Integrated Performance Report Southwark Social Services and Southwark Primary Care Trust 2003/04 Provisional Indicators
Integrated Performance Report: 2003/04 Provisional Indicators 1. Recommendation 1.1 That the Health and Social Care Board note this report. 2. Purpose of report 2.1 This report sets out provisional data on full year 2003/04 performance on the indicators and targets contained within the integrated performance management framework of Southwark PCT and Southwark Social Services. 2.2 End of year performance indicators are still being ratified by the relevant authorities so the figures in this report are provisional, but expected in most cases to be very close to the final picture. The final indicators and star ratings will be announced in July in the case of the PCT and in the Autumn in the case of Social Services. These rating will be subject to separate reports. It is not yet possible to say with any certainty what the star ratings will be. However in general terms we can say that on most indicators across health and social care performance has largely been maintained or improved. 2.3 In addition to the summary of key performance issues and table of results at Annex 1, a more detailed analysis of performance on each indicator is available to the Board upon request. 3 Background the integrated performance management framework 3.1 On 25 th November 2003 the Southwark Health and Social Care Board agreed an approach to integrated performance management. This is the second report based on this framework, and focuses on performance up to the end of Quarter 4 of 2003/04. 3.2 The integrated framework is based on a basket of key health and social care performance indicators that were selected according to the following criteria: - the indicator reflects performance on key shared objectives - performance on the indicator depends on effective whole system working - performance on the health indicator will impact on social services performance or visa versa - the indicator is central to either organisation s star rating - the indicator covers an area where there are performance concerns 3.3 The indicators are broadly categorised under the headings of access and waiting times, community support, prevention and outcomes. 3.4 The overall purpose of the framework is to provide a manageable balanced scorecard of key indicators that will help measure whole system performance
across health and social care and improve the strategic understanding of how performance in one area impacts on performance in another area. This in turn should help inform business and financial planning and the further integration of service provision. 3.5 The framework does not attempt to comprehensively cover all the performance data covering health and social care, which would require a framework running into thousands of indicators. The full range of data will however continue to be monitored internally through the performance management function and reported on an exception basis. 3.6 This framework will be developed further over 2004/05. In particular, data collection systems need refining and some new indicators of increased relevance will be added. 4 Overview of Performance 2004/05 4.1 In general terms performance across health and social care in Southwark is positive and the key strengths that helped both the Primary Care Trust and Social Services achieve two star status are being maintained. 4.2 However there continues to be significant areas for development that will be addressed during 2004/05, including immunisation, screening and other public health targets such as smoking cessation and Social Care waiting time indicators. 4.3 In terms of whole system issues a notable feature is the high level of pressure on the A&E system. This needs considering in the context of issues about access and quality in primary care, linkages with the social care system, NHS Direct, and the effectiveness of community based preventative strategies. A detailed analysis of patient flows is currently being undertaken by the PCT s Modernisation Team to better understand the issues and ensure that strategies are developed during 2004/05 to reduce pressure on A&E services. 5 Summary of key performance issues 5.1 Access/waiting times indicators: 5.1.1 Access to a GP: With nearly 100% of patients able to see a GP within two working days the national target of 90% has been met. However this indicator only captures one element of GP access. We are aware that in some areas registering with a GP has proved problematic. We will continue to work with local GPs to improve the position for local residents. 5.1.2 Access to a Primary Care Professional: The national target that 90% of patients should be able to see a primary care professional (usually a practice nurse) within one day has been met, but with performance at 92% it is clearly a weaker area than GP access, and can vary considerably from week to week. This is in part because many surgeries do not have full time practice nurse coverage.
5.1.3 Inpatients/Outpatient waiting times: Targets have been met as there were zero breaches against the key targets recorded for Southwark patients as a result of intensive performance management in the acute sector. 5.1.4 A&E waiting times: With 92.6% of people waiting no more than 4 hours in A&E during 2003/4 the national target has been met, which is also a considerable achievement in the context of increased attendances at A&E (as outlined elsewhere in the report). The target to achieve 98% by December 2004 is considered a major challenge for this year and the PCT and Social Services will continue to work with local hospitals to help prevent admissions and facilitate timely discharge to reduce pressure on the A&E system. 5.1.5 Delayed transfers of care: The jointly managed multi-agency hospital discharge teams have secured good improvement to an average of around 15 patients on this indicator by the end of the year. This has been done by ensuring rapid access to appropriate social care services for patients who are ready for discharge, including the development of intermediate care services. 5.1.6 Community Equipment Delivery within 7 days: Performance on this stringent new indicator is some way below the 100% target that is likely to be in place in future. The separate equipment services of the PCT and Social Services will be fully integrated during 2004/05, and pooled budgets are in place which should provide an opportunity for the service to be redesigned and improved. 5.1.7 Early Intervention Mental Health Services: London-wide delays in funding for the development of these specific services resulted in a performance of zero for this indicator in 2003/04. However 2004/05 funding is now available and a service plan is in place which should see the service fully established during 2004. 5.1.8 Waiting time for social care assessments and care packages: 62% of social care clients had an assessment and a care package implemented in line with new strict target timescales. This is an area that will be subject to extra funding in 2004/05 and close management controls will be in place to ensure performance improves. The introduction of integrated assessment, management and commissioning processes will provide an opportunity to rationalise and further improve processes. 5.1.9 Sexual Health: access to services for early unintended pregnancy: There has been a good improvement in the percentage of abortions undertaken at nine weeks or less, reflecting increased investment in relevant services. Performance has improved from 44% to 52% and is now in line with the national average. 5.1.10 Substance mis-use numbers in treatment: The position on this indicator is currently unclear. Recently released national data suggests that the target was not met in Southwark but this does not accord with local records which suggest that the target was met. Southwark is querying the data through the Healthcare Commission/National Drug Treatment Monitoring Agency. 5.1.11 Social Care Clients receiving a review: The target for improving the rate for clients being reviewed to 65% has been achieved, helping ensure the quality and
appropriateness of services and prompt access to new or enhanced services for clients whose needs have changed. 5.1.12 Health of Children Looked After: Strong performance achieved on ensuring Children Looked After have good access to health services as measured by the provision of annual primary and dental healthcare checks. The location of health visitors within children looked after teams has assisted in this and further integration of children s services will promote this objective. 5.1.13 Waiting times for cancer treatment: 100% of urgently referred patients were seen by a specialist after 14 days of the decision to refer by their GP in line with NHS targets. 5.1.14 Waiting times for rapid access chest pain clinics: 98% of clients were seen in Rapid Access Chest Pain Clinics within 14 days of referral, a target set to measure progress in the modernisation of Coronary Heart Disease treatment. 5.2 Prevention and Community Support indicators: 5.2.1 Four week smoking quitters: Problems in achieving the highly challenging target set for Southwark have been discussed in previous reports. The various initiatives in place, including the joint work based cessation service across the PCT/Council workforce, have contributed to a significant increase in performance in quarter 4, which recorded 240 quitters as opposed to around 90 in each of the previous quarters. 5.2.2 Smoking in pregnancy/breast feeding initiation: On these indicators we now have baseline data showing 12.9% of smokers at time of birth and 88% of breast feeding mothers and await comparative data to assess performance. 5.2.3 MMR immunisation: At 63% as compared to a national figure of 80%, Southwark is significantly below average, although this is a London-wide issue. 5.2.4 Cervical Screening: At 72% as compared to a national figure of 81%, Southwark is significantly below average, although this is a London-wide issue. 5.2.5 Flu vaccinations: At 51.6% as compared to a national figure of 71%, Southwark is significantly below average, although this is a London-wide issue. 5.2.6 Child protection reviews completed to timescale: There were just 6 breaches on this target giving a performance level of 97%. System changes are building in controls that eliminate the risk of further breaches. The numbers of unallocated child protection cases had been successfully held to zero by the year end. 5.2.7 Household receiving intensive homecare: Comparative performance remains strong but the causes of the slight decline in 2003/04 are being analysed. Performance is being closely monitored alongside residential care admissions rates with which there is a strong relationship.
5.2.8 People supported to live at home by social services: The most significant area of change in this indicator relates to mental health clients, where a major increase is due to improved data capture. Slippage in other adult client groups against target is linked to the time delays involved in the implementation of long term strategies for reducing reliance in residential care. 5.2.9 Carers assessments/mental health carers support: Data has not yet been finalised due to collection problems. 5.2.10 Diabetic retinopathy screening: Screening rates have increased substantially to 52% but will need to increase further to achieve national targets of 80% by 2006. Note: the final Star Rating indicator concerns the strength of arrangements in place to extend screening, which Southwark has met the criteria for. 5.3 Outcome indicators: 5.3.1 Emergency admissions (change in rate): There has been a dramatic recorded increase of 18.5% in emergency admissions, putting substantial pressure on acute services. The underlying causes of this and possible policy solutions are being assessed across the whole system. 5.3.2 Emergency re-admissions: Previous data returns indicating a high rate of readmissions have proved to be incorrect and performance is now in line with the national average. 5.3.3 Emergency psychiatric re-admissions: Strong performance in comparison to the national average maintained. 5.3.4 Intensive homecare rates (as a proportion of care home usage): Although overall performance is comparatively strong, performance is below target and there is a slight downward trend which needs to be closely monitored and managed alongside the related issue of admissions to long term care where significant increases have been recorded. 5.3.5 Death rates from cancer and heart disease: Mortality rates have reduced in these areas, exceeding the national average reduction. 5.3.6 Adoptions of children looked after: Strong performance recorded with 7.4% of children looked after adopted, which research shows significantly improves the life chances of children looked after in terms of health, education and employment. 5.3.7 Teenage Pregnancy: Latest data (relating to 2002) shows that Southwark s figures remain very high, presenting a major challenge to all agencies involved in tackling this issue. However, Southwark rates are levelling off whereas on average across London they are increasing by 4%, indicating there may be a long term reduction in the performance gap. 5.3.8 Stability of children looked after: Comparative performance remains strong but there has been a slight increase in the numbers changing placement three or
more times in a year. This will be monitored and the whole system response to placement instability will be further developed as part of integration plans. 5.3.9 Educational attainment of children looked after: Improvements have been recorded reflecting the high levels of effort that have been put into this area of historical weakness over recent years. 5.3.10 Final warnings and convictions of children looked after: An increase in this indicator is linked to improved data capture. 5.3.11 Child protection duration on the register: Continued improvements to this indicator reflect improvements in the overall quality of the system which is benefiting from substantial additional investment and joint working.
Summary table of indicators (provisional outturn 2003/04) INTEGRATED FRAMEWORK INDICATORS Actual 2002/03 Target 03/04 Final 03/04 Target 04/05 Performance Ref Access/waiting times See key 1 Access to a GP % 100 90 99.7 100 2 Access to a Primary Care Professional 95.7 90 92.7 100 % 3 Number of inpatients waiting > 9 months NA 0 0 0 4 Number of outpatients waiting > 17 NA 0 0 0 weeks 5 Total time in A&E 82.6 90 92.6 98 6 Delayed transfers of care (patients) 26.5 15 19.2 15 7 Community equipment delivery NA 75 65.8 75 8 Early Intervention mental health 0 0 0 100! 9 Waiting time for assessment NA - 62.3 75! 10 Waiting time for care package NA - 62 75! 11 Sexual health - Access to services for 44% - 51.9%? early unintended pregnancy 12 Substance misuse number in 1148 1263? 1650 treatment? 13 Clients receiving a review % 52 65 66.6 75 14 Health of children looked after % 75 85 80.6 85 15 Waiting times for cancer treatment % 100 100 99.86 100 16 Waiting time for RACPC % 100 98.6 97.7 100 Prevention and community support 17 Four-week smoking quitters 290 1560 543 1559! 18 Smoking in pregnancy rates NA - 12.9-19 Breast feeding initiation NA - 88-20 MMR Immunisation % 71 82 63 80! 21 Cervical Screening % 72.3 72.68 71.65?! 22 Flu Vaccinations % 49.2 51.6 54 54! 23 Child protection reviews % 99 100 98 100 24 Households receiving intensive 22.9 25 21.9 25 homecare 25 People with physical disabilities helped 3.4 5 3.48 5.1 to live at home per 1000 26 People with learning disabilities helped 2.3 3 2.2 3 to live at home per 1000! 27 People with mental health problems 3.4 3.6 8.86 8.86 helped to live at home per 1000 28 Older People helped to live at home per 122 115 117.7 115 1000 29 Carers Assessments % 17 30 17 40! 30 Mental health carers support % 21 24 32 28! 31 Diabetic Retinopathy % 33.3 33.3 52? 32 Emergency admissions (change in rate) 3.2 87720 18.5 NA!
Actual Target Final Target 2002/03 03/04 03/04 04/05 Performance 33 Emergency re-admissions % change 5.6 5.6 6 6 Outcome Measures 34 Emergency psychiatric re-admissions 2.91 8.5 2.5 8.5 35 Intensive homecare rates as percentage 32 35 29.3 34 of all intensive social care 36 Admissions to long term care (65+) 112 110 139.8 110! 37 Admissions to long term care (18-65) 4.5 3.25 4.7 3.25! 38 Death rates from Circulatory Disease 15.5 22 22.2 25 40 Death rates from Cancer and heart 9.3 10.7 10.7 12 disease 41 Adoptions of children looked after % 5.6 7 7.4 7.5 42 Teenage Pregnancy % -3.53 3.7 NA 8.9%! 43 Stability of Children Looked After % > 2 9 8 10.9 8 moves 44 Educational attainment of Children 38.2 55 45 55 Looked After! 45 Employment, education training of care 41 50 41 60 leavers 46 Final warnings/convictions children 1.6 2 2.3 2 looked after 47 Child protection duration on register 15 12 11.6 10 KEY Performance Good Performance satisfactory! Performance needs to improve? Data still being compiled/quality assured