As a guide, specialist lymphoedema services could expect each 1.0WTE lymphoedema therapist to hold a caseload of 200-220 patients/year but this is dependent on the availability of administrative support and clinical assistants. Based on the estimated prevalence (see Appendix 1) and the cost per patient per year of £951, the cost of the service is estimated to be: xxx patients x £951 per year = £xxx,xxx Total cost per year [INSERT SUMMARY based on CCG/STP calculations] The savings from reduced admissions (estimated to be 87% reduction in hospital admissions due to lymphoedema), and improved effectiveness of prescribing are estimated to be: [Local data] [INSERT SUMMARY based on CCG/STP calculations] 4.2 Option appraisal The following options should be considered (see Figure 3): Figure 3: Options appraisal Advantages Disadvantages Option 1: Do nothing None The benefits shown in Figure 2 will not be realised Option 2: Develop a comprehensive lymphoedema service at CCG level The benefits shown in Figure 2 will be realised Service is more adaptable to local needs Project implementation requires set up costs and management capacity More difficult to recruit to small services and less skill mix Small services are less resilient Fewer patients can access service Option 3: Develop a comprehensive lymphoedema service at STP level The benefits shown in Figure 2 will be realised Larger service footprint covers more patients Larger services are more resilient Easier to recruit and better skill-mix Project implementation requires set up and management capacity Set up phase for a larger service may take longer
and reduced waste, lower incidences of cellulitis and reduced hospital admissions) appear largely unrecognised by commissioners. Education and training of both the specialist and non-specialist lymphoedema workforce is a clear priority moving forward. The issues and challenges faced by these services appear to be long-standing and are unlikely to be resolved without a comprehensive strategy (encompassing both primary and secondary lymphoedema) within each STP. 2. Outcomes 2.1 NHS Outcomes Framework Domains & Indicators 2.2 Local defined outcomes Services can select from the following nationally recognised tools to assess their outcomes: Patient experience Macmillan 9 outcomes Service quality and patient experience: Principles and Expectations of Good Adult Rehabilitation See also Section 5 for quality requirements. 3. Scope
Frequency of data collection Quarterly Organisation responsible for data collection Provider Frequency of reporting to commissioner Quarterly Baseline period/date 2016/17 activity and outcomes Baseline value Enter the baseline value indicator period/date (on which payment is based) Q4, 2017/18 Final indicator value (payment threshold) Introducing the agreed initiatives as set out in their plan Rules for calculation of payment due at final indicator period/date (including evidence to be supplied to commissioner) Payment to be based on achievement of in-year milestones. Evidence (a lymphoedema improvement plan) must be produced at quarterly clinical quality review meetings for review. Payment is triggered based on % delivery of implementation plan. Final indicator reporting date 31 March 2018 Are there rules for any agreed in-year milestones that result in payment? Yes If yes, please details in tables below. Are there any rules for partial achievement of the indicator at the final indicator period/date? No Exit Route – how will the change including any performance requirements be sustained once the CQUIN indicator has been retired? Option A: As per TCST service specification, outcome indicators and an agreed selection of key performance indicators are included within 2018/19 Contract (Quality Requirements schedule). Option B: Using TCST service specification and progress made against the 17/18 CQUIN, a service development improvement plan is agreed within 2018/19 contract (and includes clear milestones for delivery with consequences of failure).
Milestones (only complete if the indicator has in-year milestones) Date/period milestone relates to Rules for achievement of milestones (including evidence to be supplied to commissioner) Date milestone to be reported Milestone weighting (% of CQUIN scheme available) Quarter 1 1. Provider conducts a robust baseline assessment against pan London specification AND 2. The Provider’s Clinical Quality Review Meeting agrees implementation plan with commissioners in June 2017. 30/06/2017 Enter the weighting of the milestone as a percentage of the total CQUIN scheme for each quarter Quarter 2 50% completion of implementation plan 30/09/2017 Quarter 3 75% completion of implementation plan 31/12/2017 Quarter 4 100% completion of implementation plan 31/03/2018 Total Auto completed If milestones are specified, this total should equal the overall indicator weighting (from cell B6 in the indicator sheet). for partial achievement at final indicator period/date (only complete if the indicator has rules for partial achievement at final indicator period/date) Final indicator value (payment threshold) % of CQUIN scheme available Enter the final indicator value for the part achievement threshold the percentage of the total CQUIN scheme available for meeting the final indicator value