Commissioning a Fracture Liaison Service

Salisbury District HospitalDr Zoe Cole

5th February 2016

History

2002 Heel ultrasound2007 DXA machine2007 First business case for FLS2011 3rd business case rejected (QOF)2013 New Consultant started

Performance against Best Practice Tariff

2009-2010

(£445 per patient)

1.5%(2)

Ranked 98th out of

100 hospitals.

Income: £890

2010-2011

(£890)

58%(131)

Ranked 12th out of

the 176 hospitals.

Income: £116,590

2011-2012

(£890)

84.7% (205/242)

Ranked 1st in the

Southwest

Region, Ranked

4th Nationally

(out of more than

200 NHS Trusts)

Income: £187,790

Outcomes

• BEST PRACTICE TARIFF % for 2012-2013: 85.7% (220/257)

• Length of stay reduced by 7.82 days from 27.6days to 20.09 days (April 2012-March 2013)

• £509,960 saved: 2,549 bed days at £200 per day • Mortality reduced from 10.1% to 7.4%• Re-admissions reduced from 4 (2010/11) to 2

(2011/12)• Positive Feedback from patients, families and staff.

(Real time feedback and very few complaints)

Bone protection on admission

Area %

Slough 22.2

Oxford 21.4

Basingstoke 14.8

Southampton 14.4

IOW 10

Milton Keynes 9.4

Stoke Mandeville 9.1

Reading 8.3

Salisbury 3.2

Portsmouth 5.2

Salisbury experience pre and post QOF

2011 Audit

• 56% not investigated• 24% on treatment• 6% re-fractured (2 hip)

2013 Audit

• 56% not investigated• 12% treatment• 6% re-fractured

50 patients who presented with colles fractures followed up at 6 months with telephone call to assess what treatment they were on.

2013

New business case put together

Help from business writing course

Health economist

HES data

Dr Foster data

Previous local and national audit

DoH FLS economic case

2014

• Case presented to Primary care forum

• Presented at Sarum CCG meeting

Full support

• Refused at Wiltshire CCG executive meeting

Economic benefits not great enough

Public Health

• Wiltshire Falls and Bone health group

External report by NHS England

First priority FLS

£30,000 promised 2015/16 only

NOS Dec 2014

• Discussed case with Tim Jones

Strong case

NOS writing new economic model

Salisbury test case

2015

• Jan-Feb: Met with CCGDecided case fitted with Better Care Fund

Whole new case written (new templates)

Year

2015 2016 2017 2018 2019 All years

Net benefit (NHS only)

-£25,634 £77,751 £183,081 £270,574 £346,759 £852,531

Net benefit (NHS and social care)

£61,833 £238,523 £419,539 £570,903 £703,858 £1,994,655

Progress to date

• March: Presented to Better Care

Pilot funding given for 2 years (verbal)

• August: written confirmation

• Nov: FLS nurse started

• Jan 2016: FLS live

McLellan et al. Osteporos Int 2003;14:1028–1034 14

Thank you

Tim Jones

Hilary Arden

Fizz Thompson

Sonya Stephenson

Kassim Javaid

Friscy

Lynn Talbot

Stuart Eastman

All colleagues at SDH