Continuing a portfolio approach to LTC Workstream

We ended last Wednesday's piece with a portfolio approach to Long Term Conditions. Just to reiterate, this will help to align individual projects to the overall strategic aims of the health economy, organisation, and workstream.

We'd just defined the main benefits across the whole workstream (World Class Commissioning competencies in brackets):

• quality of life (WCC 3)
• care per £ (WCC 5, 9, 11)
• units of appropriate care delivered (WCC 2, 7, 8)
• coverage of target population (WCC 3, 5, 10)
• future improvements (WCC 8, 10, 11)
• staff retention and recruitment (WCC 4)

Taking one particular area, COPD (Chronic Obstructive Pulmonary Disorder - respiratory disease)

In this case, for each of the high-level benefits listed, a benefit can also be measured within the COPD area:

High Level Benefit	in COPD
Quality of life	Motility, ability to get around Pt satisfaction
Care per £	cost of A&E services for COPD (HRG codes . . .) cost of admissions ( . . ) costs of community services 999 attendance and admission costs incurred/ saved using community services
Units of care delivered	numbers receiving treatment for each level of severity
Coverage of total population	estimates of population with COPD from deprivation levels, mapped estimates of population aligned to this using social marketing techniques numbers on register at GPs numbers on care plans
Future Improvements	innovative pathways use of innovative pathways resources needed for new pathways
Staff retention & recruitment	current staff levels & competences future requirements gap analysis completed and reviewed education commissioned

Individual projects within COPD, such as 'Stop Smoking', 'Pulmonary Rehabilitation', 'Home Management' etc) will record improvements to one or more of these benefits.

The benefits from each individual project can be aggregated (for example, if there are 120 fewer people smoking after 12 months than there were at the start, there will always be a question how many were as a result of 'Stop Smoking' which saw 200 clients, and how many as part of 'Get Active', 'Healthy Eating' or any number of other initiatives which could have an impact? The numbers from each programme can't always be added together) and make their contribution. The combined contribution to eg User Experience (to use the four quadrants from earlier) will make a contribution to the overall PE (Patient Experience, another name for User Experience) measure across the whole health economy.

Reporting back - next