The White Paper “Equity and Excellence. Liberating the NHS” stated that the health service must be focused on outcomes and quality standards that deliver them. INHALE (Interactive Health Atlas for Lung in UK), www.inhale@nhs.uk.contains over 70 outcome measures for all the Regions and PCTs in UK. Demonstrating variation in outcomes drives service change. Hospital mortality has been reduced using this methodology. Wright J, Dugdale B, Hammond I et al Learning from death. A hospital mortality reduction programme. JRSM 2006; 99: 303–308.

Methods Four key outcome measures which reflect hospital, community and primary care of COPD have been selected from INHALE These are COPD mortality rate per 100,000 PCT population 2008–10, hospital bed-days per 1000 population 2010–11,% hospital readmissions within 28 days for COPD 2010–11, ratio of expected to observed COPD cases over the PCT for 2010–11. An action list of COPD service improvements has been prepared by the EoE Respiratory Team.

Results There is considerable variation for each outcome measure across the East of England (EoE). 2.04 fold for mortality, 2.61 fold for bed-days, 1.67 fold for hospital readmissions and 1.56 for Observed/Expected. These measurements have been ranked across the PCTs. The ranking of these 4 outcome measures have been summated and then ranked to give an overall PCT ranking. The Table shows ranking of each outcome measure and unified summated ranking.

Conclusion The wide variation in outcomes across the EoE has been more clearly demonstrated by using a ranking system. An EoE data pack has been produced demonstrating this and includes the overall ranking, bar charts and funnel plots of the outcome measures, a trend analysis of the outcome measures, and the suggested service improvements. This has been circulated to all respiratory consultants, CCG leads, local respiratory networks, and hospital chief executives in the Region. This allows comparisons to be made and helps to drive change. Localities and hospitals have started to draw up service improvements.