Transcript Slide 1

NHS Yorkshire and the Humber
Monthly QIPP Resource Pack
March 2010
Introduction
This is the fourth 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’ example focuses on treatment in hospital of fractured neck of femur.
URGENT CARE ‘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 urgent care.
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.
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.
The next resource pack will be published week commencing 5th April. The hot topic will be
planned care. If you have any questions or comments on the pack, please contact Ian Holmes.
([email protected])
1) Healthy Ambitions: Better for Less
Better for Less – Fractured neck of femur
Because looking after hip fracture patients well is a lot
cheaper than looking after them badly.
Better quality care can be delivered at reduced cost with
patients, clinicians, fracture services and those
responsible for patients all seeing the benefits.
Why Fractured neck of femur?
• Across Yorkshire and the Humber there are
over 30,000 fragility fractures each year.
• Fractured neck of femur is the most serious
consequence of falls in the elderly, with a
mortality rate of 10% one month after falling
and 30% at one year.
• The care and rehabilitation of patients with
hip fractures is a central challenge for UK
trauma services, but the quality and cost
effectiveness of such care varies considerably
across the region.
• The average length of a super spell is 28
days although this varies from 17 to 40 days
across trusts. Reducing the number of preoperative bed days is central to quick and
full recovery.
• These patients are among the most frail to
be admitted to hospital and their outcomes
depend critically on how their care is
managed. Avoidable delays, incomplete
assessment and lack of attention to
important details will result in poorer
outcomes.
Better for Less – Fractured neck of femur
What is the picture in Y&H?
What is the challenge?
• There were around 5,600 fractured necks
of femur in 2007-08.
• Despite a well established evidence base,
best practice has not been adopted
consistently across our region. The cost of
poor care far outweighs that of providing
good care.
• The cost to our healthcare system is
around £56m, including £36m in emergency
admissions.
• There are currently large variations in
average length of stay and re-admissions
rates for fractured neck of femur.
• Around 12% of patients discharged from
hospital following emergency admissions for
FNOF are re-admitted as an emergency
within 28 days. There is a 3-fold variation in
re-admission rates across PCTs in our region.
• There is a greater than 2 fold variation on
average length of stay for fractured neck of
femur HRGs in providers across our region.
• Only 68% of fragility fractures are treated
in surgery within 48 hours of admission.
This adds up to 3 days to total length of
stay.
• Care and rehabilitation services for
patients with a hip fracture are a central
challenge for trauma services; and those
that can provide good care for these
patients will cope well with the range of
other fragility fractures encountered.
Better for Less – Fractured neck of femur
How could we provide better for less?
A local case study – Barnsley FT
• The evidence-base for hip fracture shows
that prompt effective multi-disciplinary
management can improve quality and reduce
costs.
• The trust has established a programme of
training for nursing assistants to enable
staff to continue mobilising patients over
weekend when physiotherapy staff are not
available.
• Best practice is well defined:
•
Commissioners reflect blue book
expectations in their contracts and
monitoring mechanisms
•
Commissioners should seek to
implement a comprehensive falls
care pathway
•
Providers need to ensure compliance
with standards described in the blue
book.
•
Commissioners and providers should
utilise NHS Institute ‘focus on
fractured neck of femur’ resource
pack and consider using these as a
means to improve the care pathway.
• These competencies include risk
assessment, understanding documentation,
walking aids and mobility re-education.
• Implementing a best practice approach in
Barnsley FT has reduced average length of
stay from 20 days to 14 days, equal to
1,650 and £380,000 based on the excess
bed day tariff.
For further information visit:
www.healthyambitions.co.uk
Or contact:
[email protected]
2) Hot topic: Urgent Care
Yorkshire and the Humber
Quality Observatory
Contents
Overview
2)
Community provision
3)
Ambulance Services
4)
Hospital Provision
5)
Annexes
Yorkshire and the Humber
Quality Observatory
Urgent Care - contents
1)
Section 1
Overview
2)
Community provision
3)
Ambulance Services
4)
Hospital Provision
5)
Annexes
Yorkshire and the Humber
Quality Observatory
Urgent Care - overview
1)
Purpose
This information pack is the fourth of a series ‘hot topics’ that will be
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. The analysis has been set out by service setting, but
organisations will want to understand performance and develop solutions
across traditional boundaries.
We would be delighted to receive comments on the contents together with
any ideas for further urgent care analysis.
Yorkshire and the Humber
Quality Observatory
Urgent Care - overview
produced by the SHA to support organisations in developing their
understanding of some of the challenges and opportunities presented by
the QIPP agenda.
Overview
Many of these urgent care events were acute
exacerbations of chronic diseases such as
COPD and cardio-vascular disease.
Hospital provision accounts for a relatively
small proportion of activity yet represents
almost 81% of costs.
Where clinically appropriate, shifting care
upstream to planned non-acute settings and
teleservices such as NHS Direct could result
in the earlier delivery of high quality and
cost-effective care.
Community provision:
GP Services
NHS Direct
14%
Pharmacies
Ambulance services
5%
14%
81%
81%
Hospital provision:
Source: Healthcare Commission,
PSSRU unit costs of health and
social care 2008
A&E
Non-elective activity
Urgent and emergency care activity by type of service, 2008/09
350
Yorkshire
England
300
250
200
150
100
50
0
NHS Direct
calls
Yorkshire and the Humber
Quality Observatory
999
ambulance
calls
Major A&E
Specialist
A&E (e.g.
dental)
Walk-in
centres,
Minor Injury
Units
Emergency
admissions
See annex for sources
Urgent Care - overview
In 2008/09 alone there were almost 700,000
calls to the Yorkshire Ambulance Service,
1.5m attendances at major A&Es and
550,000 emergency admissions.
Relative spend on urgent care services:
Activity per 1000 head of weighted population
As a region we spend over £900m per annum
on urgent and emergency care from a total
allocation of £8bn. Ensuring that patients
receive the right care at the right time in
the right setting can deliver improved
outcomes for patients and reduced costs for
commissioners.
The urgent and emergency care pathway
There are significant productivity gains which can be realised by streamlining and rationalising
existing services and using patient engagement to ensure patients are aware of the most
appropriate care setting for their needs.
WIC
GP Out
of hours
service
GP Practice
Pharmacy
A&E
NHS
Direct
Yorkshire and the Humber
Quality Observatory
999
Ambulance
Service
Admission
Urgent Care – community provision
The urgent and emergency care system is complex. Patients can present at a range of contact
points, which may result in their condition being resolved or a referral to another service. While
there are well-defined care pathways for some conditions such as cardiac care and trauma,
commissioning clear pathways through urgent care for other frequent conditions such as falls and
COPD could reduce the multiple hand-offs within the emergency care system which impair
patient experience and increase costs.
Service demand
Activity
1,250,000
1,000,000
671,700
750,000
542,500
504,600
500,000
303,000
250,000
17,300
0
NHS Direct
calls
999
ambulance
calls
Major A&E
.
Specialist
A&E (e.g.
dental)
Walk-in
centres,
Minor Injury
Units
Emergency
admissions
Attendances at A&E
.
See annex for sources
Elective and non-elective activity by PCT
7.00%
Elect ive Act ivit y
Non-Elect ive Act ivit y
5.00%
3.00%
Yorkshire and the Humber
Quality Observatory
Kirklees PCT
Leeds PCT
Calderdale PCT
Barnsley PCT
Sheffield PCT
North East Lincs PCT
NHS Yorkshire & The Humber
Bradford & Airedale Teaching
PCT
-9.00%
East Riding of Yorkshire PCT
-7.00%
Wakefield District PCT
-5.00%
Rotherham PCT
-3.00%
North Yorkshire & York PCT
-1.00%
North Lincolnshire PCT
1.00%
Hull Teaching PCT
There is no relationship between recent
activity growth and population growth
within PCTs.
1,480,200
1,500,000
Doncaster PCT
Non-elective activity across our region has
increased by 3.6% between 2006/07 and
2008/09, though this masks regional
variation across trusts. 3 PCTs have
experienced reductions in non-elective
activity.
1,750,000
Urgent Care - overview
The uptake of relatively new services such
as Walk In Centres has continued, but this
has not reduced the demand for GP
consultations, ambulances and emergency
admissions. While calls to NHS Direct have
decreased recently, visits to their website
have increased.
Urgent and emergency care activity by type of service, Yorkshire 2008/09
Percentage
Nationally, the demand for emergency
services is growing faster than would be
expected based on the growth in the size
and average age of the population.
Section 2
Overview
2)
Community provision
3)
Ambulance Services
4)
Hospital Provision
5)
Annexes
Yorkshire and the Humber
Quality Observatory
Urgent Care – community provision
1)
Community provision overview
Lower-cost Teleservices such as NHS Direct and GP out of hours (OOH) offer an alternative to
dialling 999 or attending A&E in urgent situations, but their utilisation depends on the extent to
which patients are aware of these services and whether they think the services as offer
convenient and high quality care.
Extended pharmacy opening hours and the expanding clinical
role of pharmacists also offer a means for delivering
community care that can help patients monitor and practice
self-care, especially for chronic conditions. Whilst data is not
available for pharmacy use as a source of urgent care, 1.4m
contacts are made across our region with GP OOH services.
Are patients aware of alternatives to calling 999 or attending
A&E? What incentives are in place to avoid patients defaulting
to these two services which are open 24/7 and always say
“Yes”?
Consultation
GP
Cost
Home visit
£117
Phone
£21
Pharmacy*
£47
NHS Direct
£22
Source: PSSRU Unit costs of health
and social care 2009
* Pharmacy cost per patient related activity
Yorkshire and the Humber
Quality Observatory
Urgent Care – community provision
Access to general practice in-hours services is available for one third of each week, PCTs are
responsible for ensuring out of hours care is available for their populations all day at weekends
and bank holidays as well as between 6.30pm and 8.00am on weekdays.
Pharmacy
Number of pharmacies per 100,000 head of population 2008/09
Provision of 100 hour pharmacies per
head of population is greater than the
national average in Yorkshire & the
Humber.
Pharmacies per 100,000 population
England
25
20
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General Pharmaceutical Services Bulletin, NHS Prescription Services
PCT
Br
Provision of 100 hour pharmacies, 2008/09
% of pharmacies open 100 hours a week
More than 10% of pharmacies in Hull and
Kirklees are open 100 hours. North
Yorkshire and York and East Riding have
the lowest proportion of 100 hour
pharmacies. A likely cause of this is the
number of dispensing GPs in these areas.
With a largely rural population,
dispensing GPs are an important feature
of the healthcare economy in North
Yorkshire & York.
Yorkshire & The Humber
General Pharmaceutical Services Bulletin, 2008/09 NHS Information Centre
14%
% of pharmacies that are open 100 hours
Yorkshire & The Humber
England
12%
10%
8%
6%
4%
2%
0%
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Yorkshire and the Humber
Quality Observatory
PCT
Urgent Care – community provision
Use of 100 hour pharmacies can help
PCTs in effectively delivering their OOH
services. Pharmacies can help manage
patients with LTCs and provide support
for self-care.
Pharmacies per 100,000 head of population
General Pharmaceutical Services Bulletin, 2008/09 NHS Information Centre
30
Use of NHS Direct
There is some regional
variation in the proportion of
calls that are referred to other
services such as primary care
or 999, some of which is
attributable to casemix and
acuity. Kirklees and Calderdale
report the lowest proportion of
calls closed within NHS Direct
without referral, and these
two PCTs also record the
lowest satisfaction for GP out
of hours care in the region.
Proportion of NHS Direct calls closed by NHS Direct or referred to other
Primary Care Services (PCS), A&E or 999, Yorkshire 2009
Closed by NHS Direct
PCS Urgent
A&E
999
100%
% of calls
80%
60%
40%
20%
*excludes calls with no demographic information
Le
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Yorkshire and the Humber
Quality Observatory
H
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To what extent is NHS Direct
integrated with the provision
of other urgent care services
and teleservices?
PCS Same Day
NHS Direct
Urgent Care – community provision
Nationally, NHS Direct is a significant point of access for telephone consultations and triage. In
Yorkshire over 500,000 calls were received in 2008/09*. The rate of calls per 100,000 population
for each PCT varies between less than 6% in Doncaster and more than 13% in Bradford & Airedale.
Demographic breakdown of NHS Direct callers
NHS Direct
100%
% of calls
80%
Callers are predominantly of
white origin, and females
aged 16-44 years old are the
biggest user group.
Mixed
AfroCaribbean
Asian
White
60%
40%
20%
st
Ea
Age and Gender distribution of NHS Direct calls, Yorkshire, 2009
NHS Direct
Male
75 +
Female
65 to 74
Age Group
Patient segmentation and
social marketing are
effective tools to understand
variation in the use of urgent
care services and encourage
the use of cheaper
teleservices.
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45 to 65
16 to 44
5 to 15
0 to 4
60
50
40
30
20
10
0
10
20
30
40
% of NHS Direct calls accounted for by a given age and gender group
*excludes calls with no demographic information
Yorkshire and the Humber
Quality Observatory
50
60
Urgent Care – community provision
Within Yorkshire, NHS Direct
receives relatively few calls
from ethnic minorities. This is
in line with underlying
demographics of populations.
NHS Direct calls by ethnic group of caller, Yorkshire, 2009
Awareness of general practice out of hours services
Calderdale
Kirklees
Bradford & Airedale
Wakefield District
Barnsley
North Lincolnshire
Rotherham
Hull Teaching
Leeds
Sheffield
East Riding Of Yorkshire
Doncaster
North Yorkshire And York
Know how to contact a GP
OOH service [% Yes]
North East Lincolnshire Care
Trust Plus
GP Patient Survey, 2008/09
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Calderdale
Kirklees
Bradford & Airedale
North Lincolnshire
Wakefield District
Sheffield
Rotherham
East Riding Of Yorkshire
Barnsley
Leeds
North East Lincolnshire Care
Trust Plus
Yorkshire and the Humber
Quality Observatory
North Yorkshire And York
Hull Teaching
England
Doncaster
Only two-thirds of patients know how
to contact a GP OOH service, though
patients find these services
convenient when they are aware of
them.
England
Convenience of care received from GP Out of Hours (OOH)
Services 2008/09, by PCT, Yorkshire
Ease of contacting GPOOH
Service by telephone (% "Easy")
81% of survey respondents in
Yorkshire & the Humber reported
finding it easy to contact OOH
services by telephone, above the
national average.
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
GP Patient Survey, 2008/09
Urgent Care – community provision
Nationally, 67% of patients are aware
and know how to contact GP OOH
services. The average is the same
across Yorkshire and the Humber
although there is variation above and
below the average by PCT. Across our
region, 14% of respondents to the
survey reported trying to access GP
OOH services.
Awareness of GP Out of Hours (OOH) Services 2008/09, by PCT,
Yorkshire
Perceived quality of general practice out of hours services
Calderdale
Kirklees
North Lincolnshire
Bradford & Airedale
Sheffield
East Riding Of Yorkshire
Barnsley
Rotherham
Leeds
Wakefield District
North Yorkshire And York
North East Lincolnshire Care
Trust Plus
Hull Teaching
Doncaster
Calderdale
Kirklees
North Lincolnshire
Bradford & Airedale
Sheffield
Barnsley
Wakefield District
Leeds
Rotherham
East Riding Of Yorkshire
Yorkshire and the Humber
Quality Observatory
North Yorkshire And York
North East Lincolnshire Care
Trust Plus
England
Hull Teaching
Other PCTs such as Kirklees and
Calderdale perform below average by
the questions presented here.
GP Patient Survey, 2008/09
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Doncaster
There is some regional variation in
results with a range from 76% of
respondents reporting their level of
satisfaction as good in Doncaster to
58% in Calderdale. Doncaster is one
of the 3 PCTs that have reported a
decrease in non-elective admissions
England
Satisfaction of care received from GP Out of Hours (OOH) Services
2008/09, by PCT, Yorkshire
Rating of care received from
GPOOH service (% "Good")
68% of respondents in Yorkshire &
the Humber rated their overall
satisfaction with care received from
their OOH service as good.
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
GP Patient Survey, 2008/09
Urgent Care – community provision
Nationally, 64% of respondents
reported that speed of care they
received from GP OOH services was
about right; Yorkshire & the Humber
is slightly above average with
67%providing this response.
Impression of speed of GP OOH
care delivery [% It was about right]
Speed of care received from GP Out of Hours (OOH) Services
2008/09, by PCT, Yorkshire
GP out of hours quality and prices
care OOH
investment
2008/09
OutPrimary
of hours investm
ent per
100,000 population
Primary care commissioning Quality & productivity Calculator
1,200,000
National average
Investment (£)
1,000,000
SHA average
800,000
600,000
400,000
200,000
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Investment in GP OOH services and patient rating of quality
of services, Yorkshire PCTs, 2008/09
GP Patient Survey, Primary Care Commissioning: Quality & Productivity Calculator
80%
% rating GP OOH care as "Good"
A high level of investment in
2008/09 does not necessarily
translate into a high proportion of
patients rating GP out of hours
services as good. There may
however be a lag between the
period in which investment this
being reflected in services.
75%
70%
High spend,
low ratings
Barnsley
Bradford
North Lincs
Kirklees
East Riding
65%
60%
55%
50%
0.0
0.2
0.4
0.6
0.8
1.0
1.2
Primary care OOH investment (£million per 100k weighted pop)
Yorkshire and the Humber
Quality Observatory
1.4
Urgent Care – community provision
There is large variation in
investment in out of hours
services per 100,000 population
across the region although most
PCTs are above the national
average. North Yorkshire & York
has the 8th highest level of OOH
investment per 100,000
population nationally while 3
PCTs fall into the lowest quartile
of investment nationally.
Use of OOH and other urgent care services
160
140
120
100
80
60
40
20
0
70%
65%
60%
55%
QMAE data, DH
GP Patient Survey
Calderdale
Kirklees
Bradford & Airedale
Wakefield District
Barnsley
North Lincolnshire
Rotherham
Hull Teaching
Leeds
Sheffield
North East Lincolnshire Care
Trust Plus
East Riding Of Yorkshire
Doncaster
North Yorkshire And York
50%
NHS Direct calls per 1000 head
NHS Direct activity
75%
Number of A&E attendances per
1000 head of resident population
Broken down by type of
attendance, the difference is most
significant for major services.
What factors other than quality of
OOH services can account for this
difference?
Awareness of GP OOH
Know how to contact a GP
OOH service [% Yes]
After adjusting for need, there is
also a relationship between
ratings of GP OOH care and
attendance at A&E. For the
quartile of PCTs scoring lowest in
the GP patient survey, attendance
at A&E is 38% higher than for
areas with the best perceived
OOH services.
Awareness of GP Out of Hours (OOH) Services 2008/09 and use of NHS Direct,
by PCT, Yorkshire
GP Patient Survey,
2008/09
for
A&E attendances per head of resident population,
NHS Direct
in top & bottom 25% for ratings of GP OOH care,
PCTs
A&E attendances per head of resident population, for PCTs in
2008/09
England
top & bottom
25% for ratings
of GP OOH care
450
Rating of GP OOH care
400
Top 25% of PCTs
350
Bottom 25% of PCTs
300
250
200
150
100
50
0
Type I
Type II
Type III
(Major A&E)
(Specialist A&E e.g.
dental/eye)
(Walk-in/Minor Injury)
Yorkshire and the Humber
Quality Observatory
Urgent Care – community provision
Lower awareness of GP OOH
services is associated with higher
use of NHS Direct within Yorkshire
and the Humber.
Use of OOH and other urgent care services
National rankings for OOH and emergency spend
Primary Care Commissioning Quality & Productivity Calculator
PCTs with very low OOH
investment and high
emergency spend may want to
carry out further analysis to
better understand this
relationship.
Rank 1 = lowest investment,
Rank 152 = highest investment.
Yorkshire and the Humber
Quality Observatory
Urgent Care – community provision
This chart ranks investment in
out of hours services per head
of population against
secondary care emergency
admissions expenditure per
head of population across all
152 PCTs in England.
Comparisons are made on a
per capita basis per weighted
population.
Section 3
Overview
2)
Community provision
3)
Ambulance Services
4)
Hospital Provision
5)
Annexes
Yorkshire and the Humber
Quality Observatory
Urgent Care – ambulance services
1)
Growth in emergency ambulance
calls
Annual ambulance calls scaled so that the
160
Yorkshire Ambulance Service
England total
150
Call volumes
140
130
120
110
100
The step change in the level of
calls between 2006/07 and
2007/08 results from a data
collection change, the latter years
include urgent calls from GPs that
were previously collected
separately.
90
80
2002-03
2003-04
2004-05
2005-06
2006-07
2007-08
2008-09
KA34 Collection, NHS Information Centre
Growth in emergency and urgent ambulance calls (2007/8 to
Growth in emergency & urgent ambulance calls (2007/08 to
2008/09)
2008/09)
16.0%
14.0%
12.0%
8.0%
6.0%
4.0%
2.0%
Yorkshire and the Humber
Quality Observatory
South
Central
North East
East of
England
North West
London
West
Midlands
Great
Western
East
Midlands
South East
Coast
-6.0%
Yorkshire
South
Western
-4.0%
Isle of
Wight
0.0%
-2.0%
England
However, between 2007/08 and
2008/09 YAS experienced growth in
calls of 7%, which was more than
twice the average rate for England
and the third highest of any
ambulance trust in the country.
Growth
10.0%
KA34 Collection, NHS Information Centre
Urgent Care – ambulance services
Calls to the Yorkshire Ambulance
Service (YAS) have increased by
over 40% between 2002/03 and
2008/09. This is slightly lower than
the England average growth rate
which was around 50% over the
same period.
number
of calls
2002-03
100
Annual
ambulance
callsin
scaled
to 100 is
in 2002/03
Case mix and deprivation
Casemix of calls to the Yorkshire Ambulance Service, 2008/09
Yorkshire Ambulance Service
Casemix of calls to the Yorkshire
Ambulance Service, 2008/09
Abdominal Pain
4%
Breathing Problems
12%
Assault
5%
Convulsions/ Fitting
5%
Chest Pain
11%
Traffic Accidents
5%
Overdose/ Poisoning/
Ingestion
5%
Deprivation
The demand for ambulances is significantly
More
higher in more deprived areas of Yorkshire. deprived
This may be due to increased need for
healthcare in general, as well as specific issues
such as the reduced access to private
transport to A&E or awareness of alternatives
to dialling 999.
Are interventions being focussed on
spearhead and deprived areas that account
for disproportionately higher demand for
ambulances?
Falls/ Back Injuries
(traumatic)
17%
Other
23%
Unconscious/Fainting
8%
Sick Person (Specific
Diagnosis)
5%
Yorkshire Ambulance Service
Ambulance activity and deprivation, by PCT
Health Services Journal, 2008/09, Index of Multiple Deprivation 2007
60
Other PCTs
Yorkshire PCTs
50
R2 = 51%
40
30
20
10
Less
deprived
0
0
Yorkshire and the Humber
Quality Observatory
50
100
150
200
Ambulance incidents per 1000 head of population
250
Urgent Care – ambulance services
The pie chart illustrates the casemix of calls
made to YAS in 2008/09. A relatively small
proportion of conditions account for a large
proportion of activity - Falls and back injuries
and breathing problems (including conditions
such as COPD) account for almost 1/3 of all
calls.
Are commissioners and providers targeting
interventions at the conditions accounting for
the majority of recorded ambulance activity?
Are services such as falls units open out of
hours to provide alternatives to conveying
falls to A&E?
Incidence and conveyance rates
London
Great
Western
East
Midlands
Yorkshire
North East
South
Central
North West
West
Midlands
South
Western
East of
England
England rate
South East
Coast
Once an emergency response has been
sent to the scene, YAS has a relatively
high conveyance rate.
1.0
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0.0
Isle of
Wight
Incidents per 999 call
Variation in "response at scene" rates for
ambulance calls, England, 2008/09
KA34 Publication, NHS IC
0.9
England rate
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
East of
England
South
Western
Great
Western
South
Central
South East
Coast
East
Midlands
West
Midlands
North East
London
Yorkshire
Isle of
Wight
0.0
North
West
What is the cost to a PCT of the
ambulance staffing and vehicle
provision that will be needed if the
trend of increasing ambulance
demand continues?
Variation in "conveyance from scene" rates for
ambulance incidents, England, 2008/09
Conveyances per incident
Could more ambulance incidents be
handled by clinical telephone advice
(hear and treat) or referral to other
healthcare tele-services?
KA34 Publication, NHS IC
Yorkshire and the Humber
Quality Observatory
Urgent Care – ambulance services
YAS has a low ranking of incident to
call rates, although the rate is slightly
above the national average. There is
relatively little variation across
ambulance trusts in England with the
exception of London. Around 80% of
calls require an ambulance to attend.
Ambulance services
Ambulance incidents per 1000 head of needs weighted population, by
Ambulance
by call
category
category
of incidents
call and PCT,
2008/09
Ambulance activity per head
160
Category C (Not serious, Not immediately life-threatening)
140
Category B (Serious, Not immediately life-threatening)
Category A (Serious, Immediately life-threatening)
120
100
80
60
40
20
ey
fie
ld
Ba
rn
sl
rk
Sh
ef
Yo
an
d
ef
ie
ld
ire
rk
sh
re
d
Yo
Ai
th
or
Health Services Journal
of attendances at A&E where primary diagnosis was
A&ENumber
attendances
where primary diagnosis “Nothing abnormal detected”
"Nothing abnormal detected", Yorkshire Trusts, 2008/09
Other means of arriving at A&E
16,000
Brought in by Ambulance
% Brought in by Ambulance
14,000
Attendances
60%
12,000
50%
40%
10,000
30%
8,000
6,000
20%
4,000
10%
2,000
Yorkshire and the Humber
Quality Observatory
Doncaster
And
Bassetlaw
FT
Calderdale
And
Huddersfield
FT
Barnsley
Hospital FT
The
Rotherham
FT
Northern
Lincolnshire
And Goole
FT
Scarborough
And North
East
Yorkshire
0%
Mid
Yorkshire
Hospitals
0
York
Hospitals FT
What support has been offered to
paramedics to enable them to treat
patients at the scene rather than
conveying?
*Experimental dataset, data not available for all providers
% of attendances brought in by Ambulance
A&E HES
Data
Information
Centre*
A&E HES
Data,NHS
NHS Information
Centre
18,000
In some areas, a high proportion of
those A&E attendances with a
primary diagnosis of “nothing
abnormal detected” are brought in
by ambulance, over 50% in
Scarborough.
W
ak
he
r
ha
m
st
er
R
ot
e
on
ca
D
in
C
al
e
al
ac
h
Te
rk
de
rd
al
g
re
s
sh
i
ee
Yo
of
ng
d
an
N
196
rd
C incidents
ad
fo
188
Br
B incidents
rk
l
id
i
Ea
st
R
th
or
214
N
A incidents
Ki
Li
Ea
st
Cost (£)
Yo
rk
Category
sh
ir e
av
Le
ed
s
er
ag
e
nc
o
N
l
n
or
sh
th
ire
Li
nc
ol
ns
hi
H
re
ul
lT
ea
ch
in
g
0
Urgent Care – ambulance services
By PCT, there is variation in the level
of ambulance activity and the type of
calls made to the ambulance service.
Per head of population, North
Lincolnshire has the greatest of
category C calls per head (not
immediately life threatening).
Ambulance services – patient satisfaction
Patient satisfaction with ambulance services in Yorkshire and the Humber is
consistently high although satisfaction was consistently lower in 2009 than the
previous years. Waiting time for an ambulance /other help to arrive remains one of
the weaker attributes of the ambulance service.
100
Ambulance Service satisfaction by service users - 2009
80
70
60
2007*
2008
2009
50
Ambulance Index
Waiting time for an Level of care that
Ambulance staff
ambulance or other you received from
explained your
help to arrive
the ambulance
care and treatment
service on your
in a way you could
way to the hospital
understand
Yorkshire and the Humber
Quality Observatory
Standard of
cleanliness and
comfort of the
vehicle in which
you travelled
Involvement in
decision about
your care
Yorkshire and the Humber patient
polling, September 2009
Urgent Care – annexes
90
Section 4
Overview
2)
Community provision
3)
Ambulance Services
4)
Hospital Provision
5)
Annexes
Yorkshire and the Humber
Quality Observatory
Urgent Care – hospital provision
1)
A&E services overview
300
200
100
East Midlands
SHA
East of
England SHA
South Central
SHA
South West
SHA
Yorkshire and
the Humber
SHA
South East
Coast SHA
West Midlands
SHA
North East
SHA
North West
SHA
London SHA
0
Growth in attendances at Type I (Major) A&E, by Trust 2004/05 to 2008/09
QMAE data, DH
2.5%
2.0%
1.5%
1.0%
0.5%
-1.5%
Yorkshire and the Humber
Quality Observatory
Leeds
Teaching
Mid
Yorkshire
Northern
Lincolnshire
Harrogate
and District
The
Rotherham
Calderdale
and
Sheffield
Children's
Hull and
East
Airedale
NHS Trust
Bradford
Teaching
Doncaster
and
Scarborough
and North
-1.0%
York
Hospitals
-0.5%
Barnsley
Hospital
0.0%
Sheffield
Teaching
What measures have been taken to
improve access to GPs in and out
of hours as an alternative to A&E?
England rate
400
Average
How can we better understand the
needs of frequent attenders at
A&E in your area?
500
QMAE data, DH
Average annual growth in attendances
There is some regional variation in
the growth in demand for A&E
services over the last 5 years. In
particular Sheffield Teaching
Hospitals has had the highest
growth in demand (2.3%p.a.) and
the demand for major A&E services
in Leeds Teaching Hospitals has the
lowest (-1.2% p.a.).
600
Urgent Care – hospital provision
Yorkshire & the Humber falls in the
middle of SHAs in terms of the
overall demand for demand for A&E
services.
A&E attendances per 1000 head of population
A&E attendances by SHA England 2008/09
Variation by type of A&E unit
Type III (Minor Injury Units, Walk in Centres)
Type II (Specialist A&E e.g. Dental, Eye)
Type I (Major A&E)
2.0
1.8
A&E Attendances
1.5
1.3
1.0
0.8
0.5
0.3
0.0
2004/05
2005/06
2006/07
2007/08
QMAE data, DH (excludes walk in centres with a commuter focus)
Making patients aware of
alternatives to A&E can also
improve patient experience
and reduce waiting times.
A&E tariff
High
Yorkshire and the Humber
Quality Observatory
2010/11
Price
£117
Standard
£87
Minor
£59
Average
£88
2008/09
Urgent Care – hospital provision
Major (Type I) A&Es are
consultant-led, open 24
hours a day, and account for
the majority of A&E
attendances. The average
tariff price for an A&E
attendance is £88, and
reducing the 2 million
attendances seen each year
in A&E could deliver
substantial cost savings if
reductions are matched by
reductions in staffing.
Growth in A&E attendances in Yorkshire SHA, by Type of A&E, 2004/05 to 2008/09
Impact of location of A&E Departments
North Yorkshire & York has areas of
the lowest A&E attendance per
1,000 population. (No data was
available for Bradford, Kingston
upon Hull and Doncaster, these
areas also have the lightest
shading.)
Per 1,000 persons, A&E attendance
is higher for those that live within
a 1 mile radius of an A&E
Department. Populations living
within 10 miles of A&E have higher
attendance than the regional
average.
Crude A&E attendance rate 2008/09 for Yorkshire & Humber SHA
by A%E drive distance
Road distance
from A&E dept
0-1 miles
287.3
1-5 miles
238.0
5-10 miles
189.1
0-10 miles
230.7
All Y&H
225.1
S o urc e : H E S 2 0 10 , O N S
m id ye a r po p e s t 2 0 0 8
Yorkshire and the Humber
Quality Observatory
0
50
100
150
Attendances per 1000 persons
200
250
300
350
Urgent Care – hospital provision
For certain A&E Departments
across the region, populations
within 5 miles seem to be higher
users of the service than those
living further away.
A&E attendances by population groups
As with ambulance services, demand
for A&E is higher amongst more
deprived populations. More deprived
populations are also more likely to
attend A&E if they live closer. This
relationship is true for all groups
however distance to A&E has a
relatively small impact for the least
deprived populations.
Crude A&E attendance rate 2008/09 for Yorkshire & Humber SHA
by ID 2007 deprivation quintile, by A&E drive distance
Most
More
Moderately
Less
Least
Attendances 300
per 1000
persons
250
200
150
100
ACORN classifies populations based on
demographic and lifestyle variables
(see annex for categories).
50
0
0-1 miles
S o urc e : H E S 2 0 10 , O N S
Highest Index =
K
154 (6.2%)
m id ye a r po p e s t 2 0 0 8
1-5 miles
5-10 miles
Road distance from A&E dept
Asian Communities
(excluding U)
Comparison between the Index value for A&E attendance in W Yorks and proportion of A&E attendance, for
Asian communities (K) have the
ACORN, for Q4 2006/07
highest level of A&E attendances
200
relative to the level that would be
expected as indicated by the index
160
bars. Categories with bars higher than
120
the red line have greater than
A&E%
expected A&E attendances.
80
Struggling families (N) have the
highest proportion of A&E
attendances as shown by the A&E%
bars.
Index
A&E %
Index = 100
25%
20%
15%
Index
value
10%
40
5%
0
0%
A
B
C
D
E
Source: A&E attendance data, ONS mid year est 2006
Yorkshire and the Humber
Quality Observatory
F
G
H
I
J
ACORN catagories
K
L
M
N
O
P
Q
Produced b y YHPHO 2008
Urgent Care – hospital provision
350
A&E attendances
In certain cases, A&E is the best setting
for patients to wait for test results or
for observation before an informed
decision to admit can be made.
However, a better understanding of this
admission profile at the local level may
drive improvements in patient
experience (patients admitted in the
last 10 mins are older on average) and
the delivery of cost-effective care (e.g.
avoiding unnecessary admissions).
A&E HES Data, NHS Information Centre
14%
Spike in admissions
10 mins before target
% of attendances
12%
4 hour
target
10%
8%
High acuity
cases
Immediately
admitted
6%
4%
2%
Time spend in A&E
Age breakdown of A&E attendances resulting in
admission, Yorkshire trusts, 2008/09
A&E HES Data, NHS Information Centre
60%
Admissions in last 10 mins before 4 hour target
50%
All admissions
40%
30%
20%
10%
0%
under 30
Yorkshire and the Humber
Quality Observatory
30 - 60
Age on admission
60+
290-299
5 hours +
280-289
270-279
260-269
250-259
240-249
230-239
220-229
210-219
200-209
190-199
180-189
170-179
160-169
150-159
140-149
130-139
120-129
110-119
90-99
100-109
80-89
70-79
60-69
50-59
40-49
30-39
20-29
0-9
10-19
0%
% of A&E admissions
Providers in Yorkshire & the Humber
perform better than the national
average in dealing with a higher
proportion of A&E attenders more
quickly after they arrive.
Distribution of waiting times in A&E for admitted patients,
Yorkshire Trusts, 2008/09
Urgent Care – hospital provision
The NHS plan set out that no one
should wait more than 4 hours in A&E
before being discharged, admitted or
transferred. The number of patients
admitted via A&E sharply increases in
the last 10 minutes before the 4 hour
target.
Treatment of patients attending A&E
Destination of patients leaving A&E, 2008/09
G
oo
sp
Ho
nc
Do
An
d
as
te
r
ns
hi
An
re
d
An
d
ire
ol
nc
Li
er
n
bo
r
rth
ou
gh
sp
Yo
rk
sh
M
ld
er
d
Ca
le
FT
Ba
s
se
No
t
la
rth
w
Ea
FT
st
Yo
rk
sh
ire
ita
lF
ita
ch
i
Ho
sle
y
id
rn
Ba
ls
T
ng
FT
ed
s
Te
a
er
h
th
Le
e
Th
Yo
r
k
Ro
Ho
sf
ie
sp
ita
ls
am
FT
FT
ld
FT
Hu
An
al
e
rro
Ha
d
ga
te
ch
dd
er
Di
An
d
g
in
d
Te
a
d
st
ric
t
FT
ls
sp
ita
Ho
Ch
ild
re
ns
FT
% of attendances
ffi
el
Sh
e
ffi
el
A&E HES data
Sc
ar
No
It should be noted
that the Sheffield
Hospitals receive
a different
casemix of patients.
Sh
e
There is wide variation in the destination of
patients leaving A&E. The destination of
patients reflects treatment at A&E as well as
links within the healthcare economy.
Doncaster refers the most patients to a GP,
Leeds has the highest rate of admittance for
patients attending A&E.
Time of emergency admission and zero night stays, Yorkshire Trusts, 2008/09
A&E HES Data, NHS Information Centre
% Emergency admissions with no overnight stay
30
20%
25
15%
20
10%
15
10
5%
5
Doncaster And Bassetlaw
FT
Sheffield Teaching Hospitals
FT
Sheffield Childrens FT
The Rotherham FT
Northern Lincolnshire And
Goole FT
York Hospitals FT
Scarborough And North East
Yorkshire
Leeds Teaching
Calderdale And Huddersfield
FT
Yorkshire and the Humber
Quality Observatory
Mid Yorkshire Hospitals
0
Harrogate And District FT
0%
% emergency admits with
no overnight stay
35
Barnsley Hospital FT
Trusts record the level of emergency
admissions with zero overnight stay. Across
Yorkshire & the Humber, around 15% of
admissions result in no overnight stay. It
does not appear to be the case that trusts
admitting patients close to the 4 hour target
have higher levels of admission with no
overnight stay.
% of emergency admissions in
last 10 mins before 4 hour target
% admits in last 10 mins
25%
Urgent Care – hospital provision
The following analysis is based on the
Experimental A&E HES dataset, not all
providers in Y&H are included. There are
data quality and coverage issues.
A&E HES Data, NHS Information Centre
Destination
of patients leaving A&E
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
A&E Attendance against national targets
A&E attendance volume and performance against the 4 hr waiting time
standard, Yorkshire 2008/09
200,000
100%
98%
150,000
96%
100,000
94%
North East Lincoln
Rotherham Primary
Hull Teaching Prim
Kirklees Primary C
East Riding Of Yor
Wakefield District
Harrogate and Dist
Sheffield Children
Scarborough and No
Airedale NHS Trust
North Yorkshire An
York Hospitals NHS
Barnsley Hospital
Bradford Teaching
The Rotherham NHS
Hull and East York
Northern Lincolnsh
Calderdale and Hud
90%
Sheffield Teaching
0
Doncaster and Bass
92%
Mid Yorkshire Hosp
50,000
A&E 4 hour Performance
4 hr standard
102%
QMAE data, DH
Weekly volume of emergency admissions and performance against A&E 4hr
operational standard (Major A&Es), England
ril
2
Ap
Operational Standard
Weekly sitrep data, DH
Yorkshire and the Humber
Quality Observatory
0.99
0.98
0.97
0.96
0.95
0.94
0.93
0.92
0.91
0.9
% of attendances
meeting 4hr standard
Type 1 performance
6/
0
M7
Juay
ne
Au July
gu
Se st
Opct
No t
De v
c
Ja
Ap
n
ril M Feb
20 ar c
07 h
/0
M8
a
Ju y
ne
J
Au uly
gu
Se st
Opct
No t
De v
c
Ja
Ap
ril M Fe n
20 ar b
08 ch
/0
M9
a
Ju y
ne
Au July
g
Seust
p
Oct
No t
De v
c
Ja
n
M F eb
ar
ch
Emergency Admissions (Type I)
70000
68000
66000
64000
62000
60000
58000
56000
54000
52000
00
Number of emergency
admissions
Poorer waiting time performance
is associated with increased
demand and increased bed
demand. This emphasises how
effective bed management
strategies can deliver improved
patient experience in A&E for
patients awaiting admission.
4 hr performance
250,000
Leeds Teaching Hos
A&E attendances
Attendances
Urgent Care – hospital provision
Higher demand for A&E is
associated with poorer
performance against the 4 hour
A&E waiting time target. Periods
of high demand over summer
heatwaves and winter pressures
highlight this relationship.
Emergency admissions
Chest pain in adults over 70
accounts for over 3% of emergency
admissions, the highest proportion
of all conditions.
Emergency Admissions Y&H 2008-09, Top 10 HRGs by age band
Age 85+
6420
6%
Age 75-84
12882
12%
Almost 30% of emergency
admissions of the highest volume
activity are for adults over age 65.
Age 0-4
18436
18%
Age 5-17
8718
8%
Age 65-74
11238
11%
Age 50-64
14944
14%
Age 18-49
32129
31%
Source:SHAPE, Hospital Episode Statistics (HES), The NHS Information Centre for health and social care
Yorkshire and the Humber
Quality Observatory
Urgent Care – hospital provision
In 2008/09, there were over
550,000 emergency admissions in
Yorkshire & the Humber. The 10
highest volume HRGs account for
almost 20% of all emergency
admissions.
Emergency admissions
Emergency Hospital Admissions: All conditions, Indirectly age and sex standardised rate per 100
000
On average, each emergency
admission costs approximately
£1,400. Therefore, early
identification and management
of patients is key to reducing
costs and increasing quality.
Indirectly age and sex standardised rate per 100,000
Only 3 PCTs in Yorkshire & the
Humber have hospital
admissions below the national
average.
12000
10000
9369
9083
9606
9458
9551
9491
Y&H
SHA
Urgent Care – hospital provision
Emergency admissions in our
region have consistently been
above the national average
although the gap has narrowed
in recent years.
Emergency hospital admissions: All conditions, rate per
100,000 population
England
8000
8038
8597
8624
8358
8493
7595
6000
4000
2000
0
2002/03
2003/04
2004/05
2005/06
2006/07
Year
2007/08
Source: NCHOD
Emergency hospital admissions 07/08 - Indirectly age and sex standardised rate per 100,000,
Including 95% confidence intervals
Hull Teaching PCT
11687
Rotherham PCT
11440
Wakefield District PCT
10599
Barnsley PCT
10395
Doncaster PCT
10391
Bradford and Airedale PCT
10291
Leeds PCT
10034
North Lincs PCT
9634
Sheffield PCT
9362
Kirklees PCT
9125
Calderdale PCT
8887
Y&H SHA
East Riding PCT
8302
8066
NE Lincs CTP
7448
North Yorks and York PCT
0
Yorkshire and the Humber
Quality Observatory
2000
4000
6000
8000
9491
ENGLAND
8493
10000
12000
Source: NCHOD
14000
Readmissions and avoidable admissions
10.00%
5.00%
0.00%
-5.00%
-10.00%
-15.00%
Sh
ef
fie
ld
Ro
th
er
ha
m
6.00%
NHS Institute: Better Care,
Better Value (2009,Q2)
Emergency readmissions as a proportion of all emergency admissions
National
average
Y&H
average
5.00%
4.00%
3.00%
2.00%
1.00%
0.00%
Sh
ef
fie
ld
C
R
hi
ot
ld
he
re
rh
n'
am
s
G
C
L
en
al
ee
de
er
ds
al
rd
Te
al
e
a
ch
&
in
H
g
ud
de
rs
fi e
ld
Ai
re
d
M
al
id
e
Yo
r
k
Yo
sh
rk
i re
Sc
H
os
ar
pi
bo
ta
ro
ls
ug
B
a
h
r
&
ns
NE
le
y
Yo
rk
sh
i re
H
H
ul
ar
l&
ro
E
ga
Y
t
Br
e
D
ad
is
fo
tri
rd
ct
Te
Sh
ac
ef
D
fie
hi
on
ng
ld
ca
T
ea
st
er
ch
&
in
g
Ba
N
or
ss
th
et
Li
la
nc
w
s
&
G
oo
le
Readmissions within 14 days could
suggest that there are unplanned
admissions that could be avoided.
Reducing readmissions in line with PCTs
performing in the top quartile would
generate savings to PCTs of almost
£12.5m across the region (Trusts will
only realise these savings if capacity is
reduced accordingly).
Hu
ll
Do
nc
as
te
r
Ba
No
r
ns
rth
ley
Li
nc
ol
ns
hi
re
Ca
NH
l
de
S
Yo
rd
ale
rk
sh
ire
Le
&
ed
Th
s
Br
e
ad
Hu
fo
m
rd
be
&
r
Ai
re
da
le
Ki
rk
le
No
es
rth
W
ak
Ea
e
Ea
st
fi e
st
Li
ld
nc
Ri
ol
di
ns
ng
No
hi
of
re
rth
Yo
Yo
rk
sh
rk
sh
ire
i re
&
Yo
rk
-20.00%
As a region, Y&H has an admission rate for -25.00%
ACS conditions 5% below the expected
-30.00%
level for our population, there is however
large variation across the patch with a
range of 16% more admissions than
expected to 30% less than expected. There
is scope for savings of almost £14.3m
across the region by reducing emergency
admissions to the level of PCTs performing 8.00%
7.00%
in the top quartile.
Yorkshire and the Humber
Quality Observatory
NHS Institute: Better Care, Better Value (2009,Q1)
Urgent Care – hospital provision
Across the patch there is scope for a
reduction in emergency admissions for
Ambulatory Care Sensitive (ACS) long-term
health conditions. Such conditions can
usually be managed in the community
without hospitalisation.
Emergency admissions relative to expected level
15.00%
Non-elective pre-operative bed days
Ratio of Non-elective pre-operative bed days to number of spells
2.5
1.5
1
0.5
Te
Sh
ac
ef
al
hi
fie
ng
de
ld
rd
T
ea
al
e
ch
&
in
H
g
ud
N
or
de
th
rs
Li
fi e
nc
ld
s
&
G
D
oo
on
le
ca
H
ul
st
l&
er
&
E
Y
Ba
ss
et
la
w
Ba
rn
sl
M
ey
id
Yo
Sc
r
ar
ks
bo
hi
re
ro
ug
A
i re
h
&
da
NE
le
Yo
rk
sh
Yo
i re
rk
R
H
ot
os
he
pi
ta
rh
ls
am
H
G
ar
en
ro
er
ga
al
te
Br
D
ad
i
s
fo
tri
rd
ct
Te
Sh
ac
ef
fie
hi
ng
ld
C
hi
ld
re
n'
s
0
C
Reducing non-elective pre-operative bed
days to the level of trusts performing in
the top quartile nationally would
generate savings to PCTs of almost
£79.4m across Yorkshire & the Humber.
Trusts will only realise savings by
reducing capacity accordingly.
National
average
2
Le
ed
s
Several providers in our area have ratios
worse than the national average on this
indicator. Rapid treatment of patients
admitted with emergency conditions not
only reduces acute bed days but can be
important in producing better outcomes.
NHS Institute Better Care, Better Value (2009, Q2)
3
Yorkshire and the Humber
Quality Observatory
Urgent Care – hospital provision
Better Care, Better Value reports the
level of non-elective pre-operative bed
days as a ratio of the number of spells; a
lower value represents better
performance.
Contents
Overview
2)
Community provision
3)
Ambulance Services
4)
Hospital Provision
5)
Annexes
Yorkshire and the Humber
Quality Observatory
Urgent Care – annexes
1)
Key Contacts
Kevin Reynard – Senior Clinical Leader for Acute Care
([email protected])
Ian Holmes – Associate Director, Economics and System Management,
NHS Y&H
([email protected])
Sivakumar Anandaciva
([email protected])
Jake Abbas – Deputy Director, YHPHO
([email protected])
Yorkshire and the Humber
Quality Observatory
Urgent Care – annexes
Helen Mercer – Economist, NHS Y&H
([email protected])
Annex
Sources of activity for the urgent and emergency care services charts in overview:
DATA
NHS Direct
Ambulances
A&E Attendances
Emergency Admissions
GP consultations
Population figures
SOURCE
NHS Direct
KA34 Data collection
QMAE data collection
HES
QResearch
ONS PCT populations and unified weighted population
Category
Description
Category
Description
A
Wealthy Executives
J
Prudent Pensioners
B
Affluent Greys
K
Asian Communities
C
Flourishing Families
L
Post Industrial Families
D
Prosperous Professionals
M
Blue Collar Roots
E
Educated Urbanites
N
Struggling Families
F
Aspiring Singles
O
Burdened Singles
G
Starting Out
P
High Rise Hardship
H
Secure Families
Q
Inner City Adversity
I
Settled Suburbia
Yorkshire and the Humber
Quality Observatory
Urgent Care – annexes
ACORN Classification by CACI
3) QIPP Metrics
Yorkshire and the Humber
Quality Observatory
QIPP metrics - overview
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
QIPP metrics (1)
Yorkshire and the Humber
Quality Observatory
QIPP metrics (2)
Yorkshire and the Humber
Quality Observatory
QIPP metrics (3)
Yorkshire and the Humber
Quality Observatory
QIPP metrics (4)
Yorkshire and the Humber
Quality Observatory
QIPP metrics (5)
Yorkshire and the Humber
Quality Observatory
QIPP metrics (6)
Yorkshire and the Humber
Quality Observatory
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
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
BCBV data for Q1 2009/10
Yorkshire and the Humber
Quality Observatory