Early detection of cancer: lessons from lung cancer CT screening.

In February 2006 the Department of Health introduced a new home oxygen service with the aim of improving the assessment of patients on oxygen and allowing access to newer technologies such as ambulatory oxygen. Oxygen is provided following completion of a home oxygen order form and is allocated a predetermined tariff according to the delivery device and usage. In South East Essex there are currently 554 patients receiving home oxygen with an annual cost of £668 546. In response to these changes, South East Essex PCT and Southend Acute Trust set up an oxygen implementation group leading to the establishment of an integrated home oxygen service. This service comprises four respiratory consultants, one respiratory physiotherapist and three respiratory nurse specialists (one of whom is based in the community and was the only new post). The role of this service is to identify patients requiring home oxygen, to provide formalised oxygen assessments and home or outpatient monitoring once oxygen is ordered, as well as ensuring that existing patients receiving home oxygen have the correct oxygen order for their needs. The cost of home oxygen was highlighted by the home oxygen service. In order to investigate high oxygen order costs, 22 patients who were on a higher tariff were identified from the supplier monthly statement of December 2006 for review either by a respiratory consultant in outpatients, formal long-term oxygen treatment (LTOT) assessment or a home visit by a nurse specialist. Of these, 4 had the correct order, 3 no longer required home oxygen, 1 was unwilling to change his order and 14 had their order altered to a more appropriate usage requirement resulting in recategorisation to a lower tariff. This resulted in an annual saving of £76 993. Over the following 6 months, during the course of routine monitoring a further 43 patients had their home oxygen order altered to reflect their actual oxygen requirements more accurately; 8 no longer required home oxygen and 35 were recategorised to a lower tariff with an annual cost saving of £52 819. Increased awareness of the need to regularly re-evaluate patients on home oxygen therefore resulted in the recategorisation to a lower tariff of 65 patients at an annual cost saving of £129 812. A cost saving of £76 993 was made by targeting the 22 patients on the highest tariff out of a total of 554 patients on home oxygen.