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NHS Performance Indicators : February 2002

Introduction

These indicators are an important part of the Government’s commitment to improve the quality of clinical and other performance information that patients receive. Patients and the public have a right to know how well different NHS organisations are performing. Different NHS organisations also need to know how well they are doing in comparison with others, so that successes can be shared and weaknesses can be identified and acted upon. This detailed publication shows the results of each health authority and hospital trust in England for a wide range of indicators. It accompanies the recent publication of NHS Performance Indicators, National Figures: February 2002, which provided a high level national summary of the information now being published for each health authority and hospital trust.

These indicators give a summary of what is going on across the NHS. They cover vital services such as treatment for heart disease, cancer and mental health. They also cover other issues that really matter to patients, such as how long they have to wait to be admitted to hospital, how clean their hospitals are and how easily they can get to see their GP. The indicators also tell us about the overall health of the population, how efficiently the health service is being managed and how well staffed it is.

This document details how performance has improved over the last year. The data show real improvements across most indicators. There has been a marked improvement in rates of cataract removal and joint replacements, death rates following surgery and death rates from circulatory diseases, but indicators for vacancy rates and cervical cancer screening show a small decline in performance. The overall picture is one of real progress but there remains considerable and unacceptable variation in performance.

In a truly national health service patients have a right to expect consistently high standards of treatment and care wherever they live. The Government is determined to tackle these inequalities in the provision and outcome of health care. Sometimes variations can be partly explained by particular local circumstances, such as the overall prosperity of the area, but in many cases they cannot. Health authorities and NHS trusts with deteriorating performance on these indicators will need to take action locally to improve their position and thus contribute to a narrowing of the health inequalities gap.

The indicators show some of the significant improvements being made and also some areas where health authorities particularly need to target action. Some of the main points are as follows:

• on life expectancy for men all but two health authorities are improving, with almost 90% of health authorities showing improvements on female life expectancy;
• over 85% of health authorities are reducing their deaths from cancer, and all health authorities are reducing their deaths from circulatory diseases;

• teenage pregnancy rates are being reduced in almost 70% of health authorities;

• revascularisation rates are being improved in over 80% of health authorities;

• numbers of hip and knee replacement operations are improving in 75% of health authorities, and operations for cataract removal are increasing in almost 90% of health authorities;

• 75% of health authorities are reducing the number of deaths within 30 days of unplanned surgery, and for deaths within 30 days of planned surgery it is 61%;

• 61% of health authorities are reducing the number of deaths within 30 days of admission to hospital with a fractured hip, and for deaths within 30 days of admission to hospital with a stroke the figure is 63%;

• for emergency readmissions, 34% are reducing the number of emergency readmissions to hospital following discharge, 39% reducing emergency readmissions to hospital following treatment for a fractured hip, and 43% reducing emergency readmission to hospital following treatment for a stroke;

• 65% of health authorities are increasing the number of patients returning home following treatment for a stroke within 56 days, and 46% are increasing the number of patients returning home following treatment for a fractured hip within 28 days.

For each indicator a graph shows the relative performance of every health authority or hospital trust in England. For the majority of indicators, where comparable earlier data are available, a second graph shows whether performance has improved or deteriorated for each health authority or hospital trust. At the start of each section a brief commentary offers contextual information where relevant and technical definitions for the indicators in that area, but this is kept to a minimum so that the graphs can speak for themselves.

The indicators are grouped into different categories or areas according to the NHS Performance Assessment Framework (PAF). The PAF has been designed to ensure that all areas of NHS performance are measured in a balanced way, so that NHS organisations, their patients and the public get a fair and more rounded view of how well their hospital trusts and health authorities are doing. The PAF enables NHS managers and clinicians to compare different key elements of performance and understand how changes in one area may have implications for others.

The health authority PAF comprises six areas of performance which, taken together, give a balanced view of the performance of the NHS:

1 Health improvement;

2 Fair access;

3 Effective delivery of appropriate health care;

4 Efficiency;

5 Patient/carer experience; and

6 Health outcomes of NHS care.

The PAF for NHS hospital trusts is similar and is designed to complement the information contained in the health authority PAF. It will enable hospital trusts to assess and compare their performance against a full range of measures. It has four areas:

A Clinical effectiveness and outcomes;

B Efficiency;

C Patient/carer experience; and

D Capacity & capability.

There is also a PAF for Personal Social Services with a set of accompanying performance indicators, published in Social Services Performance Assessment Framework Indicators, 2000-2001 (October 2001) and at www.doh.gov.uk/paf. This includes some "interface" indicators, which also feature in the health authority PAF. Increasingly health and social services must work together to improve the care that people receive, so both health authorities and councils with social services responsibilities will be held accountable for performance against these indicators.

The purpose of the indicator sets is to provide a high level summary of NHS performance, reflecting as fully as possible the functions of the health service and the wide range of services patients receive. In particular, the indicators should reflect the priorities that have been set for the health service and measure progress against key standards and targets. Consequently the indicator sets are constantly being developed and improved as new sources of information become available. This publication better reflects key service standards as defined in the National Service Frameworks and includes a broader range of clinical indicators, which reflect the quality of treatment that patients receive. By the time the next indicator sets are published information from a national programme of patient and staff surveys will also be available to better reflect people’s experiences of the NHS.

This publication has been informed by an extensive public consultation exercise – a key part of the Government’s programme to develop and improve the indicators. The development programme involves the Department of Health working closely with the Commission for Health Improvement as it moves towards taking over responsibility for publishing the Performance Indicators. We are committed to an ongoing annual consultation process, to ensure that the NHS and others with relevant knowledge and interest are able to influence the development of performance indicators. A summary of the findings of the first consultation, held over summer 2001, and the Government’s response can be found in Annex D of this document. A more detailed account of the responses to each of the issues raised in the consultation can be found on the Performance Indicators website at www.doh.gov.uk/nhsperformanceindicators/2002.

As part of this indicator publication summary reports have been prepared for the boards of hospital trusts, the new health authorities, as well as their host primary care trusts and primary care groups. Although they are designed for NHS management use, these reports are public documents and can be found on the website at www.doh.gov.uk/nhsperformanceindicators/2002. Each report is customised for the health authority or hospital trust concerned and presents a summary of its performance on all the indicators. The board of each organisation will consider its report carefully, paying particular attention to any areas of relatively poor performance, and take whatever action is appropriate to try to ensure that overall performance improves and services to patients are enhanced.

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