4      The Peninsula needs assessment model and other estimates of shortfall

Using a spreadsheet model involving data and assumptions on the effects of primary prevention, use of medical treatments (statins), rates of referral, indications for angiography, private sector revascularisations, and an assumption that about 10% of angina patients will require revasularisation each year, an assessment of the number of revascularisations required over the next 20 years has been made (South West Consortium of Health Authorities, 2001). The number of procedures predicted are also presented as percentage changes compared to 1999 levels of activity.

The model assumes that between 16 and 20% of CABGs will be done in the private sector, so the predicted CABG requirement for 2000 for the NHS is almost exactly matched by procedures performed in 1999. It is somewhat surprising that the 1999 NHS provision alone, excluding private provision, is in excess of PTCA predicted requirement for 2000.

It should be noted that the expansion in provision required over the next 10 years to meet predicted revascularisation numbers is modest compared with the trends observed since 1991.

If the normative crude rates of provision stated in the National Service Framework of 750 CABG and 750 PTCA procedures per million population are applied to the South West Region population, current 1999/2000 provision of about 488 CABGs per million and 340 PTCAs per million would have to increase to 4080 CABGs and 4028 PTCAs a year, representing 54% and 121% increases for CABG and PTCA procedures respectively.

In contrast to the Peninsula model or normative planning, the approach adopted here makes no assumptions about changing levels of need, but simply examines the requirements to achieve a greater equity of provision for older people, women and those living in more deprived areas. Our estimated extra 540 CABG and 450 PTCA procedures required for men and 830 CABG and 2080 PTCA procedures for women if fair provision for age were a policy objective are close to the normative planning targets, representing 52% and 139% increases in CABG and PTCA procedures for 1999 respectively.

The Public Health Observatory is part of the South West Observatory, a wider Regional intelligence function, currently supported by the South West Regional Assembly, the Department of Health, the Department for Education and Skills. Government Office South West, the South West of England Regional Development Agency and the Environment Agency.