2011/12 LOCAL DELIVERY PLAN
METHODS AND SOURCES
This document is intended as a reference source for use in completing
2011/12 LDP HEAT Delivery Trajectories.
NHS Scotland Performance and Business Management Team
Health Delivery Directorate
Scottish Government
Version 1.0
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HEAT KEY MEASURES
These are the performance measures to monitor performance against the HEAT targets.
Health Improvement for the people of Scotland – improving life expectancy and healthy life expectancy
Alcohol Brief Interventions
Inequalities Targeted Cardiovascular Health Checks
Suicide Reduction
Child healthy weight interventions
Smoking cessation (SIMD)
Child Fluoride Varnish Applications (SIMD)
Efficiency and Governance Improvements – continually improve the efficiency and effectiveness of the NHS
Financial Performance
Cash Efficiencies
Reduce carbon emissions
Reduce energy consumption
Access to Service – recognising patients’ need for quicker and easier use of NHS services
Suspicion-of-cancer referrals (62 days)
All Cancer Treatment (31 days)
18 weeks Referral To Treatment
Drug and Alcohol Treatment: Referral to Treatment
Faster access to CAMHS
Faster access to psychological therapies
Treatment Appropriate to Individuals – ensure patients receive high quality services that meet their needs
Reduction in emergency bed-days for patients aged 75+
Stroke Unit
MRSA/MSSA bacterium
Clostridium difficile infections
Rate of attendance at Accident and Emergency
Health Improvement
1 / Measure Identifier / ABI
2 / Target Wording / Achieve agreed number of screenings using the setting-appropriate screening tool and appropriate alcohol brief intervention, in line with SIGN 74 guidelines during 2011/12
3 / Quality Ambition / 3: The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.
4 / National Outcomes / We live longer, healthier lives.
We have strong, resilient and supportive communities where people take responsibility for their own actions and how they affect others.
Our public services are high quality, continually improving, efficient and responsive to local people’s needs.
We have improved the life chances for children, young people and families at risk.
5 / Performance Measure Description / The performance measure is the number of alcohol brief interventions delivered during 2011/12.
The exact number of interventions will be agreed through the LDP process. Indicative target numbers will be provided to Boards by the end of the calendar year.
6 / Performance measure directly relates to HEAT target / Yes
7 / Performance management information data source
Frequency
Time lag / NHS Health Board leads direct to SG lead
Quarterly
One month
8 / Published data source supplying Scotland Performs
Frequency
Time lag
National Statistics Status / ISD Official Statistic
Annual (financial year)
Six months
No
9 / Units / Number (cumulative from April 2011)
10 / Coverage / All geographic boards
11 / Accuracy / Aggregate returns from NHS Boards
12 / Comparability (between boards or over time) / This is comparable to the previous H4 target (2008/09 – 2010/11)
13 / Additional Information / A national Delivery Support Team was established in August 2008 to provide: expert advice to NHS Health Scotland and Scottish Government on action required in order to ensure achievement of the alcohol brief interventions HEAT target; guidance and strategic leadership to health boards in relation to the development of delivery infrastructure and implementation of alcohol brief interventions; support to health boards to effectively plan and coordinate the delivery of alcohol brief interventions.
Antenatal and Accident & Emergency subgroups were established and provided guidance on the delivery and monitoring of alcohol brief interventions in those settings.
Guidance setting out the target description, sources, definitions, etc. was issued to Health Boards in December 2007 (Methods and Sources template and paper setting out additional information on target setting). National data reporting guidance was issued by Mike Palmer to Health Board Chief Executives, LDP Leads and Alcohol Brief Intervention Strategic Leads for 2008-09, 2009-10, 2010-11 and will be issued again for 2011-12.
The focus of delivery in 2011-12 will be to support embedding of delivery for the long term goal of ABIs being part of the standard offer of NHSScotland.
Back to index / Inequalities Targeted Cardiovascular Health Checks
1 / Measure Identifier / Health Checks
2 / Target Wording / Achieve agreed number of inequalities targeted cardiovascular Health Checks during 2011/12
3 / Quality Ambition / 3: The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.
4 / National Outcomes / We live longer, healthier lives.
We have tackled the significant inequalities in Scottish society.
Our public services are high quality, continually improving, efficient and responsive to local people’s needs.
5 / Performance Measure Description / Cumulative number of new inequalities targeted cardiovascular health checks to be delivered by NHS Scotland during 2011/12.
The number and content of health checks and the inequalities targeting required will be agreed with each NHS Board as part of the LDP sign-off process. This will reflect local circumstances, eligible population and the stage of engagement with appropriate programmes in each Board area.
Consideration is being given to reducing the age to 40 in line with SIGN guidance. The qualifying age for some vulnerable groups is lower by agreement.
6 / Performance measure directly relates to HEAT target / Yes
7 / Performance management information data source
Frequency
Time lag / Data returns are provided to NHS Health Scotland by NHS Boards and reported to Scottish Government
Monthly
One month
8 / Published data source supplying Scotland Performs
Frequency
Time lag
National Statistics Status / Cardiovascular Anticipatory Care Screening
Financial year
Four months
No
9 / Units / Number (cumulative from April 2011)
10 / Coverage / All geographic boards
11 / Accuracy
12 / Comparability (between boards or over time) / Common principles will inform the process of agreement regarding the number, content and inequalities targeting of health checks to be delivered in each Board. However, flexibility is essential to ensure that these agreements reflect variation in local circumstances as well as different stages of delivery, engagement and development of appropriate programmes.
The 2011/12 target relates to health checks carried out in 2011/12 and judgement of performance is independent of the previous target or performance.
The default content of a “cardiovascular health check” should include as a minimum all components associated with the Keep Well mandatory data items.To accommodate the variation in programmes, especially in remote and rural boards this may be varied, subject to agreement with Scottish Government. Further guidance about the required content of health checks was issued to NHS Boards in December 2009.
The means by which health checks will be “inequalities targeted” will vary depending on local circumstances, but health checks must be aimed at the most deprived communities in each Board area. Locally specific definitions of this will be agreed with each NHS Board in advance of April 2010.
13 / Additional Information / More information about this measure is available from Tim Warren (Tel: 0131 2443015).
Published data and notes therein:
www.isdscotland.org/isd/6259.html
Keep Well:
www.keepwellscotland.com
1 / Measure Identifier / Suicide
2 / Target Wording / Reduce suicide rate between 2002 and 2013 by 20%
3 / Quality Ambition
4 / National Outcomes / We live longer, healthier lives.
Our public services are high quality, continually improving, efficient and responsive to local people’s needs.
5 / Performance Measure Description / NHS Boards are not requested to supply trajectories.
The performance measure against the national target is the three-year centred moving average European age standardized suicide rate. Thus the target is for the 2012–2014 rate to be less than or equal to 80 per cent of the 2001–2003 rate.
For the purposes of this performance measure, suicides are deaths as a result of intentional self-harm (ICD-9 codes E950-959; ICD-10 codes X60-X84 plus Y87.0) or an event of undetermined intent (ICD-9 codes E980-989; ICD-10 codes Y10-Y34 plus Y87.2).
NHS specific actions that contribute to the delivery of the target include:
- Discharge planning
- Brief interventions
- Front line training
- Response to depression
- Crisis management
6 / Performance measure directly relates to HEAT target / Yes
7 / Performance management information data source
Frequency
Time lag / As published data
8 / Published data source supplying Scotland Performs
Frequency
Time lag
National Statistics Status / GROS from death certificate data
Centred three-year rolling period with annual updates
Eight months
No
9 / Units / Suicides per year per 100,000 population European age standardized
10 / Coverage / All geographic boards
11 / Accuracy
12 / Comparability (between boards or over time)
13 / Additional Information / Published data and notes therein:
www.gro-scotland.gov.uk/statistics/deaths/suicides/index.html
Age standardized data by NHS Board:
www.scotpho.org.uk/home/Healthwell-beinganddisease/suicide/suicide_data/suicide_nhsboard.asp
Back to index / Child healthy weight interventions
1 / Measure Identifier / Child Weight
2 / Target Wording / Achieve agreed completion rates for child healthy weight intervention programme over the three years ending March 2014
3 / Quality Ambition / 3: The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.
4 / National Outcomes / Our children have the best start in life and are ready to succeed.
We live longer, healthier lives.
We have improved the life chances for children, young people and families at risk.
Our public services are high quality, continually improving, efficient and responsive to local people’s needs.
5 / Performance Measure Description / The performance measure is the number of children aged 2–15 years completing Scottish Government approved healthy weight intervention programmes over the period 2011/12 to 2013/14.
The exact number of interventions will be agreed through the LDP process. Indicative target numbers will be provided to Boards by the end of the calendar year.
6 / Performance measure directly relates to HEAT target / Yes
7 / Performance management information data source
Frequency
Time lag / Child Healthy Weight Quarterly Data Collection
Quarterly
Two months
8 / Published data source supplying Scotland Performs
Frequency
Time lag
National Statistics Status / Child Healthy Weight Quarterly Data Collection
Annual
Two months
No
9 / Units / Number (cumulative from April 2011)
10 / Coverage / All geographic NHS Boards
11 / Accuracy / Aggregated returns from NHS Boards
12 / Comparability (between boards or over time) / Interventions during this second target period will have greater commonality across the country and hence comparability between Boards will be more possible than previously. For some Boards their interventions will need to evolve significantly from previous modes of delivery in order the meet the number of interventions required under the new target. For this reason direct comparison with their performance during the previous target period will not be appropriate.
13 / Additional Information / Preventing Overweight and Obesity in Scotland: A Route Map Towards Healthy Weight
Child Healthy Weight Guidance 2011-14 (available Feb 2011)
1 / Measure Identifier / Smoking
2 / Target Wording / NHSScotland to deliver universal smoking cessation services to achieve at least 80,000 successful quits (at one month post quit) including 48,000 in the 40% most-deprived within-Board SIMD areas over the three years ending March 2014
3 / Quality Ambition / 3: The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.
4 / National Outcomes / We live longer, healthier lives.
We have improved the life chances for children, young people and families at risk.
Our public services are high quality, continually improving, efficient and responsive to local people’s needs.
5 / Performance Measure Description / Number of successful quits for people residing in the 40 per cent most-deprived datazones in the NHS Board (i.e. two most-deprived local quintiles). NHSScotland to deliver 48,000 quits from April 2011 to March 2014.
6 / Performance measure directly relates to HEAT target / Directly relevant to second part of the target
7 / Performance management information data source
Frequency
Time lag / Smoking cessation data from ISD – National Smoking Cessation Database.
Quarterly
Two months
8 / Published data source supplying Scotland Performs
Frequency
Time lag
National Statistics Status / Smoking cessation data from ISD – National Smoking Cessation Database.
Annual
Three months
No
9 / Units / Number (cumulative from April 2011)
10 / 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.
11 / Accuracy
12 / Comparability (between boards or over time) / There are some concerns that different recording practices between Boards may make comparisons between Boards problematic.
13 / Additional Information / ISD Smoking Cessation pages
www.isdscotland.org/isd/4647.html
1 / Measure Identifier / Child Fluoride
2 / Target Wording / At least 60% of 3 and 4 year old children in each SIMD quintile to receive at least two applications of fluoride varnish (FV) per year by March 2014.
3 / Quality Ambition / 3: The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.
4 / National Outcomes / Our children have the best start in life and are ready to succeed.
We have improved the life chances for children, young people and families at risk.
Our public services are high quality, continually improving, efficient and responsive to local people’s needs.
5 / Performance Measure Description / The HEAT performance measure separatelyasks whether 5-year olds had two varnishings when they were 4 years old and whether 4-year olds had two varnishings when they were 3 years old and will report performance of the worst performing age and SIMD 2009 quintile combination. Thus if the performance of the worst-performing age/quintile is above 60 per cent then the performance in every other age–SIMD 2009 quintile combination must be above 60 per cent and the target will have been delivered. This is to ensure that each and every age–quintile combination achieves the target level, rather than allowing a focus one particular age–quintile combination mask neglect of the others.
The intervention will be delivered via primary dental care services twice yearly, with a further two applications of fluoride varnish available to those children attending designated nurseries (which have a majority of enrolled children residing in the lowest SIMD quintile in each NHS Board).
The measure will be defined as follows:
The datazones in each board are to be divided into five groups according to SIMD 2009 rank. The allocation of datazones to quintiles within health boards is given in column G of the Health Board (SIMD) tab of the spreadsheet at www.scotland.gov.uk/Topics/Statistics/SIMD/localHBquin09
For each group the following should be calculated:
3-year-olds
Numerator - number of children who are 4 years old (i.e. who have reached their 4th birthday) by the last day of the reporting period who received two or more FV applications in the year prior to (but not including) their latest birthday (i.e. when they were 3 years old).
Denominator – GRO mid year estimates for the number of 3-year-old children. The latest available estimates at the end of the reporting period will be used.
4-year-olds
Numerator - number of children who are 5 years old (i.e. who have reached their 5th birthday) by the last day of the reporting period who received two or more FV applications in the year prior to (but not including) their latest birthday (i.e. when they were 4 years old).
Denominator – GRO mid year estimates for the number of 4-year-old children. The latest available estimates at the end of the reporting period will be used.
Performance should be calculated for each of the ten age–quintile combinations and the lowest performance will be reported.
A summary of performance at Scotland level will be shown based on the grouping of datazones by national SIMD 2009 quintiles and may therefore show inconsistent results with the board level results, which group datazones by local quintiles. The target can be considered to be met if Scotland-level performance is at or above 60%. Local targets for each NHS Board will be agreed through the LDP.
6 / Performance measure directly relates to HEAT target / Yes
7 / Performance management information data source
Frequency
Time lag / Childsmile data collated by ISD
Quarterly
One month
8 / Published data source supplying Scotland Performs
Frequency
Time lag
National Statistics Status / ISD is developing plans for the publication of these statistics.
9 / Units / Percentage
10 / Coverage / All geographic boards
11 / Accuracy
12 / Comparability (between boards or over time) / Fluoride varnish applications are available from April 2010. This will need to be taken into consideration when analysing data.
13 / Additional Information
Efficiency