NHS Yorkshire and the Humber Monthly QIPP Resource Pack March 2010

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 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:[email protected]

http://www.healthyambitions.co.uk/

mailto:[email protected]

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




5) Annexes

Urg

en

t Care

- overv

iew


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

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- overv

iew


OverviewU

rgen

t Care

- overv

iew


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

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mu

nity

p

rovis

ion


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

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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

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CT

Nor

th L

inco

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ire P

CT

Nor

th Y

orks

hire

& Y

ork

PC

T

Rot

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am P

CT

Wak

efie

ld D

istr

ict P

CT

Eas

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ing

of Y

orks

hire

PC

T

NH

S Y

orks

hire

& T

he H

umbe

r

Nor

th E

ast L

incs

PC

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Bra

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dale

Tea

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CT S

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eld

PC

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Bar

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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




5) Annexes

Urg

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p

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Community provision overview U

rgen

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– com

mu

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p

rovis

ion


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


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

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t Care

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mu

nity

p

rovis

ion


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

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*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

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mu

nity

p

rovis

ion


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

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idin

g O

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hire

Nor

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ast

Linc

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hire

Car

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Plu

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Rot

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Nor

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Bar

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Wak

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Bra

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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

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Hul

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Nor

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And

Yor

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Nor

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Linc

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Car

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Plu

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idin

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Rot

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Wak

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Nor

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Bra

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Kirk

lees

Cal

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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

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p

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ion


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

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Nor

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Tru

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Of Y

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hire

She

ffiel

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Bra

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d &

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dale

Nor

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inco

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Kirk

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Cal

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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

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Nor

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Eas

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Kirk

lees

Cal

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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

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– com

mu

nity

p

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ion


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


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

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are

Tru

st P

lus S

heffi

eld

Leed

s

Hul

l Tea

chin

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Rot

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Nor

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inco

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Bar

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Wak

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Bra

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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

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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




5) Annexes

Urg

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– am

bu

lan

ce

serv

ices


Growth in emergency ambulance calls

Urg

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– am

bu

lan

ce

serv

ices


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

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idla

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Lond

on

Nor

th W

est

Eas

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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

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– am

bu

lan

ce

serv

ices


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


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


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




5) Annexes

Urg

en

t Care

– hosp

ital

pro

vis

ion


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


-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


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


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


A&E attendances by population groupsU

rgen

t Care

– hosp

ital

pro

vis

ion


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


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


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


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


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


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

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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


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


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


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


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


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


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

orou

gh &

NE Y

orks

hire

York

Hospi

tals

Rothe

rham

Gen

eral

Harro

gate

Dist

rict

Bradf

ord

Teach

ing

Sheffie

ld C

hildr

en's

NHS Institute Better Care, Better Value (2009, Q2)

National average

Contents

1) Overview




5) Annexes

Urg

en

t Care

– an


Quality Observatory

Key Contacts U

rgen

t Care

– an


Quality Observatory

Kevin Reynard – Senior Clinical Leader for Acute Care ([email protected])

Ian Holmes – Associate Director, Economics and System Management, NHS Y&H([email protected])

Helen Mercer – Economist, NHS Y&H([email protected])

Sivakumar Anandaciva([email protected])

Jake Abbas – Deputy Director, YHPHO([email protected])






Annex U

rgen

t Care

– an


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


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]

QIPP metrics - overview


QIPP metrics (1)


QIPP metrics (2)


QIPP metrics (3)


QIPP metrics (4)


QIPP metrics (5)


QIPP metrics (6)


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


Activity - PCTs


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


Documents

NHS Yorkshire and the Humber Monthly QIPP Resource Pack March 2010