At our June 2017 South Central Medical Directorate Conference we had a strong focus on clinical leadership and on cardiovascular disease prevention, including sessions on Atrial fibrillation, hypertension and diabetes treatment target achievement and smoking. We asked Dr James Mapstone and Aimee Stimpson from Public Health England to set the scene further.
We all know that CVD prevention is highlighted as a key focus in the funding efficiency section of the Five Year Forward View (FYFV) Delivery plan. The reason is that there is an incredibly strong evidence base for real activity reductions, benefits for the population and reductions in inequalities. By focusing on those most likely to be admitted over the next few years with CVD or associated conditions, the impact will be quick. Evidence from the Smokefree legislation implementation showed an impact within a month that builds over a year.
We have analysed data and looked at variance between STPs and CCGs and this tells us that for Atrial Fibrillation (AF) if registers across the South matched the performance of the practices in Ashford CCG (the best in the South) in 15/16 (i.e. had 96.1% of the estimated prevalence of AF in the population), then 94,276 more people would be on AF registers. Then if all were then anti-coagulated, this would result in: 3,771 fewer people suffering a stroke. [Based on a number needed to treat of 25 for anti-coagulation to prevent 1 case of stroke – PHE menu of preventative interventions v9.0] saving £135 million pounds of net savings in health and care costs every year by year 5
Using benefit modelling from the London hypertension project, if the rate of detection and control of hypertension in the South of England matched that of Canada (best in the world): 8,925 strokes and 3,971 heart attacks could be prevented over 5 years with potential costs avoided of almost £240 million, or if we were able to match Swindon CCG (best in the South of England): 2,121 strokes and 943 heart attacks could be prevented over 5 years with potential costs avoided of almost £57 million.
Therefore I’m pleased to let you know that in the South the STP board chaired by Jennifer Howells, Regional Director NHS England South West has approved a proposal from PHE that in the region we work with other partners including NICE, Public Health England, British Heart Foundation, NHS Improvement, Health Education England and RightCare to focus on our collective efforts on CVD prevention.
We believe that by working together we can deliver change and improved outcomes for our populations. No matter where we are working in the system we all have a clinical responsibility for prevention, whether this is advocacy, ensuring our clinical teams are adequately trained, auditing the prevention opportunities for key patient groups or ensure time given, where possible, to maximise patient fitness for surgery – e.g. stop before the op, weight reduction
We want to be ambitious in our plans and challenge ourselves to be as good as our best performing CCGs or be as good as Canada. We also want to challenge the prevention myths that it takes a long time to get a payback, prevention can’t save the NHS money and the health and wellbeing gap is improving.
The group have agreed to focus on four priority areas – Atrial Fibrillation, Hypertension, Smokefree NHS and CQUINs 1b, 9a-e supported by MECC during the next 12 months and an integrated support offer will be produced. This will set out the ambition, the support available from partners, key resources, tools and our local contacts.
If you’d like to find out more, access your local data, get involved please contact me or my PHE colleague leading this work Dr. James Mapstone, Deputy Regional Director, PHE South firstname.lastname@example.org
In September 2017, Public Health England and NHS England, together with partners, hosted the first of a series of workshops across the region to help local health economies achieve these potential financial savings and reductions in morbidity, mortality and more efficient use of workforce resources.