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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: - PowerPoint PPT Presentation
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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. (Ian.holmes@yorksandhumber.nhs.uk)
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 pre-operative 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?
• There were around 5,600 fractured necks of femur in 2007-08.
• 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.
What is the challenge?
• 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.
• 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?
• The evidence-base for hip fracture shows that prompt effective multi-disciplinary management can improve quality and reduce costs.
• 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.
A local case study – Barnsley FT
• 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.
• 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:Tim.barton@yorksandhumber.nhs.uk
2) Hot topic: Urgent Care
Yorkshire and the Humber Quality Observatory
Contents
1) Overview
2) Community provision
3) Ambulance Services
4) Hospital Provision
5) Annexes
Urg
en
t Care
- con
ten
tsYorkshire and the Humber Quality Observatory
Section 1
1) Overview
2) Community provision
3) Ambulance Services
4) Hospital Provision
5) Annexes
Urg
en
t Care
- overv
iew
Yorkshire and the Humber Quality Observatory
This information pack is the fourth 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. 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.
PurposeU
rgen
t Care
- overv
iew
Yorkshire and the Humber Quality Observatory
OverviewU
rgen
t Care
- overv
iew
Yorkshire and the Humber Quality Observatory
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.
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.
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.
0
50
100
150
200
250
300
350
NHS Directcalls
999ambulance
calls
Major A&E SpecialistA&E (e.g.
dental)
Walk-incentres,
Minor InjuryUnits
Emergencyadmissions
Acti
vit
y p
er
100
0 h
ea
d o
f w
eig
hte
d p
op
ula
tio
n
Yorkshire England
Urgent and emergency care activity by type of service, 2008/09
See annex for sources
81%
14%
5% 14%
81%
Hospital provision:
A&E
Non-elective activity
Ambulance services
Community provision:
GP Services
NHS Direct
Pharmacies
Relative spend on urgent care services:
Source: Healthcare Commission, PSSRU unit costs of health and social care 2008
The urgent and emergency care pathwayU
rgen
t Care
– com
mu
nity
p
rovis
ion
Yorkshire and the Humber Quality Observatory
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.
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.
Admission
GP Practice A&E
NHS Direct
Pharmacy
WIC
999 Ambulance Service
GP Out of hours service
Urg
en
t Care
- overv
iew
Yorkshire and the Humber Quality Observatory
Service demand
-9.00%
-7.00%
-5.00%
-3.00%
-1.00%
1.00%
3.00%
5.00%
7.00%
Don
cast
er P
CT
Hul
l Tea
chin
g P
CT
Nor
th L
inco
lnsh
ire P
CT
Nor
th Y
orks
hire
& Y
ork
PC
T
Rot
herh
am P
CT
Wak
efie
ld D
istr
ict P
CT
Eas
t Rid
ing
of Y
orks
hire
PC
T
NH
S Y
orks
hire
& T
he H
umbe
r
Nor
th E
ast L
incs
PC
T
Bra
dfor
d &
Aire
dale
Tea
chin
gP
CT S
heffi
eld
PC
T
Bar
nsle
y P
CT
Cal
derd
ale
PC
T
Leed
s P
CT
Kirk
lees
PC
T
Per
cen
tag
e
Elective Activity Non-Elective Activity
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.
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.
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.
There is no relationship between recent activity growth and population growth within PCTs.
Elective and non-elective activity by PCT
504,600
1,480,200
17,300
303,000
542,500
671,700
0
250,000
500,000
750,000
1,000,000
1,250,000
1,500,000
1,750,000
NHS Directcalls
999ambulance
calls
Major A&E SpecialistA&E (e.g.
dental)
Walk-incentres,
Minor InjuryUnits
Emergencyadmissions
. Attendances at A&E .
Acti
vit
y
Urgent and emergency care activity by type of service, Yorkshire 2008/09
See annex for sources
Section 2
1) Overview
2) Community provision
3) Ambulance Services
4) Hospital Provision
5) Annexes
Urg
en
t Care
– com
mu
nity
p
rovis
ion
Yorkshire and the Humber Quality Observatory
Community provision overview U
rgen
t Care
– com
mu
nity
p
rovis
ion
Yorkshire and the Humber Quality Observatory
Consultation Cost
GP
Home visit £117
Phone £21
Pharmacy* £47
NHS Direct £22
* Pharmacy cost per patient related activity
Source: PSSRU Unit costs of health and social care 2009
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.
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”?
PharmacyU
rgen
t Care
– com
mu
nity
p
rovis
ion
Yorkshire and the Humber Quality Observatory
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.
Provision of 100 hour pharmacies per head of population is greater than the national average in Yorkshire & the Humber.
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.
General Pharmaceutical Services Bulletin, NHS Prescription Services
General Pharmaceutical Services Bulletin, NHS Prescription Services
0
5
10
15
20
25
30
Hull Teaching
Doncaster
Kirklees
Bradford and Airedale Teaching
North East Lincolnshire
Sheffield
Rotherham
BarnsleyLeeds
Wakefield
Calderdale
North Lincolnshire
East Riding of Y
orkshire
North Yorkshire and York
PCT
Ph
arm
acie
s p
er 1
00,0
00 h
ead
of
po
pu
lati
on
Pharmacies per 100,000 population Yorkshire & The Humber England
Number of pharmacies per 100,000 head of population 2008/09General Pharmaceutical Services Bulletin, 2008/09 NHS Information Centre
0%
2%
4%
6%
8%
10%
12%
14%
PCT
% o
f p
ha
rma
cie
s o
pe
n 1
00
ho
urs
a w
ee
k
% of pharmacies that are open 100 hoursYorkshire & The HumberEngland
Provision of 100 hour pharmacies, 2008/09General Pharmaceutical Services Bulletin, 2008/09 NHS Information Centre
Use of NHS Direct
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.
Urg
en
t Care
– com
mu
nity
p
rovis
ion
Yorkshire and the Humber Quality Observatory
Proportion of NHS Direct calls closed by NHS Direct or referred to other Primary Care Services (PCS), A&E or 999, Yorkshire 2009
0%
20%
40%
60%
80%
100%
% o
f c
alls
Closed by NHS Direct PCS Same Day PCS Urgent A&E 999
NHS Direct
*excludes calls with no demographic information
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.
To what extent is NHS Direct integrated with the provision of other urgent care services and teleservices?
Demographic breakdown of NHS Direct callersWithin Yorkshire, NHS Direct receives relatively few calls from ethnic minorities. This is in line with underlying demographics of populations.
Callers are predominantly of white origin, and females aged 16-44 years old are the biggest user group.
Urg
en
t Care
– com
mu
nity
p
rovis
ion
Yorkshire and the Humber Quality Observatory
*excludes calls with no demographic information
NHS Direct calls by ethnic group of caller, Yorkshire, 2009
0%
20%
40%
60%
80%
100%
% o
f ca
lls MixedAfroCaribbeanAsianWhite
NHS Direct
60 50 40 30 20 10 0 10 20 30 40 50 60
0 to 4
5 to 15
16 to 44
45 to 65
65 to 74
75 +
Ag
e G
rou
p
% of NHS Direct calls accounted for by a given age and gender group
Male Female
Age and Gender distribution of NHS Direct calls, Yorkshire, 2009NHS Direct
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.
Awareness of general practice out of hours services
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.
81% of survey respondents in Yorkshire & the Humber reported finding it easy to contact OOH services by telephone, above the national average.
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.
Urg
en
t Care
– com
mu
nity
p
rovis
ion
Yorkshire and the Humber Quality Observatory
Awareness of GP Out of Hours (OOH) Services 2008/09, by PCT, Yorkshire
0%10%20%30%40%50%60%70%80%90%
100%
Nor
th Y
orks
hire
And
Yor
k
Don
cast
er
Eas
t R
idin
g O
f Y
orks
hire
Nor
th E
ast
Linc
olns
hire
Car
eT
rust
Plu
s She
ffie
ld
Leed
s
Hul
l Tea
chin
g
Rot
herh
am
Nor
th L
inco
lnsh
ire
Bar
nsle
y
Wak
efie
ld D
istr
ict
Bra
dfor
d &
Aire
dale
Kirk
lees
Cal
derd
ale
GP Patient Survey, 2008/09
Kn
ow
ho
w t
o c
on
tact
a G
P
OO
H s
ervi
ce [
% Y
es]
England
Convenience of care received from GP Out of Hours (OOH) Services 2008/09, by PCT, Yorkshire
0%10%20%30%40%50%60%70%80%90%
100%
Don
cast
er
Hul
l Tea
chin
g
Nor
th Y
orks
hire
And
Yor
k
Nor
th E
ast
Linc
olns
hire
Car
eT
rust
Plu
s
Leed
s
Bar
nsle
y
Eas
t R
idin
g O
f Y
orks
hire
Rot
herh
am
She
ffie
ld
Wak
efie
ld D
istr
ict
Nor
th L
inco
lnsh
ire
Bra
dfor
d &
Aire
dale
Kirk
lees
Cal
derd
ale
GP Patient Survey, 2008/09
Eas
e o
f co
nta
ctin
g G
PO
OH
S
ervi
ce b
y te
lep
ho
ne
(% "
Eas
y")
England
Perceived quality of general practice out of hours services U
rgen
t Care
– com
mu
nity
p
rovis
ion
Yorkshire and the Humber Quality Observatory
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.
68% of respondents in Yorkshire & the Humber rated their overall satisfaction with care received from their OOH service as good.
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
Other PCTs such as Kirklees and Calderdale perform below average by the questions presented here.
Speed of care received from GP Out of Hours (OOH) Services 2008/09, by PCT, Yorkshire
0%10%20%30%40%50%60%70%80%90%
100%
Don
cast
er
Hul
l Tea
chin
g
Nor
th E
ast L
inco
lnsh
ire C
are
Tru
st P
lus
Nor
th Y
orks
hire
And
Yor
k
Wak
efie
ld D
istr
ict
Leed
s
Rot
herh
am
Bar
nsle
y
Eas
t Rid
ing
Of Y
orks
hire
She
ffiel
d
Bra
dfor
d &
Aire
dale
Nor
th L
inco
lnsh
ire
Kirk
lees
Cal
derd
ale
GP Patient Survey, 2008/09
Imp
ress
ion
of
spee
d o
f G
P O
OH
ca
re d
eliv
ery
[%
It w
as a
bo
ut
rig
ht]
England
Satisfaction of care received from GP Out of Hours (OOH) Services 2008/09, by PCT, Yorkshire
0%10%20%30%40%50%60%70%80%90%
100%
Don
cast
er
Hul
l Tea
chin
g
Nor
th E
ast L
inco
lnsh
ire C
are
Tru
st P
lus
Nor
th Y
orks
hire
And
Yor
k
Rot
herh
am
Leed
s
Wak
efie
ld D
istr
ict
Bar
nsle
y
She
ffiel
d
Bra
dfor
d &
Aire
dale
Nor
th L
inco
lnsh
ire
Eas
t R
idin
g O
f Y
orks
hire
Kirk
lees
Cal
derd
ale
GP Patient Survey, 2008/09
Rat
ing
of
care
rec
eive
d f
rom
G
PO
OH
ser
vice
(%
"G
oo
d")
England
GP out of hours quality and pricesU
rgen
t Care
– com
mu
nity
p
rovis
ion
Yorkshire and the Humber Quality Observatory
SHA averageNational average
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.
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.
Primary care OOH investment 2008/09Primary care commissioning Quality & productivity Calculator
Investment in GP OOH services and patient rating of quality of services, Yorkshire PCTs, 2008/09
50%
55%
60%
65%
70%
75%
80%
0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4
Primary care OOH investment (£million per 100k weighted pop)
% r
ati
ng
GP
OO
H c
are
as
"G
oo
d"
GP Patient Survey, Primary Care Commissioning: Quality & Productivity Calculator
High spend, low ratings BarnsleyBradford
North LincsKirklees
East Riding
Use of OOH and other urgent care servicesU
rgen
t Care
– com
mu
nity
p
rovis
ion
Yorkshire and the Humber Quality Observatory
50%
55%
60%
65%
70%
75%
Nor
th Y
orks
hire
And
Yor
k
Don
cast
er
Eas
t Rid
ing
Of Y
orks
hire
Nor
th E
ast L
inco
lnsh
ire C
are
Tru
st P
lus S
heffi
eld
Leed
s
Hul
l Tea
chin
g
Rot
herh
am
Nor
th L
inco
lnsh
ire
Bar
nsle
y
Wak
efie
ld D
istr
ict
Bra
dfor
d &
Aire
dale
Kirk
lees
Cal
derd
ale
020406080100120140160
NH
S D
irect
cal
ls p
er 1
000
head
Awareness of GP OOH NHS Direct activity
Kno
w h
ow to
con
tact
a G
P
OO
H s
ervi
ce [%
Yes
]
GP Patient Survey, 2008/09NHS Direct
Awareness of GP Out of Hours (OOH) Services 2008/09 and use of NHS Direct, by PCT, YorkshireLower awareness of GP OOH
services is associated with higher use of NHS Direct within Yorkshire and the Humber.
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.
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?
0
50
100
150
200
250
300
350
400
450
Type I Type II Type III
(Major A&E) (Specialist A&E e.g.dental/eye)
(Walk-in/Minor Injury)
Nu
mb
er o
f A
&E
att
end
ance
s p
er
1000
hea
d o
f re
sid
ent
po
pu
lati
on
Top 25% of PCTs
Bottom 25% of PCTs
QMAE data, DHGP Patient Survey
Rating of GP OOH care
A&E attendances per head of resident population, for PCTs in top & bottom 25% for ratings of GP OOH care
Urg
en
t Care
– com
mu
nity
p
rovis
ion
Yorkshire and the Humber Quality Observatory
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.
PCTs with very low OOH investment and high emergency spend may want to carry out further analysis to better understand this relationship.
Use of OOH and other urgent care services
0
20
40
60
80
100
120
140
160
OOH Spend Emergency admissions expenditure
National rankings for OOH and emergency spend
Primary Care Commissioning Quality & Productivity Calculator
Rank 1 = lowest investment, Rank 152 = highest investment.
Section 3
1) Overview
2) Community provision
3) Ambulance Services
4) Hospital Provision
5) Annexes
Urg
en
t Care
– am
bu
lan
ce
serv
ices
Yorkshire and the Humber Quality Observatory
Growth in emergency ambulance calls
Urg
en
t Care
– am
bu
lan
ce
serv
ices
Yorkshire and the Humber Quality Observatory
Growth in emergency and urgent ambulance calls (2007/8 to 2008/09)
-6.0%
-4.0%
-2.0%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
Eng
land
Isle
of
Wig
ht
Sou
thW
este
rn
Yor
kshi
re
Eas
tM
idla
nds
Sou
th E
ast
Coa
st
Gre
atW
este
rn
Wes
tM
idla
nds
Lond
on
Nor
th W
est
Eas
t of
Eng
land
Nor
th E
ast
Sou
thC
entr
al
Gro
wth
KA34 Collection, NHS Information Centre
Growth in emergency & urgent ambulance calls (2007/08 to 2008/09)
80
90
100
110
120
130
140
150
160
2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09
Cal
l vo
lum
es
Yorkshire Ambulance ServiceEngland total
KA34 Collection, NHS Information Centre
Annual ambulance calls scaled so that the number of calls in 2002-03 is 100Annual ambulance calls scaled to 100 in 2002/03
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.
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.
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.
Case mix and deprivationU
rgen
t Care
– am
bu
lan
ce
serv
ices
Yorkshire and the Humber Quality Observatory
Breathing Problems12%
Chest Pain11%
Unconscious/Fainting8%
Other23%
Falls/ Back Injuries (traumatic)
17%
Convulsions/ Fitting5%
Assault5%
Abdominal Pain4%
Traffic Accidents5%
Overdose/ Poisoning/ Ingestion
5%
Sick Person (Specific Diagnosis)
5%
Casemix of calls to the Yorkshire Ambulance Service, 2008/09Yorkshire Ambulance ServiceCasemix of calls to the Yorkshire Ambulance
Service, 2008/09
R2 = 51%
0
10
20
30
40
50
60
0 50 100 150 200 250
Ambulance incidents per 1000 head of population
Other PCTs
Yorkshire PCTs
More deprived
Less deprived
Dep
riva
tio
n
Ambulance activity and deprivation, by PCTHealth Services Journal, 2008/09, Index of Multiple Deprivation 2007
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?
The demand for ambulances is significantly higher in more deprived areas of Yorkshire. 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?
Yorkshire Ambulance Service
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.
Once an emergency response has been sent to the scene, YAS has a relatively high conveyance rate.
Could more ambulance incidents be handled by clinical telephone advice (hear and treat) or referral to other healthcare tele-services?
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 "response at scene" rates for ambulance calls, England, 2008/09
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Sou
th E
ast
Coa
st
Isle
of
Wig
ht
Eas
t of
Eng
land
Sou
thW
este
rn
Wes
tM
idla
nds
Nor
th W
est
Sou
thC
entr
al
Nor
th E
ast
Yor
kshi
re
Eas
tM
idla
nds
Gre
atW
este
rn
Lond
on
Inci
den
ts p
er 9
99 c
all
KA34 Publication, NHS IC
England rate
Variation in "conveyance from scene" rates for ambulance incidents, England, 2008/09
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
No
rth
We
st
Isle
of
Wig
ht
Yo
rksh
ire
Lo
ndo
n
No
rth
Ea
st
We
stM
idla
nd
s
Ea
stM
idla
nd
s
So
uth
Ea
stC
oa
st
So
uth
Ce
ntr
al
Gre
at
We
ste
rn
So
uth
We
ste
rn
Ea
st o
fE
ng
lan
d
Co
nv
ey
an
ce
s p
er
inci
de
nt England rate
KA34 Publication, NHS IC
Incidence and conveyance rates
Urg
en
t Care
– am
bu
lan
ce
serv
ices
Yorkshire and the Humber Quality Observatory
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).
Urg
en
t Care
– am
bu
lan
ce
serv
ices
Yorkshire and the Humber Quality Observatory
Category Cost (£)
A incidents 214
B incidents 188
C incidents 196
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
York
Hosp
itals
FT
Mid
York
shire
Hosp
itals
Nort
hern
Lin
coln
shire
And G
oole
FT
Sca
rboro
ugh
And N
ort
hE
ast
York
shire
The
Roth
erh
am
FT
Barn
sley
Hosp
ital F
T
Donca
ster
And
Bass
etla
wF
TC
ald
erd
ale
And
Hudders
field
FT
Att
en
dan
ces
0%
10%
20%
30%
40%
50%
60%
% o
f att
en
dan
ces b
rou
gh
t in
by A
mb
ula
nce
Other means of arriving at A&E
Brought in by Ambulance
% Brought in by Ambulance
A&E HES Data, NHS Information Centre
Number of attendances at A&E where primary diagnosis was "Nothing abnormal detected", Yorkshire Trusts, 2008/09
0
20
40
60
80
100
120
140
160
Am
bula
nce
act
ivity
per
head
Category C (Not serious, Not immediately life-threatening)
Category B (Serious, Not immediately life-threatening)
Category A (Serious, Immediately life-threatening)
Ambulance incidents per 1000 head of needs weighted population, by category of call and PCT, 2008/09
Health Services Journal
Ambulance incidents by call category
A&E attendances where primary diagnosis “Nothing abnormal detected”
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.
What support has been offered to paramedics to enable them to treat patients at the scene rather than conveying?
A&E HES Data NHS Information Centre*
*Experimental dataset, data not available for all providers
Ambulance services – patient satisfaction
Urg
en
t Care
– an
nexesYorkshire and the Humber
Quality Observatory
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.
50
60
70
80
90
100
Ambulance Index Waiting time for anambulance or other
help to arrive
Level of care thatyou received from
the ambulanceservice on your
way to the hospital
Ambulance staffexplained your
care and treatmentin a way you could
understand
Standard ofcleanliness andcomfort of the
vehicle in whichyou travelled
Involvement indecision about
your care
2007*20082009
Ambulance Service satisfaction by service users - 2009
Yorkshire and the Humber patient polling, September 2009
Section 4
1) Overview
2) Community provision
3) Ambulance Services
4) Hospital Provision
5) Annexes
Urg
en
t Care
– hosp
ital
pro
vis
ion
Yorkshire and the Humber Quality Observatory
A&E attendances by SHA England 2008/09
0
100
200
300
400
500
600
Lond
on S
HA
Nor
th W
est
SH
A
Nor
th E
ast
SH
A
Wes
t M
idla
nds
SH
A
Sou
th E
ast
Coa
st S
HA
Yor
kshi
re a
ndth
e H
umbe
rS
HA
Sou
th W
est
SH
A
Sou
th C
entr
alS
HA
Eas
t of
Eng
land
SH
A
Eas
t M
idla
nds
SH
A
A&
E a
tten
dan
ces
per
100
0 h
ead
of
po
pu
lati
on
England rate
QMAE data, DH
Yorkshire & the Humber falls in the middle of SHAs in terms of the overall demand for demand for A&E services.
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.).
How can we better understand the needs of frequent attenders at A&E in your area?
What measures have been taken to improve access to GPs in and out of hours as an alternative to A&E?
A&E services overview
Urg
en
t Care
– hosp
ital
pro
vis
ion
Yorkshire and the Humber Quality Observatory
-1.5%
-1.0%
-0.5%
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
Ave
rage
Sheff
ield
Teach
ing
Barn
sley
Hosp
ital
York
Hosp
itals
Donca
ster
and
Bra
dfo
rdT
each
ing
Airedale
NH
S T
rust
Hull
and
East
Sheff
ield
Child
ren's
Cald
erd
ale
and
Sca
rboro
ugh
and N
ort
h
The
Roth
erh
am
Harr
ogate
and D
istr
ict
Nort
hern
Lin
coln
shire
Mid
York
shire
Leeds
Teach
ing
Avera
ge a
nn
ual g
row
th in
att
en
dan
ces
Growth in attendances at Type I (Major) A&E, by Trust 2004/05 to 2008/09QMAE data, DH
A&E tariff 2010/11
Price
High £117
Standard £87
Minor £59
Average £88
Variation by type of A&E unitU
rgen
t Care
– hosp
ital
pro
vis
ion
Yorkshire and the Humber Quality Observatory
0.0
0.3
0.5
0.8
1.0
1.3
1.5
1.8
2.0
2004/05 2005/06 2006/07 2007/08 2008/09
A&
E A
tte
nd
an
ces
Type III (Minor Injury Units, Walk in Centres)Type II (Specialist A&E e.g. Dental, Eye)Type I (Major A&E)
QMAE data, DH (excludes walk in centres with a commuter focus)
Growth in A&E attendances in Yorkshire SHA, by Type of A&E, 2004/05 to 2008/09
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.
Making patients aware of alternatives to A&E can also improve patient experience and reduce waiting times.
Impact of location of A&E Departments
Urg
en
t Care
– hosp
ital
pro
vis
ion
Yorkshire and the Humber Quality Observatory
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.
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.
287.3
238.0
189.1
230.7
225.1
0 50 100 150 200 250 300 350
0-1 miles
1-5 miles
5-10 miles
0-10 miles
All Y&H
Road distance from A&E dept
Attendances per 1000 persons
Source: HES 2010, ONS mid year pop est 2008
Crude A&E attendance rate 2008/09 for Yorkshire & Humber SHAby A%E drive distance
119
750
210
1079
1174
0 200 400 600 800 1000 1200 1400
0-1 miles
1-5 miles
5-10 miles
0-10 miles
All Y&H
Road distance from A&E dept
A&E attendances by population groupsU
rgen
t Care
– hosp
ital
pro
vis
ion
Yorkshire and the Humber Quality Observatory
Highest Index = K 154 (6.2%) Asian Communities(excluding U)
Comparison between the Index value for A&E attendance in W Yorks and proportion of A&E attendance, for ACORN, for Q4 2006/07
0
40
80
120
160
200
A B C D E F G H I J K L M N O P Q
ACORN catagories
A&E%
0%
5%
10%
15%
20%
25%
Index value
Index
A&E %
Index = 100
Produced b y YHPHO 2008Source: A&E attendance data, ONS mid year est 2006
ACORN classifies populations based on demographic and lifestyle variables (see annex for categories).
Asian communities (K) have the highest level of A&E attendances relative to the level that would be expected as indicated by the index bars. Categories with bars higher than the red line have greater than expected A&E attendances.
Struggling families (N) have the highest proportion of A&E attendances as shown by the A&E% bars.
0
50
100
150
200
250
300
350
0-1 miles 1-5 miles 5-10 miles
Road distance from A&E dept
Most More Moderately Less Least
Source: HES 2010, ONS mid year pop est 2008
Crude A&E attendance rate 2008/09 for Yorkshire & Humber SHA by ID 2007 deprivation quintile, by A&E drive distance
Attendances per 1000 persons
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.
A&E attendancesU
rgen
t Care
– hosp
ital
pro
vis
ion
Yorkshire and the Humber Quality Observatory
0%
10%
20%
30%
40%
50%
60%
under 30 30 - 60 60+
Age on admission
% o
f A
&E
ad
mis
sio
ns
Admissions in last 10 mins before 4 hour target
All admissions
Age breakdown of A&E attendances resulting in admission, Yorkshire trusts, 2008/09
A&E HES Data, NHS Information Centre
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.
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.
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).
Distribution of waiting times in A&E for admitted patients, Yorkshire Trusts, 2008/09
0%
2%
4%
6%
8%
10%
12%
14%
0-9
10-
19
20-
29
30-
39
40-
49
50-
59
60-
69
70-
79
80-
89
90-
99
100
-10
9
110
-11
9
120
-12
9
130
-13
9
140
-14
9
150
-15
9
160
-16
9
170
-17
9
180
-18
9
190
-19
9
200
-20
9
210
-21
9
220
-22
9
230
-23
9
240
-24
9
250
-25
9
260
-26
9
270
-27
9
280
-28
9
290
-29
9
5 h
ours
+
Time spend in A&E
% o
f at
ten
dan
ces
A&E HES Data, NHS Information Centre
4 hour target
Spike in admissions 10 mins before target
High acuity cases
Immediately admitted
Treatment of patients attending A&EU
rgen
t Care
– hosp
ital
pro
vis
ion
Yorkshire and the Humber Quality Observatory
0%
5%
10%
15%
20%
25%
Bar
nsle
y H
ospi
tal F
T
Har
roga
te A
nd D
istr
ict
FT
Mid
Yor
kshi
re H
ospi
tals
Leed
s T
each
ing
Cal
derd
ale
And
Hud
ders
field
FT
Sca
rbor
ough
And
Nor
th E
ast
Yor
kshi
re
Yor
k H
ospi
tals
FT
Nor
ther
n Li
ncol
nshi
re A
ndG
oole
FT
The
Rot
herh
am F
T
She
ffie
ld C
hild
rens
FT
She
ffie
ld T
each
ing
Hos
pita
lsF
T
Don
cast
er A
nd B
asse
tlaw
FT
0
5
10
15
20
25
30
35
% admits in last 10 mins % Emergency admissions with no overnight stay
Time of emergency admission and zero night stays, Yorkshire Trusts, 2008/09A&E HES Data, NHS Information Centre
% o
f em
erg
ency
ad
mis
sio
ns
in
last
10
min
s b
efo
re 4
ho
ur
targ
et
% e
mer
gen
cy a
dm
its
wit
h
no
ove
rnig
ht
stay
0%10%20%30%40%50%60%70%80%90%
100%
% o
f att
enda
nces
A&E HES Data, NHS Information Centre
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.
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.
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.
Destination of patients leaving A&E
A&E HES data
It should be noted that the Sheffield Hospitals receive a different casemix of patients.
A&E Attendance against national targets
0
50,000
100,000
150,000
200,000
250,000
Lee
ds
Te
ach
ing
Hos
Mid
Yo
rksh
ire H
osp
Sh
effi
eld
Tea
chin
g
Do
nca
ste
r a
nd B
ass
Ca
lder
dal
e a
nd
Hu
d
No
rth
ern
Lin
coln
sh
Hu
ll a
nd
Ea
st Y
ork
Bra
dfo
rd T
ea
chin
g
Th
e R
oth
erha
m N
HS
Ba
rnsl
ey
Ho
spita
l
Yo
rk H
osp
itals
NH
S
No
rth
Yo
rksh
ire A
n
Aire
da
le N
HS
Tru
st
Sh
effi
eld
Ch
ildre
n
Sca
rbo
rou
gh
and
No
Ha
rro
gate
an
d D
ist
Wa
kefie
ld D
istr
ict
Kirk
lees
Prim
ary
C
Ea
st R
idin
g O
f Y
or
Hu
ll T
ea
chin
g P
rim
Ro
the
rha
m P
rima
ry
No
rth
Ea
st L
inco
ln
A&
E a
tten
dan
ces
90%
92%
94%
96%
98%
100%
102%
A&
E 4
ho
ur
Per
form
ance
Attendances 4 hr performance 4 hr standard
A&E attendance volume and performance against the 4 hr waiting time standard, Yorkshire 2008/09
QMAE data, DH
Urg
en
t Care
– hosp
ital
pro
vis
ion
Yorkshire and the Humber Quality Observatory
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.
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.
Weekly volume of emergency admissions and performance against A&E 4hr operational standard (Major A&Es), England
52000540005600058000600006200064000660006800070000
Num
ber o
f em
erge
ncy
adm
issi
ons
0.90.910.920.930.940.950.960.970.980.99
% o
f atte
ndan
ces
mee
ting
4hr s
tand
ard
Emergency Admissions (Type I) Type 1 performance Operational Standard
Weekly sitrep data, DH
Emergency admissionsU
rgen
t Care
– hosp
ital
pro
vis
ion
Yorkshire and the Humber Quality Observatory
Emergency Admissions Y&H 2008-09, Top 10 HRGs by age band
Age 0-41843618%
Age 5-1787188%
Age 18-493212931%
Age 50-641494414%
Age 65-741123811%
Age 75-841288212%
Age 85+64206%
Source:SHAPE, Hospital Episode Statistics (HES), The NHS Information Centre for health and social care
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.
Chest pain in adults over 70 accounts for over 3% of emergency admissions, the highest proportion of all conditions.
Almost 30% of emergency admissions of the highest volume activity are for adults over age 65.
Emergency admissionsU
rgen
t Care
– hosp
ital
pro
vis
ion
Yorkshire and the Humber Quality Observatory
Emergency Hospital Admissions: All conditions, Indirectly age and sex standardised rate per 100 000
949195519083 9369 9458 9606
8493859786248358
80387595
0
2000
4000
6000
8000
10000
12000
2002/03 2003/04 2004/05 2005/06 2006/07 2007/08
Year
Ind
irec
tly
age
and
sex
sta
nd
ard
ised
rat
e p
er 1
00,0
00
Source: NCHOD
England
Y&H SHA
Emergency hospital admissions: All conditions, rate per 100,000 population
Emergency hospital admissions 07/08 - Indirectly age and sex standardised rate per 100,000, Including 95% confidence intervals
11687
11440
10599
10395
10391
10291
10034
9634
9362
9125
8887
8302
8066
7448
0 2000 4000 6000 8000 10000 12000 14000
North Yorks and York PCT
NE Lincs CTP
East Riding PCT
Calderdale PCT
Kirklees PCT
Sheffield PCT
North Lincs PCT
Leeds PCT
Bradford and Airedale PCT
Doncaster PCT
Barnsley PCT
Wakefield District PCT
Rotherham PCT
Hull Teaching PCT
Source: NCHOD
ENGLAND
Y&H SHA
9491
8493
Emergency admissions in our region have consistently been above the national average although the gap has narrowed in recent years.
Only 3 PCTs in Yorkshire & the Humber have hospital admissions below the national average.
On average, each emergency admission costs approximately £1,400. Therefore, early identification and management of patients is key to reducing costs and increasing quality.
Readmissions and avoidable admissionsAcross 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.
As a region, Y&H has an admission rate for ACS conditions 5% below the expected 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 in the top quartile.
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).
Urg
en
t Care
– hosp
ital
pro
vis
ion
Yorkshire and the Humber Quality Observatory
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%
7.00%
8.00%
NHS Institute: Better Care, Better Value (2009,Q1)
-30.00%
-25.00%
-20.00%
-15.00%
-10.00%
-5.00%
0.00%
5.00%
10.00%
15.00%
NHS Institute: Better Care, Better Value (2009,Q2)
Emergency admissions relative to expected level
Emergency readmissions as a proportion of all emergency admissions
Y&H average
National average
Ratio of Non-elective pre-operative bed days to number of spells
Urg
en
t Care
– hosp
ital
pro
vis
ion
Yorkshire and the Humber Quality Observatory
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.
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.
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.
Non-elective pre-operative bed days
0
0.5
1
1.5
2
2.5
3
Leed
s Tea
ching
Sheffie
ld T
each
ing
Calde
rdale
& H
udde
rsfie
ld
North
Lin
cs &
Goo
le
Hull &
EY
Donca
ster &
Bas
setla
w
Barns
ley
Mid
Yor
kshi
re
Aireda
le
Scarb
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gh &
NE Y
orks
hire
York
Hospi
tals
Rothe
rham
Gen
eral
Harro
gate
Dist
rict
Bradf
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Teach
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Sheffie
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en's
NHS Institute Better Care, Better Value (2009, Q2)
National average
Contents
1) Overview
2) Community provision
3) Ambulance Services
4) Hospital Provision
5) Annexes
Urg
en
t Care
– an
nexesYorkshire and the Humber
Quality Observatory
Key Contacts U
rgen
t Care
– an
nexesYorkshire and the Humber
Quality Observatory
Kevin Reynard – Senior Clinical Leader for Acute Care (Kevin.Reynard@Lth.nhs.uk)
Ian Holmes – Associate Director, Economics and System Management, NHS Y&H(Ian.Holmes@Yorksandhumber.nhs.uk)
Helen Mercer – Economist, NHS Y&H(Helen.mercer@yorksandhumber.nhs.uk)
Sivakumar Anandaciva(Sivakumar.Anandaciva@dh.gsi.gov.uk)
Jake Abbas – Deputy Director, YHPHO(Ja18@york.ac.uk)
Annex U
rgen
t Care
– an
nexesYorkshire and the Humber
Quality Observatory
Sources of activity for the urgent and emergency care services charts in overview:
DATA SOURCENHS Direct NHS DirectAmbulances KA34 Data collectionA&E Attendances QMAE data collectionEmergency Admissions HESGP consultations QResearchPopulation figures ONS PCT populations and unified weighted population
ACORN Classification by CACI
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
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 forrest.frankovitch@yorksandhumber.nhs.uk
QIPP metrics - overview
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
QIPP metrics - definitions and sourcesIndicator Units Source
Activity - PCTs
A1: Emergency Readmission rates - nonelective; within 14 days of discharge % Dr Foster data Q1 2009/ 10
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
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 admissionsper 100,000 admissions
2008/ 9 provisional EASR
Indicator Units Source
Indicator Units Source
Activity - PCTs
Indicator Units Source
Activity - Acute trusts
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 J ul 2009
Quality & Safety - Acute Trusts
QS1: Hospital acquired Infection rates - Cumulative Rates of C.Diff per 1000 ord adms age 2+
SHA Sep 2009
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
Workforce - PCTs & Acute Trusts
WF1: PCT total paybill millions £ ESR J ul-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 J ul-Sep 2009
WF6: PCT ratio of Clincal to Non-clinical staff Ratio Med & Non-Med Census '08
WF7: Acute trust total paybill millions £ ESR J ul-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
WF11: Acute trust turnover using FTE % ESR J ul-Sep 2009
WF12: Acute trust ratio of Clincal to Non-clinical staff Ratio Med & Non-Med Census '08
Yorkshire and the Humber Quality Observatory
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