No funding has been allocated directly to the Venous Thromboembolism (VTE) Exemplar Network. The aim is to mainstream good practice on VTE within the national health service, and the network demonstrates what a number of NHS organisations have achieved.
(2) how much funding has been allocated to the (a) Healthcare Acquired Infection Reduction Strategy, (b) National Venous Thromboembolism Strategy and (c) National Cervical Cancer Vaccination Programme in each of the last five years.
The amounts of funding for the areas requested are as follows.
The following table represents funding from the Department and its arm’s length bodies on the Healthcare Acquired Infection Reduction Strategy. Other organisations have had a role in tackling HCAIs but their expenditure could not be separately identified. For a more detailed breakdown of these costs, please see sections 15 and 16 (p.31-36) of the National Audit Office Report, which can be found at:
www.nao.org.uk/publications/0809/reducing_healthcare_ associated.aspx
£ million 2004-05 6.5 2005-06 7 2006-07 8 2007-08 10 2008-09 24.5 Total 57 Source: National Audit Office (NAO) report: Reducing Healthcare Associated Infections in Hospitals in England—12 June 2009.
The following table shows funding for venous thromboembolism (VTE) prevention strategy for the past five years and the current financial year. These figures do not include any of the funding related to the national VTE Commissioning for Quality and Innovation (CQUIN) goal. Prior to 2007 the funding of VTE prevention work was limited to expenses for the VTE Expert Working Group members and other related domestic costs for hosting meetings.
£ 2004-05 n/a 2005-06 n/a 2006-07 n/a 2007-08 93,500 2008-09 125,936 2009-10 192,764 Total 412,200
A national vaccination programme against human papillomavirus, which causes cervical cancer, began in September 2008. The Department has allocated funds to PCTs for the implementation of the programme. The funding levels (which do not include the cost of the vaccines as this is commercially confidential), which varied by year depending on the number of catch-up cohorts that the vaccine was offered to, were as follows:
£ million 2004-05 n/a 2005-06 n/a 2006-07 n/a 2007-08 n/a 2008-09 18.9 Total 18.9
Current and future funding (£ million) 2009-10 42 2010-11 9.2 Total 52.1
The following guidance and support has been made available on the implementation of the Venous Thromboembolism (VTE) National Commissioning Goal within the Commissioning for Quality and Innovation (CQUIN) payment framework:
Details of the national CQUIN goal on VTE risk assessment for 2010-11 were included within published guidance on the CQUIN payment framework in December 2009.
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091443
Draft guidance on data collection was put onto UNIFY on 26 January 2010 for UNIFY users.
Some basic information on VTE and CQUIN has been put on the Department's website at:
www.dh.gov.uk/en/Publichealth/Healthprotection/Bloodsafety/VenousThromboembolismVTE/DH_113359
Inquiries on the VTE goal within CQUIN from staff in the national health service are being answered individually by the Department and the queries that come up regularly will also be used to form a Frequently Asked Questions section in guidance currently being prepared.
The Department's venous thromboembolism (VTE) risk assessment template was revised in February 2010 in conjunction with the National Institute for Clinical Excellence (NICE) to ensure it was fully compliant with the guidance issued by NICE in January 2010. This then became a National VTE Risk Assessment Tool for hospitals to use. To raise awareness about the risk assessment, information has been put on the Department's website at:
www.dh.gov.uk/en/Publichealth/Healthprotection/Bloodsafety/VenousThromboembolismVTE/DH_113359
The National Patient Safety Agency (NPSA) have been key stakeholders and supportive of the work on preventing venous thromboembolism (VTE) from the outset. As we move into implementation of VTE prevention, appropriate opportunities for greater involvement of NPSA are now emerging.
Information on admitted patients in hospital who have a diagnosis of deep vein thrombosis (DVT) or pulmonary embolism (PE) is shown in the following table—Patients treated by their general practitioner or as out-patients are not included.
Finished consultant episodes by diagnosis4 DVT5 PE6 All relevant ICD codes ICD10 I80.2 2008-09 62,066 46,786 56,029 2007-08 61,050 46,031 49,114 2006-07 61,459 46,257 46,685 2005-06 63,373 48,952 43,360 2004-05 59,695 46,303 40,059 1 A finished consultant episode (FCE) is a continuous period of admitted patient care under one consultant within one health care provider. FCEs are counted against the year in which they end. Figures do not represent the number of different patients, as a person may have more than one episode of care within the same stay in hospital or in different stays in the same year. 2 The information is the number of episodes where this diagnosis was recorded in any of the 20 (14 from 2004-05 to 2006-07) primary and secondary diagnosis fields in a Hospital Episode Statistics (HES) record. Each episode is only counted once, even if the diagnosis is recorded in more than one diagnosis field of the record. 3 Activity in English NHS Hospitals and English NHS commissioned activity in the independent sector. 4 Counts for the different diagnoses shown are not necessarily mutually exclusive and therefore summing the different diagnoses is not possible (e.g. a patient may have a DVT and a PE in a single episode, and would be counted once in each relevant column—double counting would occur if the values were summed). 5 Diagnosis is recorded in HES using ICD10 codes. ICD10 code I80.2 is used for a diagnosis of DVT where there is no further information on the site of the thrombosis. However DVT may also be recorded under a number of different codes, although these codes may also include cases which are not considered deep. The full list of relevant ICD10 codes is as follows: I80.0 Phlebitis and thrombophlebitis of superficial vessels of lower extremities I80.1 Phlebitis and thrombophlebitis of femoral vein I80.2 Phlebitis and thrombophlebitis of other deep vessels of lower extremities I80.3 Phlebitis and thrombophlebitis of lower extremities, unspecified I80.8 Phlebitis and thrombophlebitis of other sites I80.9 Phlebitis and thrombophlebitis of unspecified site O22.2 Superficial thrombophlebitis in pregnancy O22.3 Deep phlebothrombosis in pregnancy O87.0 Superficial thrombophlebitis in the puerperium O87.1 Deep phlebothrombosis in the puerperium 6 Pulmonary embolisms are coded as 126.0 (Pulmonary embolism with mention of acute cor pulmonale) and 126.9 (Pulmonary embolism without mention of acute cor pulmonale). Note: Assessing growth through time: HES figures are available from 1989-90 onwards. Changes to the figures over time need to be interpreted in the context of improvements in data quality and coverage (particularly in earlier years), improvements in coverage of independent sector activity (particularly from 2006-07) and changes in NHS practice. For example, apparent reductions in activity may be due to a number of procedures which may now be undertaken in outpatient settings and so no longer included in admitted patient HES data. Source: Hospital Episode Statistics (HES), The NHS Information Centre for health and social care
At a joint meeting of the Department, Academy of Royal Colleges and Strategic Health Authority Medical Directors in October 2009, it was agreed to work together on tackling venous thromboembolism prevention through professional leadership provided by the Academy coupled with national health service system levers. The Academy confirmed their commitment to provide the necessary leadership in November 2009.
Work to develop a prototype venous thromboembolism (VTE) risk assessment tool is ongoing. A prototype tool is being piloted at three national health service secondary care locations. The pilot work is aimed at testing the utility of a VTE risk assessment checklist on mobile and hand-held digital equipment.
When complete we will consider the contribution of this pilot work with the context of overall VTE prevention programme.