LOCAL DELIVERY PLANS 2009/10
METHODS AND SOURCES
This document is intended as a reference source for use in completing LDP 2009/10 Trajectories.
Directorate of Delivery - Analysis Team
Analytical Services Division
Health Directorates
Scottish Government
Version 1.3
Version Log
Version 1.1
Amended 18/11/2008
Clarification to Advance Booking – GP measure
Version 1.2
Amended 23/12/2008
Guidance relating to performance measures for 18 weeks RTT
Further guidance relating to cancer performance measures
Clarification to C.diff infections: 30% Reduction measure
Energy consumption measure guidance included
Healthcare experience website address amended
Version 1.3
Amended 26/1/2008
Further guidance relating to cancer performance measures, specifically around exclusions.
HEAT KEY MEASURES
Health Improvement for the people of Scotland – improving life expectancy and healthy life expectancy
Dental registrations
Child Healthy weightinterventions
Alcohol BriefInterventions
Suicide Prevention training
Successful 1 monthsmokingcessationquit attempts
Breastfeeding at 6-8 weeks
InequalitiesTargetedCardiovascular HealthChecks
Efficiency and Governance Improvements – continually improve the efficiency and effectiveness of the NHS
Efficiency savings: Day case rates
Efficiency savings: Non-routine inpatients average length of stay
Efficiency savings: Reviewto NewOutpatient Attendance Ratio
Efficiency savings:New outpatientappointment DNA rates
Financial Performance
Cash Efficiencies: 2% per annum
Electronic Management of Referrals
Reduce Energy consumption
CHI Utilization (radiology requests)
Knowledge and Skills Framework – Personal Development Plan Review
Access to Service – recognising patients’ need for quicker and easier use of NHS services
48 HourAccess – GP Practice team
Advancebooking–GP
Suspicion-of-cancer referrals (62 days)
All Cancer Treatment(31days)
18 weeks RTT: Admitted Performance
18 weeks RTT: Admitted Completeness
18 weeks RTT: Non-admitted Performance
18 weeks RTT: Non-admitted Completeness
New outpatients: Maximum 12 weeks from referral
Inpatients& Day cases: Maximum 12weeks
Faster accessto treatment for drug misusers
Faster access to specialist Child and AdolescentMental Health Services (CAMHS)
Treatment Appropriate to Individuals – ensure patients receive high quality services that meet their needs
QIS: improving clinicalgovernance and risk management standards
Prescribing ofanti-depressants
Reduction of psychiatric readmissions
Hospital admissionsfor long term conditions
Improvement in the quality of healthcare experience
Balance of care for older people with complex careneeds
Dementia
Rate of attendance at Accident and Emergency
MRSA/MSSA bacterium: 30% Reduction
C.diff infections: 30% Reduction
Reductionin emergency bed-days for patients aged 65+
Health Improvement for the people of Scotland – improving life expectancy and healthy life expectancy
Backtoindex / Dental registrations1 / 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
Back toindex / Child healthy weight interventions
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
9 / Description / The performance measure is the number of children aged 5-15 years completing Scottish Government approved healthy weight intervention programmes.
NHS Scotland will be expected to deliver interventions to 13.5% (19,493) of children aged 5-15 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.
The final target for public reporting will be re-confirmed with each Board in March 2010.
10 / Relevance / Directly relevant to target
11 / Data Sources / NHS Boardsshould now have local information systems in place to capture the number of children completing healthy weight interventions. NHS Boards will be asked to submit data for 2008/09 by end May 2009. Requests for these data will be issued in March 2009.
12 / Date Type / Annual
13 / Time Lag / Two months
14 / Performance Direction / Increase
15 / Amber Threshold
16 / Value Type / Number of completed interventions
17 / Coverage / All NHS Boards
18 / Concepts & Definitions / Guidance around the content and delivery of programmes for H3 was issued by the Scottish Government and NHS Health Scotland in April 2008:
Guidance around monitoring and data collection requirements for H3 was issued by the Scottish Government in July 2008.
Further guidance will be issued by the H3 Monitoring & Evaluation Steering Group, which met for the first time in October 2008. NHS Health Scotland will also be issuing guidance on Evaluation of H3 before March 2009.
19 / Quarters Measurement
20 / National Weighting
21 / National Statistics Status / No
22 / Accuracy / Aggregated returns from NHS Boards
23 / Comparability
24 / Additional Information
Back toindex / 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
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 / NHS Boards are in the process of developing local information systems to capture the number of alcohol brief interventions delivered in the priority areas of primary care, A&E and antenatal care.Information Services Division (ISD) led a short-life data and information working group to work with Boards to develop a minimum dataset, prepare accompanying guidance on data definitions, data standards and coding and to examine current methods of data capture and reporting.
NHS Boards have been asked to submit data for 2008/09 by 31 May 2009 for the HEAT performance management system. The frequency of reporting in 2009-2010 is currently under discussion; national reporting requirements for 2009-10 will be issue in the coming months.
12 / Date Type / Annual
13 / Time Lag / Two months
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 / 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). HEAT (H4): Alcohol Brief Interventions - National guidance on data reporting 2008-9 was issued by Pam Whittle to Health Board Chief Executives and LDP leads on 25August 2008.
19 / Quarters Measurement
20 / National Weighting
21 / National Statistics Status / No
22 / Accuracy / Aggregate returns from NHS Boards
23 / Comparability
24 / 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.
Backto index / Suicide Prevention training
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.
LDP Trajectories are not required for the “Reduce suicide rate between 2002 and 2013 by 20%” part of this target.
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 / Annually
13 / Time Lag
14 / Performance Direction / Increase
15 / Amber Threshold
16 / Value Type / Percentage
17 / Coverage / All boards
18 / Concepts & Definitions
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):
General Register Office for Scotland:
Scottish Public Health Observatory:
Back to index / Successful 1 month smoking cessation quit attempts
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.
We are currently exploring whether the data source can report on financial year, if not, then the target in HEAT 2010/11 would need to relate to calendar years.
12 / Date Type / Annual
13 / Time Lag / 3 months
14 / Performance Direction / Increase
15 / Amber Threshold
16 / Value Type / Number of smoking cessations per NHS board
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 April 2005) 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 is improving 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 data quality is improving over time.
23 / Comparability / There is only two years of past data available, so time-series comparisons are limited. 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 / Breastfeeding at 6-8 weeks
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. Data available for NHS Highland is currently partial (part of former Argyll & Clyde area only), but the system has been implemented across the whole board from 01/05/2007. NHS Western Isles also recently implemented the system – from 01/05/2006 – and first data were published in May 2008. NHS 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.
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:
Back toindex / Inequalities Targeted Cardiovascular Health Checks
1 / Measure Identifier / H8.KPM1
2 / Measure Title / Inequalities Targeted Cardiovascular Health Checks
3 / Short Measure Title / Inequalities Health Checks
4 / Target Identifier / H8
5 / Target Details / Achieve agreed number of inequalities targeted cardiovascular Health Checks during 2009/10.
6 / Short Target Title / H8 Inequalities Health Checks
7 / HEAT Objective / Health Improvement
8 / Level / Key
9 / Description / Cumulative number ofinequalities targeted cardiovascular health checks to be delivered by NHS Scotland during 2009/10 (based on quarterly data).
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.
A “cardiovascular health check” should include as a minimum all components associated with the Keep Well mandatory data items. Further guidance about the required content of health checks will be issued to NHS Boards in December 2008.
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 2009.
Guidance on monitoring and reporting requirements around this target will be issued to Boards in December 2008.
10 / Relevance / Directly relevant to target.
2007 Spending Review Target - to reduce the age-standardised CHD mortality rate amongst the under 75s in the most deprived areas:
Better Health Better Care - Scottish Government commitment to support the Keep Well programme, complimenting the commitment to extend screening and health checks;
Equally Well- Recommendation 46 - The Government commitment to health checks for all at age 40 should be implemented in ways that build on the Keep Well programme;
Equally Well - Recommendation 47 - The Government should create and fund new evidence-based anticipatory care programmes for other groups at high risk of health problems.
11 / Data Sources / Keep Well - Quarterly performance reporting has already been established. Data returns are held centrally by NHS Health Scotland and reported to Scottish Government.
Well North - A similar systemto the Keep Well reporting mechanism will be developed.
Inequalities targeted anticipatory care health checks outwith existing Keep Well/Well North areas - A similar systemto the Keep Well reporting mechanism will be developed.
12 / Date Type / Quarterly
13 / Time Lag / Variable (dependent on programme through which the health checks are being delivered and type of systems in place to record and report number of checks carried out. Keep Well quarterly data reports currently have a one month time lag.)
14 / Performance Direction / Increase
15 / Amber Threshold
16 / Value Type / Cumulative number
17 / Coverage / All Boards
18 / Concepts & Definitions / This target is intended as a first step toward a “successor” target, which would involve universally implementing inequalities targeted high risk primary prevention across Scotland
19 / Quarters Measurement
20 / National Weighting
21 / National Statistics Status / No
22 / Accuracy
23 / Comparability / 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.
24 / Additional Information / More information about this measure is available from Tim Warren (Tel: 0131 2443015).
Efficiency and Governance Improvements – continually improve the efficiency and effectiveness of the NHS
Back toindex / Efficiency savings: Day case rates1 / Measure Identifier / E4.KPM1
2 / Measure Title / Efficiency Savings: Day case rates
3 / Short Measure Title / Day case rates
4 / Target Identifier / E4
5 / Target details / NHS Boards to deliver agreed improved efficiencies for 1st outpatient attendance DNA, non-routine inpatient average length of stay, review to new outpatient attendance ratio and day case rate by March 2011
6 / Short Target / E4 Efficiency savings
7 / HEAT Objective / Efficiency and Governance Improvements
8 / Level / Key
9 / Description / The number of the BADS surgical procedures performed in a day case or outpatient setting (same day care) expressed as a percentage of the total number of BADS procedures including inpatients.