THE QUALITY OF CARE IN
North Lincolnshire Data report
CQC prototype report
Data produced: August 2015 Publication: February 2016
2.3 Enhancing the quality of life ...... 32 Contents 2.4 Do people have a positive experience of care and support? ...... 33 2.5 Are there problems with access and unmet need? ...... 34 INTRODUCTION ...... 3 3. SYSTEM INDICATORS ...... 41 KEY FINDINGS ...... 5 3.1 Quality and partnership working ...... 41 Provider Section ...... 5 3.2 Indicators of partnership working ...... 44 Population Section ...... 5 3.3 Potential savings emergency admissions anD System Section ...... 6 readmissions (ambulatory care sensitive conditions) ..... 45 1. WHAT IS THE QUALITY OF CARE ACROSS 3.4 National Reporting and Learning System (safety incident PROVIDERS IN NORTH LINCOLNSHIRE? ...... 7 reporting) ...... 47 1.1. Ratings analysis – Northern Lincolnshire and Goole NHS 3.5 Bed occupancy at Northern Lincolnshire and Goole NHS Foundation Trust and Scunthorpe General Hospital ...... 8 Foundation Trust ...... 49 1.2. The provision of acute hospital care in North Lincolnshire10 3.6 Workforce statistics ...... 49 1.3. Ratings analysis – GP practices in North Lincolnshire ... 15 3.7 NHS Staff Survey Results ...... 51 1.4. The provision of GP practice care in North Lincolnshire 17 3.8 Commissioning ...... 53 1.5. Ratings analysis – Adult Social Care providers in North 4. APPENDICES ...... 57 Lincolnshire ...... 19 4.1 Description of the data indicators ...... 58 1.6. The provision of adult social care in North Lincolnshire . 21 4.2 Additional sources of data ...... 65 2. WHAT IS THE QUALITY OF CARE FOR POPULATIONS BEYOND WHAT WE KNOW ABOUT PROVIDERS? .... 22 FIGURES AND TABLES ...... 66
2.1. What are the health and wellbeing outcomes for people?24 2.2 Delaying and reducing the need for care and support and helping people to recover ...... 28
2 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
Introduction
Our Quality in a Place programme is intended to explore the Reporting only at a provider level does not give a complete role of CQC in quality regulation in a local area. Our approach picture of what it is like to live in a local area and use the local tests whether going beyond the regulation of individual services. Section two of this report focuses on a population providers helps us to achieve our purpose. This data report approach and looks at whether services achieve good accompanies the prototype report which explores the quality of outcomes for people, meet population needs and minimise care in North Lincolnshire. inequalities. A useful starting point to understand quality of care in a Finally, looking at individual population groups, the population particular place is provider ratings and what they tell us about as a whole and what we can say about providers will not the quality of services in that area. Section one of this report sufficiently enable us to explain whether the system/all uses CQC’s data on provider registration and ratings to look at organisations in an area are working to provide the best this. We also use external data sources to look at providers and possible quality of care. Section three of the report provides their services. some system indicators around partnership working, how well- led the organisations appear to be and some data relating to
commissioning.
INTRODUCTION 3
This data report was produced in August 2015 for use by Where data has been used from CQC’s mental health crisis CQC’s fieldwork team. The team conducted interviews, care review publication (Right here, right now), this has been engaged locally and reviewed official documents, among other benchmarked using five bandings of “much higher than methodologies, to explore quality of care in North Lincolnshire. expected”, “higher than expected”, “similar”, “lower than The fieldwork took place in October 2015. The main (prototype) expected” or “much lower than expected”. Data from CQC’s report, which includes findings from this data report, has been forthcoming publication on integrated care for older people has published at the same time. Both reports are available at again been benchmarked using five bandings of “much higher www.cqc.org.uk/qualityinaplace. than average”, “higher than average”, “similar”, “lower than average”, or “much lower than average”. CQC’s own data on providers was instrumental to this project. However, we also relied on data from other sources, particularly For ease of use, appendix 4.1 provides a table which maps the when looking at population outcomes. Section two is informed data indicators to the assessment framework which was used by data from Public Health England (PHE), the Health and by the fieldwork team. Social Care Information Centre (HSCIC) and NHS England, in addition to CQC publications. Where data has been published by external organisations, the source of the data will refer to the organisation that published the data. Appendix 4.2 contains a detailed breakdown of the origins of the data indicators.
Data that is from a PHE publication has been benchmarked against an England average. PHE uses the system of “significantly higher”, “significantly lower” or similar. Where a comparison is similar this means that the difference is not statistically different. Occasionally it has not been appropriate to benchmark the data and this is indicated by “not compared”.
4 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
Key findings
PROVIDER SECTION POPULATION SECTION
Northern Lincolnshire and Goole NHS Foundation Trust North Lincolnshire is ranked as the 129th most deprived local (NLaG) and the Scunthorpe General Hospital, which is part authority out of 326 in England. Across the social gradient of this trust, are both rated as requires improvement. there is a high variation in life expectancy. Life expectancy is Of the 20 GP practices in North Lincolnshire, six have been 8.3 years lower for men and 9.3 years lower for women in rated. Five were rated as good, and one as requires the most deprived areas of North Lincolnshire than in the improvement. least deprived areas. Of the 77 adult social care providers in North Lincolnshire, North Lincolnshire has a significantly higher proportion of 33 have been rated. Twenty four were rated as good and older residents than the England average. However, the nine as requires improvement. prevalence of mental health conditions is significantly better and the prevalence of dementia, learning disabilities and alcohol use is not statistically different from the England average. Drug use is significantly worse than the England average.
KEY FINDINGS 5
North Lincolnshire is worse for some indicators of excess SYSTEM SECTION mortality and similar to the England rate for others. North Lincolnshire scores well on indicators of partnership There are mixed outcomes for delaying and reducing the working. This suggests effective use of NHS resources need for care and support. The rates of unplanned hospital through improvements in the quality of primary care by peer admissions are higher than the England rate but North review. Lincolnshire has similar treatment completion rates to The rate of emergency admissions is below the England England. average. Data indicates that North Lincolnshire could reduce There doesn’t appear to be a problem with delayed transfers emergency admissions to hospital and as a result make of care in North Lincolnshire. Further, emergency and financial savings. The potential financial saving is £875,363 avoidable admissions are the same as or better than the with a reduction of 476 emergency attendances in quarter 4 England average. of 2014/15. The number of safety incidents reported by NLaG has increased over time. Bed occupancy was lower than the England average at NLaG from July 2014 to June 2015. Workforce statistics indicate a relatively stable workforce at NHS North Lincolnshire Clinical Commissioning Group (CCG) and NLaG. NHS staff survey results are similar to the average of all other acute trusts in England.
6 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
1. What is the quality of care across providers in North Lincolnshire?
In order to explore quality of care in North Lincolnshire, we At the time this data report was produced (August 2015), North looked at the ratings for GP practices, adult social care Lincolnshire had one acute hospital, 20 registered GP practices providers and acute hospitals in that area. and 77 registered adult social care providers. However, not all of the services had received a rating.
1. WHAT IS THE QUALITY OF CARE ACROSS PROVIDERS IN NORTH LINCOLNSHIRE? 7
1.1. RATINGS ANALYSIS – NORTHERN Scunthorpe General Hospital provides a wide range of district LINCOLNSHIRE AND GOOLE NHS FOUNDATION general services to the population of North Lincolnshire. This TRUST AND SCUNTHORPE GENERAL HOSPITAL hospital has approximately 400 inpatient beds as well as day beds.2 The ratings from this inspection are in table 2. Northern Lincolnshire and Goole NHS Foundation Trust (NLaG) serves a population of more than 350,000 people living in North and North East Lincolnshire and East Riding of Yorkshire. In total the trust employs around 6,500 staff and has 850 beds across three hospitals, Diana Princess of Wales, Scunthorpe General Hospital and Goole and District Hospital. This trust was one of the first to undergo a comprehensive inspection under CQC’s new inspection methodology as NLaG was considered high risk. The trust was also one of 14 trusts, which were subject to Sir Bruce Keogh’s (the Medical Director for NHS England) investigation in June 2013, as part of the review of high mortality figures across trusts in England. An announced inspection of the trust took place between 23 and 25 April and on 8 May 2014, and an unannounced visit took place on 6 May 2014. Community service provision at the trust was not inspected as part of this inspection.1 The ratings from this inspection are in table 1.
1 Northern Lincolnshire and Goole NHS Foundation Trust (NLaG) inspection 2 Scunthorpe General Hospital inspection report report http://www.cqc.org.uk/provider/RJL http://www.cqc.org.uk/location/RJL32
8 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
Table 1: CQC ratings, Northern Lincolnshire and Goole NHS Foundation Trust Key: Name Overall Safe Effective Caring Responsive Well-led Outstanding NLaG Good Scunthorpe Requires improvement General Hospital Inadequate Source: CQC inspection ratings
Table 2: CQC ratings by core service, Scunthorpe General Hospital
Name Urgent and Medical care Surgery Critical care Children and End of life care Outpatients Maternity emergency young people care Scunthorpe General Hospital
Source: CQC inspection ratings
1. WHAT IS THE QUALITY OF CARE ACROSS PROVIDERS IN NORTH LINCOLNSHIRE? 9
Rotherham Doncaster and South Humber NHS Foundation Figure 1: Attendances at Northern Lincolnshire and Goole Trust (RDaSH) operates services in 200 locations across NHS Foundation Trust, 2011/12 to 2013/14 Rotherham, Doncaster, North Lincolnshire, North East Lincolnshire and Manchester. The trust has diversified from mental health and learning disability services to include 450,000 +2% 2011/12 - 2013/14 community services, such as district nursing and health visitors. 400,000 This service has not yet been rated under CQC’s new 350,000 methodology. 300,000 East Midlands Ambulance Service NHS Trust (EMAS) provides 250,000 emergency 999, urgent care and patient transport services for 200,000
Attendances 150,000 the 4.8 million people living in Derbyshire, Leicestershire, +6% 2011/12 - +3% 2011/12 - 100,000 2013/14 2013/14 Rutland, Lincolnshire (including North and North East 50,000 Lincolnshire), Northamptonshire and Nottinghamshire. This 0 service has not yet been rated under CQC’s new methodology. Inpatient – elective Inpatient – Outpatient emergency Attendance type 1.2. THE PROVISION OF ACUTE HOSPITAL CARE 2011/12 2012/13 2013/14 IN NORTH LINCOLNSHIRE Figure 1 shows the percentage increases in attendances at Source: Health and Social Care Information Centre (HSCIC), Hospital Episodes Statistics (HES) NLaG in a two-year period. In 2013/14 there were 6% more elective inpatient attendances, 3% more emergency inpatient In 2013/14, patients attended NLaG as emergency inpatients attendances and 2% more outpatient attendances than in from 19 different local authorities. Less than half of these 2011/12. patients were North Lincolnshire residents. However, this trust also provides A&E services at the Diana Princess of Wales hospital in Grimsby, North East Lincolnshire. All other attendances accounting for more than 1% of the total attendances were residents from other local authorities in Lincolnshire or neighbouring Yorkshire. For reasons of deductive disclosure, local authorities with less than five attendances were omitted from the analysis (table 3).
10 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
Table 3: Emergency inpatient attendances at Northern Figure 2 shows the local authorities of residence where more Lincolnshire and Goole NHS Foundation Trust by patient’s than 1% of the emergency attendances at NLaG live. local authority of residence, 2013/14
Local authority Attendances % of Figure 2: Emergency inpatient attendances at Northern attendances Lincolnshire and Goole NHS Foundation Trust by patient’s North Lincolnshire 15,062 42.9% local authority of residence, 2013/14 North East Lincolnshire 12,246 34.8% East Lindsey 2,952 8.4% East Riding of Yorkshire 1,934 5.5%
West Lindsey 1,871 5.3% East Riding of Yorkshire 5.5% Local authorities with <1% attendances 465 1.3% North Lincolnshire 42.9%
Unknown local authority of residence 619 1.8% North East Lincolnshire 34.8%
Total 35,149 - West Lindsey 5.3% Source: HES East Lindsey 8.4%
Source: HES
1. WHAT IS THE QUALITY OF CARE ACROSS PROVIDERS IN NORTH LINCOLNSHIRE? 11
In 2013/14 patients attended Scunthorpe General Hospital as Figure 3 shows the local authorities of residence where more emergency inpatients from 16 different local authorities. The than 1% of the emergency attendances at Scunthorpe General majority of these patients were North Lincolnshire residents. All Hospital live. other attendances accounting for more than 1% of the total attendances were residents from other local authorities within Figure 3: Emergency inpatient attendances at Scunthorpe Lincolnshire or neighbouring Yorkshire. For reasons of General Hospital by patient’s local authority of residence, deductive disclosure Local Authorities with less than five 2013/14 attendances were omitted from the analysis (table 4).
Table 4: Emergency inpatient attendances at Scunthorpe
General Hospital by patient’s local authority of residence, East Riding of Yorkshire 10.0% 2013/14
Local authority Attendances % of North Lincolnshire 78.2% attendances North Lincolnshire 14,570 78.2% North East Lincolnshire 1.5% East Riding of Yorkshire 1,871 10.0% West Lindsey 6.5% West Lindsey 1,204 6.5% North East Lincolnshire 271 1.5% Local authorities with <1% attendances 390 2.1% Unknown LA of residence 323 1.7% Total 18,629 -
Source: HES
Source: HES
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In 2013/14, patients attended NLaG as elective inpatients from Figure 4 shows the local authorities of residence where more 13 English local authorities, excluding those with counts of less than 1% of the elective attendances at NLaG live. than five attendances and where local authority of residence was unknown. Less than half of these patients were North Figure 4: Elective inpatient attendances at Northern Lincolnshire residents (table 5). Lincolnshire and Goole NHS Foundation Trust by patient’s local authority of residence, 2013/14 Table 5: Elective inpatient attendances at Northern Lincolnshire and Goole NHS Foundation Trust by patient’s local authority of residence, 2013/14
% of Local authority Attendances attendances East Riding of Yorkshire 9.7% North Lincolnshire 22,054 38.6% North Lincolnshire 38.6% North East Lincolnshire 20,397 35.7% North East Lincolnshire 35.7% East Riding of Yorkshire 5,559 9.7% West Lindsey 4.9% East Lindsey 3,848 6.7% East Lindsey 6.7% West Lindsey 2,800 4.9% Local authorities with <1% attendances 947 1.7% Unknown local authority of residence 1,607 2.8% Total 57,212 -
Source: HES
Source: HES
1. WHAT IS THE QUALITY OF CARE ACROSS PROVIDERS IN NORTH LINCOLNSHIRE? 13
In 2013/14, patients attended Scunthorpe General Hospital as Figure 5 shows the local authorities of residence where more elective inpatients from 10 English local authorities, excluding than 1% of the elective attendances at Scunthorpe General those with counts less than five attendances and where local Hospital live. authority of residence was unknown. Most of these patients were North Lincolnshire residents (table 6). Figure 5: Elective inpatient attendances at Scunthorpe General Hospital by patient’s local authority of residence, Table 6: Elective inpatient attendances at Scunthorpe 2013/14 General Hospital by patient’s local authority of residence, 2013/14
Local Authority Attendances % of attendances North Lincolnshire 19,182 79.7% East Riding of Yorkshire 1,746 7.3% East Riding of Yorkshire 7.3% West Lindsey 1,327 5.5% North Lincolnshire 79.7%
North East Lincolnshire 763 3.2% North East Lincolnshire 3.2%
Local authorities with <1% attendances 370 1.5% West Lindsey 5.5% Unknown local authority of residence 682 2.8% Total 24,070 -
Source: HES
Source: HES
14 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
In 2013/14, residents of North Lincolnshire Local Authority 1.3. RATINGS ANALYSIS – GP PRACTICES IN attended 19 trusts and five private providers as elective NORTH LINCOLNSHIRE inpatients. For reasons of deductive disclosure, trusts with less Of the 20 GP practices in North Lincolnshire, six have been than five attendances have been omitted. Of the elective rated. The ratings have been plotted on the map of the North inpatient attendances made by North Lincolnshire residents, Lincolnshire area (figure 6). Five were rated as good (green 76% were to NLaG (table 7). square) and one as requires improvement (orange square). Ratings information is correct to August 2015. Table 7: Trusts with elective inpatient attendances made by residents of North Lincolnshire Local Authority, 2013/14 Table 8 provides a comparison of the GP practice ratings received in North Lincolnshire to the England average. Please Trust name Attendances % of note that the proportions must be interpreted with caution attendances due to the very small numbers involved. Overall North Northern Lincolnshire and Goole NHS Lincolnshire has about the same proportion of GP practices Foundation Trust 22,054 75.8% positively rated as good, as the England average. The data is Hull and East Yorkshire Hospitals NHS Trust 3,886 13.4% correct at August 2015. Doncaster and Bassetlaw Hospitals NHS Foundation Trust 890 3.1% Figure 6: GP practices with their overall rating, North Lincs Sheffield Teaching Hospitals NHS Foundation Trust 660 2.3% Sheffield Children's NHS Foundation Trust 439 1.5% Leeds Teaching Hospitals NHS Trust 234 0.8% United Lincolnshire Hospitals NHS Trust 210 0.7% Independent providers 449 1.5% Trusts <200 attendances by North Lincolnshire residents 263 0.9% Total 29,085
Source: HES
Source: CQC provider data
1. WHAT IS THE QUALITY OF CARE ACROSS PROVIDERS IN NORTH LINCOLNSHIRE? 15
Table 8: Breakdown of GP practice ratings in North Lincolnshire and in England
Outstanding Good Requires Inadequate Total improvement North Lincolnshire (overall) 0 (0%) 5 (83%) 1 (17%) 0 (0%) 6 (100%) England (overall) 63 (4%) 1,292 (82%) 167 (11%) 58 (4%) 1,580 (100%) North Lincolnshire (safe) 0 (0%) 4 (67%) 1 (17%) 1 (17%) 6 (100%) England (safe) 12 (1%) 1,088 (69%) 404 (26%) 74 (5%) 1,578 (100%) North Lincolnshire (effective) 0 (0%) 5 (83%) 1 (17%) 0 (0%) 6 (100%) England (effective) 56 (4%) 1,349 (86%) 131 (8%) 39 (2%) 1,575 (100%) North Lincolnshire (caring) 0 (0%) 6 (100%) 0 (0%) 0 (0%) 6 (100%) England (caring) 33 (2%) 1,483 (94%) 53 (3%) 6 (<1%) 1,575 (100%) North Lincolnshire (responsive) 0 (0%) 6 (100%) 0 (0%) 0 (0%) 6 (100%) England (responsive) 98 (6%) 1,377 (88%) 72 (5%) 26 (2%) 1,573 (100%) North Lincolnshire (well-led) 0 (0%) 5 (83%) 1 (17%) 0 (0%) 6 (100%) England (well-led) 62 (4%) 1,292 (82%) 159 (10%) 62 (4%) 1,575 (100%)
Source: CQC provider data
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1.4. THE PROVISION OF GP PRACTICE CARE IN Figure 7: Location of GP practices in North Lincolnshire NORTH LINCOLNSHIRE with the Index of Multiple Deprivation scores of each lower super output area GP practices are well positioned to have a positive impact on health inequalities at a number of levels: through clinical care, wider patient advocacy, community engagement and influencing the wider political agenda. One factor that may contribute to health inequalities is that there are generally fewer GP practices in areas of higher deprivation leading to the assumption that that the most deprived populations have the worst access to primary care.3 Least deprived Figure 7 shows the location of registered GP practices in North Lincolnshire (as at August 2015) and the corresponding deprivation score (from the 2011 Index of Multiple Deprivation) of the lower super output area they are located in. While most of the areas with high deprivation appear to have GP practices Most deprived located within the area, there are pockets of high deprivation which don’t have registered GP practices. Source: CQC provider registration data and Office for National Statistics (ONS) 2010 Index of Multiple Deprivation scores
3 Asthana, Sheena, and Alex Gibson, ‘Deprivation, Demography, and the Distribution of General Practice: Challenging the Conventional Wisdom of Inverse Care,’ The British Journal of General Practice 58.555 (2008): 720-726. PMC. Web. 24 August 2015.
1. WHAT IS THE QUALITY OF CARE ACROSS PROVIDERS IN NORTH LINCOLNSHIRE? 17
Figure 8 presents the location of registered GP practices in The average GP practice list size in North Lincolnshire North Lincolnshire (as at August 2015) and the corresponding increased between 2010/11 and 2013/14, and is higher than population density estimate from the Office for National the average for England (figure 9). Statistics (ONS) mid-2012 population estimates for lower super output areas. As figure 8 shows, some of the most populated Figure 9: Change in GP practice list sizes 2010/11 to areas don’t have a registered GP located there. 2013/14, North Lincolnshire and England Average list size Figure 8: Location of GP practices in North Lincolnshire No. of GPs 10,000 25 with the corresponding population density at lower super output area 8,000 +5% 20
6,000 +6% 15
4,000 10
2,000 5
0 0 2010/11 2011/12 2012/13 2013/14 North Lincolnshire England No. of practices Least populated
Source: QOF data
Most Populated
Source: CQC provider registration data and ONS mid-2012 population estimates
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1.5. RATINGS ANALYSIS – ADULT SOCIAL CARE Figure 11: Care homes (without nursing) that have received PROVIDERS IN NORTH LINCOLNSHIRE a rating, North Lincolnshire Of the 77 adult social care providers in North Lincolnshire, 33 have been rated. The ratings have been plotted on the two maps of the North Lincolnshire area below and divided between care homes with nursing (figure 10) and care homes without nursing (figure 11). Ratings are good (green square) or requires improvement (orange square); no outstanding or inadequate ratings have been received as yet. Ratings information is correct to August 2015. Due to small numbers, domiciliary care (two rated) hospice services (none rated), supported living (one rated), and rehabilitation services (one rated) have not been mapped.
Figure 10: Care homes (with nursing) that have received a rating, North Lincolnshire Source: CQC provider data
Key: Outstanding Good Requires improvement Inadequate
Source: CQC provider data
1. WHAT IS THE QUALITY OF CARE ACROSS PROVIDERS IN NORTH LINCOLNSHIRE? 19
Table 9 provides a comparison of the adult social care ratings Please note that the proportions must be interpreted with received in North Lincolnshire with the England average. caution due to the very small numbers involved.
Table 9: Breakdown of adult social care ratings in North Lincolnshire and in England
Requires North Lincolnshire Outstanding Good Inadequate Total improvement North Lincolnshire 0 (0%) 24 (73%) 9 (27%) 0 (0%) 33 (100%) Overall England 33 (0%) 4,101 (60%) 2,332 (34%) 331 (5%) 6,797 (100%) North Lincolnshire 0 (0%) 24 (73%) 9 (27%) 0 (0%) 33 (100%) Safe England 8 (0%) 3,988 (59%) 2,349 (34%) 464 (7%) 6,809 (100%) North Lincolnshire 1 (3%) 24 (73%) 8 (24%) 0 (0%) 33 (100%) Effective England 38 (1%) 4,323 (64%) 2,195 (32%) 244 (4%) 6,800 (100%) North Lincolnshire 1 (3%) 32 (97%) 0 (0%) 0 (0%) 33 (100%) Caring England 136 (2%) 5,732 (84%) 862 (13%) 68 (1%) 6,798 (100%) North Lincolnshire 2 (6%) 23 (70%) 8 (24%) 0 (0%) 33 (100%) Responsive England 86 (1%) 4,681 (69%) 1,857 (27%) 178 (3%) 6,802 (100%) North Lincolnshire 0 (0%) 23 (70%) 10 (30%) 0 (0%) 33 (100%) Well-led England 71 (1%) 4,183 (62%) 2,185 (32%) 358 (5%) 6,797 (100%)
Source: CQC provider data
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1.6. THE PROVISION OF ADULT SOCIAL CARE IN Figure 13 presents the location of registered adult social care NORTH LINCOLNSHIRE providers in North Lincolnshire (as at August 2015) and the corresponding population density estimate from the ONS mid- Figure 12 shows the location of registered adult social care 2012 population estimates for lower super output areas. providers in North Lincolnshire (as at August 2015) and the corresponding deprivation score (from the 2011 Index of Due to small numbers domiciliary care, hospice services, Multiple Deprivation) of the lower super output area they are supported living, and rehabilitation services have not been located in. mapped.
Figure 12: Location and type of adult social care providers Figure 13: Location of adult social care providers in North in North Lincolnshire with the Index of Multiple Deprivation Lincolnshire with the corresponding population density at scores of each lower super output area lower super output area
Least deprived
Least populated
Most deprived Source: CQC provider registration data and ONS mid-2012 Source: CQC provider data population estimates Most populated Domiciliary care
Care home without nursing
Care home with nursing
1. WHAT IS THE QUALITY OF CARE ACROSS PROVIDERS IN NORTH LINCOLNSHIRE? 21
2. What is the quality of care for populations beyond what we know about providers?
The health of people in North Lincolnshire is varied compared strategic plan), the Child and Adult Lifestyles strategy and the with the England average. Deprivation is lower than the Healthy Ageing strategy.4 England average, the local authority is ranked 129th most North Lincolnshire has a significantly higher proportion of older deprived out of the 326 local authorities in England. Life residents than the England average. However, the prevalence expectancy for both men and women is lower than the England of mental health conditions is significantly better and the average. Life expectancy is 8.3 years lower for men and 9.3 prevalence of dementia, learning disabilities and alcohol use is years lower for women in the most deprived areas of North not statistically different from the England average. Drug use is Lincolnshire than in the least deprived areas. significantly worse than the England average (table 10). Priorities in North Lincolnshire include improving public mental and physical health and reducing inequality through focusing on high impact actions across the life course, from Best Start (part of the North Lincolnshire’s Children and Young People’s 4 PHE Health Profile and http://www.nelincsdata.net/IAS/
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Table 10: Identified health needs in North Lincolnshire and North Lincolnshire has a higher proportion of White and a lower in England proportion of Black and minority ethnic groups reported than the England average (figure 14). Health needs Time North England Compared period Lincolnshire to England % of total population aged 2013 10.7 9.3 Significantly Figure 14: Proportion of population by ethnicity, North 65-74 higher Lincolnshire and England, 2011 % of total population aged 2013 6.2 5.7 Significantly % Other 1.0% 0.2% 75-84 higher % of total population aged 2013 2.4 2.3 Significantly % Mixed 2.3% 0.7% 85+ higher % Black 3.5% 0.3% Prevalence of dementia 2012/13 0.59 0.57 Similar (% of registered patients) % Asian 7.8% 2.7% Prevalence of a mental 2012/13 0.72 0.84 Significantly % White 85.0% 96.0% health diagnosis (% of better registered patients) National % North Lincolnshire
Prevalence of learning 2012/13 0.47 0.47 Similar disabilities aged 18+ (% of Source: ONS 2011 census data registered patients)
Alcohol use – rate per 2013/14 653 645 Similar 100,000 hospital stays for alcohol-related harm Prevalence of opiate or 2011/12 11.1 8.4 Significantly crack use, rate per 1,000 worse population aged 15-64
Source: PHE adult social care and health profile Fingertips tools
2. WHAT IS THE QUALITY OF CARE FOR POPULATIONS BEYOND WHAT WE KNOW ABOUT PROVIDERS? 23
2.1. WHAT ARE THE HEALTH AND WELLBEING Using the 2011 Index of Multiple Deprivation scores, the slope OUTCOMES FOR PEOPLE? index of inequality in life expectancy at birth based on national deprivation deciles within England show that the range in life Life expectancy in North Lincolnshire is worse for both males expectancy across the social gradient is greater for women in and females at birth and at age 65 than the overall life North Lincolnshire than in England. However, males in North expectancy in England. Healthy life expectancy at birth in North Lincolnshire have less of a range in life expectancy than the Lincolnshire is similar to England (figure 15). England average (figure 16). Figure 15: Life expectancy in years for North Lincolnshire and England, 2011 to 2013 Figure 16: Range in years of life expectancy across the social gradient, from most to least deprived, North Life expectancy at 65 (female) 20.8 Lincolnshire and England 21.1
Life expectancy at 65 (male) 17.8 18.7 N.Lincs 9.3 years Female England 6.9 Life expectancy at birth (female) 82.5 83.1 years
Life expectancy at birth (male) 78.1 79.4 N.Lincs 8.3 years Male England 9.1 Healthy life expectancy at birth 62.3 (female) 63.9 years
Healthy life expectancy at birth (male) 62.5 63.3 0 1 2 3 4 5 6 7 8 9 10 11 12 Inequality in life expectancy at birth 0 20 40 60 80 100 Life expectancy (years) Source: Data from PHE Public Health Outcomes Framework Fingertips tool using ONS and Department for Communities and Local Government data North Lincolnshire England
Source: PHE Public Health Outcomes Framework Fingertips tool (using ONS data)
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Potential years of life lost (PYLL) from causes considered considered preventable. North Lincolnshire is comparable to amenable to health care calculates the number of additional the England average for other diseases with preventable years a person might have been expected to live with timely mortality, the infant mortality rate and excess winter deaths. and effective health care had they not died of a cause Cold weather can have a serious effect on health and considered to be avoidable. In North Lincolnshire the potential healthcare services. The causes of increased mortality in the years of life lost per 100,000 registered patients is higher than winter months are complex and can include circulating the England rate. However the confidence intervals around this infectious disease and health inequalities. Emergency planning rate are quite large. and health promotion activities can reduce the number of 5 Figure 17: Potential years of life lost (PYLL) from causes excess winter deaths. considered amenable to health care in North Lincolnshire and England, 2013 Table 11: Avoidable and excess deaths in North Lincolnshire and in England
3,500 2,474 Measures of Time North England Compared to 3,000 2,209 1,952 avoidable/excess period Lincolnshire England 2,215 2,500 2,027 mortality 1,845 2,000 Mortality rate per 2011-13 208.9 183.9 Significantly 1,500 100,000 from causes worse
1,000 considered preventable 500 (persons)
0 patients Rate per 100,000 registered Under 75 mortality rate 2011-13 58 50.9 Significantly Persons Male Female North Lincolnshire England per 100,000 from worse cardiovascular diseases Source: HSCIC NHS Outcomes Framework Indicator Portal considered preventable (persons)
Table 11 presents the rates of avoidable and excess deaths in North Lincolnshire and in England. North Lincolnshire is significantly worse for the overall mortality rate considered preventable and for cardiovascular and respiratory mortality 5 PHE, Cold weather plan for England, https://www.gov.uk/government/collections/cold-weather-plan-for-england
2. WHAT IS THE QUALITY OF CARE FOR POPULATIONS BEYOND WHAT WE KNOW ABOUT PROVIDERS? 25
Measures of Time North England Compared to What are the health and wellbeing outcomes for people avoidable/excess period Lincolnshire England with a mental health condition? mortality Excess under 75 mortality rate per 100,000 adults with serious Under 75 mortality rate 2011-13 88.8 83.8 Similar mental illness is higher in North Lincolnshire than in England per 100,000 from cancer considered preventable but the significance has not been calculated. The suicide rate in (persons) North Lincolnshire is statistically similar and the rate of recovery Under 75 mortality rate 2011-13 16.7 15.7 Similar from psychological therapies is significantly higher in North per 100,000 from liver Lincolnshire than in England (table 12). disease considered preventable (persons) Table 12: Outcomes for individuals in contact with mental Under 75 mortality rate 2011-13 24.9 17.9 Significantly health services, North Lincolnshire and England per 100,000 from worse respiratory disease Outcomes for Time North England Compared considered preventable individuals in contact period Lincolnshire to England (persons) with mental health services Mortality per 100,000 2011-13 63.4 62.2 Similar from communicable Excess under 75 mortality 2012/2013 519.3 347.2 Not diseases (persons) rate in adults with serious compared mental illness Excess Winter Deaths Aug 2012 29 20.1 Similar Index (single year, all to July Suicide rate per 100,000 2011-2013 11.2 8.8 Similar ages) 2013 (persons) Excess Winter Deaths Aug 2010 20.9 17.4 Similar Rate of recovery from 2012/2013 67.00% 45.90% Significantly Index (3 years, all ages) to July IAPT treatment (% higher 2013 recovering from treatment) Infant mortality – rate of 2011-13 4.6 4.0 Similar Source: PHE Public Health Outcomes Framework Fingertips tool/PHE community deaths in infants aged mental health Fingertips tool under 1 year per 1,000 live births
Source: PHE Public Health Outcomes Framework Fingertips tool
26 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
What are the health and wellbeing outcomes for older Table 13: Outcomes for older people, North Lincolnshire people? and England Table 13 presents the outcomes for older people In North Outcomes for older Time North England Compared to Lincolnshire and in England. Excess winter deaths in North people period Lincolnshire England Lincolnshire which can be attributed to health inequalities or a Excess Winter Deaths August 41.6 28.2 Similar lack of appropriate health promotion activities or emergency Index (1 year, ages 85 +) 2012 to planning activities are not statistically different from the England (persons) July 2013 average. Excess Winter Deaths August 27.8 24.1 Similar Health-related quality of life is significantly better in North Index (3 years, ages 2010 to Lincolnshire than overall in England. This indicator is derived 85+) (persons) July 2013 from the NHS England GP Patient Survey which asks people to Health-related quality of 2012/13 0.74 0.73 Significantly describe their mobility, self-care, usual activities, pain / life for older people better discomfort/anxiety/depression. The range of scores in England (survey score) is 0.64 to 0.79, the higher the score, the better the quality of life. Rate per 100,000 hip 2013/14 558 580 Similar fractures in people aged Suffering from a hip fracture is a debilitating condition as only 65+ (persons) one in three sufferers returns to their former levels of Rate per 100,000 hip 2013/14 231 240 Similar independence and one in three ends up leaving their own home fractures in people aged 6 and moving to long-term care. North Lincolnshire’s rate of hip 65+ – aged 65-79 fractures per 100,000 population is similar to the England rate. (persons) Rate per 100,000 hip 2013/14 1,504 1,566 Similar fractures in people aged 65+– aged 80+ (persons)
Source: PHE Public Health Outcomes Framework Fingertips tool
6 National Institute for Health and Clinical Excellence (2015), Quality standard for hip fracture, https://www.nice.org.uk/guidance/QS16/chapter/introduction-and- overview
2. WHAT IS THE QUALITY OF CARE FOR POPULATIONS BEYOND WHAT WE KNOW ABOUT PROVIDERS? 27
Have there been any improvements in outcomes over 2.2 DELAYING AND REDUCING THE NEED FOR time? CARE AND SUPPORT AND HELPING PEOPLE TO RECOVER An age-standardised mortality rate (ASMR) describes the number of deaths in an area that would occur if it had the same Often hospital admissions can be reduced for long-term age structure as the standard population. Variation in mortality conditions if there is effective management of the condition in rates between different areas can have multiple causes, the community. These conditions include, for example, including deprivation and certain health behaviours like diabetes, epilepsy and high blood pressure. Figure 19 presents smoking and excess alcohol. the rate per 100,000 registered patients who have an emergency admission/unplanned hospitalisation where There has been a decline in mortality rates since 2001 in both effective community care may have prevented this. North North Lincolnshire and in England (figure 18). Lincolnshire has a higher rate of emergency admissions for Figure 18: Age-standardised mortality rates, North acute conditions and unplanned hospitalisations for chronic Lincolnshire, and England and Wales, 2001 to 2013 ambulatory care sensitive conditions than the overall England rate.
1,400 1,273.7
1,200 1,054.4
1,000 1,236.1 986.0 800
600
400
Rate per 100,000 population 200
0 2001200220032004200520062007200820092010201120122013 Year North Lincolnshire England
Source: ONS
28 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
Figure 19: Rate per 100,000 registered patients who have Table 14: Measures of health improvement, North an emergency admission/unplanned hospitalisation for a Lincolnshire and England, 2013/14 condition which would not usually require it, North Measures of health Time North Compared England Lincolnshire and England, 2013/14 improvement period Lincolnshire to England 1,448 1,600 1,349 Successful completion of drug 1,400 1,196 treatment, opiate users (% of 2013 7.2% 7.8% Similar 1,200 adults in treatment) 1,000 800 800 Successful completion of drug 350 600 356 400 treatment non-opiate users (% 2013 36.0% 37.7% Similar 200 of adults in treatment) 0 Successful completion of Emergency Emergency Unplanned admissions for acute admissions for hospitalisation for alcohol treatment (% of adults 2013 47.0% 42.5% Similar conditions that should children with lower chronic ambulatory in treatment) not usually require respiratory tract care sensitive % of people entering prison
Rate per 100,000 registeredpatients hosptial admission infections conditions with substance dependence Significantly England North Lincolnshire issues who are previously not 2013/13 33.8% 46.9% better known to community Source: HSCIC NHS Outcomes Framework Indicator Portal treatment
Source: PHE Public Health Outcomes Framework Fingertips tool and PHE alcohol profiles
Delaying and reducing the need for care and support and helping people to recover: mental health and substance misuse Crisis resolution teams can play an important role in delaying and reducing the need for help and support for patients with a Work on health improvement can enable a healthy life for the mental health crisis. Crisis resolution teams will assess patients targeted populations. For example, substance misuse who are being considered for hospital admission and where interventions can improve the health and wellbeing in possible, provide intensive home treatment to prevent such individuals with substance misuse problems. Table 14 demonstrates North Lincolnshire’s performance on health improvement interventions compared to the England average.
2. WHAT IS THE QUALITY OF CARE FOR POPULATIONS BEYOND WHAT WE KNOW ABOUT PROVIDERS? 29
admission. Where a hospital admission does happen they can Figure 21: Percentage of emergency admissions to 7 also play a role in facilitating an early discharge from hospital. specialist mental health providers that are gate-kept by North Lincolnshire’s use of this intensive community support is crisis resolution home treatment teams, North Lincolnshire statistically similar to that of England overall for both the ratio of and England, 2012/13 home treatment episodes by crisis resolution home treatment 100% 99.6% 98.2% teams to people using secondary mental health services, and to 90% the proportion of emergency admissions to specialist mental 80% 70% health providers that are gate-kept by crisis resolution home 60% treatment teams (figures 20 and 21). 50%
40% admissions Figure 20: Rate of home treatment episodes, North 30%
Lincolnshire and England 20% Percentage of emergency 10% 100 0% 90 North Lincolnshire England 80 76 70
57 60 Source: CQC (2015), Right here, right now (mental health crisis care review, first 50 phase data)
services 40 30
20 secondarymental health
Rateper 1000 peopleusing 10 0 North Lincolnshire England
Source: CQC (2015), Right here, right now (mental health crisis care review, first phase data)
7 Johnson, S. (2013), ‘Crisis resolution and home treatment teams: an evolving model’, Advances in psychiatric treatment, 19(2), 115-123
30 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
8 CQC’s mental health crisis care review found that one of the Table 15: Delaying and reducing the need for care and most important preventative tools in mental health crisis care is support in older people, North Lincolnshire and England, giving people who have a known mental health condition a care 2013/14 plan that includes guidance on what to do in a crisis. The Delaying and reducing the Time North England Compared Quality and Outcomes Framework (QOF) measures the need for care – older people period Lincolnshire to England percentage of people with a serious mental illness who have an Permanent admissions to 2013/14 692 651 Similar agreed care plan documented in their primary care record in the residential and nursing care last 12 months. In North Lincolnshire, 81.3% of patients had an homes, per 100,000 population agreed care plan documented, which is the same as the overall aged 65+ England proportion in 2012/13. Proportion of older people 2013/14 90.0% 82.5% Significantly aged 65+ who were still at better Delaying and reducing the need for care and support and home 91 days after discharge helping people to recover: older people from hospital into re- ablement/rehabilitation services Avoiding permanent placements in residential and nursing care Proportion of older people 2013/14 1.9% 3.3% Significantly homes is a good indication of delaying dependency, and local aged 65+ who were offered re- worse health and social care services should work together to reduce ablement services following avoidable admissions. Research suggests that where possible discharge from hospital people prefer to stay in their own homes rather than move into Source: PHE, adult social care Fingertips tool residential care. Permanent admissions to care are similar in North Lincolnshire compared with the England average. The proportion of people offered re-ablement services following discharge from hospital was significantly worse in North Lincolnshire than in England overall. However, where people are receiving re-ablement services they are more likely to still be at home 90 days after discharge into that service (table 15).
8 CQC (2015), Right here, right now, http://www.cqc.org.uk/content/right-here- right-now-mental-health-crisis-care-review
2. WHAT IS THE QUALITY OF CARE FOR POPULATIONS BEYOND WHAT WE KNOW ABOUT PROVIDERS? 31
2.3 ENHANCING THE QUALITY OF LIFE North Lincolnshire has a mixed performance for measures of quality of life. The proportion of adults with a learning disability The social care-related quality of life score is based on in employment is significantly lower than the England average. responses to the 2013/14 HSCIC Adult Social Care Survey. However, the proportion of adults in contact with secondary Eight questions are scored based on whether there are no mental health services who are in settled accommodation are unmet needs, needs adequately met, some unmet needs and significantly higher than the England average. The remaining no needs met. The domains to which the questions relate are indicators are not significantly different from the England control, dignity, personal care, food and nutrition, safety, average (table 16). occupation, social participation and accommodation. The average score in England is 19 (range 17.8 to 20.6) and the Table 16: Adult social care user's quality of life, North 9 score for North Lincolnshire is 19.2. The higher the score the Lincolnshire and England more needs that are met. The carer reported quality of life Measures of quality of life Time North England Compared score is derived from the 2012/13 HSCIC Carers Survey. Six period Lincolnshire to England questions are scored based on whether there are no unmet Proportion of adults with a 2013/14 4.2% 6.7% Significantly needs, some unmet needs and no needs met. The domains to learning disability in worse which the questions relate are occupation, control, personal employment care, safety, social participation and encouragement and Proportion of adults in 2012/13 11.0% 8.8% Similar support. The score represents the respondents’ self-reported contact with secondary quality of life across the six questions. The average score in mental health services in employment England is 8.1 (range 6.5 to 9.3) and the score for North Lincolnshire is 8.410 the higher the score the more needs that Proportion of adults with a 2013/14 73.6% 74.9% Similar learning disability in settled are met. The results do not suggest there is greater unmet accommodation need in North Lincolnshire as both scores are similar to the Proportion of adults in 2012/13 75.2% 58.5% Significantly overall England scores. contact with secondary better mental health services in settled accommodation
Proportion of people who 2013/14 46.3% 44.5% Similar 9 PHE adult social care Fingertips tool, use services and their carers, http://fingertips.phe.org.uk/profile/adultsocialcare/data#gid/1000101/pat/6/ati/10 who reported that they had as 2/page/1/nn//par/E12000002/are/E08000006/iid/90582/age/168/sex/4 much social contact as they 10 PHE adult social care Fingertips tool would like
32 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
Source: PHE adult social care Fingertips tool The Carers Survey also asks “In the last 12 months, do you feel you have been involved or consulted as much as you wanted to 2.4 DO PEOPLE HAVE A POSITIVE EXPERIENCE be, in discussions about the support or services provided to the OF CARE AND SUPPORT? person you care for?” Carers’ involvement in decisions can have a positive impact on the outcomes for both the patient and The Adult Social Care Survey asks the question, “Overall, how carer and can reduce the risk of a breakdown in care. Table 17 satisfied or dissatisfied are you with the care and support shows the positive experience of care felt by carers and the services you receive?” The proportion of people in England who people they support in North Lincolnshire and in England. answered “I am extremely satisfied” or “I am very satisfied”, in 2013/14 was 64.8%. North Lincolnshire scored in line with the Table 17: Positive experience of care felt by carers and the England average with 65.3% of responses being positive.11 people they support in North Lincolnshire and England, 2012/13 and 2013/14 The 2012/13 Carers Survey asks “Overall, how satisfied or dissatisfied are you with the support or services you and the Measures of quality Time North England Compared of life period Lincolnshire to England person you care for have received from Social Services in the last 12 months?” The proportion of people in England who Proportion of people who 2012/13 77.9% 71.4% Not use services and carers who Compared answered “I am extremely satisfied” or “I am very satisfied”, in find it easy to find 2012/13 was 42.7%. North Lincolnshire’s figure is more positive information about services at 50.0%.12 Proportion of people who 2013/14 77.5% 74.5% Significantly The Adult Social Care Survey and the Carers survey ask use services who find it easy better whether service users/carers found it easy or difficult to find to find information about information and advice about support, services or benefits. services Access to information can promote greater choice and control Proportion of carers who 2012/13 77.4% 72.9% Significantly over their lives and can be a factor in reducing dependency. report that they have been better included or consulted in discussion about the person they care for 11 PHE adult social care Fingertips tool, Source: PHE adult social care Fingertips tool http://fingertips.phe.org.uk/profile/adultsocialcare/data#gid/1000101/pat/6/ati/10 2/page/1/nn//par/E12000002/are/E08000006/iid/90582/age/168/sex/4 12 PHE adult social care Fingertips tool
2. WHAT IS THE QUALITY OF CARE FOR POPULATIONS BEYOND WHAT WE KNOW ABOUT PROVIDERS? 33
The GP Patient Survey shows the proportion of respondents residential care.13 The North Lincolnshire rate of permanent who report that their care is “very good” or “fairly good”. admissions into residential care is similar to the England rate. Between July 2013 and March 2014 North Lincolnshire North Lincolnshire’s rate for delayed transfers of care is performed in line with England overall (table 18). significantly better than England overall which may be a reflection of the whole system working effectively to ensure Table 18: Results from the GP Patient Survey, North appropriate transfer from hospital to other providers of care Lincolnshire and England, 2013 to 2014 (table 19).
England North Lincolnshire Patient experience of GP services described as “very good’ or “fairly good” 85.7 85.0 Patient experiences of GP out-of- hours services described as “very good” or “fairly good” 66.2 67.5
Source: HSCIC NHS Outcomes Framework Indicator Portal
2.5 ARE THERE PROBLEMS WITH ACCESS AND UNMET NEED?
Where there is an unmet need there are healthcare problems in the population for which some or all of that population are not receiving the treatment they need. Avoiding permanent placements in residential and nursing care homes is a good indication of delaying dependency, and local health and social care services should work together to reduce 13 PHE adult social care Fingertips tool, avoidable admissions. Research suggests that where possible http://fingertips.phe.org.uk/profile/adultsocialcare/data#page/6/gid/1000102/pat/ people prefer to stay in their own homes rather than move into 6/par/E12000004/ati/102/are/E06000015/iid/1194/age/27/sex/4
34 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
Table 19: Indicators of permanent admissions to care and Access to healthcare services is essential in order for people to delayed transfer of care, North Lincolnshire and England, benefit from the healthcare system. Responses from the GP 2013/14 Patient Survey indicate that primary care in North Lincolnshire is similar to the England average (table 20). Indicators of permanent Time North England Compared to admissions to care and period Lincolnshire England delayed transfer of care Table 20: Access to GP services, responses from the GP Permanent admissions to 2013/14 9.9 14.4 Similar Patient Survey 2013/14, North Lincolnshire and England residential and nursing care Access to GP services Time period North England homes, per 100,000 Lincolnshire population aged 18-64 % who would recommend 2013/14 78.8% 78.7% Total delayed transfers of 2013/14 3.7 9.6 Significantly practice care per 100,00 aged 18+ better % satisfied with phone 2013/14 73.4% 75.5% Delayed transfers of care 2013/14 1.5 3.1 Similar access attributable to adult social care per 100,000 aged 18+ % satisfied with opening 2013/14 79.2% 76.9% hours Permanent admissions into 2013/14 161.2 105 Significantly residential care per 100,000 worse % who saw/spoke to nurse 2013/14 62.8% 50.7% population aged 18+ or GP same or next day Permanent admissions into 2013/14 15 49.2 Significantly % reporting good overall 2013/14 74.5% 74.6% nursing care per 100,000 better experience of making population aged 18+ appointment Total number of delayed October 3.7 11.6 Significantly % who know how to contact 2013/14 51.7% 55.8% transfers of care per month 2014 better an out-of-hours GP service per 100,000 aged 18+ Source: PHE GP Profiles using the GP Patient Survey results Source: PHE adult social care Fingertips tool
2. WHAT IS THE QUALITY OF CARE FOR POPULATIONS BEYOND WHAT WE KNOW ABOUT PROVIDERS? 35
Short waiting times are important to help people recover from Table 22: Consultant-led referral to treatment times for dependencies. Data from the National Drug Treatment North Lincolnshire CCG, October 2013 to March 2014 Monitoring System indicate that the majority of patients in North % within 18 weeks Trend Treatment Function Lincolnshire are seen within three weeks (table 21). Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Oct 13- March 14 General Surgery 90.6% 91.0% 93.8% 95.0% 93.6% 95.4% Urology 96.1% 92.8% 98.1% 100.0% 93.5% 93.0% Table 21: Patients waiting more than three weeks for drug Trauma & Orthopaedics 87.2% 88.3% 89.1% 82.8% 85.5% 86.7% or alcohol treatment in North Lincolnshire and in England, ENT 97.3% 95.9% 100.0% 98.0% 92.5% 97.7% 2013/14 Ophthalmology 96.0% 96.6% 97.0% 92.8% 96.0% 96.2% Neurosurgery - - - 100.0% - - North Lincolnshire England Plastic Surgery 94.9% 88.9% 87.5% 91.7% 90.3% 84.4% Cardiothoracic Surgery 75.0% 80.0% 100.0% 81.8% 90.0% 72.7% Proportion waiting more than 3 weeks for drug treatment General Medicine 100.0% 100.0% 100.0% 100.0% 100.0% 88.9% 0.5% 2.0% Gastroenterology 100.0% 96.4% 98.4% 100.0% 98.0% 97.1% Cardiology 87.7% 95.5% 84.8% 81.3% 84.7% 75.0% Proportion waiting more than 3 weeks for alcohol treatment Dermatology 100.0% 66.7% - 100.0% 100.0% - 00.0% 7.3% Thoracic Medicine 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Rheumatology - 100.0% 100.0% - - 100.0% Source: PHE coexisting substance misuse and mental health profiles Neurology - 100.0% 100.0% 100.0% 100.0% 100.0% Gynaecology 99.0% 97.8% 98.8% 100.0% 98.8% 96.6% Other 81.9% 68.5% 79.5% 69.1% 65.8% 83.7% Waiting times may also have an impact on access to healthcare Total 92.3% 91.1% 93.2% 89.8% 89.6% 91.0% and a patient’s overall experience of the NHS. Referral to Source: NHS England Treatment (RTT) waiting times data is collected from NHS providers (NHS trusts and other providers) and signed off by commissioners. Table 22 shows the percentage of North Lincolnshire Clinical Commissioning Group (CCG) patients treated within 18 weeks. Where the proportion falls below 90%, this is highlighted. See appendix 4.3 for England values.
36 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
Unmet needs: mental health Table 24: Indicators of unmet need – hospital admissions, The indicators in tables 23, 24 and 25 do not imply that North North Lincolnshire and England 2012/13 Lincolnshire has issues with unmet population needs. Hospital Indicators of unmet need Time North England Compared admissions and readmissions are all either better than the – hospital admissions period Lincolnshire to England overall England rate or similar to the overall England rate. % of emergency admissions 2012/13 25.2% 25.0% Similar via A&E for a mental health (MH) condition (for patients Table 23: Indicators of unmet need, North Lincolnshire and with a history of previous MH England contact) that returned to A&E Indicators of unmet need Time North England Compared within 30 days (for any period Lincolnshire to England reason) Rate per 100,000 hospital 2013/14 266 374 Significantly % of emergency admissions 2012/13 15.0% 13.5% Similar admissions for alcohol- better via A&E for a MH condition specific conditions (for patients with no history of previous MH contact) that Rate per 100,000 hospital 2011/12 23.5 40.1 Significantly returned to A&E within 30 admissions for alcohol- better to 2013/14 days (for any reason) specific conditions under 18 Source: CQC (2015), Right here, right now review data using HES and Mental Health Rate per 100,000 hospital 2009/10- 20.9 32.1 Significantly Minimum Data Set (MHMDS) admissions for unipolar 2011/12 lower depressive disorders per 100,000 aged 15+ Rate per 100,000 emergency 2011/12 19.7 16.8 Similar admissions for neuroses Rate per 100,000 hospital 2013/14 70.7 87.2 Similar admissions for mental health conditions, aged 0-17 years Rate per 100,000 hospital 2010/11 300.5 352.3 Significantly admissions as a result of to 2012/13 lower self-harm, aged 10-24 years
Source: PHE Alcohol Profiles and PHE Common Mental Health Disorders Profile
2. WHAT IS THE QUALITY OF CARE FOR POPULATIONS BEYOND WHAT WE KNOW ABOUT PROVIDERS? 37
Table 25: Observed number of emergency admissions to Figure 22: Access to psychological treatments, North an acute hospital for mental health condition/behaviours, Lincolnshire and England, 2012/13
North Lincolnshire, 2012/13 80% 67% Acute admissions for: Observed Expected National 70% Comparison 60% 47% 46% Self-harm 193 207 Similar to expected 50% 40% Alzheimer's disease 25 24 Similar to expected 30% 30% 22% Other organic forms of 27 19 Similar to expected 20% dementia (not Alzheimer's) 10% 10% Schizophrenia * * Lower than expected 0% Mood disorders * 8 Similar to expected % with % referrals for talking % of people who depression/anxiety therapies taking >28 complete treatment Mental health conditions Much lower than 37 62 entering talking days and are 'moving to resulting from alcohol misuse expected therapies recovery'
Source: CQC (2015), Right here, right now review data using HES and MHMDS, North Lincolnshire England *values <5 have been suppressed The Improving Access to Psychological Therapies (IAPT) Source: CQC (2015), Right here, right now review data using HSCIC Improving Access to Psychological Therapies (IAPT) programme supports the frontline NHS implementation of the National Institute for Health and Clinical Excellence (NICE) guidelines for people suffering from depression and anxiety A higher proportion of patients being admitted to an acute disorders. The overall ratio of the number of people entering hospital via A&E for a mental health condition may indicate that talking therapies to the estimated number of people with identification, treatment and monitoring of mental health depression and/or anxiety disorders is much higher than conditions need to be improved, that services may not be average in North Lincolnshire. The proportion of people who effective or that services are not available/accessible. The complete treatment and are 'moving to recovery’ is also much proportion of patients admitted to an acute hospital via A&E for higher than average in North Lincolnshire. While the number of a mental health condition in North Lincolnshire is statistically referrals for talking therapies that have waited more than 28 similar to the overall England proportion. days from referral to treatment is lower in North Lincolnshire, it is statistically similar to the England average (figure 22).
38 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
Further, a high proportion of patients admitted to an acute Figure 23: Admissions to A&E for mental health conditions, hospital via A&E for a mental health condition who had North Lincolnshire and England, 2012/13 attended A&E multiple times in the preceding five years can
100% also be an indication that identification, treatment and monitoring of mental health conditions need to be improved, 80% that services may not be effective or that services are not 66.0% available/accessible. The proportion of North Lincolnshire 60% 54.8% patients admitted for a mental health condition who had attended A&E multiple times in the preceding five years is also 40% statistically similar to the overall England proportion. Attending A&E multiple times prior to admission when there is 20% 6.0% 4.8%4.0% 3.5%2.1% 3.9% previous contact with a specialist mental health service could Percentage ofpatients/admissions 0% indicate that services are not effective and responsive to % Patients % Patients % Patients with % Patients peoples’ needs. The proportion of North Lincolnshire patients admitted attended a specialist MH admitted 11pm with a specialist mental health contact attending A&E multiple multiple times contact or acute to 5am times is again statistically similar to the England proportion admission (figure 23). England North Lincolnshire
The proportion of patients admitted between 11pm and 5am is Source: CQC (2015), Right here, right now review data , HES and MHMDS linked statistically lower than expected in North Lincolnshire. This may data indicate good out-of-hours support.
2. WHAT IS THE QUALITY OF CARE FOR POPULATIONS BEYOND WHAT WE KNOW ABOUT PROVIDERS? 39
Unmet needs: older people Indicators of unmet need Time North England Compared period Lincolnshire to England Table 26 presents information which may indicate that there is little unmet need for older people in North Lincolnshire. Of the Number of emergency 2013/14 4.6% 4.9% Similar admissions, 75+ with a 11 indicators of emergency attendances, admissions and mental health condition readmissions, North Lincolnshire is either similar to or better Rate of emergency 2013/14 15.9% 14.4% Similar than the England average. readmissions, 75+ with a mental health condition Table 26: Indicators of unmet need for older people, North Number of A&E attendances, 2013/14 3.2% 5.4% Much better Lincolnshire and England 2013/14 75+ for falls with a mental than average Indicators of unmet need Time North England Compared health condition period Lincolnshire to England Number of emergency 2013/14 3.0% 4.3% Much better admissions, 75+ for falls than average Number of A&E attendances, 2013/14 52.5% 46.9% Similar 75+ Rate of emergency 2013/14 14.9% 13.1% Similar readmissions, 75+ for falls Number of emergency 2013/14 20.3% 19.5% Similar admissions, 75+ Source: CQC‘s forthcoming publication on integrated care for older people using Rate of emergency 2013/14 9.6% 9.5% Similar HES and MHMDS readmissions, 75+
Avoidable emergency 2013/14 1.6% 1.7% Similar admissions for urinary tract infections (UTIs), 75+ Avoidable emergency 2013/14 0.6% 0.6% Similar admissions for UTIs, 75+ with a mental health condition
Number of A&E 2013/14 12.2% 10.6% Similar attendances, 75+ with a mental health condition
40 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
3. System indicators
This section will address how well the providers in the system are functioning and how well they work together to promote an 3.1 QUALITY AND PARTNERSHIP WORKING overall positive experience of care. The nine quality and productivity indicators in the QOF are aimed at promoting more effective use of NHS resources through improvements in the quality of primary care in terms of peer review of outpatient referral, A&E attendances and emergency admission data. North Lincolnshire scored the maximum number of points for all the nine indicators (table 27).
3. SYSTEM INDICATORS 41
QOF indicator: Quality and North North NHS Table 27: Quality and productivity indicators, North productivity (QP) domain Lincolnshire Lincolnshire England Lincolnshire and England, 2013/14 score (%)
QOF indicator: Quality and North North NHS same clinical commissioning group to productivity (QP) domain Lincolnshire Lincolnshire England compare its data on emergency score (%) admissions with that of the other contractors. The contractor agrees with QP001: The contractor reviews data on 105 100% 98.4% the group areas for commissioning or secondary care outpatient referrals, for service design improvements patients on the contractor's registered list, provided by the NHS CB QP006: The contractor engages with 588 100% 96.7% the development of and follows 3 care QP002: The contractor participates in 105 100% 97.9% pathways, agreed with the NHS CB an external peer review with other (unless in individual cases they justify contractors who are members of the clinical reasons for not doing this), in same clinical commissioning group to the management and treatment of compare its secondary care outpatient patients in aiming to avoid emergency referral data with that of the other admissions contractors. The contractor agrees with the group areas for commissioning or QP007: The contractor reviews data on 147 100% 98.1% service design improvements accident and emergency attendances, for patients on the contractor's QP003: The contractor engages with 231 100% 96.9% registered list, provided by the NHS CB. the development of and follows 3 care The review will include consideration of pathways, agreed with the NHS CB, for whether access to clinicians in the improving the management of patients contractor's premises is appropriate, in in the primary care setting (unless in light of the patterns on accident and individual cases they justify clinical emergency attendance reasons for not doing this) to avoid inappropriate outpatient referrals QP008: The contractor participates in 189 100% 97.8% an external peer review with other QP004: The contractor reviews data on 105 100% 98.2% contractors who are members of the emergency admissions, for patients on same clinical commissioning group to the contractor's registered list, provided compare its data on accident and by the NHS CB emergency attendances with that of the QP005: The contractor participates in 315 100% 97.9% other contractors. The contractor an external peer review with other agrees an improvement plan with the contractors who are members of the group. The review should include, if
42 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
QOF indicator: Quality and North North NHS High-quality care at the end of life in general practice can be productivity (QP) domain Lincolnshire Lincolnshire England achieved by identifying and assessing needs and proactively score (%) planning care. This can be achieved by using a register to appropriate, proposals for improvement identify patients and having regular multidisciplinary meetings to access arrangements in the contractor's premises in order to reduce for planning suitable care. North Lincolnshire performed worse avoidable accident and emergency than NHS England at having regular multidisciplinary meetings attendances and may also include (table 28). proposals for commissioning or service design improvements Table 28: Clinical quality indicators, palliative care, North QP009: The contractor implements the 315 100% 97.4% improvement plan that aims to reduce Lincolnshire and England, 2013/14 avoidable accident and emergency QOF indicator: Clinical domain North North NHS attendances (palliative care) Lincolnshire Lincolnshire England Copyright © 2015. Re-used with the permission of the Health and Social Care achievement achievement Information Centre. All rights reserved score (%) PC001: The contractor establishes 63 100% 100% and maintains a register of all patients in need of palliative care/support irrespective of age
PC002: The contractor has regular 51 81% 95.6% (at least 3 monthly) multi-disciplinary case review meetings where all patients on the palliative care register are discussed Copyright © 2015, Re-used with the permission of the Health and Social Care Information Centre. All rights reserved
3. SYSTEM INDICATORS 43
3.2 INDICATORS OF PARTNERSHIP WORKING Another indicator of effective partnership working is emergency readmissions within 30 days of discharge from hospital. A high Leadership can have an impact on the quality of care across number of readmissions can indicate that services are not the system through effective partnership and joint working. One working together to help people recover from illnesses or measure of effectiveness within the NHS and health and social injuries. The percentage14 of emergency admissions occurring care services is timely and appropriate transfers of care from within 30 days of discharge is slightly lower in North hospital. Delays in transfers of care may indicate that elements Lincolnshire (11.2%) compared to England (11.8%). The of the system are not cohesive (table 29). England range is 7.9% to 14.5%.
Table 29: Indicators of partnership working, North Lincolnshire and England
Indicators of partnership Time North England Compared working period Lincolnshire to England Rate per 100,000 of total 2013/14 3.7 9.6 Significantly delayed transfers of care Better aged 18+ Rate per 100,000 of delayed 2013/14 1.5 3.1 Similar transfers of care attributable to adult social care aged 18+
Source: PHE adult social care Fingertips tool
14 2011/12 data from the HSCIC Indicator Portal
44 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
3.3 POTENTIAL SAVINGS EMERGENCY Figure 24: Directly standardised rate of emergency ADMISSIONS AND READMISSIONS admissions by CCG, quarter 4, 2014/15 (AMBULATORY CARE SENSITIVE CONDITIONS) 1,800
NHS Better Care, Better Value publishes data showing the 1,600 potential efficiency savings that could be made by reducing the 1,400 number of emergency admissions for 19 conditions where effective community care could prevent hospitalisation 1,200 (ambulatory care sensitive conditions). 1,000 Figure 24 shows the rate of emergency admissions for these 800 N. Lincs conditions per 100,000 population in each CCG, as well as the 600 England 485 434 national figure. A directly standardised rate for each of these 400 conditions is calculated for each area based on the age, sex
Emergency admissions per pop. 100,000 admissions Emergency 200 and social deprivation of the population. Figure 25 shows the 0 number of admissions which could be avoided in each CCG if the rate of admissions was the same as that of the CCG at the Source: NHS Better Care, Better Value indicators top 25%. The value is shown as a percentage of all relevant admissions. A financial value is calculated for each admission based on the tariff value for each type of diagnosis. It is estimated that around £309 million could be saved nationally per quarter if admissions were reduced. The potential savings for North Lincolnshire are £875,363. This is based on a 56% reduction meaning that the 850 emergency attendances could be reduced by 476 attendances in the quarter (table 30).
3. SYSTEM INDICATORS 45
Figure 25: Potential reduction in emergency admissions by Figure 26: Emergency readmissions within 14 days by CCG, quarter 4, 2014/15 acute trust, quarter 4, 2014/15
100% 14%
90% 12% 80% N. Lincs 70% 10% 56% Englan60% 8% 50% N. Lincs & 40% England 5.5% 6% Goole 30% 4.2% 4% 20%
Potential reduction % a attendances as of Potential reduction 10% 2% Emergency readmissions admissions % as of readmissions Emergency 0% 0%
Source: NHS Better Care, Better Value indicators Source: NHS Better Care, Better Value Indicators Emergency readmissions within 14 days
This indicator measures the number of patients who are Table 30: Potential efficiency savings by CCG, quarter 4, readmitted to hospital, following their discharge, within 14 days. 2014/15 Figure 26 shows this figure for each acute trust in England, expressed as the number of emergency admissions to any CCG Financial Potential Attendances Patients hospital within 14 days of previous discharge as a percentage opportunity reduction of the total number of admissions. NHS North £875,363 476 850 760 Lincolnshire CCG Tables 30 and 31 show the potential reduction in emergency National £309,579,394 153,735 252,650 227,530 readmissions, along with the associated financial savings. Source: NHS Better Care, Better Value indicators
46 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
Table 31: Potential efficiency savings by trust, quarter 4, Figure 27: Rate of patient safety incidents per 1,000 bed 2014/15 days, April to September 2014 – all acute trusts
Financial Potential reduction Attendances Patients 100 Trust opportunity 90 Northern £857,972 386 1,010 17,500 Lincolnshire and 80 Goole NHS 70 Foundation Trust 60 National £194,854,818 94,381 18,0390 23,15820 N. Lincs & Goole Source: NHS Better Care, Better Value indicators 50 42 40
3.4 NATIONAL REPORTING AND LEARNING per bed 1,000 Rate days 30 SYSTEM (SAFETY INCIDENT REPORTING) 20 NHS staff report patient safety incidents via their local risk 10 management systems, or e-forms, to the National Reporting 0 and Learning System (NRLS) (figure 27). A low rate of incidents isn’t always a good indication as it may be reflective of poor incident reporting. The number of incidents that NLaG has been reporting has increased over time (figure 28). Patient accidents Source: NRLS account for a slightly higher proportion of incidents than the England average. The “other categories” is much higher than the England proportion which may suggest a coding issue (figure 29).
3. SYSTEM INDICATORS 47
Figure 28: Number of patient safety incidents, Northern Figure 29: Incident type, April to September 2014 – Lincolnshire and Goole NHS Foundation Trust Northern Lincolnshire and Goole NHS Foundation Trust
Medical device / equipment
6,000 Consent, communication, confidentiality
5,500 Infrastructure (including staffing, facilities, environment) 5,124 Clinical assessment (including diagnosis, 5,000 scans, tests, assessments) 4,720 4,866 4,487 Documentation (including records, 4,574 identification) 4,500 4,217 Access, admission, transfer, discharge (including missing patient) 4,000
NumberofIncidents Medication
3,500 Implementation of care and ongoing monitoring / review 3,000 Treatment, procedure Oct 11 - Mar Apr 12 - Sep Oct 12 - Mar Apr 13 - Sep Oct 13 - Mar Apr 14 - Sep 12 12 13 13 14 14 Patient accident
Source: NRLS All others categories
0% 10% 20% 30% % of all incidents
Northern Lincolnshire & Goole England
Source: NRLS
48 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
3.5 BED OCCUPANCY AT NORTHERN 3.6 WORKFORCE STATISTICS LINCOLNSHIRE AND GOOLE NHS FOUNDATION HSCIC workforce statistics (Total NHS excluding bank staff, TRUST locums and trainees) suggest that the workforce at NLaG is The average daily bed occupancy at NLaG was lower than the relatively stable. NLaG has a lower leaver’s rate and a higher total England bed occupancy between July 2014 and June stability rate than NHS England (table 32). 2015 (figure 30).
Figure 30: Average daily bed occupancy for Northern Lincolnshire and Goole NHS Foundation Trust and England
100%
95%
90% 87.6% 88.5% 86.3% 86.9% 85% 83.9% 83.3%
%Occupied 79.9% 80% 80.6%
75%
70% July to September October to January to March April to June 2015 2014 December 2014 2015
Northern Lincolnshire & Goole NHS Foundation Trust England
Source: NHS England
3. SYSTEM INDICATORS 49
Table 32: Workforce statistics
Between April 14 and April 15 Leavers Leaving rate Joiners Joining rate Stability index NHS England 101,314 8.8% 116,029 10.1% 91.1% NHS North Lincolnshire 2 7.7% 3 11.5% 92.0% CCG Northern Lincolnshire and Goole NHS Foundation 443 7.7% 541 9.4% 92.2% Trust
Source: HSCIC, provisional monthly NHS workforce data
50 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
3.7 NHS STAFF SURVEY RESULTS Figure 32: Responses to the 2014 NHS staff survey question, "Communication between senior Senior management leadership management and staff is effective", Northern Results from the 2014 NHS staff survey have found that for Lincolnshire and Goole NHS Foundation Trust and All questions regarding the leadership of the senior management, NHS Organisations NLaG performs in line with the ‘all trusts’ average in England 100% 5% 9% (figures 31 and 32). 90% 30% 80% 31% Figure 31: Responses to the 2014 NHS staff survey question, "I 70% know who the senior managers are here", Northern 60% Lincolnshire and Goole NHS Foundation Trust and all NHS 50% 30% 29% organisations 40%
100% %of respondents 30% 90% 23% 22% 24% 31% 20% 80% 10% 12% 70% 10% 0% 60% Northern Lincolnshire & Goole All organisations 50% 59% 53% NHS Foundation Trust 40%
30% Strongly Disagree Disagree %of respondents 20% 6% Neither agree nor disagree Agree 10% 8% 9% 7% Strongly agree 0% 3% 2% Northern Lincolnshire & Goole All organisations Source: NHS staff survey 2014 NHS Foundation Trust
Strongly Disagree Disagree Neither agree nor disagree Agree Strongly agree
Source: NHS staff survey 2014
3. SYSTEM INDICATORS 51
Staff training Figure 34: NHS staff survey 2014 responses to, "My The NHS staff survey collects information on staff’s perceptions of training, learning and development has helped me to their training. When asked, “To what extent do you agree or stay up to date with professional requirements” disagree with the following statements? ‘My training, learning and 100 development has helped me to…’ “do my job more effectively,” 90 “stay up-to-date with professional requirements,” “deliver a better 80 70 patient /service user experience,” NLaG had a higher proportion of 60 53%53% respondents who “strongly agree” than the all acute trusts average 50 (figures 33, 34 and 35). 40 30 22%25%
Percentage ofresponses 15% Figure 33: NHS staff survey 2014 responses to, “My training, 20 13% 6% 7% 4% learning and development has helped me to do my job more 10 2% 0 effectively" Strongly Disagree Neither Agree Strongly disagree agree nor agree
100 disagree 90 80 All Acute Trusts 70 Northern Lincolnshire and Goole Hospitals NHS Foundation Trust 60 50%49% 50 40 30 21% 24% Percentage of responses 18% 18% 20 5% 10 6% 6% 5% 0 Strongly Disagree Neither agree Agree Strongly disagree nor disagree agree All Acute Trusts
Northern Lincolnshire and Goole Hospitals NHS Foundation Trust
52 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
Figure 35: NHS staff survey results 2014, “My training, learning and development has helped me to deliver a better 3.8 COMMISSIONING patient/service user experience” Tables 33 and 34 provide information on funding in North 100 Lincolnshire with an overall comparator to England. Figures 90 36 and 37 show the variation in weekly expenditure in 80 supporting older people and supporting people aged under 70 65 with mental health needs across England. Table 35 60 provides expenditure unit costs for North Lincolnshire and 47% 50 47% comparable CCGs from the commissioning for value packs. 40
30 24% 21% 19% 18% Table 33: Adult social care funding, North Lincolnshire Percentage ofresponses 20 and England 10 5% 7% 6% 6% Time North England Compared 0 Adult social care funding period Lincolnshire to England Strongly Disagree Neither agree Agree Strongly agree disagree nor disagree Adult social care gross 2013/14 34.7 39.9 Not expenditure £m per compared All Acute Trusts 100,000 population aged Northern Lincolnshire and Goole Hospitals NHS Foundation Trust 18+, excluding ‘supporting people’ Source: NHS England Adult social care 2013/14 0.5 0.9 Not ‘supporting people’ gross compared expenditure £m per 100,000 population aged 18+ Total adult social care 2013/14 35.2 40.7 Not gross expenditure £m per compared 100,000 population aged 18+
Source: PHE adult social care Fingertips tool
3. SYSTEM INDICATORS 53
Table 34: Funding on mental health services, North Lincolnshire and England
Time North Compared Mental health funding England period Lincolnshire to England Specialist mental health 2012/13 £26,708 £26,756 Not services spend: rate (£000s) compared per 100,000 aged 18+ % spend on specialist mental 2011/12 11.5% 12.1% Not health services: % of all compared secondary care service spend categorised as mental health
Source: PHE Community Mental Health Profile Fingertips Tool
54 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
Figure 36: Average gross weekly expenditure per person on Figure 37: Average gross weekly expenditure on home supporting older people in residential care (including full cost care per adult aged under 65 with mental health needs paying and preserved rights residents) by CCG receiving home care at 31 March by CCG
Source: HSCIC expenditure and unit costs, England – 2013/14 Source: HSCIC expenditure and unit costs, England – 2013/14
3. SYSTEM INDICATORS 55
Table 35: Expenditure and unit costs, by CCG, North Lincolnshire and similar CCGs as defined by the Commissioning for Value Pack – 2013/14
NHS NHS Chorley NHS NHS North NHS East NHS NHS South NHS NHS South NHS NHS North Newark & and South Warwickshire Lincolnshire Staffordshire Bassetlaw Kent Coast Hardwick Cheshire Darlington Staffordshire Sherwood Ribble North Average gross weekly expenditure per person on supporting 416.7 565.8 420.4 565.8 524.8 474.4 452.2 478.3 471.0 467.9 420.4 older people in nursing care Average gross weekly expenditure per person on supporting older people in residential care (including full cost paying and 447.4 505.3 486.7 505.3 524.2 445.8 545.9 502.1 447.9 550.9 486.7 preserved rights residents) Average gross weekly expenditure per person on supporting older people in own provision residential care (including full 1731.5 739.2 941.0 739.2 1140.8 442.3 747.9 1211.7 941.0 cost paying and preserved rights residents) Average gross weekly expenditure on supporting adults with a Learning disability in residential and nursing care (including full 910.7 1488.9 1329.1 1488.9 1291.8 1284.2 1559.4 1749.3 1116.1 1449.6 1329.1 cost paying and preserved rights residents) Average gross weekly expenditure on supporting adults with mental illness in residential and nursing care (including full cost 506.5 859.7 912.7 859.7 694.8 853.9 988.7 609.7 368.8 553.3 912.7 paying and preserved rights residents) Average gross weekly expenditure per person on supporting adults with a Physical disability in residential and nursing care 497.8 781.2 841.5 781.2 974.8 736.9 841.3 612.0 503.2 899.7 841.5 (including full cost paying and preserved rights residents) Average gross hourly cost for home help/care 17.5 21.2 17.8 21.2 17.9 14.5 18.4 17.1 12.1 13.5 17.8 Average gross hourly cost for home help/care provided by LA 93.0 83.4 26.9 83.4 42.4 24.8 28.9 57.9 16.0 60.5 26.9 Average gross hourly cost for home help/care provided by 11.5 16.9 17.0 16.9 15.4 14.4 15.6 14.8 11.4 12.1 17.0 others Average gross weekly expenditure on home care per adult and 260.8 128.9 198.6 128.9 178.7 213.7 194.6 361.5 240.8 290.2 198.6 older person receiving home care at 31 March Average gross weekly expenditure on home care per adult aged under 65 with a Learning disability receiving home care at 31 303.4 149.3 307.2 149.3 131.5 425.6 392.3 679.4 603.2 628.6 307.2 March Average gross weekly expenditure on home care per adult aged under 65 with mental health needs receiving home care at 31 74.0 90.7 116.7 90.7 291.0 179.9 161.4 526.6 181.6 178.1 116.7 March Average gross weekly expenditure on home care per adult aged under 65 with a Physical disability receiving home care at 31 131.3 151.5 189.6 151.5 170.1 253.7 255.2 294.6 256.1 170.4 189.6 March Average gross weekly expenditure on direct payments per 237.6 236.9 213.4 236.9 237.2 269.5 217.1 282.3 236.5 225.8 213.4 adult and older person receiving direct payments at 31 March Average gross weekly expenditure on direct payments per adult aged under 65 with a Learning disability receiving direct 259.4 286.4 310.5 286.4 315.6 308.4 258.9 342.5 245.7 271.4 310.5 payments at 31 March Average gross weekly expenditure on direct payments per adult aged under 65 with mental health needs receiving direct 107.1 91.2 112.4 91.2 116.6 119.4 155.2 92.2 137.8 78.3 112.4 payments at 31 March Average gross weekly expenditure on direct payments per adult aged under 65 with a Physical disability receiving direct 183.1 306.1 258.2 306.1 200.7 328.8 237.0 224.5 247.9 281.9 258.2 payments at 31 March Source: HSCIC, Personal Social Services: Expenditure and Unit Costs, England 2013/14, Final Release: Unit Costs by CASSR
56 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
4. Appendices
4. APPENDICES 57
4.1 DESCRIPTION OF THE DATA INDICATORS Indicator Source Original Benchmarking organisation source data method Indicator Source Original Benchmarking Under 75 mortality rate per PHE’s Public ONS Confidence organisation source data method 100,000 from Health intervals % of total population aged PHE’s adult 2011 census Statistical process cardiovascular diseases Outcomes overlapping 65-74/75-84, 85+ social care control for considered preventable Fingertips reference value Fingertips proportions (persons) tool with a significance tool (binomial) with a level of 95%. significance level Under 75 mortality rate per PHE’s Public ONS Confidence of 95%. 100,000 from cancer Health intervals Prevalence PHE’s adult HSCIC QOF Statistical process considered preventable Outcomes overlapping (% of registered patients) social care database control for (persons) Fingertips reference value of dementia Fingertips proportions tool with a significance mental health diagnosis tool (binomial) with a level of 95%. significance level learning disabilities aged Under 75 mortality rate per PHE’s Public ONS Confidence of 95%. 18+ 100,000 from liver disease Health intervals Alcohol use – rate per PHE’s Local HSCIC HES Confidence considered preventable Outcomes overlapping 100,000 hospital stays for Alcohol data and ONS intervals (persons) Fingertips reference value alcohol-related harm Profiles mid-year overlapping tool with a significance population reference value level of 95%. estimates with a significance Under 75 mortality rate per PHE’s Public ONS Confidence level of 95%. 100,000 from respiratory Health intervals Prevalence of opiate or PHE’s Public Alcohol, Drugs Confidence disease considered Outcomes overlapping crack use, rate per 1,000 Health & Tobacco intervals preventable (persons) Fingertips reference value population aged 15-64 Outcomes Division and overlapping tool with a significance Fingertips ONS reference value level of 95%. tool with a significance Mortality per 100,000 from PHE’s Public ONS Confidence level of 95%. communicable diseases Health intervals Mortality rate per 100,000 PHE’s Public ONS Confidence (persons) Outcomes overlapping from causes considered Health intervals Fingertips reference value preventable (persons) Outcomes overlapping tool with a significance Fingertips reference value level of 95%. tool with a significance level of 95%.
58 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
Indicator Source Original Benchmarking Indicator Source Original Benchmarking organisation source data method organisation source data method Excess Winter Deaths PHE’s Public ONS Confidence Rate of recovery from IAPT PHE’s HSCIC Confidence Index (single year, all ages) Health intervals treatment (% recovering Community Improving intervals Outcomes overlapping from treatment) Mental Health Access to overlapping Fingertips reference value Profiles Psychological reference value tool with a significance Therapies with a significance level of 95%. dataset level of 95%. Excess Winter Deaths PHE’s Public ONS Confidence Excess Winter Deaths PHE’s Public ONS Confidence Index (3 years, all ages) Health intervals Index (1 year, ages 85+) Health intervals Outcomes overlapping (persons) Outcomes overlapping Fingertips reference value Fingertips reference value tool with a significance tool with a significance level of 95%. level of 95%. Infant mortality – rate of PHE’s Public ONS Confidence Excess Winter Deaths PHE’s Public ONS Confidence deaths in infants aged Health intervals Index (3 years, ages 85+) Health intervals under 1 year per 1,000 live Outcomes overlapping (persons) Outcomes overlapping births Fingertips reference value Fingertips reference value tool with a significance tool with a significance level of 95%. level of 95%. Excess under 75 mortality PHE’s Public ONS Not compared Health-related quality of life PHE’s Public GP Patient Confidence rate in adults with serious Health for older people (survey Health Survey intervals mental illness Outcomes score) Outcomes overlapping Fingertips Fingertips reference value tool tool with a significance level of 95%. Suicide rate per 100,000 PHE’s Public ONS Confidence (persons) Health intervals Rate per 100,000 hip PHE’s Public HSCIC HES Confidence Outcomes overlapping fractures in people aged Health data and ONS intervals Fingertips reference value 65+ (persons) Outcomes population overlapping tool with a significance 65-79 (persons) Fingertips estimates reference value level of 95%. 80+ (persons) tool with a significance level of 95%.
4. APPENDICES 59
Indicator Source Original Benchmarking Indicator Source Original Benchmarking organisation source data method organisation source data method Successful completion of PHE’s Public National Drug Confidence Proportion of older people PHE’s Adult HSCIC ASC- Statistical Process drug treatment, opiate Health Treatment intervals (65+) who were still at Social Care CAR Control for users (% of adults in Outcomes Monitoring overlapping home 91 days after Fingertips proportions treatment) Fingertips System reference value discharge from hospital into tool (binomial) with a tool with a significance reablement/rehabilitation significance level level of 95%. services of 95%. Successful completion of PHE’s Public National Drug Confidence Proportion of older people PHE’s Adult HSCIC ASC- Statistical Process drug treatment non-opiate Health Treatment intervals (65+) who were offered Social Care CAR Control for users (% of adults in Outcomes Monitoring overlapping reablement services Fingertips proportions treatment) Fingertips System reference value following discharge from tool (binomial) with a tool with a significance hospital significance level level of 95%. of 95%. Successful completion of PHE’s Local National Drug Confidence Proportion of adults with a PHE’s Adult ASC-CAR Statistical Process alcohol treatment (% of Alcohol Treatment intervals learning disability in Social Care proforma Control for adults in treatment) Profiles Monitoring overlapping employment Fingertips proportions System reference value tool (binomial) with a with a significance significance level level of 95%. of 95%. % of people entering PHE’s Public National Drug Confidence Proportion of adults in PHE’s adult HSCIC Statistical Process prison with substance Health Treatment intervals contact with secondary social care MHMDS Control for dependence issues who Outcomes Monitoring overlapping mental health services in Fingertips proportions are previously not known Fingertips System reference value employment tool (binomial) with a to community treatment tool with a significance significance level level of 95%. of 95%. Permanent admissions to PHE’s Adult HSCIC Statistical Process Proportion of adults with a PHE’s adult ASC-CAR Statistical Process residential and nursing care Social Care NASCIS - Control for Directly learning disability who are social care proforma Control for homes, per 100,000 Fingertips ASC-CAR and Standardised in settled accommodation Fingertips proportions population aged 65+ tool ONS Rates and crude tool (binomial) with a population rates (poisson) significance level estimates with a significance of 95%. level of 95%.
60 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
Indicator Source Original Benchmarking Indicator Source Original Benchmarking organisation source data method organisation source data method Proportion of adults in PHE’s adult HSCIC Statistical Process Permanent admissions to PHE’s adult HSCIC Statistical Process contact with secondary social care MHMDS Control for residential and nursing social care NASCIS - Control for Directly mental health services who Fingertips proportions care homes, per 100,000 Fingertips ASC-CAR and Standardised are in settled tool (binomial) with a population aged 18-64 tool ONS Rates and crude accommodation significance level population rates (poisson) of 95%. estimates with a significance level of 95%. Proportion of people who PHE’s adult Adult Social Statistical Process use services and their social care Care Survey Control for Total delayed transfers of PHE’s adult Department of Statistical Process carers, who reported that Fingertips Carers Survey proportions care per 100,00 aged 18+ social care Health Delayed Control for Directly they had as much social tool (binomial) with a Fingertips Transfer of Standardised contact as they would like significance level tool Care and ONS Rates and crude of 95%. population rates (poisson) estimates with a significance Proportion of people who PHE’s adult HSCIC ASCOF Statistical Process use services and carers social care (2013/14 Adult Control for level of 95%. who find it easy to find Fingertips Social Care proportions Delayed transfers of care PHE’s adult Department of Statistical Process information about services tool Survey and (binomial) with a attributable to adult social social care Health Delayed Control for Directly 2012/13 significance level care per 100,000 Fingertips Transfer of Standardised Carers of 95%. ged 18+ tool Care and ONS Rates and crude Survey) population rates (poisson) estimates with a significance Proportion of people who PHE’s adult HSCIC ASCOF Statistical Process use services who find it social care (2013/14 Adult Control for level of 95%. easy to find information Fingertips Social Care proportions Permanent admissions into PHE’s adult HSCIC Statistical Process about services tool Survey) (binomial) with a residential care per social care NASCIS - Control for Directly significance level 100,000 population aged Fingertips ASC-CAR and Standardised of 95%. 18+ tool ONS Rates and crude rates (poisson) Proportion of carers who PHE’s adult HSCIC ASCOF Statistical Process population with a significance report that they have been social care (2012/13 Control for estimates included or consulted in Fingertips Carers Survey) proportions level of 95%. discussion about the tool (binomial) with a person they care for significance level of 95%.
4. APPENDICES 61
Indicator Source Original Benchmarking Indicator Source Original Benchmarking organisation source data method organisation source data method Permanent admissions into PHE’s adult HSCIC Statistical Process Rate per 100,000 hospital PHE’s HSCIC HES Confidence nursing care per 100,000 social care NASCIS - Control for Directly admissions for unipolar common data and ONS intervals population aged 18+ Fingertips ASC-CAR and Standardised depressive disorders per mental health population overlapping tool ONS Rates and crude 100,000 aged 15+ disorders estimates reference value population rates (poisson) profile with a significance estimates with a significance level of 95%. level of 95%. Rate per 100,000 PHE’s HSCIC HES Confidence Total number of delayed PHE’s adult NHS England Statistical Process emergency admissions for common data and ONS intervals transfers of care per month social care and ONS Control for Directly neuroses mental health population overlapping per 100,000 aged 18+ Fingertips Standardised disorders estimates reference value tool Rates and crude profile with a significance rates (poisson) level of 95%. with a significance Rate per 100,000 hospital PHE’s HSCIC HES Confidence level of 95%. admissions for mental Children and and ONS intervals Access to GP services, PHE’s GP GP Survey Not compared health conditions, 0-17 Young population overlapping responses from the GP Profiles year olds People estimates reference value survey profiles with a significance level of 95%. Rate per 100,000 hospital PHE’s HSCIC HES Confidence admissions for alcohol Alcohol data and ONS intervals Rate per 100,000 hospital PHE’s HSCIC HES Confidence specific conditions Profiles population overlapping admissions as a result of Children and and ONS intervals estimates reference value self-harm, 10-24 year olds Young population overlapping with a significance People estimates reference value level of 95%. profiles with a significance level of 95%. Rate per 100,000 hospital PHE’s HSCIC HES Confidence admissions for alcohol Alcohol data and ONS intervals % of emergency CQC Mental HSCIC HES Z-scores to specific conditions under 18 Profiles population overlapping admissions via A&E for a Health Crisis and MHMDS indicate the estimates reference value MH condition (for patients Review standard with a significance with a history of previous deviations from the level of 95%. MH contact) that returned mean with 95% to A&E within 30 days (for significance, any reason)
62 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
Indicator Source Original Benchmarking Indicator Source Original Benchmarking organisation source data method organisation source data method % of emergency CQC Mental HSCIC HES Z-scores to Mood disorders CQC Mental HSCIC HES Z-scores to admissions via A&E for a Health Crisis and MHMDS indicate the Health Crisis and MHMDS indicate the MH condition (for patients Review standard Review standard with NO history of previous deviations from the deviations from the MH contact) that returned mean with 95% mean with 95% to A&E within 30 days (for significance, significance any reason) Mental health conditions CQC Mental HSCIC HES Z-scores to Self-harm CQC Mental HSCIC HES Z-scores to resulting from alcohol Health Crisis and MHMDS indicate the Health Crisis and MHMDS indicate the misuse Review standard Review standard deviations from the deviations from the mean with 95% mean with 95% significance significance Number of A&E CQC HSCIC HES Z-scores to Alzheimer's disease CQC Mental HSCIC HES Z-scores to Attendances, 75+ Integrated and MHMDS indicate the Health Crisis and MHMDS indicate the Care for data standard Review standard Older People deviations from the deviations from the Review mean with 95% mean with 95% significance significance Number of emergency CQC HSCIC HES Zscores to indicate Other organic forms of CQC Mental HSCIC HES Z-scores to admissions, 75+ Integrated and MHMDS the standard dementia (not Alzheimer's) Health Crisis and MHMDS indicate the Care for data deviations from the Review standard Older People mean with 95% deviations from the Review significance mean with 95% (forthcoming) significance Rate of emergency CQC HSCIC HES Zscores to indicate Schizophrenia CQC Mental HSCIC HES Z-scores to readmissions, 75+ Integrated and MHMDS the standard Health Crisis and MHMDS indicate the Care for data deviations from the Review standard Older People mean with 95% deviations from the Review significance mean with 95% (forthcoming) significance
4. APPENDICES 63
Indicator Source Original Benchmarking Indicator Source Original Benchmarking organisation source data method organisation source data method Avoidable emergency CQC HSCIC HES Zscores to indicate Number of A&E CQC HSCIC HES Z-scores to admissions for UTIs, 75+ Integrated and MHMDS the standard Attendances, 75+ for falls Integrated and MHMDS indicate the Care for data deviations from the with a mental health Care for data standard Older People mean with 95% condition Older People deviations from the Review significance Review mean with 95% (forthcoming) significance Avoidable emergency CQC HSCIC HES Zscores to indicate Number of emergency CQC HSCIC HES Z-scores to admissions for UTIs, 75+ Integrated and MHMDS the standard admissions, 75+ for falls Integrated and MHMDS indicate the with a mental health Care for data deviations from the Care for data standard condition Older People mean with 95% Older People deviations from the Review significance Review mean with 95% (forthcoming) significance Number of A&E CQC HSCIC HES Z-scores to Rate of emergency re- CQC HSCIC HES Z-scores to Attendances, 75+ with a Integrated and MHMDS indicate the admissions, 75+ for falls Integrated and MHMDS indicate the mental health condition Care for data standard Care for data standard Older People deviations from the Older People deviations from the Review mean with 95% Review mean with 95% significance (forthcoming) significance Number of emergency CQC HSCIC HES Z-scores to Rate per 100,000 of total PHE’s adult NHS England Statistical Process admissions, 75+ with a Integrated and MHMDS indicate the delayed transfers of care social care and ONS Control for Directly mental health condition Care for data standard aged 18+ Fingertips Standardised Older People deviations from the tool Rates and crude Review mean with 95% rates (poisson) significance with a significance level of 95%. Rate of emergency re- CQC HSCIC HES Z-scores to admissions, 75+ with a Integrated and MHMDS indicate the Rate per 100,000 of PHE’s adult Department of Statistical Process mental health condition Care for data standard delayed transfers of care social care Health Delayed Control for Directly Older People deviations from the attributable to adult social Fingertips Transfer of Standardised Review mean with 95% care aged 18+ tool Care and ONS Rates and crude significance population rates (poisson) estimates with a significance level of 95%.
64 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
4.2 ADDITIONAL SOURCES OF DATA
National consultant-led referral to treatment times, October 2013 to March 2014
% within 18 weeks Trend Treatment Function Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Oct 13- March 14 General Surgery 90.7% 90.3% 90.7% 89.4% 88.5% 88.0% Urology 91.7% 91.8% 92.6% 91.4% 90.9% 90.0% Trauma & Orthopaedics 88.1% 87.9% 88.1% 86.8% 86.2% 85.4% ENT 88.0% 87.9% 88.8% 87.8% 87.7% 87.9% Ophthalmology 91.4% 91.1% 91.7% 90.5% 90.2% 89.2% Oral Surgery 89.8% 88.1% 89.0% 87.2% 86.6% 85.8% Neurosurgery 87.8% 86.7% 86.4% 85.4% 85.4% 84.3% Plastic Surgery 91.4% 90.8% 91.0% 89.2% 88.1% 88.7% Cardiothoracic Surgery 87.5% 86.9% 88.0% 88.3% 87.8% 88.5% General Medicine 98.7% 98.6% 98.3% 98.3% 98.6% 98.6% Gastroenterology 98.9% 98.7% 98.9% 98.6% 98.6% 98.6% Cardiology 94.3% 93.7% 93.8% 94.2% 93.1% 93.1% Dermatology 95.7% 95.7% 95.1% 93.6% 93.2% 93.8% Thoracic Medicine 98.5% 98.4% 97.1% 97.2% 98.2% 98.8% Neurology 99.1% 98.3% 98.9% 98.4% 97.7% 97.0% Rheumatology 98.4% 98.3% 99.0% 98.7% 98.5% 98.1% Geriatric Medicine 100.0% 98.9% 99.5% 98.9% 98.7% 98.8% Gynaecology 93.9% 93.8% 94.2% 93.6% 92.6% 92.2% Other 92.3% 91.7% 92.2% 90.7% 90.7% 90.7% Total 91.4% 91.0% 91.5% 90.4% 89.9% 89.4%
Source: NHS England
4. APPENDICES 65
Figures and tables
Figure 1: Attendances at Northern Lincolnshire and Goole NHS Foundation Trust, 2011/12 to 2013/14 10 Figure 2: Emergency inpatient attendances at Northern Lincolnshire and Goole NHS Foundation Trust by patient’s local authority of residence, 2013/14 11 Figure 3: Emergency inpatient attendances at Scunthorpe General Hospital by patient’s local authority of residence, 2013/14 12 Figure 4: Elective inpatient attendances at Northern Lincolnshire and Goole NHS Foundation Trust by patient’s local authority of residence, 2013/14 13 Figure 5: Elective inpatient attendances at Scunthorpe General Hospital by patient’s local authority of residence, 2013/14 14 Figure 6: GP practices with their overall rating, North Lincs 15 Figure 7: Location of GP practices in North Lincolnshire with the Index of Multiple Deprivation scores of each lower super output area 17 Figure 8: Location of GP practices in North Lincolnshire with the corresponding population density at lower super output area 18 Figure 9: Change in GP practice list sizes 2010/11 to 2013/14, North Lincolnshire and England 18 Figure 10: Care homes (with nursing) that have received a rating, North Lincolnshire 19 Figure 11: Care homes (without nursing) that have received a rating, North Lincolnshire 19 Figure 12: Location and type of adult social care providers in North Lincolnshire with the Index of Multiple Deprivation scores of each lower super output area 21 Figure 13: Location of adult social care providers in North Lincolnshire with the corresponding population density at lower super output area 21 Figure 14: Proportion of population by ethnicity, North Lincolnshire and England, 2011 23 Figure 15: Life expectancy in years for North Lincolnshire and England, 2011 to 2013 24 Figure 16: Range in years of life expectancy across the social gradient, from most to least deprived, North Lincolnshire and England 24 Figure 17: Potential years of life lost (PYLL) from causes considered amenable to health care in North Lincolnshire and England, 2013 25 Figure 18: Age-standardised mortality rates, North Lincolnshire, and England and Wales, 2001 to 2013 28 Figure 19: Rate per 100,000 registered patients who have an emergency admission/unplanned hospitalisation for a condition which would not usually require it, North Lincolnshire and England, 2013/14 29 Figure 20: Rate of home treatment episodes, North Lincolnshire and England 30
66 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
Figure 21: Percentage of emergency admissions to specialist mental health providers that are gate-kept by crisis resolution home treatment teams, North Lincolnshire and England, 2012/13 30 Figure 22: Access to psychological treatments, North Lincolnshire and England, 2012/13 38 Figure 23: Admissions to A&E for mental health conditions, North Lincolnshire and England, 2012/13 39 Figure 3240: Directly standardised rate of emergency admissions by CCG, quarter 4, 2014/15 45
Table 1: CQC ratings, Northern Lincolnshire and Goole NHS Foundation Trust 9 Table 2: CQC ratings by core service, Scunthorpe General Hospital 9 Table 3: Emergency inpatient attendances at Northern Lincolnshire and Goole NHS Foundation Trust by patient’s local authority of residence, 2013/14 11 Table 4: Emergency inpatient attendances at Scunthorpe General Hospital by patient’s local authority of residence, 2013/14 12 Table 5: Elective inpatient attendances at Northern Lincolnshire and Goole NHS Foundation Trust by patient’s local authority of residence, 2013/14 13 Table 6: Elective inpatient attendances at Scunthorpe General Hospital by patient’s local authority of residence, 2013/14 14 Table 7: Trusts with elective inpatient attendances made by residents of North Lincolnshire Local Authority, 2013/14 15 Table 8: Breakdown of GP practice ratings in North Lincolnshire and in England 16 Table 9: Breakdown of adult social care ratings in North Lincolnshire and in England 20 Table 10: Identified health needs in North Lincolnshire and in England 23 Table 11: Avoidable and excess deaths in North Lincolnshire and in England 25 Table 12: Outcomes for individuals in contact with mental health services, North Lincolnshire and England 26 Table 13: Outcomes for older people, North Lincolnshire and England 27 Table 14: Measures of health improvement, North Lincolnshire and England, 2013/14 29 Table 15: Delaying and reducing the need for care and support in older people, North Lincolnshire and England, 2013/14 31 Table 16: Adult social care user's quality of life, North Lincolnshire and England 32 Table 17: Positive experience of care felt by carers and the people they support in North Lincolnshire and England, 2012/13 and 2013/14 33 Table 18: Results from the GP Patient Survey, North Lincolnshire and England, 2013 to 2014 34 Table 19: Indicators of permanent admissions to care and delayed transfer of care, North Lincolnshire and England, 2013/14 35 Table 20: Access to GP services, responses from the GP Patient Survey 2013/14, North Lincolnshire and England 35
FIGURES AND TABLES 67
Table 21: Patients waiting more than three weeks for drug or alcohol treatment in North Lincolnshire and in England, 2013/14 36 Table 22: Consultant-led referral to treatment times for North Lincolnshire CCG, October 2013 to March 2014 36 Table 23: Indicators of unmet need, North Lincolnshire and England 37 Table 24: Indicators of unmet need – hospital admissions, North Lincolnshire and England 2012/13 37 Table 25: Observed number of emergency admissions to an acute hospital for mental health condition/behaviours, North Lincolnshire, 2012/13 38 Table 26: Indicators of unmet need for older people, North Lincolnshire and England 2013/14 40 Table 27: Quality and productivity indicators, North Lincolnshire and England, 2013/14 42 Table 28: Clinical quality indicators, palliative care, North Lincolnshire and England, 2013/14 43 Table 29: Indicators of partnership working, North Lincolnshire and England 44 Table 30: Potential efficiency savings by CCG, quarter 4, 2014/15 46 Table 31: Potential efficiency savings by trust, quarter 4, 2014/15 47 Table 32: Workforce statistics 50 Table 33: Adult social care funding, North Lincolnshire and England 53 Table 34: Funding on mental health services, North Lincolnshire and England 54 Table 35: Expenditure and unit costs, by CCG, North Lincolnshire and similar CCGs as defined by the Commissioning for Value Pack – 2013/14 56
68 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT
How to contact us Call us on 03000 616161 Email us at [email protected] Look at our website www.cqc.org.uk
Write to us at Care Quality Commission Citygate Gallowgate NE1 4PA
Follow us on Twitter @CareQualityComm Read more and download this report at www.cqc.org.uk/qualityinaplace CQC-309-022016
Pictures: North Lincolnshire Council
FIGURES AND TABLES 69
70 THE QUALITY OF CARE IN NORTH LINCOLNSHIRE – DATA REPORT