LOCAL DELIVERY PLANS 2008/09
METHODS AND SOURCES
(ANNEX 2)
This document is intended as a reference source for use in completing LDP 2008/09 Trajectories, and analysing information from the HEAT Performance Management system.
Directorate of Delivery - Analysis Team
Analytical Services Division
Health Directorates
Scottish Government
Version 1
HEAT KEY MEASURES
Health Improvement for the people of Scotland – improving life expectancy and healthy life expectancy
Health Inequalities - CHD
Dental registrations
Healthy weightofchildren
Alcohol BriefInterventions
Suicide Prevention
Smoking Cessation
Breastfeeding at 6-8 weeks
Efficiency and Governance Improvements – continually improve the efficiency and effectiveness of the NHS
Community Health Index (CHI) Usage
Sickness Absence
Knowledge and Skills Framework – Personal Development Plan
Efficiency savings: Day case rates
Efficiency savings: Emergency inpatients average length of stay
Efficiency savings: Reviewto New Outpatient Attendance Ratio
Efficiency savings: New outpatientappointment DNA rates
Financial Performance
Cash Efficiencies
Online triage of new outpatient referrals
Access to Service – recognising patients’ need for quicker and easier use of NHS services
Primary Care Team – 48 hour access
All Cancer Waiting Times (62 days)
Ambulanceresponse times
Outpatients waiting over 15 weeks from GP referral
Inpatients/Day Cases waiting over 15 weeks
Key Diagnostic Tests waiting over 6 weeks
A&E Attendances
A&E waits to be a maximumof 4 hours
Treatment Appropriate to Individuals – ensure patients receive high quality services that meet their needs
Multiple Emergency Admissions (aged 65+)
Reduction in emergency bed-days for patients aged 65+
QIS : improving clinical governance and risk management standards
Prescribing of anti-depressants
Reduction of psychiatric readmissions
Healthcare Associated Infection
Hospital admissions for long term conditions
Healthcare Experience
Older People cared for at home
Dementia
Health Improvement for the people of Scotland – improving life expectancy and healthy life expectancy
Back to index / Health Inequalities - CHD1 / Measure Identifier / H1.KPM1
2 / Measure Title / Health Inequalities - CHD
3 / Short Measure Title / Inequalities - CHD
4 / Target Identifier / H1
5 / Target Details / Reduce mortality from Coronary Heart Disease among the under 75s in deprived areas
6 / Short Target Title / H1 Reducing health inequalities
7 / HEAT Objective / Health Improvement
8 / Level / Key
9 / Description / European Age-Standardised CHD Mortality Rate per 100,000 population for people aged under 75 years, in the 15% most deprived datazone areas in Scotland, defined by Scottish Index of Multiple Deprivation 2006.
This measure does not have a target end point. Boards are asked to propose improvement trajectories taking account of local ambitions and circumstances.
10 / Relevance / Directly relevant to the target
11 / Data Sources / General Register Office for Scotland, GROS, and Scottish Government (Health Analytical Services)
12 / Date Type / Annual
13 / Time Lag / 8 months
14 / Performance Direction / Decrease
15 / Amber Threshold
16 / Value Type / European Age-Standardised Rate per 100,000 population (aged <75 years) presented in the form of a 3-year rolling average
17 / Coverage / All Boards except Orkney, Shetland and Western Isles
(These Boards do not have any 15% most deprived SIMD 2006 datazones)
18 / Concepts & Definitions / The 2007 Spending Review Target is to reduce the standardised CHD mortality rate amongst the under 75s in the most deprived areas.
Spending Review 2007 Technical Notes:
19 / Quarters Measurement
20 / National Weighting
21 / National Statistics Status / Yes
22 / Accuracy
23 / Comparability / Borders and Dumfries & Galloway NHS Boards have only a very small area defined as part of the 15% SIMD 2006 most deprived datazones in Scotland. Rates are therefore based on small numbers of deaths in small denominator populations and should be interpreted with caution.
24 / Additional Information / Further details about this measure are available from Emma Stevens or Julie Ramsay on 0131 244 2589 or 0131 244 2368.
General Register Office For Scotland:
http://www.gro-scotland.gov.uk/
Back to index / Dental registrations
1 / Measure Identifier / H2.KPM1
2 / Measure Title / Dental registrations
3 / Short Measure Title / Dental registrations
4 / Target Identifier / H2
5 / Target Details / 80% of all three to five year old children to be registered with an NHS dentist by 2010/11
6 / Short Target Title / H2 Dental registrations
7 / HEAT Objective / Health Improvement
8 / Level / Key
9 / Description / Percentage of 3-5 year olds registered with an NHS General Dentist
10 / Relevance / Directly relevant to target
11 / Data Sources / ISD Management Information and Dental Accounting System (MIDAS)
12 / Date Type / Quarterly
13 / Time Lag / 4 months
14 / Performance Direction / Increase
15 / Amber Threshold
16 / Value Type / Percentage
17 / Coverage / All Boards
18 / Concepts & Definitions / ISD Scotland General Dental Service registrations information:
19 / Quarters Measurement
20 / National Weighting
21 / National Statistics Status / Yes
22 / Accuracy
23 / Comparability
24 / Additional Information / Action plan for improving Oral Health and modernising NHS Dental Services in Scotland
http://www.scotland.gov.uk/Publications/2005/03/20871/54813
Back toindex / Healthy weight of children
1 / Measure Identifier / H3.KPM1
2 / Measure Title / Child healthy weight interventions
3 / Short Measure Title / Healthy weight
4 / Target Identifier / H3
5 / Target Details / Achieve agreed completion rates for child healthy weight intervention programme by 2010/11
6 / Short Target Title / H3 Healthy weight of children
7 / HEAT Objective / Health Improvement
8 / Level / Key (Developmental)
9 / Description / The performance measure is the number of children aged 7-13 years completing Scottish Government approved healthy weight intervention programmes.
NHS Scotland will be expected to deliver interventions to 15% (19,638) of children aged 7-13 years defined as overweight (includes obese) cumulatively over the period 2008/9 – 2010/11.
All interventions completed from April 2008 will contribute to the cumulative total.
This is a developmental measure. Target to be reviewed after year one.
10 / Relevance / Directly relevant to target
11 / Data Sources / Scottish Government specification to quantify level of funding required for interventions (to be published spring 2008).
NHS boards to develop information systems and flows to capture number of interventions delivered.
12 / Date Type / Annual
13 / Time Lag / To be established during development phase
14 / Performance Direction / Increase
15 / Amber Threshold
16 / Value Type / Number of interventions
17 / Coverage / All NHS Boards
18 / Concepts & Definitions / Target number of interventions defined using prevalence of overweight children and information about the level of funding required for each intervention.
Overweight defined as child Body Mass Index greater than or equal to the 85th percentile of the 1990 UK Growth Reference Charts.
19 / Quarters Measurement
20 / National Weighting
21 / National Statistics Status / New data on interventions are unlikely to be NS.
Child obesity statistics from the Scottish Health Survey are not yet NS, but are likely to become NS when future Scottish Health Survey results are published (mid 2009 onwards).
22 / Accuracy / Accurate information about funding and resource required for interventions is not yet available, but the need to start to address this problem is too pressing to wait for the collection of accurate data.
The estimates of children overweight assume that the national prevalence of overweight is applicable at NHS Board level.
23 / Comparability
24 / Additional Information /
Back to index / Alcohol Brief Interventions
1 / Measure Identifier / H4.KPM1
2 / Measure Title / Alcohol Brief Interventions
3 / Short Measure Title / Alcohol Intervention
4 / Target Identifier / H4
5 / Target Details / Achieve agreed number of screenings using the setting-appropriate screening tool and appropriate alcohol brief intervention, in line with SIGN 74 guidelines by 2010/11
6 / Short Target Title / H4 Alcohol brief interventions
7 / HEAT Objective / Health Improvement
8 / Level / Key (Developmental)
9 / Description / NHS Scotland will be expected to deliver 149,449 alcohol brief interventions cumulatively over the period 2008/9 – 2010/11, in line with SIGN 74 guideline.
The longer-term aim is for SIGN 74 to become part of the routine offer of the NHS.
10 / Relevance / Brief interventions identified as a key priority in SR07
11 / Data Sources / A number of different sources have been used to derive an estimate of the total number of patients requiring screening and a brief intervention.
The number of presentations to primary care with a potential alcohol-related diagnosis is estimated from ISD Practice Team Information (PTI) data. This suggests a potential alcohol-related presentation rate of 190 per 1000 primary care presentations.
The number of emergency admissions for an alcohol-related diagnosis was just over 35,000 in 2005/6 (ISD, Scottish Morbidity Records). The number of attendances to A&E due to alcohol misuse was estimated to be 11% of all A&E attendances in an audit of A&E departments carried out by NHS Quality Improvement Scotland. While figures for the total number of A&E attendances are not available, scaling up from the NHS QIS audit suggests the number of alcohol-related attendances could be in the region of 100,000.
The number potentially drinking to excess and requiring a brief intervention was estimated from Scottish Health Survey data (with an adjustment for under-reporting). Harmful and hazardous drinking is defined as over 21 units a week for men and 14 units a week for women.
Boards may not have information systems in place to capture the number of brief interventions delivered in year 1. They should, however, provide an indication of the total number of interventions delivered. As far as possible, this information will be validated.
By the end of year one Boards to have developed information systems and flows to capture number of screenings and brief interventions delivered.
12 / Date Type / Annual
13 / Time Lag / To be established during development phase
14 / Performance Direction / Increase
15 / Amber Threshold
16 / Value Type / Number of alcohol brief interventions per NHS board
17 / Coverage / All Boards
18 / Concepts & Definitions / This is a developmental target in year one (i.e. 2008-9). The cumulative target number of brief interventions will be reviewed at the end of year one.
The development phase will:
- establish delivery arrangements and baseline, build capacity, and develop information systems and flows.
- provide a basis for establishing firmer trajectories for boards from year two, based on the cumulative target, (subject to review at the end of year one), delivery in year one and baseline.
Boards will be expected to demonstrate how they will target efforts in A&E, primary care and ante-natal care, and amongst deprived populations.
19 / Quarters Measurement
20 / National Weighting
21 / National Statistics Status / New data on number of interventions unlikely to be NS.
Harmful and hazardous drinking statistics from the Scottish Health Survey are not yet NS, but are likely to become NS when future Scottish Health Survey results are published (mid 2009 onwards).
PTI and SMR01 data are NS.
22 / Accuracy / Accurate information about capacity, funding and resources required for screening and interventions across settings is not yet available, but the pressing need to address alcohol-related harms is such that it is not feasible to wait for the collection of accurate data.
As the total number of alcohol-related presentations across primary and secondary care is not known, a screening rate of 190 per 1000 presentations is assumed.
The estimates of the number of harmful and hazardous assumes that the national prevalence rate is applicable at NHS Board level (data is not available at Board level). Similarly, the national primary care presentation rate is applied to all Boards.
The development phase for this target run until the end of year one (i.e. 2008-9). This development phase will establish more accurate baselines and targets. The cumulative target for delivery by 2010-11 will be reviewed at year one.
23 / Comparability
24 / Additional Information /
Back to index / Suicide Prevention
1 / Measure Identifier / H5.KPM1
2 / Measure Title / Suicide prevention training
3 / Short Measure Title / Suicide prevention
4 / Target Identifier / H5
5 / Target Details / Reduce suicide rate between 2002 and 2013 by 20%, supported by 50% of key frontline staff in mental health and substance misuse services, primary care, and accident and emergency being educated and trained in using suicide assessment tools/ suicide prevention training programmes by 2010
6 / Short Target Title / H5 Suicide prevention
7 / HEAT Objective / Health Improvement
8 / Level / Key
9 / Description / 50% of key staff trained in suicide prevention relative to the established baseline and learning levels.
10 / Relevance / Directly relevant to target
11 / Data Sources / Commitment 7: Delivering for Mental Health proforma (which includes numerators and denominators for this measure)
12 / Date Type / 6 monthly
13 / Time Lag
14 / Performance Direction / Increase
15 / Amber Threshold
16 / Value Type / Yet to be determined as baseline figures are still being collected (as at December 2007)
17 / Coverage / All boards
18 / Concepts & Definitions / Learning levels and relevant staff groups are still being established (as at December 2007)
19 / Quarters Measurement
20 / National Weighting
21 / National Statistics Status / No
22 / Accuracy
23 / Comparability
24 / Additional Information / Commitment 7 and Target 2 in Delivering For Mental Health (published December 2006):
http://www.scotland.gov.uk/Topics/Health/health/mental-health/servicespolicy/DFMH
General Register Office for Scotland:
http://www.gro-scotland.gov.uk/
Scottish Public Health Observatory:
Back to index / Smoking Cessation
1 / Measure Identifier / H6.KPM1
2 / Measure Title / Successful 1 month smoking cessation quit attempts
3 / Short Measure Title / Smoking Cessation
4 / Target Identifier / H6
5 / Target Details / Through smoking cessation services, support 8% of your Board’s smoking population in successfully quitting (at one month post quit) over the period 2008/9 – 2010/11
6 / Short Target Title / H6 Smoking Cessation
7 / HEAT Objective / Health Improvement
8 / Level / Key
9 / Description / NHS Scotland will be expected to deliver 83,978 successful quit attempts (at 1 month post quit) over the period 2008/9 – 2010/11
10 / Relevance / Directly relevant to target
11 / Data Sources / Smoking cessation data from ISD – National Smoking Cessation Database. Smoking population calculated using the Scottish Household Survey estimates of smoking prevalence and GRO(S) population estimates
12 / Date Type / Annual (potentially could become quarterly in future)
13 / Time Lag / 3 months
14 / Performance Direction / Increase
15 / Amber Threshold
16 / Value Type / Percentage
17 / Coverage / Data for Greater Glasgow and Clyde and Tayside pharmacies is not included on the National Smoking Cessation Database, but aggregate stats are provided to ISD from local information systems.
18 / Concepts & Definitions / The dataset is relatively new (established in April2005) and ISD have been working with cessation services to maximise the quality and completeness of the data collected. An expert group was set up during 2007 to review the minimum dataset and recommend changes to recording practices which should improve the quality of the data collected.
19 / Quarters Measurement
20 / National Weighting
21 / National Statistics Status / No
22 / Accuracy / As it is a relatively new system, there have been some teething problems with data quality and completeness. These are being resolved, and it is hoped that data quality will improve over time.
23 / Comparability / There is currently only one year of data available so no time-series comparisons can be made. There are also some concerns that different recording practices between Boards may make comparisons between Boards problematic.
24 / Additional Information / ISD Smoking Cessation pages
Back to index / Breastfeeding at 6-8 weeks
1 / Measure Identifier / H7.KPM1
2 / Measure Title / Percentage of children recorded as exclusively breastfed at 6-8 weeks review
3 / Short Measure Title / Breastfeeding
4 / Target Identifier / H7
5 / Target Details / Increase the proportion of new-born children exclusively breastfed at 6-8 weeks from 26.6% in 2006/07 to 33.3% in 2010/11
6 / Short Target Title / H7 Breastfeeding
7 / HEAT Objective / Health Improvement
8 / Level / Key
9 / Description / Number of babies recorded as being exclusively breastfed at their 6-8 week review as a percentage of all babies receiving a 6-8 week review.
10 / Relevance / Directly relevant to target
11 / Data Sources / Data published by ISD from Child Health Systems Project – Pre-school (CHSP-PS).
12 / Date Type / Rolling annual averages updated quarterly (time period relates to time of birth, not review).
13 / Time Lag / 6 months
14 / Performance Direction / Increase
15 / Amber Threshold
16 / Value Type / Percentage
17 / Coverage / 9 boards have complete coverage. Highland has partial coverage (part of former Argyll & Clyde area only) and has implemented the system across the whole board from 01/05/2007 – first complete data expected March 08. Western Isles also recently implemented the system – from 01/05/2006 – data available but currently unpublished. Grampian, Orkney and Shetland have not implemented the system.
18 / Concepts & Definitions / The quarterly data are volatile and therefore the target will be measured by a rolling annual average, updated each quarter. The baseline is financial year 2006-07 and end point will be financial year 2010-11. Boards will be required to increase their proportion by 25% on the baseline rate to meet the target.
Health for All Children 4: Guidance on Implementation in Scotland 2005
http://www.scotland.gov.uk/Publications/2005/04/15161325/13443
19 / Quarters Measurement
20 / National Weighting
21 / National Statistics Status / Yes
22 / Accuracy / There may be some minor data issues as new boards adopt the system, but otherwise a well-established system with no data quality issues.
23 / Comparability / Several years of time-series data available providing robust trends. Scotland level figures may fluctuate as new boards begin using the system.
The figures quoted in the target actually relate to calendar years as this was the information available at the time the target was published. The actual figure for 2006/7 is 26.2% and 2010/11 is 32.7%.
24 / Additional Information / ISD Scotland Breastfeeding webpages:
Efficiency and Governance Improvements – continually improve the efficiency and effectiveness of the NHS
Back to index / Community Health Index (CHI) Usage1 / Measure Identifier / E1.KPM1
2 / Measure Title / Community Health Index (CHI) Usage
3 / Short Measure Title / CHI
4 / Target Identifier / E1
5 / Target Details / Universal utilisation of CHI
6 / Short Target Title / E1 Universal utilisation of CHI
7 / HEAT Objective / Efficiency and Governance Improvements
8 / Level / Key
9 / Description / Laboratory requests that include a CHI number, expressed as a percentage of all laboratory requests made.
10 / Relevance / Directly relevant to target
11 / Data sources / NHS Board sampling (based on existing processes to produce monthly reports for IST CHI Programme)