Knowledge Matters Volume 4 Issue 3

Volume 4 Issue 3 August 2010 Welcome to Knowledge Matters Hello everyone and welcome to this back to school edition of Knowledge Matters.

Despite it being the holiday season, the team have had a really productive summer resulting in a number of developments which will interest our readers. Firstly, I am pleased to report that quite a number of the high level monitoring dashboards to support QIPP (referred to in the June edition of Knowledge Matters) have now been developed. Full details of these dashboards and the indicators contained on each are detailed on pages 4—7 along with a summary of some of the forthcoming products that will be available soon. One of the tools what will be featured in the next edition of Knowledge Matters is the Activity Explorer Tool which enables users to view historic trends for different types of activity and also model activity patterns into the future.

Secondly, well done to our Web Team for developing a web-based searchable catalogue of tools developed by the Quality Observatory (and others). A beta version of the catalogue will go live on 17th September. We would be grateful if users of our website could thoroughly test the website and come back to us with any errors that they come across.

The catalogue should make it much easier for our customers to locate tools, dashboards and guides which are relevant to their area of interest—the catalogue will contain all of the QIPP dashboards developed to date.

We are currently arranging a series of local road shows across the region which will enable anyone to come along and learn more about the range of support available from the Quality Observatory. A full list of dates will appear in the next edition of Knowledge Matters. If you can’t wait until then to find out, please contact Suzanne Gregg (suzanne.gregg@southeastcoast.nhs.uk) who will be pleased to provide you with details of a road show near you.

That’s all until next time—see you in October!

Inside This Issue : To analyse or not to analyse ……...

2

Enhanced recovery programme for total hip replacement

10

Analysis Ancient and Modern

17

New On-line catalogue developed

3

Skills builder—more on activity data

12

Quest—managing strategic programmes

18

Measuring progress against QIPP

4

A3: Ask an Analyst

14

News

19

National Technology Adoption Centre

8

An introduction to paramedic Practitioners

16

Hellos, goodbyes and fun fact

20

http://nww.sec.nhs.uk/QualiityObservatory Quality.Observatory@southeastcoast.nhs.uk

Page 2

To analyse or not to analyse, that is the question ?

The South East Coast Quality Observatory has made some new friends at Facebookville NHS Trust Introducing :

Join in the Analytical Fun on facebook and pose those important questions!

http://www.facebook.com/pages/The-Information-Analyst/308482892955

Page 3

QO Resource Catalogue coming soon to a N3 connection near you We are getting ready to launch our new resources catalogue in a few weeks, making it easier to find and access our resources! Below is a peak at the new features.

Would you like an advanced preview? Want a chance to feedback on the development?

Get in contact with us at: Quality.Observatory@southeastcoast.nhs.uk

TAG Based Browsing Advanced Filter Options You will have the Option of Three different filter types to refine your searches !

The catalogue can be browsed using selected Themes or Relevance

Save Your Favourites Save favourite: Search's &

Filter By Data Coverage

Items

Filter catalogue by SHA

Filter by Product Type: Catalogue Item Types : Download Item External Weblink (links to another webwite)

Internal Weblink (Item on this site)

Page 4

Measuring our progress against QIPP

By Samantha Riley, Head of the Quality Observatory The team have made really good progress over the past couple of months in working with SHA level programme leads in developing high level dashboards to support the QIPP programmes. This work is still very much in progress, however we were keen to take this opportunity to share with readers of Knowledge Matters what has been developed to date. For each QIPP programme, we have focussed on populating a dashboard with key indicators (for which data is regularly available from existing data sources) which cover the domains of activity, finance, workforce and of course quality. Some programmes are more easily supported by readily available data than others so the number of indicators contained within each dashboard does vary.

Each dashboard is constructed to enable users to view the data at SHA, County or individual organisation level— hence providing a useful mechanism for reviewing performance at a range of levels. We have tried to used a consistent format for each dashboard with measures for each domain clearly identified with the use of background colour coding. The following pages provide an overview of information that is available now to monitor progress for a range of QIPP programmes.

Long term conditions The Quality Observatory lead for this area is Katherine Cheema (Katherine.cheema@southeastcoast.nhs.uk) Indicators currently contained on the dashboard are described below. The dashboard provides an explanation of data sources and rationale for each indicator.

Long term conditions: QIPP measures dashboard: NHS South East Coast

•

Select PCT/county:

QUALITY 10.0%

30

8.0%

1200 20%

2.0%

Q37

Q37

QOF effective exception rate

2002

Q4 2009/10

Q3 2009/10

Q2 2009/10

Q1 2009/10

Period

ENG

Q37

Q37

ENG

ACTIVITY

• •

0

900 Q4 2008/09

2010/11

2009/10

0.0%

Q3 2008/09

0% Q1 2008/09

% people with an LTC who have been involved in a care planning discussion

2008/09

% whose doctor/nurse told them they had a 'care plan'

10 5

950

1.0%

% people with an LTC who benefit as a result of a care plan

15

1000 5%

0.0%

20

Q37 (No.)

Period Q37

Q37

ACTIVITY & FINANCE

No. of people with an LTC with 2 or more admits. per year (2009/10)

Emergency bed days for LTCs per 1,000 population

6000

7

Period

2008

10.0%

1050

2007

3.0%

1100

10%

4.0%

20.0%

Percentage of people with an LTC who have been involved in a care planning discussion

15%

5.0%

2006

30.0%

25

1150

% readmissions

40.0%

6.0%

2007/08

% people

50.0%

2006/07

•

% attendances

7.0%

60.0%

DSR per 100,000

70.0%

Percentage of people whose doctor/nurse told them they had a 'care plan' (this indicator has replaced 'percentage of people with an LTC who have a care plan')

1250

2005

80.0%

SMR for DM/COPD 35

25%

9.0%

2004

90.0%

2003

100.0%

Rate and number of emergency readmissions for patient with LTC

Q2 2008/09

Percentage of people with an LTC who benefit as a result of a care plan

•

QOF effective exception rate

Q1-4 2009/10: patient experience of care planning

Q37 (DM)

Q37 (DM)

ENG (DM)

Q37 (COPD)

Q37 (COPD)

ENG (COPD)

FINANCE

Number and PbR cost of emergency admissions with LTC as a primary diagnosis

QIPP YTD savings against plan to month 3 £900

£4,000

2500

£800

6

3 2

1000

£1,500 £1,000

500

£300 £200 £100

Period

Period

Q37

Q37

Admissions

Plan

SEC

K&M

SUSSEX

East Kent

West Kent

Hastings & R

Surrey

East Sussex

West Sussex

Apr-10

May-10

Jan-10

Mar-10

Feb-10

Dec-09

Nov-09

Jul-09

Oct-09

Jun-09

Sep-09

Aug-09

Apr-09

£0

Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10

0

0

Frequency

£400

£0

1000

2 adm. 3 adm. 4 adm. 5 adm. 6+ adm.

£500

£500

1

0

£600

Brighton & Hove

2000

£2,000

Medway

3000

£2,500

1500

Savings (000s)

No. emergency admissions

No. people

4

Frequent admissions (number of people with 2 or more LTC admissions within 1 year)

•

No. bed days per 1,000

5

May-09

•

£3,000

4000

Directly standardised mortality rates for key LTCs (per 100,000 population, all ages, all persons)

£700

2000

5000

PbR cost ('000s)

Rate and number of emergency readmissions within 30 days for patients with LTCs

•

£3,500

PCT/County

Actual

PbR price (000s)

Emergency bed days for LTC patients per 1,000 population

• •

Number and cost of LTC emergency admissions QIPP YTD savings: actual vs plan Long Term Conditions Costs Explorer - NHS South East Coast

Select PCT NHS South East Coast Select condition(s)

30

£140,000

Diabetes Motor Neurone Diseas Parkinson's Disease Multiple Sclerosis

£120,000

Epilepsy Angina

25

Coronary Heart Disease COPD Emphysema

£100,000

Cost/100,000 population

15

Asthma

Totals for 20 months 19,882

£80,000

Admission Cost

£60,000

£93,604,624

Set percentage reduction (max. 50%)

10 £40,000

15.0 5

£20,000

Total cost difference (over 20 months) Admission

Nov-09

Jul-09

Oct-09

Sep-09

Aug-09

Apr-09

Jun-09

Mar-09

Feb-09

May-09

Jan-09

Dec-08

Oct-08

Actual admissions

Nov-08

Jul-08

Jun-08

Sep-08

Apr-08

Aug-08

2008/09

2009/10

Remodelled admissions

Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09

£-

0 May-08

Admissions/100,000 population

20

2008/09 SEC actual

Actual cost

2009/10 Remodelled cost

SEC actual

Cost

2,980 £14,040,694

In addition, Kate has developed a long term conditions cost explorer tool which enables PCT to compare admission rates for each long term condition with other PCTs within South east Coast and model the impact on numbers of admissions and associated value if the admission rate were reduced.

Page 5

End of Life Care The Quality Observatory lead for this area is Adam Cook (adam.cook@southeastcoast.nhs.uk) Indicators currently contained on the dashboard are : -

• • • •

% of patients on a palliative care register Total in-hospital deaths by primary diagnosis for a number of selected clinical conditions Numbers of palliative care staff (community and acute)

End of Life Care: QIPP Measures Dashboard: South East Coast Select condition for activity & finance:

Value of in-hospital deaths by primary diagnosis QUALITY

The following breakdowns are available for the activity and finance indicators: -

ACTIVITY

Total in-hospital deaths by primary diagnosis All Above Causes

% of patients on a Palliative Care Register 0.110%

450

1 Week

0.108%

2 Weeks

3 Weeks

4 Weeks

400 0.106%

• • • • • • • • • •

350 0.104% 300

Cancer—breast

0.102% 250 0.100% 200 0.098% 150

Cancer—colon

0.096% 100 0.094% 50 0.092%

Cancer—lung

0 0.090% 2006/07

Cancer—other cancers

2007/08

Apr09

2008/09

WORKFORCE Numbers of Palliative Care Staff (FTE)

COPD

May09

Jun- Jul-09 Aug09 09

Sep09

Oct09

Nov09

Dec09

Jan10

Feb10

Mar10

Apr10

May10

Jun10

FINANCE

120

Total in-hospital deaths by primary diagnosis

Community

Acute

All Above Causes £1,200,000

1 Week

100

2 Weeks

3 Weeks

4 Weeks

£1,000,000

Dementia

80

Heart failure All of the above

£800,000

60

£600,000

40

£400,000

£200,000

20

£0 Apr-09

Other causes of death (non accident)

May-09

Apr- May- Jun09 09 09

Jun-09

Jul09

Aug- Sep- Oct- Nov- Dec- Jan09 09 09 09 09 10

Feb- Mar10 10

Apr- May- Jun10 10 10

All causes of death (non accident)

The activity and finance indicators use different shades of colour to indicate the time band within which patients died (1 week, 2 weeks, 3 weeks and 4 weeks).

Adam has also developed a more comprehensive dashboard which enables rates and numbers to be viewed by Trust and PCT—this is also available to download from the website.

Medicines Management The Quality Observatory lead for this area is Rebecca Matthews (Rebecca.matthews@southeastcoast.nhs.uk) Indicators currently contained on the dashboard are : -

SEC SHA Total

Diabetes measures - newer oral hypoglycaemics

QUALITY

Diabetes measures - long acting insulin analogues

Long acting insulin analogues

Antiobiotic Prescribing

Diabetes Measures

% High Risk ABs

14%

70.0

14%

60.0

14%

50.0

13%

40.0

13%

30.0

13%

20.0

13%

10.0

13%

0.0

13%

35%

30%

Generic drugs Cost per APU Actual savings compared to plan

40

30

30

20

20

20

10

10

10

0

0

0

ACTIVITY

WORKFORCE

35

% medicines reconciled by Band 5 or below

30

4%

25

2%

35%

50

80%

40

0

Ap r-1 0 Ju n10 Au g10 O ct10 De c10 Fe b11 1

20% 60%

0.5

15% 0 40% 10%

20

1 0 0 0 0 0 r-1 n-1 g-1 ct-1 ec-1 b-1 O A p Ju Fe D Au

England

1.5

25%

Indicator in development.

30

5

PCT 2.5 2

30%

10 1%

Cost per APU

% Generic Drugs 120%

100%

60 20

Losartan

BCBV Measures

90 80

5%

FINANCE Renin-angiotensin drugs

Ap r-1 0

Specials and Gluten Free Prescribing

Ju n10 Au g10 O ct10 D ec -1 0 Fe b11

Specials

Ezetimibe Prescribing

150

Ap r-1 0 Ju n-1 0 Au g10 O ct10 D ec -1 0 Fe b11

0%

Ap r-1 Ju 0 n-1 Au 0 g1 O 0 ctD 10 ec Fe 10 b1 Ap 1 r-1 Ju 1 n11

5%

0.00

0%

BCBV measures - PPIs

40

30

0.05

15

BCBV measures - statins

40

Indicator in development.

Data to be collected from April 2011

15% 0.10

70

BCBV measures - renin-angiotensin drugs

50

50

20%

3%

% meds reconciliation by AfC band 5 or below (indicator in development)

60

50

60

25%

6%

Gluten free prescribing

70

60

10%

Ezetimibe prescribing Specials prescribing

80

70

70

0.20

0.15

% Patients with own medication on admission 90

80

80

0.25

Ap r-1 0 Ju n10 Au g10 O ct10 De c10 Fe b11

% patients with there own medication on admission (data to be collected from April 2011)

14%

80.0

% High Risk ABs

Medicines per 10,000 episodes causing adverse effects

14%

90.0

Ap r-1 0 Ju n-1 0 Au g10 O ct10 De c10 Fe b11

Anti-psychotic prescribing for dementia patients

90

100.0

Items per STAR PU

NSAIDs (non-steroidal anti-inflammatory drugs)

40%

0.30 ABs: items per STAR PU

Medicines per 10,000 episodes causing adverse effects

Anti-psychotic prescribing for dementia patients

NSAIDs

5%

20%

10 0

QIPP Savings for latest month 0%

Ap r-1 0 Ju n10 Au g10 O ct10 D ec -1 0 Fe b11

• • • • • •

Draft QIPP Medicines Management Dashboard Refer to Glossary sheet for detailed definitions

Ap r-1 0 Ju n10 Au g10 O ct10 De c10 Fe b11

• • • •

Antibiotic Prescribing - high risk antibiotics

Ap r-1 0 Ju n10 Au g10 O ct10 D ec -1 0 Fe b11

•

Antiobiotic Prescribing - overall prescribing

Ap rJu 10 n Au -10 gO 10 ctDe 10 cFe 10 b11

• • • • • • •

0%

0 0 10 t-10 -10 -11 r-1 c n-1 ugb c O Ap Ju Fe De A

Jun-10 Plan to date (£000)

£2,576.00

Actual (£000)

£1,480.73

Page 6

Measuring our progress against QIPP—continued Primary Care The Quality Observatory lead for this area is Katherine Cheema (katherine.cheema@southeastcoast.nhs.uk) Indicators currently contained on the dashboard appear below. This dashboard has two tabs : one covering quality indicators and the other containing workforce and finance : -

QOF effective exception rate

Prevalence model vs QOF registers- Stroke

Prevalence model vs QOF registers- COPD

Prevalence model vs QOF registers- CHD

Prevalence model vs QOF registers- Diabetes

94%

64%

83%

94%

93%

62%

83%

60%

91%

82%

56%

56%

84% 81% 81%

80%

52% 87%

48%

80%

74%

84%

46%

79%

72%

2006

2007

2008

2009

2006

2010

Year

53%

76%

85%

NB: 2009 & 2010 forecast

54%

78%

80%

50%

86%

55%

82%

54% 88%

Emergency admissions per 1,000 UWP

57%

86%

82%

89%

Number of practices under 80% on overall satisfaction measures (GPPS)

58%

88%

58%

90%

Prevalence model vs QOF registersHypertension 59%

92% 90%

92%

2007

NB: 2009 & 2010 forecast

2008

2009

2010

2006

Year

2007

2008

2009

52% 51% 2006

2010

Year

NB: 2009 & 2010 forecast

2007

2008

2009

2010

Year

NB: 2009 & 2010 forecast

2006

2007

2008

2009

2010

Year

NB: 2009 & 2010 forecast

ACTIVITY QOF effective exception rate

Number of practices under 80% on over all satisfaction measures (GPPS) 35

7%

Emergency admissions per 1,000 UWP

Proportion of dental treatment bands

10

100%

100%

90%

90%

80%

80%

70%

70%

60%

60%

9

6%

Proportion of dental recall time bands

30

5%

8

Proportion of dental recall time bands

7

25

% of recalls

Proportion of dental treatment bands

6 5

30%

20%

20%

2

10%

1

0%

Month

% band 2

% band 3

2010/11 Q4

2010/11 Q3

2010/11 Q2

2010/11 Q1

2009/10 Q4

0%

% band 1

2009/10 Q3

Oct-10

Jun-10

Feb-11

Dec-10

Apr-10

Aug-10

Oct-09

Feb-10

Jun-09

Year

10%

Quarter

% urgent

Feb-11

2010/11

Dec-10

Year

2009/10

Oct-10

2008/09

Aug-10

0

2006/07 2007/08 2008/09 2009/10 2010/11

Jun-10

0

0%

40%

3

Apr-10

5

50%

30%

2009/10 Q2

10

1%

40%

4

15

2%

A demand management tool is in development in addition.

For further details on this refer to page ?

50%

20

3%

2009/10 Q1

4%

PMS and LES spend

Dec-09

• • • •

Select PCT: NHS SOUTH EAST COAST

QUALITY

Apr-09

• •

PRIMARY CARE QIPP MEASURES (QUALITY & ACTIVITY): NHS SOUTH EAST COAST

Prevalence model vs QOF registers (stroke, COPD, CHD, diabetes and hypertension)

Aug-09

•

Month

3-6 months

6-9 months

12-15 months

15+ months

9-12 months

Maternity and Neonates There are two Quality Observatory leads for this area: Katherine Cheema (neonates) (katherine.cheema@southeastcoast.nhs.uk) and Adam Cook (maternity) (adam.cook@southeastcoast.nhs.uk) Adam has constructed the high level QIPP dashboard for this programme. This dashboard uses a combination of data sources including SUS and the regularly detailed maternity submissions which should be provided to the SHA on a monthly basis. Currently not all Trusts are regularly submitting data, so the dashboard will be more complete for some Trusts than others. Indicators currently contained on the dashboard appear below.

• • • • • • • • • • •

Spontaneous vaginal delivery rate Women booked before 12 9+6) complete weeks

Maternity: QIPP Measures Dashboard: NHS SOUTH EAST COAST

Number of in-utero transfers (in development) QUALITY

Breast-feeding at initiation Term babies admitted to special care baby units Women delivered

Women Booked before 12 (+6) complete weeks

Spontaneous Vaginal Delivery Rate 90%

Actual

Target

Actual

100%

Number of In-Utero Transfers Target

90%

1

70%

80%

1

60%

70%

1

60%

1

50%

1

50%

1-1 care in labour

Kate has also developed a neo-natal pledges dashboard (more about this in the next issue) and a regularly updated tool to support the normalising birth programme. Again, further detail on this next time.

Term Babies Admitted to SCBU

Target

12%

Actual

Limit

10% 70%

Indicator in development

8%

60% 50%

6%

0

30%

0

20%

20%

0

20%

10%

0

10%

0%

0% Apr-10

May-10

Jun-10

May-10

Jun-10

2%

0% Apr-10

Jul-10

May-10

Jun-10

ACTIVITY Women Delivered 3000

Induction of Labour (not augmentation) Actual

Number of Births outside labour ward Limit

1-1 care In Labour 0

Jun-10

Jul-10

80% 70%

21%

20%

20%

500

19%

0

19%

May-10

Jun-10

Jul-10

Woman/Midwife ratio Actual

PbR Value of Delveries £1.00 Limit £0.90

35 £0.80

Indicator in development

0

30

0

£0.70

25

0

50% 40%

1000

Apr-10

FINANCE

0

21%

Indicator in development

£0.60

20

£0.50

0

15

£0.40

0

10

0

5

30% 20% 10%

Apr-10 May- Jun-10 Jul-10 10

May-10

40

100% 90%

1500

0% Apr-10

Jul-10

WORKFORCE

22%

2000

4%

30%

0 Apr-10

Jul-10

60%

PbR value of deliveries (in development)

Actual

80%

40%

2500

Woman/midwife ratio

Breast Feeding at Initiation 90%

Target

40%

10%

Number of births outside labour ward (indicator in development)

Actual

40% 30%

Induction of labour (not augmentation)

1

80%

Apr-10 May- Jun-10 Jul-10 10

£0.30 £0.20 £0.10

0% Apr-10 May- Jun-10 Jul-10 10

0

0 Apr10

May10

Jun- Jul-10 10

Apr- May- Jun10 10 10

Jul10

£Apr-10

May-10 Jun-10

Jul-10

Page 7

Children and Young People The Quality Observatory lead for this area is David Harries (david.harries@southeastcoast.nhs.uk) A comprehensive notes tab provides details on data sources and definitions. Indicators currently contained on the dashboard are as follows : -

30

6 4

10% 20

2

0

5

10

15

20

25

Aged 5

Emergency Admissions per 100,000

2009-10

95%

South East Coast SHA

90%

England

Source: Sexual Health Balanced Scorecard, APHO

85% 80%

GP prescribing rate of LARC per 1,000 women aged 15-44 yrs (12 month rolling a e age) 80

75% 70% 65%

Emergency readmissions (0-18 years) < 30 days

60

60%

SEC SHA

55%

40

England Q4

Q3

Q2

Q1

Q4

Q3

Q2

Q1

2009-10

1400

12%

1000

10%

800

8%

600

6%

400

4%

200

SEC SHA

Q4

Q3

Q2

Q1

14%

1200

In development

2%

200708

200809

200910

0%

201011

2008-09

2009-10

2010-11

Source: SUS, SECSHA Database

Source: SUS, SECSHA Database

Source: ePACT

Source: COVER, HPA

16%

1600

0

2010-11

Please note KPI still undergoing quality checking

18%

1800

Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11

Wte in post for key groups of staff (in development)

Q4

20

2008-09

SEC SHA

20%

0

South East Coast SHA

50%

2010-11

South East Coast SHA

SHA

2000

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Emergency admissions (all conditions) per 100,000 population aged 0-18 years

South East Coast SHA

2008-09

100%

2009-10

Emergency readmissions (0-18 years) <30 days

Emergency Admissions (All Conditions) per 100,000 Population aged 0-18 years i h 95% CI

%

2007-08

Aged 2

2008-09

FINANCE

Percentage aged under 18 at CSRH* services choosing LARC

Immunisation rate for children aged 5 who have been immunised for measles, mumps and rubella (MMR) 2nd dose

Source: VSMR, UNIFY2 (Department of Health)

Source: NCMP Dataset (Information Centre)

Q4

Source: Department of Health

GP prescribing rate of LARC per 1,000 women aged 15-44 years

Primary Care Trusts

Source: Survey of parents' experiences of services provided to disabled children (TNS-BMRB)

Q4

Q1 0%

0

2010

Q2

2009

Q1

2008

Q3

0

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2007

Awaiting breakdown of WTE monthly data

5%

10

Q2

0

8

Q3

1

0

10

Q1

2

50

15%

12

Q2

100

Percentage aged under 18 at CSRH services choosing LARC

40

20%

Q4

3

50

Q3

150

60

Q1

4

25%

Q4

200

14

England CIs

70

Q3

5

Selected PCT(s)

Q2

6

250

16

Upper Quartile

30%

Q1

300

Effectiveness of child and adolescent mental health (CAMHS) services (NI051 & VSB12)

Interquartile range Lower Quartile

Selected PCT(s)

Q4

7

35%

All PCTs

Score (rated out of 16)

350

Prevalence of obese Year 6 children, with associated 95% CIs, by PCT, 2008/09

Overall Score 80

Abortion rate women aged U18

Immunisation rate for children (aged 2 and 5) who have been immunised for MMR

8 Score out of 100 (higher is better ->)

QUALITY

Number of abortions women aged U18

Effectiveness of child and adolescent mental health services

9

Q2

SEC SHA rate England rate

WORKFORCE

Parental Experiences of services provided to disabled children, by PCT, 2009

SEC SHA number

400

Q3

Abortions for women aged under 18

450

Prevalence

Prevalence of obese year 6 children

Q3

• • •

South East Coast SHA

South East Coast SHA

Q2

•

CHILDREN & YOUNG PERSONS QIPP DASHBOARD:

Parental experiences of services provided to disabled children

ACTIVITY

• •

Abortion for women aged under 18

Q1

• • • • •

PbR value of activity (in development)

Staying Healthy The Quality Observatory lead for this area is David Harries (david.harries@southeastcoast.nhs.uk) This dashboard is currently in draft. Indicators currently on the dashboard appear below: NHS Health Checks

Kent and Medway

DRAFT STAYING HEALTHY QIPP KPI DASHBOARD: South East Coast SHA Alcohol

Rate of alcohol-related admissions per 100,000 population (EASR)

18,000

370

16,000

360

14,000

350

12,000 10,000

340

8,000 6,000

330

4,000 0 Q4

Q1

2009-10

Q2

Q3

Q4

450

14000

400

12000

350 300

10000

250

8000

200

6000

150

4000

100

2000

310

50

0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2010-11

Rate

16000

320

2,000

2008-09

2009-10

Workforce

0

2006/07 2007/08 2008-

2010-11

Estimated number of admissions that can be attributed to smoking and the percentage of all admissions attributed to smoking for persons aged 35+

Rate per 100,000

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Estimated number of admissions that can be attributed to smoking and the percentage of all admissions attributed to smoking for persons aged 35+

Number

Number

Rate per 100,000

Number of quitters

Number

2009-

Under development

8000

8%

7000

7%

6000

6%

5000

5%

4000

4%

3000

3%

2000

2%

1000

1%

0

0%

2010-

2006/07 2007/08 2008-09 2009-10 2010-11

% of admissions attributable to smoking

Successful quitters at 4 week follow up

Tobacco Control Successful quitters at 4 week follow up

Number Received YTD

Estimated number of admission attributable to smoking

NHS Health Checks

Number Offered YTD

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Rate of alcohol related admissions per 100,000 population

Rate per 100,000

• • • •

2000

35%

1800 30% 1600 25%

1400 1200

20%

1000 15%

800 600

10%

400 5% 200 0

0% 2005/06

Source: SEC SHA/UNIFY

Source: Stop Smoking Quzrterly Return, Information Centre

2006/07

250

20%

200

4

15%

150

3

10%

2

5%

=

Source: SEC SHA/UNIFY

15% 10%

400

Source: Omnibus Information Centre, Model-based estimates derived from HsFE, NatCen

Q4

0%

20%

1000 800

0 Q3

0%

0

2006-2008

25%

1200

600

5% Q3

0

Smoking at time of delivery (SATOD)

1600

20%

50

Q4

1

100

Q3

5

Please note: Taken from Practices' Primis systems. PCT currently investigating the validaity of the recording of smoking status.

Q4 Q1 2009-10 Q2

10

25%

Q1

5

30%

30%

2008-09 Q2

Under development

35%

1800

35%

1400

25%

6

2000

% SATOD % SATOD (SHA)

Q4 Q1 2007/08 Q2

7

15

Smoking prevalence

2009-10

Under development

No. known SATOD

300

Q3

30%

Q4

8

99% CI Model based estimates

Q3

35%

Q1

40%

9

Q1

20

Smoking at time of delivery (SATOD)

Smoking Prevalence % GP recorded Smokers

10

2006/07 Q2

25

2005/06 Q2

Recorded crime attributable to alcohol: Crude rate per 1000

South East Coast SHA 30

Recorded crime attributable to alcohol

2008-09

Finance

Prevalence of obesity (adults aged 16 and over)

Prevalence of obesity (adults aged 16 and over)

2007/08

Source: SUS Database, South East Coast SHA

Obesity

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

• • • •

Source: HES and ONS (Mid Year Estimates)

15%

10%

5% 200 0

0% 2005/ 06

2006/07

2007/08

2008-09

2009-10

Source: Omnibus Information Centre

In addition to programme level dashboards, high level Trust and PCT dashboards have been developed which show key activity, workforce, finance and quality indicators - again viewable by whole SHA, County or individual organisation level.

Products coming soon……..

•

QIPP Dashboards for the following programmes: - safe care, urgent care, planned care and mental health

•

A set of dashboards looking at progress against the KPIs published by the UK National Screening Committee

•

An activity explorer tool which enables activity trends to be viewed graphically and a forecast line added

•

A specialty dashboard which provides high level monitoring by specialty for key indicators including mortality, readmissions and length of stay

Page 8

Closing the gap—Enabling Clinical Change through Technology

By Hadleigh Stollar, Programme Manager, NHS Technology Adoption Centre The NHS Technology Adoption Centre (NTAC) was set up in 2007 with the vision of overcoming the complexities that medical technology present to the NHS. It was felt that the NHS in England could no longer be stagnant when it came to embracing new technology – but before a grand model of mass adoption could be reached, NTAC was mandated to identify the problems or barriers associated with the low uptake of [innovative] technology across the health service. This would pave the way for an impressive plan which, it was envisaged, would go on to provide a solution to these problems on a national scale.

With high expectations of NTAC on the horizon, the team worked around the clock to develop NTACs ‘core’ work programme – with Technology Implementation Projects and the infamous “How to Why to Guide” underpinning NTACs very foundation. The concept was that the team would identify an array of technologies that had a strong evidence base but that were under-adopted, choose a variety of host sites to work through the barriers to adoption to implement these technologies locally, and then share the learning through an online guide that would facilitate wider adoption across the NHS. As the months went on and NTAC become more sophisticated in its approach, the organisation continued its work with over 70 NHS organisations across England, as well as those organisations NTAC embraced as part of its work streams – charities, patient advocacy groups, industry partners, the Royal Colleges of England, the Department of Health, to name but a few. Indeed, the external interface associated with NTACs work began to highlight that there was a bigger role for the organisation to play than was previously thought.

The team have gone on to introduce key changes to the way that health services are being delivered – and because of NTACs organic thought process, the structures that have been put in place now will be just as fruitful when the new GP Consortia model is introduced (as laid out in the recently published White Paper: Equity and excellence: Liberating the NHS).

NTAC How to Why to Guides NTAC has implementation projects on the technologies listed below, which will have a How to Why to Guide associated to them. Downloadable business cases, costing models, patient pathways, operational service specifications and clinical papers showcasing the evidence can all be found on the guides, downloaded and used for the implementation of the technology in any health economy:

•

Doppler guided intra-operative fluid management – through an oesophageal Doppler, surgery is enhanced and bed days saved.

•

Continuous subcutaneous insulin infusion – optimises the management of diabetes in line with NICE guidance on this therapy.

•

The suprapubic foley catheter kit – enables the safe incursion of a suprapubic catheter, which avoids the requirement for a general anaesthetic and subsequent bed days.

Forward Look A number of additional guides will be launched within the next six months (listed at the top of the next page), and you can sign up to receive them by logging on to www.howtowhyto.nhs.uk and putting your details into the relevant guide (a short survey will appear to prompt you for your email address):

Page 9 • Intra-operative breast lymph node analysis – has the potential to remove a second operation from the pathway of care.

• Photodynamic diagnosis of bladder cancer – identifies more of the cancerous tumour in initial surgery, thus reducing the risk of a second surgical procedure.

• Cardiac resynchronisation therapy – improves the management and outcome of certain patients with moderate and severe heart failure.

• Non invasive bladder analysis for men – an innovative test which is reproducible and can be used to establish the presence or absence of obstruction in the bladder.

• 12 lead ECG telemedicine in primary care – remotely monitors heart rhythms, with access to a 24 hour, immediate telemedicine interpretation service.

NTAC is also working on a national programme with the 10 Strategic Health Authorities (SHA’s) through the Innovation Technology Adoption Procurement Programme (iTAPP), which aims to bring coherence and clarity to technology adoption across the NHS. This programme is funded by the Department of Health.

Part of the ambitious National Innovation Procurement Plan, iTAPP involves NTAC in supporting innovation and commercial support unit leads in SHA’s to collaborate with partners across their own health economies with the aim of identifying , understanding and dismantling systemic and commercial barriers to adoption.

Plans are also underway to develop 5 key work streams which will contribute to an NHS which is technologically advanced and which embraces a unique persona around the adoption of clinically proven and cost effective technologies:

Case Study: Doppler Guided Intra-Operative Fluid Management NTAC’s systemic approach is well illustrated by its work to implement an innovative technique to guide fluid management, also known as oesophageal Doppler monitoring (ODM), which improves patient outcomes following major surgery.

Using three real world implementer sites, NTAC set out not only to measure the impact of the technique, but also to identify the potential benefits, costs and practical issues associated with the routine implementation of Doppler guided perioperative fluid management.

The results from the three implementer sites clearly demonstrated that the effectiveness of the technique had indeed improved patient outcomes, achieving a 3.5 day decrease in post-operative length of stay, a 23% reduction in the use of central venous catheters, a 33% decrease in readmissions and a 25% decrease in the rate of re-operations.

The direct benefits to patients were equally significant – minimally invasive monitoring, low risk of cardiac complications, reduced risk of catheter related infection, shorter hospital stays and fewer post-operative complications. ODM costs around £70 per patient, but, with an average bed day costing £250, a total of £625 per patient was saved due to shorter lengths of stay.

1. Mapping the adoption landscape. We will provide evidence based solutions to the most common challenges faced by health professionals, managers and decision makers when it comes to the adoption of new technology. We’ll do this by mapping the critical stages and stakeholders in the in the adoption process – providing practical information, tools and support from product launch on the UK market through to sustainable implementation.

2. Systematic adoption processes. We’ve worked collaboratively with more than 70 NHS organisations, so no one is in a better position than us to develop and support an evidence based methodology for a systematic approach to successful implementation of new technology across the NHS. 3. Generic adoption tools. Drawing on our wealth of experience, we will develop a range of evidence based, generic tools and resources and offer practical implementation support to help you adopt a wide range of healthcare technologies in a rapid and sustainable way.

4. Continuing professional development programme. In conjunction with our academic partners, we will develop a professional development programme to increase the capacity and capability of managers so they can support frontline clinicians with rapid adoption of innovative healthcare technologies.

5. Metrics programme. We will help health economies to assess the current levels of adoption of a range of healthcare technologies and enable them to determine the level of adoption required to realise maximum efficiencies and improvements in service.

To find out more about the NHS Technology Adoption Centre and the exciting work it is working on please visit www.technologyadoptioncentre.nhs.uk or www.howtowhyto.nhs.uk.

Page 10

Enhanced Recovery Programme for Total Hip Replacement Surgery

By Mr Hugh Apthorp, Consultant Orthopaedic Surgeon, Conquest Hospital As mentioned in the previous issue of Knowledge Matters, orthopaedic consultant Mr Hugh Apthorp has achieved nationally outstanding results for his hip replacement patients, achieving the fastest recovery, and thus lowest length of hospital stay, in England. In this article, we describe the process by which these results were obtained. .

The Conquest Hospital in Hastings is a normal district general hospital that serves a local population of 190,000. It faces the typical challenges of many district general hospitals having to look after a high proportion of cases with significant comorbidities and social problems, which exclude them from the local independent treatment centres. Additionally because Hugh’s specialty interest in complex hip surgery many patients are treated from distant areas. The combination of these factors would normally lead to higher than average lengths of stay.

The enhanced recovery project was structured around the general objective that as much care as possible should be provided in the outpatient and community setting, with hospital facilities used only for essential inpatient activities. The primary objective was to redistribute patient care, not reduce it. Every aspect of the patient’s journey from the referral letter to follow up was optimised. Because the postoperative stay is so short interventions such as physiotherapy and occupational therapy have to occur preoperatively when patients are more receptive to information.

Out patient Appointment Patients are treated within the 18-week pathway. Breach dates are indicated on the referral letters. Once the decision to operate is made, the program is discussed and expectations of an enhanced recovery are raised. A date for surgery and discharge are given and an information booklet regarding the program is given. Consent is taken and a pre-screen is carried out to ensure they are fit enough to join the waiting list.

Pre-assessment clinic The pre-assessment clinic is run to allow the patient to meet the whole team without necessitating multiple hospital visits.

At every interaction between the team (nurses, physiotherapists, occupational therapists) and the patient, all members of the clinical team reaffirm the main aspects of the programme, ensuring patients receive consistent and clear information about their treatment. Crucially, patients must understand at all times the length of hospital stay and time scales surrounding recovery, which they can expect. The pre-assessment clinic is nurse led (no doctors) and they also check test results and liaise with anaesthetists.

Most of the physiotherapy and occupational therapy is given at this clinic, and consists of both group and individual sessions. Patients are informed of precautions and exercises they will need to do after their procedure. They are taught to use walking aids and how to do stairs – allowing them to practice at home before the surgery. At this stage, even before any surgery has taken place, the discharge planning process begins.

Anaesthesia Making the right anaesthetic choices is absolutely critical to ensuring rapid recovery can take place, the influence of the anaesthetic on post operative recovery is often underestimated. The objectives of the anaesthetic should be to allow safe surgery with minimal physiological effects, good post operative analgesia, rapid motor recovery and little nausea. When these goals are achieved patients can be mobilised within hours of their surgery without the encumbance of drips, drains or catheters. A wide number of options were tried before arriving at the consistent solution now used.

Our approach: 1.5mls 0.5% plain Bupivacaine plus 0.5mg Diamorphine, with a light short acting general anaesthetic. This results in the rapid recovery of motor function, often by the end of the operation, with the patient usually able to mobilise a few hours post op. The ward nurses have been skilled to mobilise the patients on the day of surgery.

The Surgery

Careful efficient surgery with minimal blood loss and soft tissue damage should be the goal of all hip replacement surgeons. Mr Apthorp uses a minimally invasive (MIS) ap‐ proach. The MIS technique involves making a smaller posterior piriformis (muscle) sparing approach, which results in less tissue trauma, less pain and reduced blood loss. This cre‐ ates the potential for faster rehabilitation. This technique is efficient and allows up 6 cases to be carried out on an all day list. It is now used by Mr Apthorp for all routine total hip replacement (THR) patients.

Page 11 However the infrastructure changes have a greater effect than surgery alone on length of stay .

Post operative pain management The initial post operative analgesic effect of the spinal anaesthetic allows day of surgery mobilisation which creates confidence. Early mobilisation in itself also appears to reduce pain levels. Simple oral analgesia is used (paracetamol, tramadol) following analgesia protocols. A crucial element of the enhanced recovery programme, however, lies in managing the patient’s expectation of pain. Where patients understood that pain was likely during recovery, and that this was a normal part of the treatment, they experience far greater success in managing this pain effectively.

Discharge criteria

• • • • • •

Able to get in and out of bed Walking safely Able to climb stairs Adequate pain control Dry wound Patient happy to go home

A patient walking up stairs 20 hours post op

The outreach team The introduction of an outreach team represented a major change to the provision of the hip replacement service. The team consists of a senior outreach nurse (also the ward sister), and a physiotherapy assistant. This allows for seamless continuity of care into the community and is very reassuring for patients as they get to know the members of staff on the ward who they will see once they go home.

The patients receive a follow-up phone call 24 hours after discharge. Those that live within 20 miles of the Conquest Hospital get a home visit 48 hours after discharge and then another for a wound check at between 5 and 7 days post discharge. Those that do not live within 20 miles tend to stay very slightly longer (1 day) but are then discharged into the care of their GP and district nursing teams. This service is highly economic requiring only 1 WTE for the hip service.

The benefit to the unit Implementing the enhanced recovery programme has resulted in improved multidisciplinary team working and increased patient awareness of the pathway they will follow. The staff are also now all aware of the potential for early discharge and it has been noted that even patients not treated as part of the enhanced recovery programme are going home more quickly. There has been an improvement in staff morale, with the ward area having very low rates of sickness absence and low staff turnover rates. Crucially, there has been a 25% reduction in the requirement for elective orthopaedic beds.

At the Conquest Hospital this led to a saving of around 289 beds per year, saving an average of £72,250 annually (based on savings of £250 / bed / day).

Conclusion The Enhanced Recovery Programme for total hip replacement is safe and practical, high levels of patient satisfaction have been achieved, and the programme has many additional benefits, alongside the significant reduction in patient length of stays, rapid recovery of patients, with low complication rates and lower than average readmission rates.

Substantial changes to patient treatment pathways take time and a lot of work, and Hugh’s advice is to initiate the project by putting together a team, encompassing representatives from each discipline involved in the hip replacement treatment pathway. Initially limit the changes to a small area of the department, for example those patients falling under a single consultant. Don’t try to change everything at once, and above all always remember that the goal is achievable.

If you would like any more information about Mr Apthorp’s programme or any assistance rolling it out in your trust, please contact Megan.Beardsmore-Rust@esht.nhs.uk

Page 12

Skills Builder - more on activity data

By Rebecca Matthews, Performance and Planning Analyst

A couple of issues ago we published an article on the different sources of patient level activity data, SUS and HES. These are the main sources of data that we use in our analysis and dashboards, but with the increased focus on QIPP, activity levels and demand management we are often being asked how we can get more timely information on activity levels and trends, as SUS data can be several months out of date by the time we have a full dataset and there is even more of a time-lag for HES data.

We do have another source of data available for activity—the Monthly Activity Return (MAR). This is submitted to Unify2 each month and as the deadline for submitting this is around 3 weeks after the end of the month it is available much more quickly than SUS or HES.

Prior to April 2010 the MAR consisted of 2 separate returns, a provider and a commissioner return. From April this has been a single prov-comm return meaning that the data is uploaded by providers for each of their commissioners and then validated and signed off by PCTs. The MAR is very different to SUS and contains only a few data items around admissions, outpatient attendances and referrals (the illustration above shows the template that is completed by each provider). Whilst the MAR is a useful indication of activity levels soon after the end of the month there are a number of ‘health warnings’ that should be noted: the MAR is a snapshot of data at a point in time so will not include any data that is yet to be coded . Although organisations are able to request changes to the data this is not an ongoing automatic process as it is for SUS. In addition, the majority of the data items are for general and acute specialities only so will exclude maternity, learning disabilities and psychiatry specialities. The MAR data is much less flexible than SUS as trusts input number of FFCEs (first finished consultant episodes) only with no details of subsequent episodes or spells. (definitions of episodes and spells to follow).

There is also a quarterly version of this return, the quarterly activity return (QAR). This has less data than the monthly return as does not include any non-elective activity, but does have the advantage of being published on the Department of Health website allowing easy benchmarking across all organisations in the country. The data should also be more robust than for the monthly return as activity for earlier months will be more validated.

In summary the MAR data is useful as an early indication of activity levels and being a much smaller dataset than SUS and available via Unify it is very easily accessible. It does have it’s limitations though in that it may not be complete, is fixed at a point in time and only has a limited number of data items. Numbers reported on SUS and the MAR can be very different. (It should be noted though that the MAR data is still widely used at the moment for performance monitoring purposes by the Department of Health and CQC).

There are a number of different currencies that can be used when monitoring inpatient activity, each has a different use and it will depend on the analysis required as to which is used.

Page 13 Finished Consultant Episodes (FCE) - the NHS Data Dictionary defines a consultant episode as “the time a patient spends in the continuous care of one consultant”. A consultant episode will be finished when a patient is either discharged or transferred to the care of another consultant. Each line of SUS data is an FCE and will show all of the procedures, diagnoses, ward stays and intensive care activity associated with the patient whilst under the care of that consultant First Finished Consultant Episodes (FFCEs) - this has the same definition as an FCE but is the first episode in a patient’s hospital stay. FFCEs are useful for looking at numbers of admissions. The MAR inpatient activity data is in FFCEs and these can easily be identified in SUS data by looking at those FCEs with an episode order of 1.

Spells - a spell is a patient’s total hospital stay from the time of admission to the time of discharge. A spell will consist of at least one Finished Consultant Episode may have several. Each spell will only have FFCE so the numbers of the two should match. (Any inconsistencies would be an indication of data quality issues). Under Payment by Results trusts are now paid for spells rather than episodes so spells should be used for any analysis involving contracting and costs.

Below are some useful links relating to activity definitions and activity returns:

•

Definitions for NHS data items including those used in all of the activity returns can be accessed via the Data Dictionary: www.datadictionary.nhs.uk

•

MAR data and guidance can be found on the Unify2 website: http://nww.unify2.dh.nhs.uk/Unify/interface/ homepage.aspx (you will need to have an account—the SHA can set this up for you if required)

•

Published activity from the Unify2 returns can be found on the Department of Health website: http:// www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/index.htm

•

Access to SUS and HES are described in the previous activity article in Volume 4 issue 1—HES published data is available from www.hesonline.nhs.uk. SUS data is via smartcard access.

Please contact me if you want any further information on any of this: rebecca.matthews@southeastcoast.nhs.uk

One giant leap for the Quality Observatory…..

The Quality Observatory is now the proud owner of an acre of the moon. Samantha purchased the land as a result of thinking about future needs in terms of potential customers and the requirement for office space …….

The land is located in Area F-4, Quadrant Charlie and has an approximate latitude of 19 degrees N and longitude of 33 degrees W (an excellent location according to the Moon Estates agent)

Hopefully a wise investment which will help future-proof what we do!

Page 14

Validation Lists Application: Microsoft Excel 2003 Dear Quality Observatory I have a spreadsheet a that contains validation rules. I have activated List validation in some cells.

Unfortunately it is a rather large spreadsheet and the text in the validation list comes out very small (see example) Is there any way I can get excel to display larger text in the validation in list without fiddling with the zoom settings?

I’m using Excel 2003 -Vince O’Mahoney Information Analyst Surrey PCT

Solution: Complexity 4/5 — Uses Macros and Forms Hi Vince The QO team have scratched their heads, scoured the library and even asked the inter-web. We were unable to find a built in option/function in excel that allows you to do this …

However as you know the QO team have never let that stop us!

You can with a bit of VBA Create pop up forms. In VBA forms you can change the font and display properties for the text in the popup: Here is an example : To do this you need to create a form in VBA editor in this Example I have Created a form with a list box in it.

Once You have Created Your List box Open the property Explorer (F4) In the property Explorer you will be able to set the following values : Bound column: if you are displaying more than one column in the list box you will need to use this to select which column contains the data you want to use Control Source: This sets the cell that you want to control, i.e. return the selected value to cell “=E26” when that option is clicked RowSource: This sets the Cells that contain the listbox values e.g.” ’sheet name’!a2:b2’ ” The row source does not have to be on the same sheet as the control source it can link to any sheet in the workbook

Page 15 The next Step is to create a script that will show the script when the cell (in this example E26 ) is clicked.

In the worksheet that contains the cell create the following macro: Private Sub Worksheet_SelectionChange(ByVal Target As Range) If ActiveCell.Address = "$E$26" Then 'MsgBox (ActiveCell.Address) Load UserForm1 UserForm1.Show End If End Sub this will activate the user form when cell E26 is activated on the worksheet.

Finish this off with two command buttons on the user form: One to hide the userform after a selection has been made: Private Sub CommandButton1_Click() UserForm1.Hide Unload UserForm1 End Sub one to cancel the selection and clear the values in the cell Private Sub CommandButton2_Click() UserForm1.Hide Unload UserForm1 Range("E26").Value = "" End Sub The above example only applies this method to a single cell, you can modify this method to work on a range, which we will show you in another issue !

Eulogy for the Weekly SITREP Medical outliers fully exposed,

Goodbye, Weekly SITREP, Goodbye, We'll be steadfast and brave and not cry.

A&E attendances by type,

Numbers of beds occupied and not closed.

And waits that caused the department to gripe.

Some of them gone at the department's behest,

Once upon time there was STEIS.

Admissions emergency and elective,

A move to monthly for some of the rest.

We followed definitions, guidance, advice,

All scrutinised and placed in perspective.

Only Ambulance data is done by week,

Cancelled ops we had to share,

The final part of a collection unique.

To return all the figures on time

And the also delayed transfers of care.

To enable weekly performance to climb.

We kept filling the numbers so true,

You've gone to the data repository in the sky,

Right up to the last days in UNIFY2.

Goodbye, Weekly SITREP, Goodbye!

Page 16

An introduction to Paramedic Practitioners

By Andy Parker, Paramedic Practitioner Co-ordinator, South East Coast Ambulance Service Paramedic Practitioners (PPs) are experienced Paramedics who undertake a 120 credit, 7 module diploma at St Georges University, London to further enhance their assessment and treatment of patients who call 999. GP placements in conjunction with the GP deanery allow the practitioner to consolidate learning and apply theory into practice. Modules are also complemented by additional clinical placements in each specialism.

The core modules the paramedic practitioner completes appear below: The main emphasis of the paramedic practitioner role is to take healthcare to the patient and avoid unnecessary admissions to the acute sector by treating and/or referral on scene to a community provider. This can be done through paramedic practitioner primary response to an incident where another ambulance resource is not required or alternatively a request from an ambulance crew/ Health Professional on scene who feels the patient could benefit from an extended assessment and or management plan to prevent admission.

Current work being undertaken includes the National Lung Improvement COPD Project looking at how a COPD patient is managed in the pre-hospital setting and subsequent referral to respiratory specialist teams. This will reduce conveyance but also improve the care and follow up of a patient by a respiratory specialist nursing team. Local Paramedic Practitioner COPD champion integration into a multi disciplinary team meeting will enable collaborative engagement encompassing the ambulance service when deciding patient management.

Examples of Paramedic Practitioner work: An ambulance crew requested a PP to attend an elderly lady who had fallen, sustaining a skin tear to her leg. The patient was thoroughly assessed to determine that she had an underlying urinary tract infection (UTI) which had caused unsteadiness. The PP dressed the wound, referring her to the district nurses for wound care follow up. Antibiotics were commenced to treat the UTI and a referral was made to the falls service to minimise the risk of another fall. An increase in the patientâ&#x20AC;&#x2122;s care package was made through social services for 72 hours to ensure the patient had assistance whilst recovering from the UTI. â&#x20AC;&#x201C; Admission avoided.

A male who called an ambulance for a head injury had a neurological exam from a Paramedic Practitioner. He showed no abnormality and the PP was able to effectively suture the head injury within one hour. He was given head injury advice and an appointment was made with his own GP to remove the sutures the following week. The PP contacted the patient two hours later to ensure patient welfare. This prevented ambulance transport time and an emergency department admittance.

An elderly male had ongoing fluctuations in his diabetic management resulting in a number of ambulance attendances for hypoglycaemic events. He lives alone without a care package in place. Examining the patient the paramedic practitioner notes limited food intake and poor living conditions. The PP discussed with the Rapid Access Clinic for Older People (RACOP) consultant the possibility of review. The patient was accepted and transported as a non emergency journey. The patient was subsequently discharged from RACOP post review and treatment with an integrated care package. The patient was managed successfully and had not called 999 since.

If you require any further information please feel free to contact Andy Parker, Paramedic Practitioner Co-ordinator (andrew.parker@secamb.nhs.uk)

Page 17

Analysis, Ancient and Modern In our continuing series looking at analytical methods and processes through history Adam Cook goes back to the very first NHS information Analyst—Florence Nightingale.

Dearest Flo, I remember the first time I saw you, it was an old battered Ladybird book at my Grandmother’s house. I read that book again and again, and you were the centre of it all, you were a true modern heroine to me. Your lamp lit up my life. Then we drifted apart, I read other books, and some were less flattering about you, and others mentioned that Mary Seacole, showing you weren’t the only one doing good works out there in the Crimea.

I joined the NHS (partly because of you), but I’m not cut out for nursing, so I went into analysis instead, crunching numbers, making charts providing the evidence for improvement and change. Then you came back into my life because that job is one you that you made (Did you make it just for me, Flo? I like to think that you did). You started it all with your elegant and beautiful analysis of mortality in the Crimea

The simple and clear way that you showed the numbers of preventable deaths, was one of those key factors that made the suits in Whitehall sit up and listen, and take you and your reforms seriously. Your hard work in collecting data and using it to evidence practice, and drive forward improvement is still an inspiration to all analysts today (and especially me.)

And so it’s come full circle I’m working on our Safer Smarter Nursing Metrics, using the information to help show good quality and outcomes in nursing care, and, Flo, that’s because of you, Thank you, Love Adam

Congratulations……..

To Adam Ceney who was the 1,000th registered user of the South East Coast Quality Observatory website.

Adam works as an Insights Analyst at East Midlands Quality Observatory. Adam’s prize is currently being designed and we hope to have a photo of the lucky winner in the next edition of Knowledge Matters.

Page 18

Quest: managing strategic programmes, projects and risk

By Andrew Lee, Head of the Programme Management Office, NHS Portsmouth City At a recent conference in NHS South Central a team from NHS Portsmouth exhibited their Quest programme management software, an in-house solution to managing the significant number of projects and programmes that an NHS organisation undertakes. Quest Solution Professional (QSP) is a multiuser ICT software programme based upon QIPP/ MSP/PRINCE2 and Performance methodologies and provides a centralised way to successfully performance manage strategic programmes, projects and risk management. QSP enables visibility to all departments and does not need expensive infrastructure to deploy and ultimately saves time around project data collection and report printing. It allows up to 100 programmes to be setup with any number of projects allocated against them.

QSP’s design was born of necessity to enable and ensure the Programme Management Office can robustly manage and challenge PCT projects. Ultimately this will ensure we have correct governance and that “savings to be achieved” have early warning systems in place to stop project and financial slippage.

So, how does it work then? Well, QSP appears simply as an icon on the desktop, so users can just click and begin the log-in process. All project boards can be managed centrally with links into risk logs, KPIs and key documents stored on the system against each project or programme. There are a range of different modules within the system that can be utilised, including Project Manager Highlight reporting, Risk Logging Milestone Tracker, KPI setting, Daily Log, Programme Dashboards, Reporting and many more!

QSP has many advantages, not least giving a fast and efficient way of collecting data from projects for QIPP submissions! Just a couple of the other advantages experienced by NHS Portsmouth include:

• • • •

Instant management and view of strategic programme/project effectiveness; Improved Data Entry Time freeing Project Managers to Project Manage; Triangulation of PMO, Finance and Information together to give instant visibility on programme / project management; Document tracking allows documents to be assigned to projects to ensure one central viewpoint for all associated projects.

The QSP software has been developed by and for NHS Portsmouth but the team are very happy to share their knowledge and expertise with other NHS organisations. If would like to know more about QSP please contact Andrew Lee, Head of the Programme Management Office at NHS Portsmouth at: Andrew.Lee2@ports.nhs.uk

Page 19

NEWS

DH_117583 Quality Accounts published

Changes to Weekly Sitreps Returns The weekly sitreps return for acute trusts has now been changed—the information will now be reported on a monthly basis. This includes both the weekly sitreps main return and the delayed transfers return. The first monthly return is due to be submitted on 7th September (for the month ending 31st August) and the full guidance and timetable are available on Unify2. The ambulance trust data should continue to be submitted on a weekly basis.

New Unify2 Collection for Mental Health From September there will be a new quarterly data collection on Unify for mental health trusts. This will collect data on early intervention services, CPA and gatekeeping by crisis resolution teams, with these lines being removed from the existing OMNIBUS community teams collection. Data will be uploaded by mental health trusts and signed off by PCTs. The deadline for quarter 1 data to be uploaded by providers is 13th September with PCTs signing off by the 29th. More information will be posted on Unify on 1st September.

NHS Outcomes Framework consultation The Government’s White Paper, Equity and excellence: liberating the NHS, set out how the Secretary of State for Health will hold the NHS Commissioning Board to account for delivering better health outcomes through a national NHS Outcomes Framework. A full consultation on how the Department of Health should develop the NHS Outcomes Framework has now been launched.

The consultation document explains and asks for views on:

• • • • •

the principles that should underpin the NHS Outcomes Framework; a proposed structure and approach that could be used to develop the framework; the potential outcome indicators (existing and future) that could be presented in the framework, including the proposed rationales for selection; how the proposed NHS Outcomes Framework can support equality across all groups and can help reduce health inequalities; and how the framework can support the necessary partnership working between public health and social care services needed to deliver the best possible outcomes for patients.

The consultation closes on 11 October 2010. For further details please see the following link http:// www.dh.gov.uk/en/Consultations/Liveconsultations/

All South East Coast providers submitted Quality Accounts on time. The following link takes you to an alphabetic list of those organisations who published Quality Accounts in June 2010. http://www.nhs.uk/aboutnhschoices/professionals/ healthandcareprofessionals/quality-accounts/pages/ quality-account-documents.aspx First Vascular Access Audit report published The new audit examines the methods and timeliness of vascular access for kidney patients requiring haemodialysis.

Ten adult haemodialysis units submitted data, and the report shows that proposed methods for collecting, extracting and validating data are effective. http://www.knowledge.ic.nhs.uk/ebulletin/article.asp? item_ID=1422 Latest National Diabetes Audit published More people with diabetes are receiving the care recommended to monitor their condition, but the number receiving effective treatment as a result has stalled and the number with certain complications has increased, according to the latest Audit. http://www.knowledge.ic.nhs.uk/ebulletin/article.asp? item_ID=1425 New Lung Cancer Audit data resource now available This online resource brings together data from the last two National Lung Cancer Audit (NLCA) annual reports to provide a profile and allows comparison between organisations as well as against targets and national trends.

The initial release covers key data completeness items and headline process and outcome measures for patients first seen in 2007 and 2008. http://www.knowledge.ic.nhs.uk/ebulletin/article.asp? item_ID=1426

Welcome to Fats

Nia named woman of the match...

Hi all, my name is Fatai Ogunlayi and as announced in the June edition of Knowledge Matters, feel free to call me Fats. I am the newest member of the Quality Observatory team on a two year contract and I will be working as Quality Innovation and Productivity Analyst under the capable hands of Kate Cheema. One of my tasks in this role is to support the Enhancing Quality Programme; a programme aimed at delivering world class clinical standards within providers in South East Coast, resulting in better quality of life for patients. Prior to this, I worked for a Bio-Pharmaceutical company in Crawley as an Associate in Modelling, Strategy and Planning. I also worked with a local charity based in London and I enjoy a game of scrabble from time to time. I have been a fan of the Quality Observatory work through the newsletter and I’m excited to now be a member of the team. I have already started to learn a lot in my new role and I’m looking forward to all the challenges I will be facing. Now that you know who I am, don’t forget to say “Hi Fats” in the corridor.

On the 9th July the SEC United (girls team) and The Knights of Earlswood (boys team) participated in the HfMA 5-a-side football tournament. The Knights put on a good show and managed to go unbeaten for all their matches – unfortunately this wasn’t enough to get them into the final.

The girls team (which included the Quality Observatory’s Nia Naibheman) on the other hand returned with a trophy and medals having not scored a single goal. As they say, it is the taking part that counts and in this instance being the only girls team to make an appearance!

Hopefully next year another girls team will give them a challenge!

Fun facts about Peter Nyaga…..

Farewells….

The Quality Observatory says a fond farewell to two members of the team. Avid Arsenal fan and Informatics Graduate Trainee David Graham left the team to move on to an 8 week placement at South West London and St Georges Mental Health Trust.

David will commence his final placement at Queen Victoria Hospital NHS Foundation Trust in November. David was awarded with a chocolate football (which he ate for lunch on his last day), Arsenal football boot money box and personalised Quality Observatory mug.

This issue, we have decided to publish some fun facts about Peter who sadly left the team this month………..

Peter Nyaga has been with the team since February 2008 and has undertaken a range of work including developing and updating the A&E dashboard, providing analysis on Better Care, Better Value indicators and providing analysis on Foundation Trust performance. Peter is setting up his own business exporting used computers to Africa and is also looking forward to becoming a father later this year. Peter was awarded a ‘My daddy is a ninja’ baby-gro, a refreshing bottle of hopping hare and (of course) a personalised Quality Observatory mug.

Thanks to both of you for all of your hard work, best of luck in your new endeavours and keep in touch!

1.

Peter speaks fluent Russian

2.

Served for 5 years in the Army

3.

Regularly ate pizza with Price William during his army days

4.

Is good at cheating in pub quizzes

5.

Is a Ninja (not proven but suspected by a number of members of the team….)

Knowledge matters is the newsletter of NHS South East Coast’s Quality Observatory, to discuss any items raised in this publication, for further information or to be added to our distribution list, please contact: NHS South East Coast York House 18-20 Massetts Road Horley,Surrey, RH6 7DE Phone:

01293 778899

E-mail: Quality.Observatory@southeastcoast.nhs.uk To contact a team member: firstname.surname@southeastcoast.nhs.uk