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Wirral Health and Care Commissioning is a strategic partnership between

NHS Wirral Clinical Commissioning Group and Wirral Council 1

Ophthalmology Service Model Redesign Engagement Event

Thursday 9th May 2019

9:30am - 12:30pm

6th Floor, Marriss House

Sue Borrington – Senior Commissioner

Wirral Health and Care Commissioning is a strategic partnership between

NHS Wirral Clinical Commissioning Group and Wirral Council 2

Introduction & Overview of the Morning

• Purpose of the morning

• Agenda

• Housekeeping

3

Ophthalmology in Wirral

• Ageing Population • Mixture of affluent areas and deprived • Overall poor health • Smoking and obesity are prevalent

4

Wirral Health and Care Commissioning is a strategic partnership between

NHS Wirral Clinical Commissioning Group and Wirral Council 5

Wirral - Current Providers

Primary Eyecare Wirral

27 x Community Optometrists

Wirral Health and Care Commissioning is a strategic partnership between

NHS Wirral Clinical Commissioning Group and Wirral Council 6

Wirral University Foundation Teaching Hospital (WUTH)

Wirral Vision

Spa Medica

Wirral Community Foundation Trust

Community Optometrists

Location of CCG commissioned Ophthalmology services

Costs

• Direct Costs £16,700,000pa

• Indirect Costs £31,400,000pa

• Wider Economic Impact £110,000,000pa

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14/15 15/16 16/17 17/18 18/19

10,503,734 11,794,363 11,410,925 11,297,903 12,104,345

Ophthalmology expenditure year on yearWirral CCG costs are rising by around £1/2 million per annum Main Areas of Growth are: -Phacoemulsification Cataract Extraction and Lens implant -Age Related Macular Degeneration (AMD) -Diagnostic CT Scans

Wirral CCG:

Wirral Health and Care Commissioning is a strategic partnership between

NHS Wirral Clinical Commissioning Group and Wirral Council 8

Expenditure Outpatients 2016/17

Wirral Health and Care Commissioning is a strategic partnership between

NHS Wirral Clinical Commissioning Group and Wirral Council 9

Receipt of Social Care for Visual Impairment 2013/14

Main Causes of Sight Loss on Wirral

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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.

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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

• In Wirral, we estimate that 3,860 people are living with cataract

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Cataract

Between 2018 and 2030 there is estimated to be an increase of 28% in the number of people living

with cataract in Wirral.

Estimated Incidence of Cataract

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1.40%

1.50%

1.60%

1.70%

1.80%

1.90%

2.00%

2.10%

Chester Warrington Wirral Congleton Crewe &Nantwich

EllesmerePort &Neston

Macclesfield Vale Royal

Series1

Source: NEHEM Population Estimates

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

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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.

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Between 2018 and 2030, estimated to be an increase of 1% in the number of people living with diabetic

retinopathy in Wirral.

Uptake of Diabetic Eye Screening 2009/10

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% of diabetic population receiving screening CVIs as a result of diabetic eye disease (cases per 1,000 population)

Wirral Health and Care Commissioning is a strategic partnership between

NHS Wirral Clinical Commissioning Group and Wirral Council 17

Non-Elective Admissions 2016/17

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

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Wirral Health and Care Commissioning is a strategic partnership between

NHS Wirral Clinical Commissioning Group and Wirral Council 19

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

Questions?

20 Wirral Health and Care Commissioning is a strategic partnership between

NHS Wirral Clinical Commissioning Group and Wirral Council

Wirral Health and Care Commissioning is a strategic partnership between

NHS Wirral Clinical Commissioning Group and Wirral Council 21

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

NHS Wirral Clinical Commissioning Group and Wirral Council 22

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

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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?

Wirral Health and Care Commissioning is a strategic partnership between

NHS Wirral Clinical Commissioning Group and Wirral Council 24

Summary of Today

• Next Steps • Questions and Answers

• Feedback forms

Wirral Health and Care Commissioning is a strategic partnership between

NHS Wirral Clinical Commissioning Group and Wirral Council 25

Thank you!