Ear,Nose and Throat Surgery - GIRFT

Ear,Nose and Throat Surgery 
GIRFT 1 November 2019

• The GIRFT review of ENT services visited 126 units across the country. This report highlights a significant degree of unwarranted variation in a number of key areas in delivery of ENT surgery and suggests how the many examples of good practice in the delivery of ENT services could be adopted in order to improve patient care and outcomes.
• The report makes 23 recommendations including increasing day case rates for tonsillectomy operations.

Atlas of Variation

The Atlas of Variation
NHS RightCare, PHE updated September 2019

• The Atlas of Variation comprises a series of publications documenting variation in health and heathcare across a range of themes, including palliative care, liver diseases, diagnostics.
• The data on variation shown in the atlases can be triangulated with data from other sources such as PHE’s National Intelligence Networks, Health Profiles and Spend and Outcome Tools.
• It also includes a CCG Opportunity Locator.
• September 2019- 2nd Atlas of variation in risk factors and healthcare for respiratory disease
• Includes Risk Factors, COPD, Asthma, Pneumonia, Bronchiolitis, All Respiratory Disease Health Service Provison, Tuberculosis, Lung Cancer, Lung Transplantation, End of Life, Case Studies
• Interactive Respiratory Atlas 2019

Home to the unknown: Getting hospital discharge right

Home to the unknown: Getting hospital discharge right
Red Cross 2019

• Research about patients’ experience of discharge from hospital and their transition from hospital to home reveal that, despite a wealth of guidance on ‘ideal’ hospital discharge and examples of excellence and good practice, problems persist. 
• Discharge processes vary considerably, not just between nations but within even local areas.

Oral and Maxillofacial Surgery: GIRFT Programme National Specialty Report

Oral and Maxillofacial Surgery: GIRFT Programme National Specialty Report
Getting It Right First Time, 28 November 2018

• The GIRFT review into oral and maxillofacial surgery across England outlines the need to centralise services and build on existing hub and spoke networks and for a standard protocol which will reduce unwarranted variations in the number of hospital follow-up appointments after surgery. In the most straight-forward of cases, eg; dental extractions, the report suggests a target of zero follow-up appointments.

Breast cancer reconstruction in England: variation in CCG policies

Rebuilding my body: Breast reconstruction in England
Breast Cancer Now, 18 June 2018

• Evidence from FOI requests conducted in 2017 shows that 47 out of 208 CCGs (22.6%) have established policies to restrict reconstruction services for non-clinical reasons, with a further nine CCGs (4.3%) having draft policies or informal restrictions in place (see p18/19). The report makes recommends for CCGs to support shared decision making, availability of surgery and patient expectations. 
• At the same time new guidelines have been published by the Association of Breast Surgery Guidance for the Commissioning of Oncoplastic Breast Surgery

At the same time new guidelines have been published by the Association of Breast Surgery:

Guidance for the Commissioning of Oncoplastic Breast Surgery
 Association of Breast Surgery June 2018 

Geographic variation in unplanned admissions

Using geographic variation in unplanned ambulatory care sensitive condition admission rates to identify commissioning priorities: an analysis of routine data from England
Journal of Health Services Research & Policy, 30 November 2016

Abstract
Objectives: To use geographic variation in unplanned ambulatory care sensitive condition admission rates to identify the clinical areas and patient subgroups where there is greatest potential to prevent admissions and improve the quality and efficiency of care.

Methods: We used English Hospital Episode Statistics data from 2011/2012 to describe the characteristics of patients admitted for ambulatory care sensitive condition care and estimated geographic variation in unplanned admission rates. We contrasted geographic variation across admissions with different lengths of stay which we used as a proxy for clinical severity. We estimated the number of bed days that could be saved under several scenarios.

Results: There were 1.8 million ambulatory care sensitive condition admissions during 2011/2012. Substantial geographic variation in ambulatory care sensitive condition admission rates was commonplace but mental health care and short-stay (less than 2 days) admissions were particularly variable. Reducing rates in the highest use areas could lead to savings of between 0.4 and 2.8 million bed days annually.

Conclusions: Widespread geographic variations in admission rates for conditions where admission is potentially avoidable should concern commissioners and could be symptomatic of inefficient care. Further work to explore the causes of these differences is required and should focus on mental health and short-stay admissions.

Atlas of Variation 2015 Opportunity Locator tool

Atlas of Variation 2015 Opportunity Locator tool
Right Care December 2015

• The Atlas of Variation Opportunities Locator is a companion tools to the NHS Atlas of Variation 2015. It uses the same data and maps but allows local commissioners to select and view the CCG and Local Authority maps for their own local population across a wide range of disease areas contained in the Atlas.

Using variation to identify opportunities for disinvestment

Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study.
Health Serv Deliv Res 2015;3(13)

• There is large inter-PCT variability in procedure rates for common NHS procedures. Variation is highest where the diffusion or discontinuance is rapidly evolving and where substitute procedures were available, suggesting that variation may be a proxy for clinical uncertainty about appropriate use. 
• Using data from two PCTs the researches examined opportunities and barriers for disinvestment. 
• Evidence to support commissioning decisions was limited. 
• Commissioning meetings were dominated by new funding requests and benchmarking did not appear to be routinely carried out because of capacity issues and concerns about data reliability. 
• Perceived barriers to disinvestment included lack of collaboration, central support and tools for disinvestment. 
• Clinicians felt threshold criteria had little impact on their practice and that prior approval systems would not be cost-effective.