Vital Signs Performance for 2008/9
and
Our Actions for 2009/10 and 2010/11
Part 1 – Vital Signs Performance
Introduction
The NHS Operating Framework 2008-09 introduced a list of indicators or Vital Signs’ across a range of services. They were developed to encourage and enable partnership working between Primary Care Trusts (PCTs) and local authorities to deliver joint outcomes.
The NHS Operating Framework 2009/10 committed to the publication of performance against the Vital Signs to reflect the 2008/09 position. The attached data sheets contain details of the actual performance of NHS North East Essex and comparison to others. This comparative data was provided by the Care Quality Commission (CQC) and helps provide an insight into what we do really well in our area as well as the instances where other PCTs have proved it is possible to deliver even better results.
This report is intended to enable local review of the 2008/09 position, provide an opportunity to update on the action taking place during 2009/10 and facilitate an informed debate with partners, service users and the wider community on the priorities and service improvements for the coming financial year (2010/11).
What did we do really well?
The attached report provides details of our performance against the vital sign relative to others. The report highlights that we performed better than expected on the following indicators.
· Reducing rates of Clostridium Difficile
· Proportion of patients with suspected cancer waiting less than 62 days
· Increasing the coverage of Chlamydia screening (as a proxy for chlamydia prevalence)
· Timeliness of social care assessment
· Reducing rates of hospital admissions per 10,000 population for alcohol related harm
· Reducing rates of deliberate or unintended injuries to people aged under 19 (per 10,000)
A more full account of our work during 08-09 can be found in our Annual Report which was presented at our Annual General Meeting on the 15th September.
What are the key issues for this year?
National Priorities
We are working to improve performance against all vital signs as well as local priorities such as those identified as key World Class Commissioning Outcomes.
Brief details are provided below on a few specific areas highlighted in the CQC comparison report, or that we expect to be reported by the CQC in October as part of the Annual Health Check are:-
Proportion of patients seen within 18 weeks for admitted pathways / The NHS has made a commitment that from the 1st January 2009 no one waits more than 18 weeks from referral to the start of hospital treatment or other clinically appropriate outcome (where it is clinically appropriate and patients or patients chose to delay their treatment). We are pleased to report that we have achieved the national standard for our eligible non-admitted or out patients. For admitted patients whilst waiting times have fallen significantly and we achieved the 18 week standard for 88.49% of patients from January – March 2009 there is a greater proportion of patients waiting longer in this area for treatment than in most other areas of the East of England.We are working closely with our providers to ensure that all our patients benefit from the commitment to reduced waits.
Women who have seen a midwife or maternity healthcare professional by 12 weeks: data quality / Our main provider is working to introduce a new maternity IT system during this year to ensure improved information is available in the future.
Childhood obesity rates Year 6 pupils (data quality) / Preliminary data relating to our obesity recording rates for the last school year show a marked improvement
Access to primary care / The GP Patient Survey results give us an understanding of the patients’ views of how the services in each of the GP practice areas meet local needs. We have used this knowledge to develop localised improvement plans with our GPs tailored to meet the specific needs of their patients. As from April this survey will now be repeated quarterly allowing us to get an even better understanding of our patients’ attitudes and experiences.
Stroke Care / In order to achieve our ambition to significantly increase the number of stroke patients who spent at least 90% of their time on a stroke unit, 12 additional rehabilitation beds will be opened at Colchester Hospital University Trust in November 2009. This is intended to be an interim arrangement whilst we undertake a review of community rehabilitation services (including stroke) to develop and deliver a new model of care. With this interim arrangement in place it is planned that 90% target will be achieved by March 2010.
Proportion of individuals who complete immunisations by recommended ages / Locally we have a lot of work to do to improve the rate if immunisations and we are particularly focused on increasing the uptake of the MMR vaccinations. We have been talking to our patients and providers about the best way to do this and are taking the following actions:-
· Commissioning a Domiciliary Immunisation Team to offer MMR advice & vaccinations (age 2y & 5y) in the child's home. This approach is in response to parents requests for easier access to vaccinations & access to health professionals to discuss their anxieties regarding the MMR.
· Has changed the way Practices are notified of their MMR uptake
· Implementing a rolling programme of immunisation training in line with Department of Health /Health Protection Agency recommendations to ensure all vaccinators are advocating the MMR.
Access to primary dental services / Good progress is being made in the number of patients accessing a dentist in the previous 24 months with the PCT ranked 6th in the region. Overall the number of patients seen in 24 months since June 2008 has increased by 5.3%, from 167,787 in June 2008, to 176,639 in June 2009. This can largely be attributed to the free treatment initiative run by NHS North East Essex earlier in the year. In February, the PCT ran an innovative initiative “Free February”, where people could access free dental care. The number of patients seen was over 6,000. A “how to guide” has now been produced by NHS East of England based on the PCTs experience.
However there is much work to be done to ensure that we reach our target milestone of 196,510 by March 2010.
Feedback from our patients tells us that there is one issue is patient perception around expected recall intervals for check-ups. In order to respond to this we will be running a media campaign focussing on the positive element of not visiting the dentist every six months if not deemed necessary by your dentist. We will also be hosting a Dental Development Forum in early October, focussing on this and we are calling on our Dental Advisors to lead discussion on this issue with their peers.
Teenageconception rates per 1,000 females aged 15-17 / We are committed to doing even more to drive rates of teenage pregnancy down and work closely in partnership with others to do this. Much effort over the past six months has been spent on not only strengthening local direction and activity, but working with our strategic and delivery partners across Essex. This has been helped greatly by the appointment of a county-wide Co-ordinator and the development of a Joint Teenage Pregnancy Commissioning Plan.
Experience of patients / To ensure we remain focussed on improving the experience of our patients and respond quickly we have established a dedicated Patient Experience team within the PCT. A Patient Experience Strategy has been developed which details our approach to improving the experience patients have of all the NHS services provided in North East Essex.
NHS Staff Satisfaction / Every year we undertake a staff survey and our Staff Survey Working Group have been using the results from last years survey to understand more about our organisation and identify areas where we can do better. We want to be a provider of choice as we rely on our staff to deliver high quality services for our patients and communities.
Local Priorities
One of our biggest challenges continues to be reducing health inequalities across North East Essex. There is a 13.3 year difference in average life expectancy between Pier Ward and Alresford Ward with Pier having the 7th lowest life expectancy nationally. The factors that contribute to this are multifaceted and can only be tackled alongside our partners. In November the findings of the Comprehensive Area Assessment for Essex will be published and this is one area of our work with partners that we expect to be highlighted within the report.
Comprehensive Area Assessment, or CAA, is a new way of assessing local public services in England. It examines how well councils are working together with other public bodies to meet the needs of the people they serve. It's a joint assessment made by a group of six independent watchdogs.
Communities and Existing Services
We are targeting a Local Enhanced Service (LES) at GP practices serving more deprived populations to ensure patients who are at high risk of heart disease due to material deprivation are assessed and receive appropriate interventions.
This is supported by targeted use of health trainers. To address lifestyle risks we have targets at a local level for addressing risk factors such as smoking. We recognise the difficulty in engaging some socially excluded population groups with health services and have developed a number of outreach schemes to assess and manage people in their communities. This includes joint working with Essex County Council in a number of areas.
Priorities and Service Improvements for 2010/11
The PCT is currently revising the 5 Year Strategy in light of the changing economic environment and the known reduction in funding growth from 2010/11 and beyond. Fully integrated to this revision, will be the outcome of our work with partner organisations and stakeholders on our Quality, Innovation, Productivity and Prevention (QIPP) work and our development and application of an investment and disinvestment prioritisation methodology. Our strategy when formed in draft later this calendar year will specifically state what priorities and service improvements we will be taking forward and where these particularly aim to improve our vital sign performance in future years.
Where to get further information
Monthly reports on our progress against the vital signs and our operational
plan are received by the Finance and Performance (F&P) Committee on behalf of the Board. The F&P chair provides an update from each of these meetings at the public Board meetings.
The Care Quality Commission will publish the results of the Annual Health Check 2008-09 for all PCTs on their website www.cqc.org.uk on the 15th October 2009.
Full details of our plans for this year and the next 5 years can be viewed on the PCT website www.northeastessexpct.nhs.uk . Specific reading includes our Operational Plan 2009-10 and the 5 year strategy.
Information on our work with the Essex Partnership can be found online at www.essexpartnership.org . Key documents include the Local Area Agreement 2008-11 , The Essex Strategy 2008-18, the Joint Strategic Needs Assessment, or JSNA and the Community Wellbeing Strategy.
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Part II: Our Plans for children with a disability
The Department of Health has made it a requirement for all PCTs to report on their specific plans for children with a disability covering short breaks, community equipment, wheelchairs and palliative care.
Background
Aiming High for Disabled Children (AHDC) was launched in May 2007 and is the transformation programme for disabled children’s services in England. It aims to deliver three priority areas:
· Access and empowerment
· Responsive services and timely support
· Improve service quality and capacity.
To support the implementation of the vision, additional Government funding has been made available to Local Authorities and Primary Care Trusts.
The Department of Health’s Child Health Strategy, ‘Healthy Lives, Brighter Futures’, published in February this year, confirmed health funding to support the implementation of AHDC and the children’s palliative care strategy ‘Better Care Better Lives’.
In Essex, a multi - agency strategic group was established in 2007 led by the Local Authority to develop the county vision for children and young people with disability and prepare to meet the AHDC readiness criteria by spring 2009.
Essex was successful in being one of the first areas to achieve this in February 2009.
Children with a Disability
The Thomas Coram Research Unit has estimated that the number of disabled children in England is likely to be in the region of between 288,000 and 513,000, with the average proportion being between 3.0% and 5.4% of the population.
Applying these figures to the population of North East Essex, this suggests that between 1,883 and 3,389 children has some form of disability.
There has been some analysis carried out by the ONS in relation to the health of children and young people using the general household survey (GHS) and the Family Fund Trust’s (FFT) register of applicants. The following tables show the data derived from this work as prevalence rates by age band for mild and serious disability.
Table 5: Age-specific prevalence rates (per 100,000 aged 0-19 yrs) with a long standing illness or disability, 2000
0 to 4 / 5 to 9 / 10 to 14 / 15 to 19Prevalence / Estimate / Prevalence / Estimate / Prevalence / Estimate / Prevalence / Estimate
Boys / 14% / 1,107 / 25% / 2,254 / 18% / 1,859 / 20% / 1,851
Girls / 13% / 995 / 18% / 1,516 / 19% / 1,723 / 16% / 1,521
Source: General Household Survey, 2000