Transcript Slide 1

NHS Yorkshire and the Humber
Monthly QIPP resource pack
January 2010
Yorkshire and the Humber
Yorkshire and the Humber
Quality Observatory
Quality Observatory
Introduction
This is the third QIPP monthly resource pack. The pack has three components:
BETTER FOR LESS EXAMPLES: We have worked with you to develop practical examples of schemes
which have been developed locally and have potential to deliver better quality at lower cost. This
month the ‘better for less’ examples focus on falls prevention.
HEALTH AND SOCIAL CARE INTERFACE ‘HOT TOPIC’: Each month we will produce one ‘hot topic’
briefing which provides more detailed analysis on a subject relevant to QIPP. This month the hot topic
is the health and social care interface. The analyses presented here are designed to offer insight and
raise questions about variation in performance. They need to be interpreted in the local context.
The next resource pack will be published week commencing 1st March. The hot topic will be urgent
care. If you have any questions or comments on the pack, please contact Ian Holmes.
([email protected])
Yorkshire and the Humber
Quality Observatory
Introduction
QIPP METRICS: We have developed a set of metrics to help understand system health in the tighter
financial climate. We will publish these metrics monthly although some of the indicators will only be
updated quarterly. The purpose is to offer insight and improve understanding of how the system
delivering with lower growth.
1) Healthy Ambitions – Better for Less
Yorkshire and the Humber
Quality Observatory
Better for Less – Falls prevention
Why Falls?
Falls present a significant risk to the health
and independence of older people. Falls
affect up to 33% of people over 65 and 42% of
people over 75 each year.
The consequences of falls can be life
changing and it some cases life threatening. It
is estimated that approximately 10% people
that fall will die within one year. It is
estimated that up to 30% of falls could be
prevented.
Falls also impose a significant financial
burden on the NHS and social care.
The additional direct cost following a
hip fracture is estimated to be £10,000
to healthcare and £5,400 to social
care.
As a region, we spend around £110m
across health and social care as a
result of hip fractures alone.
Yorkshire and the Humber
Quality Observatory
Better for Less – falls prevention
Health and social care working together
locally to establish comprehensive falls
care pathways can drive up quality,
efficiency and effectiveness.
Better for Less – Falls prevention
How can we provide better for less?
• Responding to a first (non hip fragility)
fracture and preventing a second – fracture
liaison services in acute and primary care
settings
• Early intervention to restore independence
– falls care pathways, linking acute and
urgent care services to secondary prevention
of further falls
• Preventing frailty, promote bone health and
reduce accidents – encouraging physical
activity, dietary advice and osteoporosis
prevention
Yorkshire and the Humber
Quality Observatory
Better for Less – falls prevention
There is scope to improve care co-ordination
and prevention for the ‘at risk’ population
through:
Better for Less – Falls prevention
NHS North Yorkshire and York – falls
prevention in action
The services are based around
comprehensive falls pathways which identify
those at highest risk.
Good practice includes:
• Falls prevention services working closely
between acute trusts to identify patients
attending A&E with a fall
• Yorkshire Ambulance Services have
developed a pathway allowing a paramedic to
make a clinical decision to refer directly to
the fast response team or falls prevention
service.
• North Yorkshire County Council are
establishing a pathway for clients at risk of
falling
• A falls co-ordinator identifies inpatients who
would benefit from a multi-factorial risk
assessment and refers these to a community
based falls prevention service.
• A fracture liaison service is being developed
to identify high risk patients who have
sustained a fragility fracture following a slip
tip or fall.
• Patients who have had a multi-factorial is
assessed using the FRAX osteoporosis risk
assessment tool and the GP is notified of the
result.
• A patient leaflet ‘STEPS to Prevent a Fall’ is
now being used across the country.
Yorkshire and the Humber
Quality Observatory
Better for Less – falls prevention
Falls services are being implemented across
North Yorkshire and York underpinned by
integrated service improvement between
health and social care, housing and the
voluntary sector.
2) Hot Topic: Health and social care
interface
Yorkshire and the Humber
Quality Observatory
1)
Overview
2)
Patterns of social care spend
3)
Key metrics
4)
Falls
5)
Dementia services
6)
Annexes
Yorkshire and the Humber
Quality Observatory
Health and social care interface - Contents
Contents
1)
Overview
2)
Patterns of social care spend
3)
Key metrics
4)
Falls
5)
Dementia services
6)
Annexes
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Overview
Section 1
This information pack is the second of a series ‘hot topics’ that will be
produced by the SHA to support organisations in developing their
understanding of some of the challenges and opportunities presented by
the QIPP agenda.
While recognising that it may raise more questions than answers, we hope
it will stimulate thought and debate within organisations and health
communities. Clearly the data presented need to be interpreted in the
local context.
We would be delighted to receive comments on the contents together with
any ideas for further health and social care interface analysis.
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Overview
Purpose
‘Putting People First’: Transforming Adult Social Care (DH, 2007) set out the vision that
every locality should seek to have a single community based support system focused on
the health and wellbeing of the local population. binding together local Government,
primary care, community based health provision, public health, social care and the wider
issues of housing, employment, benefits advice and education/training.
The aim should be to:
• Develop universal services (including
information and advice) that help
people maintain their independence;
• Offer targeted early intervention
that prevents needs escalating and
avoids unnecessary use of intensive
social care and health services;
• Develop self-directed support as the
norm for people who have longer-term
social care needs; and
• Develop the use of social capital,
including through user-led
organisations, so that people can meet
their needs with the least recourse to
specialist services.
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Overview
Overview
The population in the UK is ageing. By 2030 it is estimated that
over one fifth of the region’s population will be aged 65+ (an
increase of 5% or 500,000 people from 2006).
People are living longer but not necessarily free from disability, or
limiting long term illness. The net result is likely to mean
increases in the demands for health and social care services.
To meet this rising demand requires significant changes in the
social care system, a shift
• from higher end complex care
• to prevention and keeping people healthy and independent
Our focus must be on extending the length of time that people
can keep healthy and active in their own homes, through
promoting active and fulfilling healthy lifestyles, social inclusion,
social integration and self care.
Population projections to 2030 for Y&H
100%
21.1%
16%
80%
60%
40%
20%
0%
2006
2010
Under 20
2014
20 - 64
2018
2022
65 - 74
2026
2030
75 and over
Life expectancy, healthy life expectancy and disabilityfree life expectancy, 1981-2004 - (ONS)
Health
and
Well
Being
Increasing age
Adapted from a presentation by Professor Andrew Kerslake – Institute of Public Care Sept 09
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Overview
Overview
The Department of Health (DH) has proposed a framework that may be
helpful in assessing how far a social care authority, with its health partners,
is progressing in making best use of its resources through a strategic shift
towards prevention and early intervention. This framework includes a
number of performance indicators:
Top quartile performance (or confident reducing trend) on:
• Proportion of spend on institutional care
• Proportion of long-term care home placements made straight from
hospital
• Number of emergency bed days per head of population
• Delayed transfers of care
• Numbers of older people supported in residential or nursing care homes
per head of population
• Numbers of fractured necks of femur
• Number of patients registered with GPs as having dementia and as a
percentage of the expected number in the local 65+ population with
dementia.
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Overview
What might good look like?
1)
Overview
2)
Patterns of social care spend
3)
Key metrics
4)
Falls
5)
Dementia services
6)
Annexes
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Spend
Section 2
As a region we spent £1.5bn on Adult Social Services in 2008-09 compared with a
total PCT allocation for the same year of £7.7bn.
PCT budgets are determined centrally by the Department of Health whereas the
proportion of the Local Authority budget allocated to social care is subject to local
decision making.
The proportion of the LA budget allocated to social care varies from 38% in York to
26% in Bradford. Social care spend as a percentage of Social care spend + PCT
allocations varies from 19.4% in Rotherham to 15.1% in Kingston upon Hull.
Social care expenditure as a percentage of LA
expenditure, 2008-09
25.00%
45.0%
Social care expenditure as a percentage of Social
Care + PCT Allocation, 2008-09
40.0%
20.00%
35.0%
30.0%
15.00%
25.0%
20.0%
10.00%
15.0%
10.0%
5.00%
5.0%
Br
ad
for
d
sh
i re
Ca
l de
No
rd
rth
ale
Ea
st
Li n
co
l ns
h ir
Ki
ng
e
s to
nu
po
nH
u ll
Yo
rk
Sh
ef
fie
ld
No
rth
Hu
mb
er
Li n
co
Ea
l
ns
st
h ir
Rid
e
ing
of
Yo
rks
hir
e
sa
nd
No
rth
Yo
rk
ha
m
Do
nc
as
te
r
Ro
the
r
W
ak
efi
eld
Ba
rn
s le
y
le e
s
En
g la
nd
Ki
rk
Le
ed
s
Yo
rk
0.0%
0.00%
Rotherham Kirklees PCT
North
Bradford East Riding Leeds PCT Calderdale North East
PCT
Yorkshire and Airedale Of Yorkshire
PCT
Lincolnshire
and York
Teaching
PCT
PCT
PCT
PCT
Yorkshire and the Humber
Quality Observatory
Sheffield
PCT
Barnsley
PCT
North
Wakefield Doncaster
Lincolnshire District PCT
PCT
PCT
Hull
Teaching
PCT
Health and social care interface – Spend
High level spend
Patterns of spend vary considerably
across local authority areas in the
region. This impacts on the quality of
services and client experience. ‘Use
of Resources in Adult Social Care’ (DH
2009)1 sets out the case for
understanding and where appropriate
reducing spend on residential care.
While residential care provides
essential care and support for those
who need it, there are concerns that:
In some cases, people have been
assessed as needing long term
higher level care when alternative
interventions may have more
effectively supported recuperation
and recovery.
There is evidence to suggest that
up to 25% of new admissions to
residential and nursing home care
can be avoided2.
• Residential care can be costly, and
more cost effective community based
options exist.
• Alternative services in the
community or at home that are more
cost effective and can support people
to stay in the community are not
receiving sufficient investment.
1: available at
http://www.dh.gov.uk/en/Publicationsandstatistics/
Publications/PublicationsPolicyAndGuidance/DH_10
7596
2: healthcareinformatics.org.uk/FLoSC
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Spend
Patterns of social care spend
On average nearly half of all spend on adult social care in Yorkshire and the Humber in 2008/9
was on residential care. The two LAs with the highest proportions of spend in this area were
Kingston-upon-Hull (68%) and East Riding (62%).
None of the LAs in this region ranked within the top quartile performance band for this
measure (40%), though most showed a decrease from 2007/8 to 2008/9.
Percentage of total adult social services spend on nursing and residential care, by Local Authority
in Yorkshire and the Humber, 2008/09
100%
60%
Top quartile
47%
47%
Yorkshire and the
Humber
North Yorkshire
Rotherham
Doncaster
North Lincolnshire
North East
Lincolnshire
East Riding of
Yorkshire
Kingston upon Hull
0%
46%
44%
44%
43%
42%
41%
41%
40%
Calderdale
48%
Barnsley
49%
Kirklees
50%
Wakefield
51%
20%
Bradford
62%
Sheffield
68%
York
40%
Leeds
% of total spend
80%
Produced by Yorkshire & Humber PHO
Source: PSS EX1 Gross Total Expenditure
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Spend
Proportion of overall spend in institutions
Percentage of older people spend in residential homes, 2008-09
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
W
ak
ef
ie
ld
le
es
Ca
ld
er
da
le
Ki
rk
Sh
ef
fie
ld
d
En
gl
an
d
Br
ad
fo
r
Yo
rk
Le
ed
s
Ba
rn
s le
y
Hu
m
be
r
ha
m
sa
nd
Ro
th
er
No
rth
Yo
rk
Ea
st
Li
nc
ol
ns
hi
re
Do
nc
as
te
r
Yo
rk
sh
i re
Li
nc
ol
ns
hi
re
No
rth
Ri
di
ng
Ea
st
No
rth
up
on
Hu
ll
of
Yo
rk
sh
ire
0.0%
Ki
ng
st
on
As a region, Yorkshire and the
Humber has a significantly
worse than average proportion
of older people spend in
institutions compared with the
national average (56% versus
51%). Yorkshire and the
Humber also has the two
highest spending LAs in the
country (Kingston upon Hull
and East Riding).
Percentage of spend on the physically disabled in residential
homes, 2008-09
70%
60%
50%
40%
30%
20%
10%
Yorkshire and the Humber
Quality Observatory
Do
nc
as
te
r
Ca
ld
er
da
le
Ba
rn
s le
y
Yo
rk
sh
i re
Yo
rk
Sh
ef
fie
ld
No
rth
ha
m
Ro
th
er
En
gl
an
d
W
ak
ef
ie
ld
le
es
Ki
rk
Li
nc
ol
ns
hi
re
Le
ed
s
Ea
st
Hu
m
be
r
sa
nd
Yo
rk
d
Li
nc
ol
ns
hi
re
of
Yo
rk
sh
ire
Br
ad
fo
r
No
rth
No
rth
Ea
st
Ri
di
ng
up
on
Hu
ll
0%
Ki
ng
st
on
As a region we are also worse
than average on spend in
institutions on the physically
disabled (25% versus 23%) and
there is wide variation across
LAs, ranging from over 60% to
10%.
Health and social care interface – Spend
Patterns of social care spend
Percentage of spend on those with learning disabilities in
residential homes, 2008-09
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
60%
Ba
rn
sl
ey
Yo
rk
d
Br
ad
fo
r
or
th
Yo
rk
sh
i re
al
de
rd
al
e
le
es
C
Ki
rk
Sh
ef
fie
ld
W
ak
ef
ie
ld
Le
ed
s
um
be
r
Li
nc
ol
ns
hi
re
N
or
th
s
Yo
rk
N
R
an
d
H
En
gl
an
d
ot
he
rh
am
on
ca
st
er
D
Li
nc
ol
ns
hi
re
Ea
st
N
Ea
st
or
th
R
id
in
g
Ki
ng
st
on
up
on
H
ul
l
of
Yo
rk
sh
ire
0.0%
Percentage of spend on those with mental health problems in
residential homes, 2008-09
50%
40%
30%
20%
10%
Yorkshire and the Humber
Quality Observatory
Do
nc
as
te
r
le
es
Ki
rk
Ca
ld
er
da
le
W
ak
ef
ie
ld
Yo
rk
sh
i re
ha
m
No
rth
Ro
th
er
Le
ed
s
Sh
ef
fie
ld
Hu
m
be
r
Yo
rk
sa
nd
Yo
rk
En
gl
an
d
Li
nc
ol
ns
hi
re
Ea
st
Li
nc
ol
ns
hi
re
No
rth
No
rth
d
Ba
rn
s le
y
Br
ad
fo
r
of
Yo
rk
sh
ire
Ri
di
ng
up
on
Hu
ll
0%
Ea
st
There is a degree of
consistency in the proportions
of spend in institutions across
each of the four client groups –
and Kingston upon Hull and
East Riding of Yorkshire are
consistently higher than others
in the region.
80.0%
Ki
ng
st
on
The proportion of spend on
people with learning
disabilities in institutions
across Yorkshire and the
Humber is close to the England
average. However there is a
more than 3 fold across the
LAs in the region on learning
disabilities spend in
institutions and a 6 fold
variation for those with mental
health problems.
Health and social care interface – Spend
Patterns of social care spend
The DH set out a range of factors to consider in understanding and potentially
reducing residential care spend.
These include:
They will also be impacted by:
• The unit costs for
residential care
• Emergency admissions to hospital
• The volumes admitted
• Hospital discharge arrangements
• Eligibility criteria on
supporting those with
high needs
• Availability of intermediate and re-enablement
services
• Supply availability
• A high number of self
funders who later
become the
responsibility of the LA
• Options for post-hospital care
• Availability of community nursing.
• Availability of domiciliary support
• Availability of therapists
• Availability of falls services
• Availability of podiatry and foot care services
• Availability of emergency and rapid response
services
• Availability of suitable housing options.
• Utilisation of assistive technologies.
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Spend
Factors to consider to reduce spend in residential care
1)
Overview
2)
Patterns of social care spend
3)
Key metrics
4)
Falls
5)
Dementia services
6)
Annexes
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Metrics
Section 3
Although the proportion of residents aged 65
and over in residential or nursing care in the
region is decreasing, rates still remain well
above the national average, with Y&H having
the third highest rate among English SHAs.
Residents aged 65 and over supported in residential or nursing
care hom es per 100,000 population, by SHA, 2008/09
London
310
South East
395
Eastern
425
West Midlands
430
South West
Furthermore, no PCT within the region
currently ranks within the top quartile
national benchmark for this measure, with
PCT rates up to over 60% above the England
average.
Trend in residents aged 65 and over supported in residential or
nursing care hom es per 100,000 population, Yorkshire and Hum ber
and England
700
600
520
495
500
505
400
480
455
440
300
200
Yorkshire & Humber
East Midlands
England
100
2007/08
515
North East
620
0
200
400
600
800
Source: NASCIS
Kirklees
York
Leeds
Wakefield
North Yorkshire
Doncaster
Calderdale
Yorkshire & Humber
Bradford
Sheffield
N Lincolnshire
Barnsley
Rotherham
East Riding
N E Lincolnshire
Kingston-upon-Hull
410
415
420
450
450
455
455
495
495
505
530
555
Top
565
quartile
625
(340)
675
725
0
2006/07
495
North West
0
2005/06
470
Yorkshire and the Humber
Residents aged 65 and over supported in residential or nursing
care hom es per 100,000 population, by PCT, 2008/09
570
600
450
200
400
600
800
2008/09
Source: NASCIS
Source: NASCIS
Source:N
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Metrics
Older people supported in care homes per head of pop.
10%
9%
8%
7%
6%
5%
4%
7.3%
7.3%
7.2%
6.6%
3%
5.7%
5.3%
Top quartile
4.2%
2%
3.9%
3.3%
3.2%
3.1%
1%
1.8%
1.7%
1.5%
Yorkshire and the Humber
Quality Observatory
Barnsley
Doncaster
East Riding of
Yorkshire
Leeds
North Lincolnshire
North East
Lincolnshire
Calderdale
Kingston upon Hull
North Yorkshire
Sheffield
Wakefield
Bradford
York
Source:CASSR
Rotherham
0.5%
0%
Kirklees
Within Y&H there is wide variation
between LAs in percentages of
patients aged 65+ who are
discharged directly to residential
homes. In 2006/07 four LAs were
ranked within the top quartile
nationally for this measure.
Percentage of patients age 65+ discharged to residential homes, by Local Authority in
Yorkshire and the Humber
Patients aged 65+ discharged to residential homes (%)
The national intermediate care
strategy recommended that
wherever possible, patients should
return to their place of residence
prior to admission.
Produced by Yorkshire & Humber PHO
Health and social care interface – Metrics
Long term discharge to care home
Across Yorkshire and the Humber we spend
over £700m per year on emergency
admissions. Common causes of admissions
include chest pain, respiratory infections and
abdominal disorders.
Em ergency Adm issions Y&H 2008/9, Top 10 HRG, All
0
Hull Teaching PCT
Barnsley PCT
Leeds PCT
Rotherham PCT
Wakefield District PCT
Calderdale PCT
Sheffield PCT
Bradford and Airedale Teaching PCT
Doncaster PCT
Kirklees PCT
East Riding Of Yorkshire PCT
North Yorkshire and York PCT
North Lincolnshire PCT
North East Lincolnshire Care Trust Plus
Yorkshire and the Humber
300
400
500
536.9
459.5
433.9
424.1
421.7
413.7
406.8
386.7
372.4
358.4
324.8
301.7
291.7
246.8
379.0
20000
13,169
10,912
Poisoning, Toxic, Env and Unsp Effects
Upper Respiratory Tract Disorders
9,969
9,434
Complex Elderly w ith a Resp Syst Prim Diag
8,997
Other Gastroint or Metab Disorders
Gen Abdominal Disorders >69 or w cc
8,918
COPD or Bronchitis w /o cc
8,856
Minor Infections (incl Immune Disorders)
8,533
Chest Pain >69 or w cc
8,313
Total = 551213
Over 75 Em ergency Adm issions 2008/9, Top 10 HRG, Over 75s
Over 75s Emergency Admissions rate per 1000 pop aged 75+, 2008/9
200
15000
17,666
General Abdominal Disorders <70 w /o cc
A significant proportion (approx 30%) of
people admitted are aged over 75 and many
of these have more than one visit each year.
100
10000
Chest Pain <70 w /o cc
It is also an area where there is considerable
variation across the region.
0
5000
600
0
2000
4000
Complex Elderly w ith a Resp Syst Prim Diag
5,120
4,681
Chest Pain >69 or w cc
Complex Elderly w ith a Card Prim Diag
3,909
3,636
3,446
COPD or Bronchitis w /o cc
3,244
Complex Elderly w ith a Musc Syst Prim Diag
3,113
Heart Failure or Shock >69 or w cc
3,102
Yorkshire and the Humber
Quality Observatory
10000
5,310
Kidney or UTIs >69 or w cc
Arrhythmia or Conduction Dis >69 or w cc
8000
7,949
Syncope or Collapse >69 or w cc
Unsp Acute Low er Resp Inf
6000
Total = 151499
Health and social care interface – Metrics
Emergency admissions to hospital
2,000
Top quartile
1,500
2,693
2,612
2,519
2,374
2,230
1,000
2,147
2,106
2,086
2,072
1,918
1,806
1,762
1,686
1,629
1,435
North Yorkshire
Bradford
Kirklees
East Riding of
Yorkshire
Barnsley
York
Doncaster
North East
Lincolnshire
Calderdale
Wakefield
Leeds
Sheffield
North Lincolnshire
Source:CASSR
Kingston upon Hull
0
Rotherham
500
Produced by Yorkshire & Humber PHO
Number of individuals age 75+ with 2+ emergency admissions per 1000, by Local
Authority in Yorkshire and the Humber, 2006/07
100
80
60
Top quartile
92
87
40
82
76
73
71
69
69
68
65
64
64
61
55
50
Source:CASSR
Yorkshire and the Humber
Quality Observatory
North Yorkshire
Wakefield
Kirklees
East Riding of
Yorkshire
North Lincolnshire
York
Calderdale
Doncaster
Bradford
Sheffield
Leeds
Barnsley
North East
Lincolnshire
0
Rotherham
20
Kingston upon Hull
Few LAs ranked among the
national top quartile for this
measure, and Kingston-upon Hull
was over 30% above the national
average.
2,500
Occupied bed days per 1000
The highest rates for Y&H, for
both occupied beds days and
multiple admissions for over 75s
were in Kingston-upon-Hull.
3,000
Number of individuals with 2+ emergency admissions per 1000
In 2006/7 only one LA, North
Yorkshire, ranked in the national
top quartile for occupied bed days
for patients aged over 75 with
multiple admissions.
Occupied bed days of those age 75+ associated with 2+ emergency admissions per
1000, by Local Authority in Yorkshire and the Humber, 2006/07
Produced by Yorkshire & Humber PHO
Health and social care interface – Metrics
Emergency admissions for over 75s
Identifying at risk groups and frequent users, and supporting these people to manage their
health across the health and social boundary can significantly improve experience and value
for money.
A number of tools currently exist that can be used to support PCTs in targeting care more
effectively in order to reduce emergency admission rates.
The Emergency Admission Risk Likelihood Index (EARLI) can help to predict risk of emergency
admissions in the elderly. (www.improvementfoundation.org/resource/view/unique-care-earlitool)
The Patients at Risk of Re-hospitalisation (PARR) software tool, uses inpatient data to identify
patients at risk of re-hospitalisation. The Combined Predictive Model broadens this approach
by linking a range of data sources in order to identfiy other patients at risk of hospital
admission.
http://www.kingsfund.org.uk/research/projects/predicting_and_reducing_readmission_to_hos
pital/index.html#inbrief
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Metrics
Emergency admissions for over 75s
During 2008/9 there was an
eight-fold variation in delayed
transfers of care between LAs
in the region.
15
10
18.5
16.8
15.1
13.4
13.2
11.2
5
10.8
10.6
9.6
7.8
7.2
6.2
6.2
6.0
4.0
Source:UNIFY2 (Department of Health)
North Lincolnshire
Bradford
East Riding of
Yorkshire
North East
Lincolnshire
Barnsley
Kirklees
Rotherham
North Yorkshire
Yorkshire and the
Humber
Wakefield
Calderdale
Kingston upon Hull
Leeds
Doncaster
2.3
0
Sheffield
Delayed transfers of care per 100,000 population aged 18+
20
York
Keeping people in hospital
longer than necessary is poor
value for money (hotel costs in
hospital are around £400 a day)
and is bad for patients.
Produced by Yorkshire & Humber PHO
Trend in delayed transfers of care from all NHS hospitals per 100,000 population
aged 18 and over, Yorkshire and the Humber
20
Delayed transfers of care per 100,000 population aged 18+
Ensuring smooth flows across
the patient journey is
important to offer the best
patient experience and
maximise value for money
through effective use of bed
capacity.
Delayed transfers of care from all NHS hospitals per 100,000 population aged 18 and
over, by Local Authority in Yorkshire and the Humber, 2008/09
15
12.3
10.6
10
7.0
5.0
4.5
5
0
2004/05
2005/06
Source:UNIFY2 (Department of Health)
Yorkshire and the Humber
Quality Observatory
2006/07
2007/08
2008/09
Produced by Yorkshire & Humber PHO
Health and social care interface – Metrics
Delayed transfers of care
For older people, the growth of intermediate care services and re-ablement
programmes have helped people recover from medical interventions and other life
events much more successfully. The Care Services Efficiency Delivery (CSED)
programme identified that up to 50% of older people who were offered a short term
package of re-ablement based care did not require further social care support at
the end of the programme. Re-ablement clearly offers potential to improve quality
of life as well as deliver financial benefits.
100.0
90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
LE
ES
KI
RK
RD
DF
O
BR
A
ST
ER
NC
A
DO
LN
SH
IR
E
NO
RT
H
O
F
LI
NC
YO
O
RK
SH
IR
E
M
RH
A
TH
E
RO
RI
DI
NG
EA
ST
IR
E
NS
LE
Y
BA
R
YO
RK
SH
M
BE
R
HU
RT
H
NO
AN
D
RK
S
YO
AL
E
W
AK
EF
IE
LD
RD
UA
RK
CA
LD
E
O
LI
NC
EA
ST
RT
H
NO
YO
LN
SH
IR
E
LL
HU
S
N
UP
ON
LE
ED
ST
O
KI
NG
FF
IE
LD
0.0
SH
E
Across Yorkshire and
the Humber the
proportion of people
living at home
following re-ablement
three months after
discharge varies from
92.7% in Sheffield to
61.6% in Kirklees.
The proportion of people 65+ discharged from hospital to intermediate
care/rehabilitation/re-ablement who are still living 'at home' three months
after discharge, 2008-09
Source: H&SC Information Centre
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Metrics
Re-ablement
There are over 50,000 deaths
each year in Yorkshire and the
Humber. The majority of
these take place in an acute
hospital and according to
national figures, the last year
of life on average, involves 23 inpatient stays and 18
inpatient bed days.
This is also an area where we
could do much better on
quality. Nationally, around
half of all hospital complaints
relate to end of life issues.
Percentage of patients who die at home 2006-08 (pooled)
England
Yorks & Humber
Calderdale
Kirklees
North Yorkshire & York
North East Lincs
Doncaster
Bradford & Airedale Teaching
Leeds
Barnsley
Wakefield District
Rotherham
North Lincolnshire
Sheffield
Hull Teaching
East Riding of Yorkshire
Replace chart
0
5
10
15
20
25
% Patients who died at home
Source: Compendium of Health Indicators - NCHOD
Produced by YHPHO
2010
Note: It is not currently possible to include nursing home or residential home deaths as a “home”
death. For this indicator, a “home” death is defined as one that has the ”H” code in the communal
establishment field, i.e. where the death has occurred at the home address and that address is not of
a communal establishment.
In Y&H Healthy Ambitions recommended that, in advanced care planning, there should be a shift in
place of dying from hospital to home. The key pledge for the end of life pathway is to double the
number of people able to die at home rather than in a hospital. Although the trend increasing,
currently only approximately 20% of people die at home.
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Metrics
End of life
Proportions of wards compliant with Liverpool Care Pathway (Source: CQUIN Q1 2009-10)
Provider
Airedale NHS Trust
Barnsley Hospital NHS Foundation Trust
Bradford Teaching Hospitals NHS Foundation Trust
Calderdale and Huddersfield NHS Foundation Trust
Doncaster and Bassetlaw Hospitals NHS Foundation Trust
Harrogate and District NHS Foundation Trust
Hull and East Yorkshire Hospitals NHS Trust
Leeds Teaching Hospitals NHS Trust
Mid Yorkshire Hospitals NHS Trust
Northern Lincolnshire and Goole Hospitals NHS Foundation Trust
Scarborough and North East Yorkshire Health Care NHS Trust
Sheffield Childrens NHS Foundation Trust
Sheffield Teaching Hospitals NHS Foundation Trust
South Tees Hospitals NHS Foundation Trust
The Rotherham NHS Foundation Trust
York Hospitals NHS Foundation Trust
wards
open
13
27
28
46
38
18
54
88
45
35
15
2
90
11
22
29
wards with
Liverpool Care
Pathway or
percentage
equivalent
with LCP
13
100%
27
100%
28
100%
44
96%
38
100%
15
83%
39
72%
60
68%
22
49%
24
69%
12
80%
0
0%
90
100%
11
100%
22
100%
15
52%
The End of Life Care Strategy states that all acute hospital providers should demonstrate that
they use a care pathway (such as the Liverpool Care Pathway or equivalent) for all those who
are dying. In Y&H, the proportions of wards compliant with the Liverpool Care Pathway varies
from 49% to 100%.
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Metrics
End of life – Compliance with Liverpool care pathway
The DH funded a programme of pilot studies to develop integrated prevention and early intervention
services for older people aimed at promoting prevention or delaying the need for high intensity or
institutional care. The evaluation found a wide range of projects resulted in improved quality of life
for participants and considerable savings as well as improved working relationships.
Evaluation of Bradford’s Health in Mind POPP programme, which provides intensive
support teams to support older people with mental health problems at risk of
institutional care in the community, found that:
• 26% of users were prevented from being admitted to a care home;
• for a further 13% of users, admission to hospital was prevented or delayed;
• 15% were supported to be discharged from hospital earlier than would have been the
case; and
• there was a 29% reduction in the number of homecare hours immediately after
intervention.
When operating at full capacity, the intensive support teams are expected to produce
net savings of around £550,000 per year.
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Metrics
Partnerships and Older People Programme Pilots
1)
Overview
2)
Patterns of social care spend
3)
Key metrics
4)
Falls
5)
Dementia services
6)
Annexes
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Falls
Section 4
Falls present a significant risk to the health and independence of older
people. Falls affect up to 33% of people over 65 and 42% of people over 75
each year.
The consequences of falls can be life changing and it some cases life
threatening. It is estimated that approximately 10% people that fall will die
within one year. It is estimated that up to 30% of falls could be prevented.
Falls also impose a significant financial burden on the NHS and social care.
The additional direct cost following a hip fracture is estimated to be £10,000
to healthcare and £5,400 to social care.
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Falls
Falls prevention
In 2008 there were 239 deaths from falls in Y&H. The last few years have shown a
slight decrease in mortality rates from falls within the region, diverging from a
national upward trend.
Between 2006/8 PCT rates in Y&H varied over 5 per 100,000 in NHS Rotherham to 3
per 100,000 in NHS East Riding.
Directly standardised mortality rates from accidental falls,2006-2008
6.00
5.00
4.00
3.00
2.00
Yorkshire and the Humber
Quality Observatory
Source : NCHOD
East Riding PCT
Leeds PCT
North Lincs PCT
North Yorks and York
PCT
Wakefield District PCT
Yorkshire & The
Humber SHA
NE Lincolnshire CTP
Calderdale PCT
Doncaster PCT
Kirklees PCT
Hull Teaching PCT
ENGLAND
Bradford and Airedale
Teaching PCT
Barnsley PCT
Rotherham PCT
0.00
Sheffield PCT
1.00
Health and social care interface – Falls
Falls prevention
120.00
100.00
80.00
60.00
40.00
CALDERDALE PCT
LEEDS PCT
NORTH YORKS AND YORK
PCT
ENGLAND
BARNSLEY PCT
DONCASTER PCT
EAST RIDING PCT
ROTHERHAM PCT
WAKEFIELD DISTRICT PCT
YORKSHIRE AND THE
HUMBER SHA
BRADFORD AND
AIREDALE PCT
KIRKLEES PCT
NE Lincolnshire CTP
SHEFFIELD PCT
0.00
NORTH LINCS PCT
20.00
HULL PCT
One of the most common
conditions relating to elderly falls
is fractured neck of femur. In
2007/8 there were approximately
5600 fractured necks of femur in
Yorkshire and the Humber,
resulting in emergency admissions
to hospital.
Emergency hospital admissions for fractured proximal femur - Indirectly age and sex standardised rate per 100,000 , 2007-08
140.00
Source: NCHOD
Emergency hospital admissions for fractured proximal femur - Indirectly age and sex standardised rate per 100,000 , 2007-08
Yorkshire and the Humber had one
of the highest emergency
admission rates for fractured neck
of femur nationally in 2007/08.
Variation within Y&H was also
marked across the PCTs.
140.00
120.00
100.00
80.00
60.00
40.00
20.00
0.00
NORTH EAST
STRATEGIC
HEALTH
AUTHORITY
EAST MIDLANDS YORKSHIRE AND
STRATEGIC
THE HUMBER
HEALTH
STRATEGIC
AUTHORITY
HEALTH
AUTHORITY
NORTH WEST
STRATEGIC
HEALTH
AUTHORITY
EAST OF
ENGLAND
STRATEGIC
HEALTH
AUTHORITY
WEST MIDLANDS
STRATEGIC
HEALTH
AUTHORITY
LONDON
STRATEGIC
HEALTH
AUTHORITY
SOUTH WEST
STRATEGIC
HEALTH
AUTHORITY
SOUTH CENTRAL
STRATEGIC
HEALTH
AUTHORITY
Source: NCHOD
Yorkshire and the Humber
Quality Observatory
SOUTH EAST
COAST
STRATEGIC
HEALTH
AUTHORITY
Health and social care interface – Falls
Falls – fractured neck of femur
18.00
16.00
14.00
12.00
10.00
8.00
6.00
4.00
BARNSLEY PCT
NORTH YORKS AND YORK
PCT
EAST RIDING PCT
NE Lincolnshire CTP
KIRKLEES PCT
WAKEFIELD DISTRICT PCT
ENGLAND
HULL PCT
SHEFFIELD PCT
YORKSHIRE AND THE
HUMBER SHA
LEEDS PCT
BRADFORD AND AIREDALE
TEACHING PCT
DONCASTER PCT
There is a threefold variation
across PCTs in rates of such
emergency readmissions.
CALDERDALE PCT
0.00
NORTH LINCS PCT
2.00
ROTHERHAM PCT
Around 9% of patients
discharged from NHS
hospitals following
emergency admission with a
fractured neck of femur are
readmitted as an emergency
within 28 days.
Emergency readmissions within 28 days for fractured proximal femur- Indirectly age and sex
standardised percent , 2007-08
Source: NCHOD
Emergency readmissions within 28 days for fractured proximal femur- Indirectly age and sex
standardised percent , 2007-08
16.00
14.00
12.00
10.00
8.00
6.00
4.00
2.00
0.00
NORTH
NORTH EAST
LONDON
WEST
STRATEGIC STRATEGIC
STRATEGIC
HEALTH
HEALTH
HEALTH
AUTHORITY AUTHORITY
AUTHORITY
Yorkshire and the Humber
Quality Observatory
WEST
MIDLANDS
STRATEGIC
HEALTH
AUTHORITY
YORKSHIRE
AND THE
HUMBER
STRATEGIC
HEALTH
AUTHORITY
EAST OF
SOUTH EAST
EAST
ENGLAND
COAST
MIDLANDS
STRATEGIC STRATEGIC STRATEGIC
HEALTH
HEALTH
HEALTH
AUTHORITY AUTHORITY AUTHORITY
SOUTH
CENTRAL
STRATEGIC
HEALTH
AUTHORITY
SOUTH
WEST
STRATEGIC
HEALTH
AUTHORITY
Source: NCHOD
Health and social care interface – Falls
Falls - readmissions
1)
Overview
2)
Patterns of social care spend
3)
Key metrics
4)
Falls
5)
Dementia services
6)
Annexes
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Dementia
Section 5
Around 60,000 people in Yorkshire and the Humber suffer from dementia. At
present there is significant under-diagnosis of dementia across our region and it is
estimated that approximately 60% of cases in our region are undiagnosed.
Nationally dementia costs the UK economy approximately £17bn and as prevalence
doubles over the next 30 years the this cost is forecast to treble to over £50bn per
year.
Furthermore diagnoses are often made at the time of crises that could have
potentially been avoided. Early intervention can be cost effective and improve the
quality of life for people with dementia and their families and the available
evidence suggests that:
• Early provision of support at home can decrease institutionalisation by 22%
• Even in complex cases, case management can reduce admissions to care homes
by 6%.
• Carer support and counselling at diagnosis can reduce home placement by 28%.
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Dementia
Dementia services - overview
Counting the cost of caring for people with dementia on hospital wards (Alzheimer’s
Disease Society 2009)
People with dementia over the age of 65 occupy up to 25% of acute beds at any
time.
Quality is variable. 97% of general nurses report that they work with people with
dementia.
People with dementia stay in beds longer than necessary. Reducing the average
length of stay by one week would save ‘hundreds of millions across the whole
system’.
Improving dementia services in England – an interim report (National Audit Office
14/1/2010)
“Efficiency savings of at least £284 million a year could be identified now. This is,
however, dependant upon widespread adoption of good practice and being able to
release funding from the acute sector to other health and social care settings, which
historically has been difficult to achieve.”
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Dementia
Dementia services – overview (2)
80%
60%
England
42.3%
44.4%
North Lincolnshire
North Yorkshire &
York
Calderdale
Yorkshire & Humber
Leeds
Barnsley
Kirklees
45.2%
45.4%
Doncaster
39.6%
Wakefield
39.6%
42.3%
35.5%
37.1%
42.2%
33.8%
Hull
20%
North East
Lincolnshire
40%
46.3%
50.9%
Source:Observed - The Information Centre; Expected - Mental Health Observatory
Bradford & Airedale
Rotherham
0%
East Riding of
Yorkshire
27.0%
Produced by Yorkshire & Humber PHO
Number of GP resistered population on dementia disease registers, by PCT in
Yorkshire and Humber, 2008/09
4500
4000
3500
3000
2500
4,191
2000
3,138
1500
3,337
2,479
Source:Quality & Outcomes Framew ork (The Information Centre)
Yorkshire and the Humber
Quality Observatory
North Yorkshire &
York
Leeds
Sheffield
Bradford & Airedale
1,860
Kirklees
1,617
Wakefield
Calderdale
0
1,510
Doncaster
878
1,320
Rotherham
848
1,236
East Riding of
Yorkshire
701
1,044
Barnsley
685
Hull
500
North Lincolnshire
1000
North East
Lincolnshire
The prevalence of dementia, as measured by
the percentage of patients registered with GPs
on dementia disease registers, varies from 0.3%
in Hull to 0.6% in Sheffield. Although
prevalence rates appear small they relate to
over 1000 patients in most Y&H PCTs, with over
4000 patients with dementia in North Yorkshire
& York.
100%
Cases of dementia - observed as a % of expected
There is also significant variation in the
estimated levels of under reporting in the
region, with East Riding of Yorkshire having the
highest estimated level of under-reporting (27%
of cases identified) and Bradford and Airedale
having the lowest levels of under-reporting
(51% of cases identified).
Observed cases of dementia on GP disease registers, 2008/09, as a percentage of
estimated dementia cases aged 65 and over, 2008, Yorkshire and Humber PCTs
No of GP registered population on dementia register
Under-diagnosis of dementia is a major issue.
Current estimates suggest that in Yorkshire and
the Humber around 60% of dementia remains
undiagnosed.
Produced by Yorkshire & Humber PHO
Health and social care interface – Dementia
Dementia – estimated versus recorded prevalence
Across the NHS in Yorkshire and the Humber we spent approximately £60m on
dementia services in 2008-091. The figures highlight very significant variations in
the levels of spend across PCTs in our region. While these variations can be in part
explained by data issues, PCTs may want to better understand their level of spend,
and the proportion of their spend in early diagnosis and intervention.
2008-09 Spend on ‘Organic Mental Health Issues’ per 100,000 population.
3,000.00
2,500.00
2,000.00
1,500.00
1,000.00
500.00
ea
nd
the
H
um
be
r
tP
CT
i st
ric
Yo
rh
s ir
PC
T
PC
T
W
ak
efi
eld
D
Sh
ef
fie
ld
ha
m
PC
T
Yorkshire and the Humber
Quality Observatory
Ro
the
r
an
dY
or
k
eP
CT
No
rth
Yo
rk
sh
i re
eP
CT
No
rth
Li n
co
l ns
h ir
PC
T
Li n
co
l ns
h ir
Le
ed
s
Ea
st
No
rth
Te
ac
hin
g
PC
T
Ca
l de
rd
ale
PC
T
Do
n
Ea
ca
st
ste
Ri
rP
d in
CT
gO
fY
or
ks
hi r
e
PC
T
Hu
ll T
ea
ch
ing
PC
T
Ki
rk l
ee
sP
CT
Br
ad
for
d
an
d
Ai
red
a le
Ba
rn
s le
yP
CT
-
1: Programme budget
category 5b, 2008-09
spend.
Health and social care interface – Dementia
Dementia services – current spend
Dementia incidence and prevalence increases as the population ages. Between 2008
and 2025, prevalence is forecast to rise by 51% across Yorkshire and the Humber.
The LA area expected to experience the highest growth is East Riding (78%) and the
lowest growth is expected in Sheffield (33%).
Chart 5: Number Predicted to have Late On-set Dementia
Yorkshire & Humber 2008 & 2025 by Local Authority District
20,000
68%
57%
57%
78%
13,876
33%
47%
70%
52%
2,928
1,932
3,308
1,947
3,274
2,222
2,360
3,461
% Change
3,850
3,304
2,523
2,795
4,397
5,059
3,347
3,587
5,641
6,245
4,170
4,000
2025
2,493
8,130
4,873
6,084
2008
4,563
8,047
Le
ed
s
8,000
6,861
8,264
hi
re
12,000
8,108
10,872
31%
C
al
de
rd
N
al
or
e
th
Li
nc
ol
ns
hi
N
re
E
Li
nc
ol
ns
hi
re
or
k
Y
sl
ey
B
ar
n
H
ul
l
m
er
he
rh
a
R
ot
ld
D
on
ca
st
ak
ef
ie
W
ee
s
irk
l
K
R
id
in
g
ra
df
or
d
B
fie
ld
he
f
S
as
t
E
th
Y
or
ks
0
N
or
Number Aged 65 Years & Over
47%
41%
35%
16,000
54%
51%
50%
Source: Using Projecting Older People Population Information System - Crown Copyright 2007
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Dementia
Dementia services – future trends
1)
Overview
2)
Patterns of social care spend
3)
Key metrics
4)
Falls
5)
Dementia services
6)
Annexes
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Annex
Section 6
Paul Rice – Associate Director of Patient Care and Partnerships, NHS
Y&H.
([email protected])
Ian Holmes – Associate Director, Economics and System Management,
NHS Y&H
([email protected])
Jake Abbas – Deputy Director, YHPHO
([email protected])
Yorkshire and the Humber
Quality Observatory
Health and social care interface – Annex
Annex A: Key Contacts
3) QIPP Metrics
Yorkshire and the Humber
Quality Observatory
We have developed an initial set of metrics so we can begin to
track how health systems are functioning in a tighter financial
climate. These focus on productivity, but also on outcomes and
other measures of system health.
The dashboard will be developed for next months pack to
include non-acute provider information and more PCT analyses.
As we develop a time series of data we will also analyse how
different metrics interact and impact on each other. If you have
any comments on these metrics and how they could be
developed please contact
[email protected]
Yorkshire and the Humber
Quality Observatory
Health and social care interface – QIPP metrics
QIPP metrics - overview
Dashboard
Indicator
Data Update
Type
Jan 2010 Update
Activity - PCTs
A2: Elective LOS (days)
Quarterly
Q2 2009/10
A3: Elective LOS compared to expected LOS (days)
Quarterly
Q2 2009/10
A4: Nonelective LOS (days)
Quarterly
Q2 2009/10
A5: Nonelective LOS compared to expected LOS (days)
Quarterly
Q2 2009/10
A6: Hospital Standardised Mortality Ratio (days)
Quarterly
Q2 2009/9
A7: Crude hospital-based mortality rates (rate per 100,000 admissions)
Quarterly
Q2 2009/10
A8: GP referrals (G&A) - YTD against VS Plans (%)
Monthly
Nov 2009
A9: Other referrals (G&A) - YTD against VS Plans (%)
Monthly
Nov 2009
A2: Elective LOS
Quarterly
Q2 2009/10
A3: Elective LOS compared to expected LOS
Quarterly
Q2 2009/10
A4: Nonelective LOS
Quarterly
Q2 2009/10
A5: Nonelective LOS compared to expected LOS
Quarterly
Q2 2009/10
A6: Hospital Standardised Mortality Ratio
Quarterly
Q2 2009/10
A7: Crude hospital-based mortality rates
Quarterly
Q2 2009/10
A8: Daycase rates - Dr Foster indicator based on CQC groups
Quarterly
Q2 2009/10
P1: Low cost prescribing for ACEI (%)
Quarterly
Q2 2009/10
P2: Low cost PPI's vs all PPI's prescriptions (%)
Quarterly
Q2 2009/10
P3: Low cost prescribing for statins - all prescriptions (%)
Quarterly
Q2 2009/10
QS3: 62 day Cancer RTT Waits (%)
Monthly
Nov 2009
QS4: Patients treated within 18 weeks Admitted (%)
Monthly
Nov 2009
QS5: Patients treated within 18 weeks Non-admitted (%)
Monthly
Nov 2009
QS3: 62 day Cancer RTT Waits
Monthly
Nov 2009
QS4: Patients treated within 18 weeks Admitted
Monthly
Nov 2009
QS5: Patients treated within 18 weeks Non-admitted
Monthly
Nov 2009
QS6: A&E 4 hour target
Monthly
17/01/2010
Prevention and Public Health - PCTs
PH1: CO validated quit rate at Stop Smoking Service
Quarterly
Q2 2009/10
Workforce - PCTs & Acute Trusts
WF2: PCT total Staff in Post by organisation
Monthly
Oct 2009
WF8: Acute trust total Staff in Post by organisation
Monthly
Oct 2009
Activity - Acute trusts
Quality & Safety and Prescribing - PCTs
Quality & Safety - Acute Trusts
Yorkshire and the Humber
Quality Observatory
Health and social care interface – QIPP metrics
QIPP metrics – Updates from the previous pack
Yorkshire and the Humber
Quality Observatory
Health and social care interface – QIPP metrics
QIPP metrics (1)
Yorkshire and the Humber
Quality Observatory
Health and social care interface – QIPP metrics
QIPP metrics (2)
Yorkshire and the Humber
Quality Observatory
Health and social care interface – QIPP metrics
QIPP metrics (3)
Yorkshire and the Humber
Quality Observatory
Health and social care interface – QIPP metrics
QIPP metrics (4)
Yorkshire and the Humber
Quality Observatory
Health and social care interface – QIPP metrics
QIPP metrics (5)
Yorkshire and the Humber
Quality Observatory
Health and social care interface – QIPP metrics
QIPP metrics (6)
%
IC Omnibus Q1 2009/10
PH2: 15-24 yr olds screened or tested for Chlamydia
YTD
HPA Sep 2009
PH3: All age all cause mortality males
rate per 100,000
ONS Q1 2008/09
PH4: All age all cause mortality females
rate per 100,000
ONS Q1 2008/09
PH5: Infants being breastfed at 6-8 week
%
VSMR - Unify Q2 2009/10
PH6: Alcohol related admissions
per 100,000
admissions
2008/9 provisional EASR
QIPP metrics - definitions and sources
Indicator
Units
Indicator
Source
Units
Source
Activity - Acute trusts
Activity - PCTs
A1: Emergency Readmission rates - nonelective; within 14 days of discharge %
Dr Foster data Q1 2009/10
A1: Emerg Readmission rates - nonelective within 14 days of discharge
%
Dr Foster data Q1 2009/10
A2: Elective LOS
Days
Dr Foster data Q1 2009/10
A3: Elective LOS compared to expected LOS
Days
Dr Foster data Q1 2009/11
A4: Nonelective LOS
Days
Dr Foster data Q1 2009/12
A5: Nonelective LOS compared to expected LOS
Days
Dr Foster data Q1 2009/10
A6: Hospital Standardised Mortality Ratio
Ratio
Dr Foster data Q1 2009/10
A7: Crude hospital-based mortality rates
%
Dr Foster data Q1 2009/10
A8: Daycase rates - Dr Foster indicator based on CQC groups
%
Dr Foster data Q1 2009/10
A9: First to Follow up OP
Ratio
BCBV data for Q1 2009/10
A10: Pre-operative bed day rates
%
BCBV data for Q4 2008/09
A11: Acute delayed discharges for adults
%
Unify Jul 2009
A2: Elective LOS (days)
Days
Dr Foster data Q1 2009/10
A3: Elective LOS compared to expected LOS (days)
Days
Dr Foster data Q1 2009/10
A4: Nonelective LOS (days)
Days
Dr Foster data Q1 2009/10
A5: Nonelective LOS compared to expected LOS (days)
Days
Dr Foster data Q1 2009/10
A6: Hospital Standardised Mortality Ratio (days)
Days
Dr Foster data Q1 2009/10
A7: Crude hospital-based mortality rates (rate per 100,000)
Rate per 100,000
Dr Foster data Q1 2009/10
A8: GP referrals (G&A) - YTD against VS Plans (%)
%
Unify & Vital Signs Oct 2009
A9: Other referrals (G&A) - YTD against VS Plans (%)
%
Unify & Vital Signs Oct 2009
Quality & Safety and Prescribing - PCTs
P1: Low cost prescribing for ACEI (%)
%
BCBV data Q1 2009/10
P2: Low cost PPI's vs all PPI's prescriptions (%)
%
BCBV data Q1 2009/10
P3: Low cost prescribing for statins - all prescriptions (%)
%
SHA Q1 2009/10
QS1: Hospital acquired Infection rates - Cumulative Rates of C.Diff
per 100,000 pop
SHA Nov 2009
QS2: Hospital acquired Infection rates - Cumualtive Rates of MRSA
per 100,000 pop
SHA Nov 2009
QS3: 62 day Cancer RTT Waits (%)
%
Unify Oct 2009
QS4: Patients treated within 18 weeks Admitted (%)
%
Unify Sep 2009
QS5: Patients treated within 18 weeks Non-admitted (%)
%
Unify Sep 2009
Quality & Safety - Acute Trusts
QS1: Hospital acquired Infection rates - Cumulative Rates of C.Diff
per 1000 ord adms
SHA Sep 2009
age 2+
QS2: Hospital acquired Infection rates - Cumualtive Rates of MRSA
per 1000 bed-days
SHA Sep 2009
QS3: 62 day Cancer RTT Waits
%
SHA Sep 2009
QS4: Patients treated within 18 weeks Admitted
%
SHA Sep 2009
QS5: Patients treated within 18 weeks Non-admitted
%
SHA Sep 2009
QS6: A&E 4 hour target
%
SHA 29/11/2009
QS7: Cancelled ops not treated within 28 days of last min cancellation
%
SHA Q2 2009/10
WF1: PCT total paybill
millions £
ESR Jul-Sep 2009
WF2: PCT total Staff in Post by organisation
number
iView Sep 2009
WF3: PCT annualised Av Basic Pay per FTE
thousands £
iView Q2 2009
WF4: PCT sickness Absence rates
%
iView Q2 2009
WF5: PCT turnover using FTE
%
ESR Jul-Sep 2009
WF6: PCT ratio of Clincal to Non-clinical staff
Ratio
Med & Non-Med Census '08
WF7: Acute trust total paybill
millions £
ESR Jul-Sep 2009
WF8: Acute trust total Staff in Post by organisation
number
iView Sep 2009
WF9: Acute trust annualised Av Basic Pay per FTE
thousands £
iView Q2 2009
WF10: Acute trust sickness Absence rates
%
iView Q2 2009
Workforce - PCTs & Acute Trusts
Prevention and Public Health - PCTs
PH1: CO validated quit rate at Stop Smoking Service
%
IC Omnibus Q1 2009/10
PH2: 15-24 yr olds screened or tested for Chlamydia
YTD
HPA Sep 2009
PH3: All age all cause mortality males
rate per 100,000
ONS Q1 2008/09
PH4: All age all cause mortality females
rate per 100,000
ONS Q1 2008/09
PH5: Infants being breastfed at 6-8 week
%
VSMR - Unify Q2 2009/10
PH6: Alcohol related admissions
per 100,000
admissions
2008/9 provisional EASR
Indicator
Units
Source
Activity - Acute trusts
A1: Emerg Readmission rates - nonelective within 14 days of discharge
%
Dr Foster data Q1 2009/10
WF11: Acute trust turnover using FTE
%
ESR Jul-Sep 2009
A2: Elective LOS
Days
Dr Foster data Q1 2009/10
WF12: Acute trust ratio of Clincal to Non-clinical staff
Ratio
Med & Non-Med Census '08
A3: Elective LOS compared to expected LOS
Days
Dr Foster data Q1 2009/11
A4: Nonelective LOS
Days
Dr Foster data Q1 2009/12
A5: Nonelective LOS compared to expected LOS
Days
Dr Foster data Q1 2009/10
A6: Hospital Standardised Mortality Ratio
Ratio
Dr Foster data Q1 2009/10
A7: Crude hospital-based mortality rates
%
Dr Foster data Q1 2009/10
A8: Daycase rates - Dr Foster indicator based on CQC groups
%
Dr Foster data Q1 2009/10
A9: First to Follow up OP
Ratio
Yorkshire and the Humber
BCBV data for Q1 2009/10Quality Observatory
Health and social care interface – QIPP metrics
PH1: CO validated quit rate at Stop Smoking Service