2013/14 LOCAL DELIVERY PLAN
METHODS AND SOURCES
This document is intended as a reference source for use in completing
2013/14LDP HEAT Delivery Trajectories
NHSScotland Resilience and Business Management Team
Health Workforce and Performance Directorate
Scottish Government
Version 1.1
Version Log
Version 1.1
HEAT KEY MEASURES
These are the performance measures to monitor performance against the HEAT targets.
Detect Cancer Early
Early Access toAntenatal Care (SIMD)
Suicide Reduction
Child healthy weight interventions
Smokingcessation (SIMD)
Child FluorideVarnishApplications (SIMD)
Financial Performance
Reduce carbonemissions
Reduce energy consumption
Faster access to CAMHS
Faster access topsychological therapies
IVF Treatment Waiting Times
Dementia Post Diagnostic Support
Reductionin emergency bed-days for patients aged 75+
14 Days Delayed Discharge
(SAB) MRSA/MSSA bacterium
Clostridiumdifficile infections
Rate ofattendance atAccident and Emergency
These are the performance measures to monitor performance against the HEAT standards
Cancer WaitingTimes
18 Weeks Referral to Treatment (RTT)
12 Weeks First Outpatient Appointment
Drug and Alcohol Treatment (RTT)
GP Access
Ambulance Response Times
Accident and Emergency Waiting Times
Sickness Absence Rate
Alcohol Brief Interventions
Back toindex / Detect Cancer Early1 / Measure Identifier / Cancer
2 / Target Wording / To increase the proportion of people diagnosed and treated in the first stage of breast, colorectal and lung cancer by 25% by 2014/15
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.
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.
5 / Performance Measure Description / The data that will underpin this target is currently under review. Further information for NHS Boards on how to complete target trajectories for Detect Cancer Early will follow.
6 / Performance measure directly relates to HEAT target / Yes
7 / Performance management information data source
Frequency
Time lag / Currently under development.
8 / Published data source supplying Scotland Performs
Frequency
Time lag
National Statistics Status / To be confirmed
9 / Units / Proportionof people diagnosed at Stage One
10 / Coverage / All geographic boards
11 / Accuracy / To be confirmed
12 / Comparability (between boards or over time)
13 / Additional Information / ISD Cancer Information Programme:
Detect Cancer Early Implementation Plan
Backtoindex / Early Access to Antenatal Services
1 / Measure Identifier / Antenatal Services
2 / Target Wording / At least 80% of pregnant women in each SIMD quintile will have booked for antenatal care by the 12th week of gestation by March 2015 so as to ensure improvements in breast feeding rates and other important health behaviours.
3 / Quality Ambition / 1. Person-centred – Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making.
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.
The target is to ensure equitable access to high quality antenatal health care, contributing to a reduction in unequal outcomes for women and babies.
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.
We have tackled the significant inequalities in Scottish society.
5 / Performance Measure Description / The national target is forat least 80% of pregnant women in each SIMD quintile to have booked for antenatal care by the 12th week of gestation by March 2015. NHSScotland will be judged on performance against the national target.
The denominator is all women who give birth in Scottish Hospitals.
Boards have already submitted 3-year trajectories for antenatal care bookings. The second and third years of those trajectories (2013/14 and 2014/15) have been included in the LDP trajectory template, along with the percentage of pregnant women booked for antenatal care by 12th week of gestation in the lowest performing SIMD quintile, during 2010/11 financial year.
For Board level SIMD quintiles, 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
Board performance will be calculated for each of their five quintiles 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 80%.
An updated SIMD 2012 is due to be published in December 2012. Following this, future updates will be aligned with the newer SIMD. The impact of switching from SIMD 2009 to SIMD 2012 on NHS Board-level results is anticipated to be minimal. However Boards will be kept informed as this work develops.
6 / Performance measure directly relates to HEAT target / Yes
7 / Performance management information data source
Frequency
Time lag / The ‘Date of booking appointment’ as recorded below the ‘history taken by’ field on page 5 of the Demographic information and EDD page in SWHMR Combined Pregnancy and Postnatal Record.
The data will include all women who book for antenatal care from April 2012 onwards. The term booked encompasses a comprehensive health assessment including health and social circumstances carried out by a registered midwife using the Scottish Woman Held Maternity Record (SWHMR).
Quarterly
Currently 20 Months (the time lag between booking appointment and the availability of data is significant as the remainder of the pregnancy and registration of birth needs to occur first).ISD aim to reduce this as data quality improves, however the minimum lag time will still be around a year.
In order to keep the time lag to a minimum it is therefore essential that NHS Boards return their SMR02 to ISD in a timeous fashion.
8 / Published data source supplying Scotland Performs
Frequency
Time lag
National Statistics Status / Births in Scottish Hospitals
Annual
The target will have an estimated time lag of at least a year between data being initially collected and data being published.
No
9 / Units / Percentageof pregnant women booked for antenatal care by 12th week of gestation.
10 / Coverage / All geographic boards. Women whose booking date is unknown are excluded from the analysis.
11 / Accuracy
12 / Comparability (between boards or over time)
13 / Additional Information / The first two trimesters following conception are periods of significant fetal development , they are also the period when fetal development is most vulnerable to the impact of adverse maternal biopsychosocial circumstances,for example: stress; use of tobacco; drugs and alcohol; and poor nutrition. Supporting women as early as possible in the antenatal period to have as healthy a pregnancy as possible is therefore vitally important.
Access to services is a key measure of quality. Early access to antenatal care and the pregnancy screening programme is vitally important to good outcomes for both the woman and the baby and will make a significant contribution to reducing health inequalities at birth and across the life course .
Improvements in the quality of antenatal care provided must take place concurrently with improvements in antenatal access rates as defined within this target. Boards should therefore consider access to antenatal care in terms of physical and ‘cognitive’[1] access by women. Cognitive access includes improvements in person centred care focussing on effective communication with all women and the delivery of care that is strengths based and sensitive to the impact of social inequalities and health literacy issues. A proportion of the £1.325m implementation resource has been made available to NHS Boards and NHS education for Scotland to support workforce development with a focus on strengths based approaches. In addition this resource should be utilised to improve pathways of care for vulnerable women- Healthcare Improvement Scotland have been asked to scope this work as part of a maternity care improvement programme.
The refreshed framework for maternity care sets out a number of principles and service descriptors relating to antenatal care. These include service improvement measures which Boards should take into account when improving their antenatal care services. The Refreshed framework can be accessed at
In addition Reducing antenatal Inequalities Guidance details key actions Boards should take to improve equity in the quality of care women receive. The guidance can be accessed at
The Refreshed Framework Implementation Support Group is currently developing a set of level 3 quality indicators for NHS Boards. These will provide NHS Boards with measureable indicators of quality in the antenatal period.
Backtoindex / Suicide Reduction
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 (updated annually by the Scottish Public Health Observatory). The target is for the 2011–2013 rate to be 20 per cent less than the 2000–2002 rate of 17.4 suicides per 100,000 population.
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, including Breathing Space phone line and rollout of psychological therapies
-Crisis management
6 / Performance measure directly relates to HEAT target / Yes
7 / Performance management information data source / The same as published data.
8 / Published data source supplying Scotland Performs
Frequency
Time lag
National Statistics Status / Scottish Public Health Observatory: Suicide National Trends (using National Records for Scotland (NRS) official statistics on suicides).
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) / For information: Scottish Public Health Observatory also produce Board level estimates of suicide rates (based on five-year rolling period with annual updates)
13 / Additional Information / Age standardized data at National Level:
Age standardized data by NHS Board:
Backtoindex / Child healthy weight interventions
1 / Measure Identifier / Child Weight
2 / Target Wording / To achieve 14,910 completed child healthy weight interventions 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.
Boards have already submitted 3-year trajectories for Child Healthy Weight interventions. The final year of those trajectories (2013/14) has been included in the LDP trajectory template, along with the number of interventions delivered during 2011/12 (the first year of the target).
There are several requirements underpinning this target (such as the requirement that 40% of Health Boards original targets should comprise children from the 40% most deprived within board SIMD areas) which are detailed in the guidance notes. In order for an intervention to count towards this HEAT target all requirements in the guidance should first be met.
Trajectories and the reporting of performance against them will remain based on total completed healthy weight interventions. The additional information on the proportion of interventions delivered in the most deprived areas will be published annually.
6 / Performance measure directly relates to HEAT target / Yes
7 / Performance management information data source
Frequency
Time lag / Child Healthy Weight Quarterly Data Collection overseen by ISD for 5 to 15 years. Pre-school children data collection overseen by Scottish Government.
Quarterly
Two months
8 / Published data source supplying Scotland Performs
Frequency
Time lag
National Statistics Status / Child Healthy Weight Quarterly Data Collection(overseen by ISD for 5 to 15 years and Scottish Government for pre-school children). Published data will also show the proportion of each Board’s interventions that comprised of children from the 40% most-deprived within-Board SIMD areas.
Annual
Three months
No
9 / Units / Number of interventions (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 third 3-year target period will have greater commonality across the country and hence comparability between Boards will be more possible than previous to April 2011. 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 inScotland: A Route Map Towards Healthy Weight
Child Healthy Weight Guidance 2011-14 (available Feb 2011)
Backto index / Smoking cessation (SIMD)
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 tackled the significant inequalities in Scottish society.
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.
Boards have already submitted 3-year trajectories for successful quits in the 40 per cent most-deprived datazones. The final year of those trajectories (2013/14) has been included in the LDP trajectory template, along with the number of successful quits delivered during 2011/12 (the first year of the target).
An updated SIMD 2012 is due to be published in December 2012. Following this, future updates will be aligned with the newer SIMD. Whilst the impact of switching from SIMD 2009 to SIMD 2012 on NHS Board-level results is anticipated to be minimal, it will probably mean some change to the list of datazones that constitute the Board’s 40 per cent most deprived. Boards will be kept informed as this work develops.
6 / Performance measure directly relates to HEAT target / Directly relevant to second part of the target (i.e. successful quits in the 40% most-deprived within-Board SIMD areas)
7 / Performance management information data source
Frequency
Time lag / Smoking cessation data from ISD – National Smoking Cessation Database.
Quarterly
Three months
8 / Published data source supplying Scotland Performs
Frequency
Time lag
National Statistics Status / NHS Smoking Cessation Service Statistics(Scotland)- from ISD National Smoking Cessation Database.
Annual, based on financial year
Six months
No
9 / Units / Number of successful quits in 40% most-deprived within-Board SIMD areas (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
Backtoindex / Child Fluoride Varnish Applications (SIMD)
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.