organisation when managing long term conditions. The HSCIC discussed this topic at HETT 2014, with reference to the following key areas: - The national picture - Population level health information - Mental health minimum dataset - CCG outcomes indicator set - Quality and outcomes framework (QOF) - The national diabetes audit - Prescribing information

1. Managing Long Term Conditions
What information is available to help you and your organisation
Healthcare Efficiency Through Technology 2014

2. The King’s Fund
2

3. The National Picture
• National Institute for Health and Care
Excellence (NICE)
– Quality Standards, Technology Appraisals,
Guidelines; social care, public health, healthcare
• Public Health England (PHE)
• Office for National Statistics
• NHS England
• Department of Health
• Health and Social Care Information Centre
3

4. Population Level Health Information
The prevalence of longstanding illness among men increased overall from 40 per cent in 1993 to around 44 per cent
between 1997 and 2003, but appears to have decreased gradually over the last few years; it was 35 per cent in 2012.
Among women, prevalence increased from 40 per cent in 1993 to 47 per cent in 2004, but has since decreased and
was 41 per cent in 2012.
4
50
45
40
35
30
25
20
15
10
5
0
Percentage with Long Standing Illness
Men
Women
All
Source: Health Survey for England 2012, Trend Tables, Table 11

5. More women than men reported chronic pain
• Overall, 31% of men and 37% of women reported this. The prevalence
of chronic pain increased with age, from 14% of men and 18% of
women aged 16-34 to 53% of men and 59% of women aged 75 and
over. (Source HSE 2011, Chapter 9)
5
70
60
50
40
30
20
10
0
16-34 35-44 45-54 55-64 65-74 75+
Percent
Age group
Men
Women
Figure 9A
Prevalence of chronic pain, by age and sex
Base: Aged 16 and over
• Chronic pain is defined as pain or discomfort that troubles a person all of the time or on and off for more than three
months. It has been shown to be associated with a number of negative outcomes including depression, job loss,
reduced quality of life, impairment of function and limiting daily activities.

6. Less affluent people more likely to report
chronic pain.
• Those living in the lowest income quintile of equivalised household
income were more likely to report having chronic pain (40% of men and
44% of women) than those in the highest income quintile (24% of men
and 30% of women respectively) (Source HSE 2011, Chapter 9)
50
45
40
35
30
25
20
15
10
5
• Chronic pain is defined as pain or discomfort that troubles a person all of the time or on and off for more than three
months. It has been shown to be associated with a number of negative outcomes including depression, job loss,
reduced quality of life, impairment of function and limiting daily activities.
6
0
Highest 2nd 3rd 4th Lowest
Percent
Equivalised household income quintile
Men
Women

7. Relationship between longstanding illness and
mental health
• 34% of men and 42% of women with a
longstanding illness had a high GHQ-12 score;
by contrast, just 7% of men and 11% of women
with no longstanding illness reported probable
mental ill health. (Source: HSE 2012)
• The 12-item General Health Questionnaire
(GHQ-12) is a widely used and validated
measure of mental health.
7

8. Mental Health Minimum Dataset
8

9. Proportion of people who feel supported to manage
their long-term condition
CCG Outcomes Indicator Set
and NHS Outcomes Framework
9
Nationally 65.6% of people feel
supported
CCG variation from 53.9% in
Brent to 75.4% in Newcastle
North and East
Other indicators:
• Health Related Quality of Life
for Carers, aged over 18
years
• Health Related Quality of Life
for People with Long Term
Conditions (and NHSOF)
• Unplanned hospitalisation for
Chronic Ambulatory Care
Sensitive Conditions

10. Emergency Admissions for Alcoholic Liver Disease
10
CCG Outcomes Indicator Set
Other Indicators:
• Under 75 mortality rates from
cardiovascular disease; from
respiratory disease; from liver
disease; from cancer
• Unplanned hospitalisation for
asthma, diabetes and epilepsy in
under 19s
NHS Outcomes Framework
Indicators:
• Excess under 75 mortality rate in
adults with serious mental illness
• Employment of people with
long-term conditions and mental
illness
• Emergency admissions for
people with long-term conditions

11. Quality and Outcomes Framework (QOF)
• The primary use of QOF is an incentive payment
scheme. Its main objective is to improve the quality of
care patients receive by rewarding practices for this
care. It is a voluntary scheme that most practices
participate in – 8020 in 2012/13.
• At HSCIC we use this data for secondary purposes and
publish recorded prevalence, points achieved and
exceptions for each general practice that takes part.
• One of the domains (Clinical) within QOF deals primarily
with long term conditions. There are 20 in total of these
for 2013/14 and they include Cancer, Dementia,
Coronary Heart Disease, Mental Health and Stroke.
11

12. Quality and Outcomes Framework (QOF)
An example of data derived from QOF
0.60%
0.50%
0.40%
0.30%
0.20%
0.10%
Dementia Prevalence in England
• HSCIC publish the QOF annually
• All results are publicly available through www.hscic.gov.uk/qof
• There is an online database of the latest years results at
www.qof.hscic.gov.uk
• The next results for 2013/14 QOF data will be published on the 28th
October 2014
12
0.40% 0.41%
0.43%
0.45%
0.48%
0.53%
0.57%
0.00%
31 Mar 2007 31 Mar 2008 31 Mar 2009 31 Mar 2010 31 Mar 2011 31 Mar 2012 31 Mar 2013

13. Diabetes – The National Diabetes Audit
Age and Gender of Patients with Type
1 Diabetes
Age and Gender of Patients with Type
2 Diabetes

14. Mortality Analysis: 2011-2012
• Linked NDA patients to death registrations using the MRIS
service
• Between 1 January 2012 and 31 December 2012 people with
all types of diabetes were 37.5 per cent more likely to die than
their peers in the general population.
• Among those with Type 1 diabetes, mortality was 129.5 per
cent greater than would be expected if they had the same
mortality rates as the general population in England and
Wales
• People with Type 2 diabetes were 34.5 per cent more likely to
die

15. The range of CCG/LHB care process completion in
England and Wales, 2011-2012
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Blood pressure
Serum creatinine
BMI
Cholesterol
Foot surveillance
Smoking
Urine albuminᵃ
HbA1cᵇ
Eight care processesᶜ
Percentage of patients
Care
process

16. Increasing prevalence of complications in
England and Wales
Complications observed in 2011-2012
Total expected
Complications
Observed
Complications
Additional
complications
Additional risk of
complication among
people with diabetes
Angina 66,755 117,278 50,523 75.7%
Myocardial Infarction (heart attack) 18,574 28,812 10,238 55.1%
Heart Failure 47,019 81,452 34,433 73.2%
Stroke 26,184 35,120 8936 34.1%
Renal Replacement Therapy (ESKD) 5,869 15,415 9546 164.3%
Minor Amputation (below the ankle) 1,343 5,869 4526 336.9%
Major Amputation (above the ankle) 1,033 3,319 2286 221.4%

17. The NDA linked to HES data
This chart shows which CCGs have higher than expected rates of heart failure in
diabetics, taking into account the background complication rate and demography
of their CCG. This utilises the NDA diabetes registrations and data from HES

18. NDA – Practice Level Reports
Table 3: Treatment target achievement rate for all patients in EXAMPLE MEDICAL
CENTRE and England and Wales by treatment target, audit year and diabetes type
All diabetesᵃ Type 1 Type 2
2009-
2010
2010-
2011
2011-
2012
2009-
2010
2010-
2011
2011-
2012
2009-
2010
2010-
2011
2011-
2012
HbA1c
<48mmol/mol
(6.5%)ᵇ
Your practice 25.4% 23.9% 20.4% 2.0% 4.4% 2.2% 27.4% 25.5% 22.0%
England & Wales 25.0% 24.8% 24.7% 7.1% 6.8% 6.5% 26.7% 26.4% 26.2%
HbA1c
≤58mmol/mol
(7.5%)ᵇ
Your practice 63.6% 62.0% 57.7% 22.4% 17.8% 21.7% 67.3% 65.6% 60.7%
England & Wales 63.3% 63.3% 62.7% 28.7% 28.1% 27.0% 66.6% 66.5% 65.8%
HbA1c
≤86mmol/mol
(10.0%)ᵇ
Your practice 93.8% 93.0% 91.1% 79.6% 73.3% 71.7% 95.1% 94.6% 92.7%
England & Wales 92.5% 92.1% 91.9% 83.2% 82.4% 81.9% 93.4% 93.0% 92.8%
Target BPᶜ Your practice 48.9% 49.8% 48.5% 47.7% 60.5% 53.5% 49.1% 48.9% 48.2%
England & Wales 35.2% 36.2% 38.8% 49.1% 49.9% 51.9% 34.0% 35.0% 37.7%
BP <140/80ᵈ Your practice 59.9% 57.6% 60.3% 54.5% 67.4% 55.8% 60.4% 56.9% 60.7%
England & Wales 43.9% 44.6% 48.1% 54.7% 55.3% 57.9% 42.9% 43.7% 47.3%
Cholesterol
<4mmol/L
Your practice 30.6% 40.0% 38.6% 17.8% 29.3% 34.1% 31.7% 40.8% 39.0%
England & Wales 40.0% 40.7% 40.4% 30.5% 30.4% 29.7% 40.8% 41.6% 41.3%
Cholesterol
<5mmol/L
Your practice 68.2% 75.9% 75.5% 53.3% 68.3% 68.3% 69.6% 76.5% 76.0%
England & Wales 77.7% 77.6% 77.0% 72.6% 72.0% 71.1% 78.3% 78.1% 77.5%
Meet all
treatment
targetsᵉ
Your practice 24.7% 23.7% 21.2% 12.5% 9.1% 13.6% 25.9% 24.9% 21.9%
England & Wales 19.3% 19.7% 20.8% 11.9% 11.8% 11.8% 19.9% 20.3% 21.5%

19. Prescribing Information
19

20. Drugs used in Diabetes prescribed in the
community in England
20
0
5
10
15
20
25
30
35
40
45
1991/92
1992/93
1993/94
1994/95
1995/96
1996/97
1997/98
1998/99
1999/00
2000/01
2001/02
2002/03
2003/04
2004/05
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
2012/13
Prescription Items (millions)
£0
£100
£200
£300
£400
£500
£600
£700
£800
1991/92
1992/93
1993/94
1994/95
1995/96
1996/97
1997/98
1998/99
1999/00
2000/01
2001/02
2002/03
2003/04
2004/05
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
2012/13
Net Ingredient Cost
(£millions)
Items Cost
Diabetes All Prescriptions Diabetes All Prescriptions
10 year % change 105% 61% 119% 20%
5 year % change 38% 25% 29% 2%

21. What data are available?
• Workforce
• Primary Care
• Secondary Care
• Mental Health
• Community Services
• Prescribing
• Population Health
• Social Care
• Patient Experience
• Patient Reported Outcomes Measures
• Clinical Audit
• Clinical Indicators...etc
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22. Useful Links
• Compendium of Population Health Indicators
http://www.hscic.gov.uk/article/1885/Compendi
um-of-Population-Health-Indicators
• Indicator Portal
http://www.hscic.gov.uk/indicatorportal
• Publication Calendar
http://www.hscic.gov.uk/pubs/calendar
• Data Tools
http://www.hscic.gov.uk/article/1662/Tools
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23. Connect with us
www.hscic.gov.uk
@hscic
www.slideshare.net/hscic
0300 303 5678