Health Improvement Monitoring Report West Midlands Q2 2010/11

Health Improvement Monitoring Report West Midlands Quarter 2 2010/11 December 2010

2

Table of Contents 1.

Q2 2010/11 Health Improvement Performance Summary

5

2.

2.3b 2.4b 2.6

Life Expectancy Indicators – CVD Mortality (quarterly) – Cancer Mortality (quarterly) – Breast Cancer Screening Round Length

11 11 11 12

3.

3.3 3.8 3.4 3.5a 3.5b 3.5c 3.9 3.10 3.11 3.12

Child and Maternal Health – Breast Feeding Initiation – 6 To 8 Weeks Breast Feeding Prevalence – Smoking During Pregnancy – Childhood Vaccinations – DtaP IPV Hib – Childhood Vaccinations - MenC – Childhood Vaccinations - MMR – Childhood Weight Management Programmes – Completed health & social assessment before 13 weeks – Antenatal continuity of carer – Smoking in pregnancy (at booking)

13 13 14 15 16 17 18 19 20 21 22

4.

4.1 4.2 4.3

Lifestyles Indicators – Stop Smoking Returns – GUM Waiting Times – Health Trainers Service Development

23 23 24 25

5.

5.1 5.2 5.3 5.4 5.5 5.6 5.8 5.10 5.11 5.12

Long Term Conditions Indicators – Expert Patients Programme – QOF Clinical Score – Blood Pressure Management for CHD Patients – Cholesterol Management for CHD Patients – Blood Pressure Management for Stroke patients – Cholesterol Management for Stroke patients – Seizures Management for Epilepsy – Blood Pressure Management for Diabetics – Cholesterol Management for Diabetics – Blood Pressure Management for CKD Patients

26 26 27 28 29 30 31 32 33 34 35

6.

6.2 6.4 6.5

Older People Indicators – Flu Vaccinations – Falls Prevention Programmes – Falls Assessments

36 36 37 38

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7.

7.1 7.3 7.4 7.5 7.6

Primary Care Indicators – QOF Total Score – Smoking Status Recording (QOF Rec23) – Ethnicity Recording New Registrants (QOF Rec21) – Child Access to NHS Dentistry – Adult Access to NHS Dentistry

8.

Appendices Appendix A – Reporting Process and Schedule Appendix B – Data Sources and Indicative Forward Schedule Appendix C – Methods Appendix D – Editorial Group : Terms of Reference Appendix E – Purpose of the Quarterly Health Improvement Report Appendix F – PCT Responses : Corrective Action

39 39 40 41 42 43 44 44 46 48 52 53 54

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1. Q2 2010/11 Health Improvement Performance Summary The table below summarises the alert assessments given for each indicator Alerts symbols used:

Data not submitted or failed quality check

Trend:

performance is significantly higher than their Current latest baseline average

Trend:

performance is significantly lower than their Current latest baseline average

Target

Current performance is below target trajectory

WM Average:



WM Average:

Significantly above the West Midlands average

Worcestershire

Wolverhampton

Warwickshire

Walsall

Significantly below the West Midlands average

Telford & Wrekin

North Staffordshire

Herefordshire

Dudley

Coventry

Indicator 2

Birmingham East & North

Appendix C.

Heart of Birmingham

Appendix F. The methods used to assign alerts to PCTs are detailed in

Stoke-on-Trent

Responses are presented in

South Staffordshire

from best practice their PCT has developed.

South Birmingham

performance would be helpful or where they feel that other PCTs may benefit

Solihull

wish to respond to other alerts where you believe an explanation of their

Data:

Shropshire

 or with data quality  problems. PCTs may also

Sandwell

indicators below target

West Midlands

and PCT. PCTs are required to respond with corrective action for instances of

Life Expectancy

2.3b

CVD Mortality (Quarterly)

Not Rated

2.4b

Cancer Mortality (Quarterly)

Not Rated

5

2.6 3

3.3

Breast Cancer Screening Round Length Child and Maternal Health

Breast Feeding Initiation

West Midlands

Worcestershire

Wolverhampton

Warwickshire

Walsall

Telford & Wrekin

Stoke-on-Trent

South Staffordshire

South Birmingham

Solihull

Shropshire

Sandwell

North Staffordshire

Herefordshire

Heart of Birmingham

Dudley

Coventry

Birmingham East & North

Indicator

               

3.5a

Childhood Vaccinations - DtaP IPV Hib

3.5b

Childhood Vaccinations - MenC

                                                            

Childhood Vaccinations - MMR

        

3.8

6-8 Week Breast Feeding Prevalence

3.4

Smoking During Pregnancy (SATOD)

3.5c

6

3.9

Childhood Weight Management Programmes

3.10

KPI1a - Completed health and social assessment <13weeks

3.11

KPI2 - Antenatal continuity of carer

3.12 4

KPI 4: Smoking in pregnancy (at booking) Lifestyles

4.1

Smoking Cessation Service Activity

4.2

GUM Waiting Times

4.3 5

Health Trainers Service Development Long Term Conditions

West Midlands

Worcestershire

Wolverhampton

Warwickshire

Walsall

Telford & Wrekin

Stoke-on-Trent

South Staffordshire

South Birmingham

Solihull

Shropshire

Sandwell

North Staffordshire

Herefordshire

Heart of Birmingham

Dudley

Coventry

Birmingham East & North

Indicator

                                                                    7

5.1

Expert Patients Programmes

5.2

QOF Clinical Score

5.3

Blood Pressure Management for CHD Patients (QOF CHD6)

5.4

Cholesterol Management for CHD Patients (QOF CHD8)

5.5

Blood Pressure Management for Stroke Patients (QOF Str6)

5.6

Cholesterol Management for Stroke Patients (QOF Str8)

5.8

Seizures Management for Epilepsy (QOF EPIL8)

5.10

Blood Pressure Management for Diabetics (QOF DM12)

West Midlands

Worcestershire

Wolverhampton

Warwickshire

Walsall

Telford & Wrekin

Stoke-on-Trent

South Staffordshire

South Birmingham

Solihull

Shropshire

Sandwell

North Staffordshire

Herefordshire

Heart of Birmingham

Dudley

Coventry

Birmingham East & North

Indicator

                                                                                         8

5.11

Cholesterol Management for Diabetics (QOF DM17)

5.12

Blood Pressure Management CKD Patients (QOF CKD3)

6

West Midlands

Worcestershire

Wolverhampton

Warwickshire

Walsall

Telford & Wrekin

Stoke-on-Trent

South Staffordshire

South Birmingham

Solihull

Shropshire

Sandwell

North Staffordshire

Herefordshire

Heart of Birmingham

Dudley

Coventry

Birmingham East & North

Indicator

             

Older People

6.2

Flu Vaccination Rates

6.4

Falls Prevention Training Programmes

               

Falls Assessments

          

6.5 7

Primary Care

7.1

QOF Total Score

7.3

Smoking Status Recording (QOF Rec23)

        9

7.4

Ethnicity Recording (QOF Rec21)

7.5

Child Access to NHS Dentistry

7.6

Adult Access to NHS Dentistry

West Midlands

Worcestershire

Wolverhampton

Warwickshire

Walsall

Telford & Wrekin

Stoke-on-Trent

South Staffordshire

South Birmingham

Solihull

Shropshire

Sandwell

North Staffordshire

Herefordshire

Heart of Birmingham

Dudley

Coventry

Birmingham East & North

Indicator

          

10

2. Life Expectancy Indicators 2.3b

– CVD Mortality (quarterly)

West Midlands– Apr – Jun 2010 This indicator measures the number of deaths for cardio-vascular disease under the age of 75 that occur each quarter. The data is adjusted to take account of seasonal variations in cardio-vascular deaths. The indicator gives a more up-to-date picture of progress towards the 2010 PSA target on cardio-vascular mortality. Data Source: ONS monthly PHMF



Not Rated

There were 962 (equivalent to 934 seasonally adjusted) under 75's deaths from CVD in the West Midlands in Apr – Jul 2009.

2.4b

– Cancer Mortality (quarterly) West Midlands– Apr – Jun 2010

This indicator measures the number of deaths for cancer under the age of 75 that occur each quarter. The data is adjusted to take account of seasonal variations in cancer deaths. The indicator gives a more up-to-date picture of progress towards the 2010 PSA target on cancer mortality. Data Source: ONS monthly PHMF



Not Rated

There were 1674 (equivalent to 1688 seasonally adjusted) under 75's deaths from CVD in the West Midlands in Apr – Jul 2009.

11

2.6

Alerts

– Breast Cancer Screening Round Length

Data:



Trend:



Target:



WM Average:



West Midlands– Jul-Sep 10 This indicator measures the percentage of eligible women who are invited for breast screening within 36 months of their previous invitation. Along with screening uptake (the proportion of women invited who attend), round length has a major influence on screening coverage. The national minimum standard for breast cancer round length is for 90% of eligible women to be invited for screening every 36 months. Trend data shown is from the first completed screening round following the expansion of services to women aged 50-70 and is for the services rather than residents. Data Source: Breast Screening Quality Assurance Reference Centre www.wmpho.org.uk/wmciu   



The West Midlands percentage of women offered screening within 36 months for Jul-Sep 10 was 96.2%.

Current performance is significantly higher than the latest baseline average (i.e. above the upper control limits for trend).

Current performance is above the target trajectory of 90.0%.

Of the 8 screening units, 6 were better than and 2 were worse than expected from the West Midlands average.

Funnel Key: 1. City, Sandwell & Walsall Screening Unit 2. Dudley & Wolverhampton Screening Unit 3. Hereford & Worcester Screening Unit 4. North Staffordshire Screening Unit 5. Shropshire Screening Unit 6. South Birmingham Screening Unit 7. South Staffordshire Screening Unit 8. Warwickshire, Solihull & Coventry Screening Unit

12

3. Child and Maternal Health 3.3

Alerts

– Breast Feeding Initiation West Midlands – Jul-Sep 10

This indicator measures the proportion of mothers who are known to initiate breastfeeding out of all maternities. It is anticipated that the breastfeeding status of 95% of new mothers will be established. There is a national target to increase breastfeeding initiation rates by 2 percentage points per annum. Data Source: LDPR-C & VSMR-C via Unify2

 



The West Midlands breastfeeding initiation rate for Jul-Sep 10 was 66.6%.

Current performance is significantly higher than the latest baseline average (i.e. above the upper control limits for trend).

Of the 17 PCTs, 5 were better than and 4 were worse than expected from the West Midlands average.

Funnel Key: 1. Birmingham East & North 2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

Data:



Trend:



Target:



WM Average:



9. Solihull 10. South Birmingham 11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

13

Alerts

3.8 – 6 To 8 Weeks Breast Feeding Prevalence

Data:



Trend:



Target:



WM Average:



West Midlands– Jul-Sep 10 This indicator measures the number of infants that are totally or partially breastfed at 6-8 weeks as a proportion of all infants that are due for a check at 6-8 weeks. It is anticipated that the breastfeeding status of 85% of new mothers will be established. This is a Vital Signs indicator. Data Source: VSMR-C via Unify2 Funnel Key: 1. Birmingham East & North

9. Solihull 10. South Birmingham

2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

Jul-Sep 10 PCT Data

Baseline (used for average) Anomaly (not used in average) 3 Sigma Control Limit

Average (mean) 3 Sigma Control Limit 5

Percentage of Mothers Breastfeeding at 6-8 Weeks

46.0 41.0

36.0 31.0

26.0 21.0

Jul-Sep 10

Jul-Sept 09

Apr-Jun 09

Jan-Mar 09

Oct-Dec 08

Jul-Sept 08

Period

10

46.0

1 4

41.0

9 8

36.0

13

31.0

17 15

2

16

11

6 12 3 14

26.0 21.0

7

16.0

16.0 Apr-Jun 08

Percentage of Mothers Breastfeeding at 6-8 Weeks

West Midlands Current Value (not used in average) Data Problem (not used in average) Average Target

Apr-Jun 10



Jan-Mar 10



The West Midlands breastfeeding 6-8 week prevalence rate for Jul-Sep 10 was 36.9%.

Current performance is not significantly different to the latest baseline average (i.e. within the control limits for trend).

Current performance is below the target trajectory of 39.7%.

Of the 17 PCTs, 6 were better than and 4 were worse than expected from the West Midlands average.

Oct-Dec 09

 

0

500 1000 1500 No. of Baby Health Checks Due

2000

14

Alerts

3.4 – Smoking During Pregnancy

Data:



Trend:



Target:



WM Average:



West Midlands – Apr-Jun 10 This indicator measures the number of mothers who smoke at the time of delivery as a proportion of mothers with known status. It is anticipated that the smoking status of 95% of new mothers will be established. There is a national target to reduce smoking during pregnancy rates by 1 percentage point per annum. Data Source: LDPR-C via Unify2 & Omnibus HSCIC Funnel Key:

Apr-Jun 10 PCT Data Average (mean) 3 Sigma Control Limit

Percentage of Mothers Smoking at Time of Delivery

13

20.0

15.0

10.0

25.0 14

Apr-Jun 10

Jan-Mar 10

Oct-Dec 09

Jul-Sep 09

Apr-Jun 09

July-Sept 08

Apr-Jun 08

Jan-Mar 08

Oct-Dec 07

Jul-Sept 07

Apr-Jun 07

Jan-Mar 07

Oct-Dec 06

Jul-Sept 06

12

20.0 16 6 9 8 5

15.0

3

2 10 7

11 15 117

10.0 4

5.0

5.0

Period

9. Solihull 10. South Birmingham 11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

1. Birmingham East & North 2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

Baseline (used for average) Anomaly (not used in average) 3 Sigma Control Limit

25.0

Apr-Jun 06

Percentage of Mothers Smoking at Time of Delivery

West Midlands Current Value (not used in average) Data Problem (not used in average) Average Target

Jan-Mar 09



The West Midlands rate of smoking at time of delivery for Apr-Jun 10 was 15.6%.

Current performance is not significantly different to the latest baseline average (i.e. within the control limits for trend).

Of the 17 PCTs, 3 were worse than and 1 was better than expected from the West Midlands average.

Oct-Dec 08

 

0

500 1000 1500 No. of Mothers with Known Smoking Status

2000

15

3.5a

Alerts

– Childhood Vaccinations – DtaP IPV Hib

Data:



Trend:



Target:



WM Average:



West Midlands– Apr-Jun 10 This indicator measures the proportion of children aged 2 years that have received all vaccinations for diphtheria, tetanus, pertussis, polio and haemophilus influenzae type b as set out in the national immunisations schedule. The WHO target for childhood vaccination coverage is 95%. This indicator forms part of a Vital Signs indicator. Data Source: HPA COVER

West Midlands Current Value (not used in average) Data Problem (not used in average) Average Target

Funnel Key: 1. Birmingham East & North 2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

PCT Data Average (mean)

96.0 95.0 94.0 93.0 92.0

91.0 Apr-Jun 10

Jan-Mar 10

Oct-Dec 09

Jul-Sep 09

Apr-Jun 09

Jan-Mar 09

Oct-Dec 08

Jul-Sept 08

Apr-Jun 08

Jan-Mar 08

Oct-Dec 07

90.0

Period

9. Solihull 10. South Birmingham 11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

Apr-Jun 10

Baseline (used for average) Anomaly (not used in average) 3 Sigma Control Limit

Percentage of Children Aged 2 Immunised against DTaP IPV Hib

97.0

Jul-Sept 07

Percentage of Children Aged 2 Immunised against DTaP IPV Hib



Apr-Jun 07



Jan-Mar 07



The West Midlands percentage of children aged 2 immunised for DTaP IPV Hib for Apr-Jun 10 was 96.9%.

Current performance is significantly higher than the latest baseline average (i.e. above the upper control limits for trend).

Current performance is above the target trajectory of 90.0%.

Of the 17 PCTs, 3 were better than and 1 was worse than expected from the West Midlands average.

Oct-Dec 06



3 Sigma Control Limit 15 2 6 8 14 13 9 4 12

99.0 98.0 97.0

11

3 10

5

96.0

7

17 1

95.0 94.0 93.0 16

92.0 0

500 1000 1500 Population Children Aged 2

2000

16

3.5b

Alerts

– Childhood Vaccinations - MenC

Data:



Trend:



Target:



WM Average:



West Midlands– Apr-Jun 10 This indicator measures the proportion of children aged 2 years that have received all vaccinations for meningitis C as set out in the national immunisations schedule. The WHO target for childhood vaccination coverage is 95%. This indicator forms part of a Vital Signs indicator. Data Source: HPA COVER

West Midlands Current Value (not used in average) Data Problem (not used in average) Average Target

Funnel Key:

Apr-Jun 10 PCT Data Average (mean) 3 Sigma Control Limit

Percentage of Children Aged 2 Immunised against MenC

99.0

95.0 94.0 93.0 92.0

91.0

6

98.0

Apr-Jun 10

Jan-Mar 10

Oct-Dec 09

Jul-Sep 09

Apr-Jun 09

Jan-Mar 09

Oct-Dec 08

Jul-Sept 08

Apr-Jun 08

Jan-Mar 08

Oct-Dec 07

Jul-Sept 07

Apr-Jun 07

Jan-Mar 07

Jan-Mar 06

15

14 2

98

97.0 96.0

513

7 4

312

11 17

95.0 94.0

10

93.0

1

92.0 16

91.0

90.0

Period

9. Solihull 10. South Birmingham 11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

1. Birmingham East & North 2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

Baseline (used for average) Anomaly (not used in average) 3 Sigma Control Limit

96.0

Oct-Dec 05

Percentage of Children Aged 2 Immunised against MenC

97.0

Oct-Dec 06



Jul-Sept 06



The West Midlands percentage of children aged 2 immunised for MenC for Apr-Jun 10 was 96.0%.

Current performance is significantly higher than the latest baseline average (i.e. above the upper control limits for trend).

Current performance is above the target trajectory of 90.0%.

Of the 17 PCTs, 5 were better than and 3 were worse than expected from the West Midlands average.

Apr-Jun 06

 

0

500 1000 1500 Population Children Aged 2

2000

17

3.5c

Alerts

– Childhood Vaccinations - MMR

Data:



Trend:



Target:



WM Average:



West Midlands– Apr-Jun 10 This indicator measures the proportion of children aged 2 years that have received all vaccinations for measles, mumps and rubella as set out in the national immunisations schedule. The WHO target for childhood vaccination coverage is 95%. This indicator forms part of a Vital Signs indicator. Data Source: HPA COVER & VS Targets Funnel Key:

Apr-Jun 10 PCT Data

Percentage of Children Aged 2 Immunised against MMR

Average (mean)

91.0 89.0 87.0 85.0

3 Sigma Control Limit 2 15

96.0 6

94.0

Apr-Jun 10

Jan-Mar 10

Oct-Dec 09

Jul-Sep 09

Apr-Jun 09

Apr-Jun 08

Jan-Mar 08

Oct-Dec 07

Jul-Sept 07

Apr-Jun 07

Jan-Mar 07

Oct-Dec 06

Jul-Sept 06

Apr-Jun 06

Jan-Mar 06

14

13

8

92.0

12

4

3

90.0

17

9

88.0 107

86.0

11

1

16

5

84.0

83.0

Period

9. Solihull 10. South Birmingham 11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

1. Birmingham East & North 2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

Baseline (used for average) Anomaly (not used in average) 3 Sigma Control Limit

93.0

Oct-Dec 05

Percentage of Children Aged 2 Immunised against MMR

West Midlands Current Value (not used in average) Data Problem (not used in average) Average Target

Jan-Mar 09



Oct-Dec 08



The West Midlands percentage of children aged 2 immunised for MMR for Apr-Jun 10 was 90.9%.

Current performance is not significantly different to the latest baseline average (i.e. within the control limits for trend).

Current performance is below the target trajectory of 93.1%.

Of the 17 PCTs, 6 were better than and 5 were worse than expected from the West Midlands average.

Jul-Sept 08

 

0

500 1000 1500 Population Children Aged 2

2000

18

3.9

Alerts

– Childhood Weight Management Programmes

Data:



Trend:



Target:



WM Average:



West Midlands – Jul-Sept 10 This indicator measures how many children complete a structured weight management programme compared to the estimated prevalence of obesity in each PCT. The denominator is currently estimated from the sex-specific prevalence of obesity seen in Reception and Year 6 children (NCMP) extrapolated to other ages in each PCT. Data Source: PCT Returns, IC, ONS

West Midlands Current Value (not used in average) Data Problem (not used in average) Average Target

9. Solihull 10. South Birmingham

2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

Jul-Sept 10 PCT Data Average (mean)

100.0 80.0 60.0

40.0 20.0 Jul-Sept 10

Apr-Jun 10

Jan-Mar 10

Oct-Dec 09

0.0 Jul-Sept 09

1. Birmingham East & North

Baseline (used for average) Anomaly (not used in average) 3 Sigma Control Limit

120.0

Period

Funnel Key:

Completions per 10,000 Obese Children 4-18

140.0

Apr-Jun 09

Completions per 10,000 Obese Children 4-18



Jan-Mar 09



The West Midlands children completing weight management programme for Jul-Sept 10 was 20.8 per 10,000.

Current performance is significantly lower than the latest baseline average (i.e. below the lower control limits for trend).

Of the 17 PCTs, 3 were better than and 8 were worse than expected from the West Midlands average.

Oct-Dec 08



3 Sigma Control Limit 2

140.0

120.0 100.0 80.0 60.0 6

40.0

12

20.0 13 59

0.0 0

16 3

14 104 7 8

1 15 17

11

10000 20000 30000 Estimated number of Obese Children 4-18

19

3.10

Alerts

– Completed health & social assessment before 13 weeks

Data:



Trend:



Target:



WM Average:



West Midlands – Apr-Jun 10 Early booking - This indicator measures how many women have a completed health and social care assessment of needs, risks and choices by 12 completed weeks of pregnancy (national vital signs definition) for each PCT.

Data Source: Perinatal Institute

  



The West Midlands Completed health & social assessment before 13 weeks for Apr-Jun 10 was 84.6%.

Current performance is significantly higher than the latest baseline average (i.e. above the upper control limits for trend).

Current performance is above the target trajectory of 80.0%.

Of the 17 PCTs, 4 were better than and 3 were worse than expected from the West Midlands average.

West Midlands Current Value (not used in average) Data Problem (not used in average) Average Target

Funnel Key: 1. Birmingham East & North

9. Solihull 10. South Birmingham

2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

Apr-Jun 10

Baseline (used for average) Anomaly (not used in average) 3 Sigma Control Limit

PCT Data Average (mean)

92.0

Percentage Completion

90.0

82.0 80.0 78.0 76.0 74.0

12 16

88.0 86.0

8

84.0 82.0

9 13

80.0

Apr-Jun 10

Jan-Mar 10

Oct-Dec 09

Jul-Sept 09

Period

10

14 17

1

3

5

76.0

4

72.0

72.0

2

7

78.0 74.0

Apr-Jun 09

Percentage Completion

84.0

3 Sigma Control Limit 15 11

6

0

500 1000 1500 Cases with Required Data

2000

20

3.11

Alerts

– Antenatal continuity of carer West Midlands – Apr-Jun 10

Continuity of carer - This indicator measures how many women received 75% of their antenatal visits in the primary care setting with the same midwife for each PCT.

Data Source: Perinatal Institute

  



The West Midlands Antenatal continuity of carer for Apr-Jun 10 was 37.6%.

Current performance is not significantly different to the latest baseline average (i.e. within the control limits for trend).

Current performance is below the target trajectory of 75.0%.

Of the 17 PCTs, 7 were better than and 7 were worse than expected from the West Midlands average.

Funnel Key:

Data:



Trend:



Target:



WM Average:



1. Birmingham East & North

9. Solihull 10. South Birmingham

2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

21

3.12

Alerts

– Smoking in pregnancy (at booking) West Midlands – Apr-Jun 10

Smoking in pregnancy - This indicator measures the number of women smoking at Booking.

Data Source: Perinatal Institute

 



The West Midlands Smoking in pregnancy (at booking) for Apr-Jun 10 was 18.3%.

Current performance is not significantly different to the latest baseline average (i.e. within the control limits for trend).

Of the 17 PCTs, 3 were worse than and 1 was better than expected from the West Midlands average.

Funnel Key:

Data:



Trend:



Target:



WM Average:



1. Birmingham East & North

9. Solihull 10. South Birmingham

2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

y

22

4. Lifestyles Indicators Alerts

4.1 – Stop Smoking Returns West Midlands – Jun-10 This indicator measures the number of smokers supported to stop smoking for at least 4 weeks by NHS Stop Smoking Services per 10,000 adults. Stop smoking services are one of the most cost effective services delivered by the NHS. This is a Vital Signs indicator.

Data Source: NHS Information Centre www.ic.nhs.uk

  



The West Midlands rate of smoking cessation for Jun-10 was 185.7 per 100,000.

Current performance is significantly higher than the latest baseline average (i.e. above the upper control limits for trend).

Current performance is below the target trajectory of 202.4 per 100,000.

Of the 17 PCTs, 6 were better than and 7 were worse than expected from the West Midlands average.

Funnel Key:

Data:



Trend:



Target:



WM Average:



1. Birmingham East & North

9. Solihull 10. South Birmingham

2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

23

Alerts

4.2 – GUM Waiting Times

Data:



Trend:



Target:



WM Average:



West Midlands – Sep-10 This indicator measures the proportion of patients attending GUM clinics who are offered an appointment to be seen within 48 hours of contacting a service. From April 2008 all patients should be offered an appointment to be seen within 48 hours. Data Source: GUMAMM via Unify2

 



The West Midlands percentage of GUM patients offered 1st appointment within 48hrs for Sep-10 was 98.9%.

Current performance is significantly lower than the latest baseline average (i.e. below the lower control limits for trend).

Current performance is above the target trajectory of 95.0%.

Of the 17 PCTs, 8 were better than and 2 were worse than expected from the West Midlands average.

1. Birmingham East & North

9. Solihull 10. South Birmingham

2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

Sep-10 PCT Data

Baseline (used for average) Anomaly (not used in average) 3 Sigma Control Limit

100.0 95.0 90.0 85.0 80.0 75.0 70.0 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 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 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10

Percentage of GUM patients offered 1st appointment within 48hrs

West Midlands Current Value (not used in average) Data Problem (not used in average) Average Target

Funnel Key:

Average (mean)

Percentage of GUM patients offered 1st appointment within 48hrs



3 Sigma Control Limit

101.0 13 6 12 85

100.0 99.0

9

16

217

14 3

7

15

11

1

98.0 4

97.0 10

96.0 95.0 94.0 0

500 1000 No. of 1st Attendances

1500

Period

24

Alerts

4.3 – Health Trainers Service Development West Midlands– Jul-Sep 10 This indicator measures the number of assessments completed by the health trainer’s service per 10,000 adults with multiple lifestyle risk factors.

Recurrent resources were made available to PCTs in 2006/7 and 2007/8 to establish health trainer services as part of the Choosing Health initiative.

Data Source: TIH   



The West Midlands rate of health trainers for Jul-Sep 10 was 281.6 per 10,000.

Current performance is significantly higher than the latest baseline average (i.e. above the upper control limits for trend).

Current performance is below the target trajectory of 303.3 per 10,000.

Of the 17 PCTs, 8 were better than and 9 were worse than expected from the West Midlands average.

Funnel Key:

Data:



Trend:



Target:



WM Average:



1. Birmingham East & North

9. Solihull 10. South Birmingham

2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

25

5. Long Term Conditions Indicators Alerts

5.1 – Expert Patients Programme West Midlands – Jul-Sep 10 The indicator measures the number of patients completing the expert patients programme per 10,000 adults with a long term condition. The Expert patients programme is the leading self-care management programmes in the UK. The Government set a target to make 100,000 places on Expert Patients Programmes available per year by 2012. Data Source: PCT Returns  



The West Midlands expert patient programme rate for Jul-Sep 10 was 8.8 per 10,000.

Current performance is not significantly different to the latest baseline average (i.e. within the control limits for trend).

Of the 17 PCTs, 4 were better than and 8 were worse than expected from the West Midlands average.

Funnel Key: 1. Birmingham East & North 2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

Data:



Trend:



Target:



WM Average:



9. Solihull 10. South Birmingham 11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

26

Alerts

5.2 – QOF Clinical Score

Data:



Trend:



Target:



WM Average:



West Midlands – 2009/10 The indicator measures the GP practice average Quality and Outcomes Framework score in the clinical domain. The clinical domain contains approximately 80 indicators in 19 disease specific sub-domains. The indicators measure the extent to which GP practices identify, effectively manage and achieve positive intermediate outcomes for people with long term conditions or lifestyle risks.

98.0

1. Birmingham East & North

9. Solihull 10. South Birmingham

2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

2009/10 PCT Data

Baseline (used for average) Anomaly (not used in average) 3 Sigma Control Limit

Average (mean)

97.0 96.0 95.0 94.0 93.0

92.0 2009/10

2008/09

2007/08

91.0 2006/07

Funnel Key:

Percentage of Total Clinical QOF Scored

West Midlands Current Value (not used in average) Data Problem (not used in average) Average Target

2005/06

Percentage of Total Clinical QOF Scored



The West Midlands percentage of QOF Clinical Score achieved for 2009/10 was 96.0%.

Current performance is significantly higher than the latest baseline average (i.e. above the upper control limits for trend).

Of the 17 PCTs, 9 were better than and 6 were worse than expected from the West Midlands average.

2004/05

 

3 Sigma Control Limit

99.0 5

98.0

9

97.0

10

96.0

6

95.0

8

3

17

15 11

14 7

16

41

12

94.0 13

93.0 2

92.0 0

20000 40000 60000 Total Available Clinical Score

80000

Period

27

Alerts

5.3 – Blood Pressure Management for CHD Patients

Data:



Trend:



Target:



WM Average:



West Midlands – Sep-10 This indicator measures the percentage of patients on CHD registers whose last blood pressure reading (taken within 15 months of year end) was below 150/90 mm Hg. Results in Q1, Q2 and Q3 show performance towards a year end position. Indicator values are reset at the end of March each year. This is QOF indicator CHD6. Data Source: QMAS

West Midlands Current Value (not used in average) Data Problem (not used in average) Average Target

Funnel Key: 1. Birmingham East & North

9. Solihull 10. South Birmingham

2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

Sep-10

Baseline (used for average) Anomaly (not used in average) 3 Sigma Control Limit

PCT Data Average (mean) 3 Sigma Control Limit 12

81.0

Percentage of CHD Patients BP < 150/90mmHg

77.0

76.0 75.0 74.0 73.0 72.0 71.0 70.0

80.0 79.0 146 8

78.0

Sep-10

Sep-09

Sep-08

10 3 15

5

77.0

4

76.0 13

75.0

11

17 2 9

7

1

74.0

73.0 16

72.0

69.0 Sep-04

Percentage of CHD Patients BP < 150/90mmHg

78.0

Sep-07



Sep-06



The West Midlands percentage of CHD patients with BP<150/90mmHg (in last 15 mths) for Sep-10 was 77.3%.

Current performance is significantly higher than the latest baseline average (i.e. above the upper control limits for trend).

Of the 17 PCTs, 3 were better than and 4 were worse than expected from the West Midlands average.

Sep-05



0

5000 10000 15000 No. of Patients on CHD Register

20000

Period

28

Alerts

5.4 – Cholesterol Management for CHD Patients

Data:



Trend:



Target:



WM Average:



West Midlands – Sep-10 This indicator measures the percentage of patients on CHD registers whose last cholesterol measurement (taken within 15 months of year end) was below 5mmol/l. Results in Q1, Q2 and Q3 show performance towards a year-end position. Indicator values are reset at the end of March each year.

This is QOF indicator CHD8. Data Source: QMAS

West Midlands Current Value (not used in average) Data Problem (not used in average) Average Target

Funnel Key:

9. Solihull 10. South Birmingham 11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

1. Birmingham East & North 2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

Sep-10

Baseline (used for average) Anomaly (not used in average) 3 Sigma Control Limit

PCT Data Average (mean)

Percentage of CHD Patients Cholesterol < 5mmol/l

4

60.0 58.0 56.0 54.0 52.0

Sep-10

Sep-09

Sep-08

3 Sigma Control Limit

64.0

10 5

62.0

2

14

60.0

11

12 3

8

9 6

1517 1 7

58.0 13

56.0

16

54.0

50.0 Sep-04

Percentage of CHD Patients Cholesterol < 5mmol/l

62.0

Sep-07



Sep-06



The West Midlands percentage of hypertension patients with cholesterol <5mmol/l (in last 15 mths) for Sep-10 was 60.7%.

Current performance is significantly higher than the latest baseline average (i.e. above the upper control limits for trend).

Of the 17 PCTs, 4 were better than and 3 were worse than expected from the West Midlands average.

Sep-05



0

5000 10000 15000 No. of Patients on CHD Register

20000

Period

29

Alerts

5.5 – Blood Pressure Management for Stroke patients

Data:



Trend:



Target:



WM Average:



West Midlands – Sep-10 This indicator measures the percentage of patients on Stroke and TIA registers whose last blood pressure reading (taken within 15 months of year end) was below 150/90 mm Hg. Results in Q1, Q2 and Q3 show performance towards a year-end position. Indicator values are reset at the end of March each year. This is QOF indicator Str6. Data Source: QMAS

75.0

9. Solihull 10. South Birmingham 11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

1. Birmingham East & North 2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

Sep-10

Baseline (used for average) Anomaly (not used in average) 3 Sigma Control Limit

PCT Data Average (mean)

73.0 71.0 69.0 67.0 65.0

Sep-10

Sep-09

Sep-08

63.0 Sep-07

Funnel Key:

Percentage of Stroke and TIA Patients BP <150/90mmHg

West Midlands Current Value (not used in average) Data Problem (not used in average) Average Target

Sep-06

Percentage of Stroke and TIA Patients BP <150/90mmHg



Sep-05



The West Midlands percentage of stroke and TIA patients with BP <150/90mmHg (in last 15 mths) for Sep-10 was 74.4%.

Current performance is significantly higher than the latest baseline average (i.e. above the upper control limits for trend).

Of the 17 PCTs, 2 were better than and 2 were worse than expected from the West Midlands average.

Sep-04



3 Sigma Control Limit

79.0

12

78.0 77.0 6

76.0 14

75.0

8

5

74.0

2

73.0 72.0

13

4

9

11

10 3 7

15 17

1

71.0 16

70.0 0

5000 No. of Patients on Stroke and TIA Register

10000

Period

30

Alerts

5.6 – Cholesterol Management for Stroke patients

Data:



Trend:



Target:



WM Average:



West Midlands – Sep-10 This indicator measures the percentage of patients on Stroke and TIA registers whose last cholesterol measurement (taken within 15 months of year end) was below 5mmol/l. Results in Q1, Q2 and Q3 show performance towards a year-end position. Indicator values are reset at the end of March each year. This is QOF indicator Str8. Data Source: QMAS

PCT Data

49.0 47.0 45.0 43.0 41.0 Sep-07

39.0

Percentage of Stroke and TIA Patients Cholesterol <5mmol/l

Average (mean)

51.0

Sep-06

9. Solihull 10. South Birmingham 11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

1. Birmingham East & North 2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

Sep-10

53.0

Sep-05

Funnel Key:

Baseline (used for average) Anomaly (not used in average) 3 Sigma Control Limit

55.0

Sep-04

Percentage of Stroke and TIA Patients Cholesterol <5mmol/l

West Midlands Current Value (not used in average) Data Problem (not used in average) Average Target

Sep-10



Sep-09



The West Midlands percentage of stroke and TIA patients with cholesterol <5mmol/l (in last 15 mths) for Sep-10 was 54.6%.

Current performance is significantly higher than the latest baseline average (i.e. above the upper control limits for trend).

Of the 17 PCTs, 2 were better than and 3 were worse than expected from the West Midlands average.

Sep-08



3 Sigma Control Limit

59.0 4

58.0

10

57.0

2 3

56.0 14

55.0 54.0

6

8

5

53.0

7 9

52.0 51.0

11

12 15 1 17

16

50.0

13

49.0 0

5000 No. of Patients on Stroke and TIA Register

10000

Period

31

Alerts

5.8 – Seizures Management for Epilepsy

Data:



Trend:



Target:



WM Average:



West Midlands – Sep-10 This indicator measures the percentage of patients on epilepsy registers aged 18 and over on drug treatment for epilepsy who have been seizure free for the last 12 months recorded within the 15 months of year end. Results in Q1, Q2 and Q3 show performance towards a year-end position.

Indicator values are reset at the end of March each year. This is QOF indicator Epil8. Data Source: QMAS

49.0

9. Solihull 10. South Birmingham 11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

1. Birmingham East & North 2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

Sep-10

Baseline (used for average) Anomaly (not used in average) 3 Sigma Control Limit

PCT Data Average (mean)

47.0 45.0 43.0 41.0 39.0 37.0 35.0 Sep-10

Sep-09

33.0

Period

Funnel Key:

Percentage of Seizure Free Epilepsy Patients

West Midlands Current Value (not used in average) Data Problem (not used in average) Average Target

Sep-08

Percentage of Seizure Free Epilepsy Patients



Sep-07



The West Midlands percentage of drug treated epilepsy patients seizure free (in last 12 mths) for Sep10 was 41.0%.

Current performance is significantly higher than the latest baseline average (i.e. above the upper control limits for trend).

Of the 17 PCTs, 0 were better than and 1 was worse than expected from the West Midlands average.

Sep-06



3 Sigma Control Limit

49.0 47.0

45.0 13

43.0

5

41.0

915 6 4 1 3 8

17 7 12

16

39.0

2 14

37.0

11

10

35.0 33.0 0

1000 2000 No. of Patients on Epilepsy Register

3000

32

5.10

Alerts

– Blood Pressure Management for Diabetics

Data:



Trend:



Target:



WM Average:



West Midlands – Sep-10 This indicator measures the percentage of patients on diabetes registers whose last blood pressure reading (taken within 15 months of year end) was below 145/85 mm Hg. Results in Q1, Q2 and Q3 show performance towards a year-end position. Indicator values are reset at the end of March each year. This is QOF indicator DM12. Data Source: QMAS

West Midlands Current Value (not used in average) Data Problem (not used in average) Average Target

Funnel Key:

9. Solihull 10. South Birmingham 11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

1. Birmingham East & North 2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

Sep-10

Baseline (used for average) Anomaly (not used in average) 3 Sigma Control Limit

PCT Data Average (mean) 3 Sigma Control Limit

Percentage of Diabetes Patients with BP <148/85mmHg

74.0

68.0 66.0 64.0 62.0 60.0

58.0

12

73.0 72.0

71.0

5

Sep-10

Sep-09

Sep-08

8 614

70.0 69.0

10

15 47

17

1 11

3

68.0 13

67.0

9

66.0

2

16

65.0

56.0 Sep-04

Percentage of Diabetes Patients with BP <148/85mmHg

70.0

Sep-07



Sep-06



The West Midlands percentage of diabetes patients with BP <148/85mmHg (in last 15 mths) for Sep-10 was 69.8%.

Current performance is significantly higher than the latest baseline average (i.e. above the upper control limits for trend).

Of the 17 PCTs, 4 were better than and 5 were worse than expected from the West Midlands average.

Sep-05



0

10000 20000 No. of Patients on Diabetes Register

30000

Period

33

5.11

Alerts

– Cholesterol Management for Diabetics

Data:



Trend:



Target:



WM Average:



West Midlands – Sep-10 This indicator measures the percentage of patients on diabetes registers whose last cholesterol measurement (taken within 15 months of year end) was below 5mmol/l. Results in Q1, Q2 and Q3 show performance towards a year-end position. Indicator values are reset at the end of March each year. This is QOF indicator DM17. Data Source: QMAS Funnel Key:

Sep-10 PCT Data Average (mean) 3 Sigma Control Limit

Percentage of Diabetes Patients with Cholesterol <5mmol/l

71.0

64.0 62.0

60.0 58.0 56.0 54.0

9

69.0

5

Sep-07

Sep-06

10 3

4

11

15

67.0 65.0

12 2

8

63.0

14

1 7 17

6

61.0

13 16

59.0

52.0 Sep-05

9. Solihull 10. South Birmingham 11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

1. Birmingham East & North 2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

Baseline (used for average) Anomaly (not used in average) 3 Sigma Control Limit

66.0

Sep-04

Percentage of Diabetes Patients with Cholesterol <5mmol/l

West Midlands Current Value (not used in average) Data Problem (not used in average) Average Target

Sep-10



Sep-09



The West Midlands percentage of diabetes patients with cholesterol <5mmol/l (in last 15 mths) for Sep10 was 65.9%.

Current performance is significantly lower than the latest baseline average (i.e. below the lower control limits for trend).

Of the 17 PCTs, 7 were better than and 6 were worse than expected from the West Midlands average.

Sep-08



0

10000 20000 No. of Patients on Diabetes Register

30000

Period

34

5.12

Alerts

– Blood Pressure Management for CKD Patients

Data:



Trend:



Target:



WM Average:



West Midlands – Sep-10 This indicator measures the percentage of patients on chronic kidney disease registers whose last blood pressure reading (taken within 15 months of year end) was below 140/85 mm Hg. Results in Q1, Q2 and Q3 show performance towards a year-end position. Indicator values are reset at the end of March each year. This is QOF indicator CKD3. Data Source: QMAS



Funnel Key:

9. Solihull 10. South Birmingham 11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

1. Birmingham East & North 2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

Sep-10 PCT Data

Baseline (used for average) Anomaly (not used in average) 3 Sigma Control Limit

Average (mean) 3 Sigma Control Limit

Percentage of CKD patients BP <140/85mmHg

68.0 66.0 64.0 62.0 60.0

12

65.0 63.0

7

11

14 6 4

13

61.0

10 3 2

59.0

5

8

15 17

1

16

57.0

9

55.0 Sep-08

Sep-07

58.0 Sep-06

Percentage of CKD patients BP <140/85mmHg

West Midlands Current Value (not used in average) Data Problem (not used in average) Average Target

Sep-10



The West Midlands percentage of CKD patients with BP <148/85mmHg (in last 15 mths) for Sep-10 was 61.0%.

Current performance is significantly lower than the latest baseline average (i.e. below the lower control limits for trend).

Of the 17 PCTs, 3 were better than and 5 were worse than expected from the West Midlands average.

Sep-09



0

5000 10000 No. of Patients on CKD Register

15000

Period

35

6. Older People Indicators Alerts

6.2 – Flu Vaccinations West Midlands – 2009/10 This indicator measures the percentage of people aged over 65 who have been vaccinated for seasonal influenza. It is anticipated that PCTs will ensure that at least 85% of their practices submit data to the HPA about seasonal influenza vaccination uptake. Data Source: HPA www.hpa.org.uk  



The West Midlands percentage of over 65's immunised against flu for 2009/10 was 71.5%.

Current performance is significantly higher than the latest baseline average (i.e. above the upper control limits for trend).

Of the 17 PCTs, 8 were better than and 6 were worse than expected from the West Midlands average..

Funnel Key: 1. Birmingham East & North 2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

Data:



Trend:



Target:



WM Average:



9. Solihull 10. South Birmingham 11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

36

Alerts

6.4 – Falls Prevention Programmes

Data:



Trend:



Target:



WM Average:



West Midlands – Jul-Sep 10 This indicator measures the number of people aged 65 and over who have experienced a fall, who have completed a programme of progressive strength and balance exercises per 10,000 adults aged over 65. programmes should last at last six weeks and may comprise one-to-one or group sessions, be evidence based in falls prevention and be tailored to the individual by an appropriately trained professional. Data Source: PCT Return Funnel Key:

Jul-Sep 10 PCT Data

Rate of Falls Prevention Exercise Programmes per 10,000

Average (mean)

120.0 100.0 80.0 60.0 40.0 20.0 Jul-Sep 10

Apr-Jun 10

Jan-Mar 10

Apr-Jun 09

Jan-Mar 09

Oct-Dec 08

Jul-Sept 08

Apr-Jun 08

0.0

Period

9. Solihull 10. South Birmingham 11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

1. Birmingham East & North 2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

Baseline (used for average) Anomaly (not used in average) 3 Sigma Control Limit

140.0

Jan-Mar 08

Rate of Falls Prevention Exercise Programmes per 10,000

West Midlands Current Value (not used in average) Data Problem (not used in average) Average Target

Oct-Dec 09



The West Midlands rate of falls prevention exercise programmes for Jul-Sep 10 was 31.8 per 10,000.

Current performance is significantly lower than the latest baseline average (i.e. below the lower control limits for trend).

Of the 17 PCTs, 4 were better than and 9 were worse than expected from the West Midlands average.

Jul-Sept 09

 

4

3 Sigma Control Limit

140.0 10

120.0 100.0 13

80.0

3

60.0 40.0

6

20.0

7

1614 9 512 2

0.0 0

17

8 15 1

11

10000 20000 30000 Population Aged 65+ (Quarterly)

37

Alerts

6.5 – Falls Assessments

Data:



Trend:



Target:



WM Average:



West Midlands – Jul-Sep 10 This indicator measures the number of people aged 65 or over who have had a multidisciplinary falls assessment per 10,000 population aged 65+. A multi-disciplinary falls assessment should include a falls history review, an osteoporosis assessment and a least one more of the following components as required: medication review, home safety check, vision assessment, physiotherapist-led gait/balance/mobility assessment. Data Source: PCT Return  



The West Midlands rate of falls assessment for Jul-Sep 10 was 119.6 per 10,000.

Current performance is significantly higher than the latest baseline average (i.e. above the upper control limits for trend).

Of the 17 PCTs, 4 were better than and 9 were worse than expected from the West Midlands average.

West Midlands Current Value (not used in average) Data Problem (not used in average) Average Target

Funnel Key:

Jul-Sep 10

Baseline (used for average) Anomaly (not used in average) 3 Sigma Control Limit

PCT Data Average (mean) 13

700.0

Rate of Falls Assessment per 10,000

600.0 500.0 400.0 300.0 200.0 100.0 Jul-Sep 10

Apr-Jun 10

Jan-Mar 10

Oct-Dec 09

Jul-Sept 09

Apr-Jun 09

Jan-Mar 09

Oct-Dec 08

Jul-Sept 08

Apr-Jun 08

3 Sigma Control Limit 7

600.0 500.0 400.0 300.0 3 6 14 8 4 16 10 9 512 2 1

200.0

100.0 0.0

0.0 Jan-Mar 08

Rate of Falls Assessment per 10,000

700.0

Period

9. Solihull 10. South Birmingham 11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

1. Birmingham East & North 2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

0

15

17 11

10000 20000 30000 Population Aged 65+ (Quarterly)

38

7. Primary Care Indicators Alerts

7.1 – QOF Total Score West Midlands – 2009/10 The indicator measures the GP practice average Quality and Outcomes Framework score. The Quality and Outcomes Framework is a set of indicators in four domains (clinical, organisational, patient experience and additional services) for which GP practices receive financial incentives. The Framework forms part of the GMS contract.  



The West Midlands percentage of QOF Total Score achieved for 2009/10 was 93.8%.

Current performance is significantly higher than the latest baseline average (i.e. above the upper control limits for trend).

Of the 17 PCTs, 9 were better than and 7 were worse than expected from the West Midlands average.

Funnel Key: 1. Birmingham East & North 2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

Data:



Trend:



Target:



WM Average:



9. Solihull 10. South Birmingham 11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

39

Alerts

7.3 – Smoking Status Recording (QOF Rec23)

Data:



Trend:



Target:



WM Average:



West Midlands – Sep-10 This indicator measures percentage of patients aged over 15 years whose smoking status has been recorded within 27 months of year. The smoking status of non-smokers aged 25 and over and ex-smokers who have not smoked for at least 3 years need only be recorded once and thereafter only should their smoking status change. Results in Q1, Q2 and Q3 show performance towards a year end position. Indicator values are reset at the end of March each year. This was formally QOF indicator Rec22 and is now Rec23. Data Source: QMAS   

Funnel Key:

Of the 17 PCTs, 6 were better than and 7 were worse than expected from the West Midlands average.

West Midlands Current Value (not used in average) Data Problem (not used in average) Average Target

9. Solihull 10. South Birmingham 11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

1. Birmingham East & North 2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

Sep-10

Baseline (used for average) Anomaly (not used in average) 3 Sigma Control Limit

PCT Data Average (mean) 3 Sigma Control Limit

84.0

Percentage of Patients with known Smoking Status

78.0 76.0 74.0 72.0 70.0 68.0 66.0

83.0

16

Sep-10

Sep-09

Sep-08

Sep-07

14 6

12

7 15

82.0 81.0 5

94

3 10

80.0 13

79.0

2

1 17

11

8

78.0

64.0 Sep-06

Percentage of Patients with known Smoking Status

80.0

0

100000 200000 300000 400000 500000 No. of Patients Registered

Period

40

Alerts

7.4 – Ethnicity Recording New Registrants (QOF Rec21)

Data:



Trend:



Target:



WM Average:



West Midlands – Sep-10 This indicator measures the proportion of patient who have registered with GP practices since April 2006 who have had their ethnicity recorded.

Patients who refuse to divulge their ethnicity can be recorded as such and will therefore not effect the practice’s or PCT’s result. This is QOF indicator Rec21. Data Source: QMAS

West Midlands Current Value (not used in average) Data Problem (not used in average) Average Target

9. Solihull 10. South Birmingham 11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

1. Birmingham East & North 2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

Sep-10 PCT Data

Percentage of Newly Registered with Recorded Ethnicity

Average (mean)

90.0 85.0 80.0 75.0 70.0

65.0 Sep-10

3 Sigma Control Limit 12 7 14

4

99.0

6

9

97.0

5

3 2

95.0

10 11 1

93.0 13

91.0

8

89.0 17 16

87.0

60.0 Sep-06

Percentage of Newly Registered with Recorded Ethnicity

95.0

Funnel Key:

Baseline (used for average) Anomaly (not used in average) 3 Sigma Control Limit

Sep-09



Sep-08



The West Midlands percentage of newly registered patients with recorded ethnicity for Sep-10 was 94.4%.

Current performance is significantly higher than the latest baseline average (i.e. above the upper control limits for trend).

Of the 17 PCTs, 10 were better than and 6 were worse than expected from the West Midlands average.

Sep-07



0

15

50000 100000 Newly Registered Patients

150000

Period

41

Alerts

7.5 – Child Access to NHS Dentistry

Data:



Trend:



Target:



WM Average:



West Midlands – Apr-10 This indicator measures the proportion of children (aged under 18) who have seen an NHS dentist in the 24 months. Data on the number of people seen are calculated on a provider basis (i.e. activity is assigned to the PCT to which the dentist is contracted) whereas population is calculated on a resident basis. This indicator forms part of a Vital Signs indicator. Data Source: HSCIC www.ic.nhs.uk  



The West Midlands percentage of children accessing NHS dentistry for Apr-10 was 69.2%.

Current performance is significantly higher than the latest baseline average (i.e. above the upper control limits for trend).

Of the 17 PCTs, 10 were better than and 7 were worse than expected from the West Midlands average.

West Midlands Current Value (not used in average) Data Problem (not used in average) Average Target

80.0

Funnel Key:

Apr-10

Baseline (used for average) Anomaly (not used in average) 3 Sigma Control Limit

PCT Data Average (mean) 3 Sigma Control Limit

80.0

13

78.0

Percentage of children accessing NHS dentistry

78.0 76.0 74.0 72.0 70.0 68.0 66.0 64.0

74.0

Apr-10

Jan-10

Oct-09

Jul-09

Apr-09

Jan-09

Oct-08

Jul-08

Apr-08

Jan-08

Oct-07

Jul-07

Apr-07

10 2

11 15

68.0 5

66.0

4

64.0 60.0

Jan-07

8

70.0

60.0 Oct-06

12

72.0

62.0 Jul-06

7

6 16

76.0

62.0 Apr-06

Percentage of children accessing NHS dentistry

9. Solihull 10. South Birmingham 11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

1. Birmingham East & North 2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

17 1

14 3 9

0

50000 100000 Population Under 18

150000

Period

42

Alerts

7.6 – Adult Access to NHS Dentistry

Data:



Trend:



Target:



WM Average:



West Midlands – Apr-10 This indicator measures the proportion of adults (aged 18 and over ) who have seen an NHS dentist in the 24 months. Data on the number of people seen are calculated on a provider basis (i.e. activity is assigned to the PCT to which the dentist is contracted) whereas population is calculated on a resident basis. This indicator forms part of a Vital Signs indicator. Data Source: HSCIC www.ic.nhs.uk  



The West Midlands percentage of adults accessing NHS dentistry for Apr-10 was 53.7%.

Current performance is not significantly different to the latest baseline average (i.e. within the control limits for trend).

Of the 17 PCTs, 9 were better than and 8 were worse than expected from the West Midlands average.

West Midlands Current Value (not used in average) Data Problem (not used in average) Average Target

Funnel Key:

Apr-10

Baseline (used for average) Anomaly (not used in average) 3 Sigma Control Limit

PCT Data Average (mean) 3 Sigma Control Limit 7

66.0

Percentage of Adults accessing NHS dentistry

66.0

61.0 56.0

51.0 46.0

Apr-10

Jan-10

Oct-09

Jul-09

Apr-09

Jan-09

Oct-08

Jul-08

Apr-08

Jan-08

Oct-07

Jul-07

Apr-07

Jan-07

Oct-06

Jul-06

16

13

61.0

12 32 10 1

56.0

4 6 14

51.0 5

15 11

8 17

46.0 9

41.0

41.0 Apr-06

Percentage of Adults accessing NHS dentistry

9. Solihull 10. South Birmingham 11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

1. Birmingham East & North 2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

0

200000 400000 Population Over 18

600000

Period

43

8. Appendices Appendix A â&#x20AC;&#x201C; Reporting Process and Schedule Quarterly Health Improvement reports will be produced and considered according to the following process; Weeks after end of Quarter 1

2

3

4

5

6

7

8

9

10+

Draft report prepared Report sent to PCTs Chief Execs and Wider Group PCTs Chief Execs consult wider group and respond to SHA SHA amend report and present to monthly Chief Execs meeting SHA bring report to SHA Board

PCT Chief Execs

Chief Execs Monthly Meeting

SHA BOARD

SHA Wider Group 44

PCTs will be asked to submit a response to the draft report setting out inaccuracies in the report improvements in performance since the end of the quarter and activity planned or in place to address any alerts. These response will be appended to the end o the final version of the report that will be taken to the NHSWM public Board meeting.

Reports will be issued according to the following timetable;

End of Q

Editorial Group Meeting Draft Report Issued to PCTs PCT Response Deadline Final Report Issued

30/06/2010

26/07/2010

02/08/2010

20/08/2010

03/09/2010

30/09/2010

25/10/2010

01/11/2010

19/11/2010

03/12/2010

31/12/2010

24/01/2011

31/01/2011

18/02/2011

04/03/2011

31/03/2011

25/04/2011

02/05/2011

20/05/2011

03/06/2011

45

Appendix B – Data Sources and Indicative Forward Schedule 09/10 Domain

Indicator

No

Source

Freq Q1

Life Expectancy All Cause All Age Mortality

Child & Maternal health

2.1

ONS Annual Deaths & PCT Quinary mid year populations

Q2

Q3

Q4



A

2.7 3.1 3.2 3.3 3.8 3.4 3.5 3.6 3.7 3.9

ONS Annual Deaths, ONS PCT Quinary mid year populations & DCLG IMD 2007 ONS Annual Deaths & PCT Quinary mid year populations PHMF ONS Annual Deaths & PCT Quinary mid year populations PHMF HSCIC West Midlands Breast Screening QA Reference Centre HSCIC ONS Annual Deaths & Births ONS Annual Deaths & Births LDPR-C & VSMR-C VSMR-C LDPR-C & HSCIC HPA COVER HSCIC / NCMP Dental Epi Survey PCT Returns

A A A Q Q Q Q A 2A Q

   

   









3.10

Perinatal Institute

Q









3.11 3.12

Perinatal Institute Perinatal Institute

Q Q

 

 

 

 

Inequalities in Mortality

2.2

CVD Mortality (3yr pooled)

2.3a

CVD Mortality (quarterly)

2.3b

Cancer Mortality (3yr pooled)

2.4a

Cancer Mortality (Quarterly) Breast Cancer Screening Coverage

2.4b 2.5

Breast Cancer Screening Round Length

2.6

Cervical Cancer Screening Coverage Infant Mortality Perinatal Mortality Breast Feeding Initiation Breast Feeding 6 to 8 Week Prevalence Smoking During Pregnancy Childhood Vaccinations Childhood Height and Weight Measurement Child Dental Health Childhood Weight Management Programmes Completed Health & Social Assessment before 13 weeks Antenatal Continuity of Carer Smoking in Pregnancy (at booking)

A

 

A Q











A Q A







 

Q









       

   

46

09/10 Domain Lifestyles

Indicator

Smoking Cessation Service Activity GUM Waiting Times Health Trainers Teenage Conceptions Incidence of STIs Long Term Expert Patients Programme Conditions QOF Clinical score Blood pressure mgt for CHD patients Cholesterol mgt for CHD patients Blood pressure mgt for Stroke patients Cholesterol mgt for Stroke patients Blood pressure mgt for hypertension patients Seizures mgt for epilepsy Blood pressure mgt for diabetics Cholesterol mgt for diabetics Blood pressure mgt CKD patients Older Excess Winter Deaths People Flu Vaccination Ambulance Calls to Falls Fall Prevention Programmes Falls Assessments Pneumococcal Vaccination Primary QOF Total score Care BMI Recording Smoking Status recording Ethnicity Recording – New Registrants Child Access to NHS Dentistry Adult Access to NHS Dentistry

No 4.1 4.2 4.3 4.4 4.5 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.10 5.11 5.12 6.1 6.2 6.3 6.4 6.5 6.6 7.1 7.2 7.3 7.4 7.5 7.6

Source SS Returns GUMAMM via Unify2 TIH TPU HPA PCT Return QMAS QMAS QMAS QMAS QMAS QMAS QMAS QMAS QMAS QMAS ONS Annual Deaths HPA WMAS PCT Return PCT Return HPA QMAS HSCIC QMAS QMAS HSCIC HSCIC

Freq Q Q Q A Q M A M M M M M M M M M A A Q Q Q A A Q M M Q Q

Q1

Q2

Q3

Q4

  

  

   

  





         

        

  

 

    

    

   

      

   

   



  

 

    

     

47

Appendix C â&#x20AC;&#x201C; Methods Control Charts Indicators have been presented where possible by two different views utilising Statistical Process Control (SPC) methodology. A p-chart has been used to look at the trend of the indicator in each individual PCT whilst a funnel chart has been used to compare between PCTs in the West Midlands for the most recent data.

P-Charts These are charts showing the trend of proportions. In these charts the final point is assessed against control limits set around the baseline (average of the previous data). Using the average for the trend and the denominator at each measure 1, 2 and 3 standard deviation control limits are calculated by the Wilson method for percentages and for directly age standardised rates by the Dobson method with Byars approximation for observed values greater than 389 and Using the link between the Poisson and ď Ł2 distributions for values less than 389 (as described in the APHO Technical Briefing 3: Commonly Used Public Health Statistics and their Confidence Intervals1). These limits are then used to assess individual points in sequence.

Values may be excluded from the calculation of the control limits if they are determined to be: 1. An anomaly = a single point above or below 3 standard deviations from the baseline 2. Data quality alert = for most indicators this is a check for no data submitted or the proportion exceeding 100%. For breastfeeding initiation and smoking during pregnancy this also includes when the data collection rate calculated by the proportion of known status in comparison to the number of maternities exceeds 100% or is below 95%.

Special cause rules are used to trigger a reset of the control limits, suggesting there has been a change in the process. These are an amalgamation of those found in SPC texts such as R. Carey (2003) Improving Healthcare with Control Chartsâ&#x20AC;?, those already utilised in the previous assessment of quarterly CVD and Cancer deaths and pragmatic decisions by the editorial team to fitting control limits by a standard and automated approach. The rules that have been used to reset the control limits are as follows: 1. 2 out of 3 above the upper 2 standard deviation control limit (not shown on the chart) 2. 2 out of 3 below the lower 2 standard deviation control limit (not shown on the chart) 3. 4 out of 5 above the upper 1 standard deviation control limit (not shown on the chart) 4. 4 out of 5 below the lower 1 standard deviation control limit (not shown on the chart) 5. 7 points consecutively increasing 6. 7 points consecutively decreasing 7. 7 consecutive points greater than the baseline 8. 7 consecutive points less than the baseline 9. 10 out of 11 points above the baseline 10. 10 out of 11 points below the baseline 48

In addition to these rules in order to form a new baseline criteria must be met.

1. 3 consecutive points must be within control (within 3 standard deviations) of their average.

2. And they must meet the data quality requirements of that indicator (see above).

Examples a)

b) Birmingham East & North Current Point (not used for average) Anomaly (not used for average) Average Target

Sandwell

Baseline (used for average) Data Problem (not used for average) 3 Sigma Control Limit West Midlands

Current Point (not used for average) Anomaly (not used for average) Average Target

Baseline (used for average) Data Problem (not used for average) 3 Sigma Control Limit West Midlands

62%

Percentage of Mothers Initiating Breastfeeding

67% 62% 57% 52%

52% 47% 42%

Period

Mar-08

Dec-07

Sep-07

Jun-07

Mar-07

Dec-06

Sep-06

Jun-06

Mar-06

Dec-05

Sep-05

Mar-08

Dec-07

Sep-07

Jun-07

Mar-07

Dec-06

Sep-06

Jun-06

Mar-06

Dec-05

Sep-05

37% Jun-05

47%

57%

Jun-05

Percentage of Mothers Initiating Breastfeeding

72%

Period

Data included in the calculation of the baseline are shown by the solid black circles, the average of these points form the baselines (shown by the solid horizontal grey line). Points not included in the base line are shaded grey either due to being an anomaly (black outline) or data quality alert (red outline). Control limits at 3 standard deviations from the baselines are shown by dashed grey lines. The current performance being assessed against the previous data is shown by a diamond. This diamond is shaded if it triggers one of the special cause rules and will be assessed when the next data point becomes available to see if the limits should be reset.

Funnel Chart Funnel charts have been calculated around the West Midlands average (solid horizontal grey line) using 3 standard deviation control limits (Wilson Method1) shown by dashed grey lines that become narrower with a increasing denominator (from left to right). PCTs are coded by number alphabetically and shaded if they exceed the upper control limit or fall below the lower control limit. A colour coded key is also provided. The PCT being assessed is shown by a diamond symbol to distinguish it from the other points.

49

Example c) March 2008 Sandwell PCT Data Average (mean) 3 Sigma Control Limit 5

8

Percentage of mothers initiating breastfeeding

72%

Key: 1. Birmingham East & North 2. Coventry 3. Dudley 4. Heart of Birmingham 5. Herefordshire 6. North Staffordshire 7. Sandwell 8. Shropshire

2 17 15

13

67%

4

9

62%

10

16

1

11

6

57% 3

52%

7

9. Solihull 10. South Birmingham 11. South Staffordshire 12. Stoke-on-Trent 13. Telford & Wrekin 14. Walsall 15. Warwickshire 16. Wolverhampton 17. Worcestershire

12 14

47% 0

500

1000

1500

2000

No. of Maternities

Alerts The results of these analyses are summarised by the following 6 alerts: Data:

Data not submitted or failed quality check

Trend:

Current performance is significantly higher than the latest baseline average

Trend:

Current performance is significantly lower than the latest baseline average

Target

Current performance is below target trajectory

WM Average:



WM Average:

Significantly above the West Midlands average

Significantly below the West Midlands average

1. APHO (2008) APHO Technical Briefing 3: Commonly Used Public Health Statistics and their Confidence Intervals http://www.apho.org.uk/resource/item.aspx?RID=48457 2. R. Carey (2003) Improving Healthcare with Control Charts (ASQ: Wisconsin) 50

Index of Disparity This report uses the relative population weighted index of disparity to assess the level of inequalities in mortality rates with PCTs. To understand how this index works, consider a population that is split into 5 sub-groups, A, B, C, D and E of the same size and age distribution.

If there were 1,000 deaths in total within the population, then one might reasonably expect that approximately 200 of these would belong to each of the population subgroups, A to E. If this were the case then one could conclude that there was equality in mortality rates between groups.

If however, 240 deaths occurred in group A, 210 in group B and only 150 in group E, then one could say that the 50, or 5% of the deaths (i.e. those that occurred in groups A and B rather than from E) were unevenly distributed.

The Index of Disparity uses this approach to estimate the proportion of deaths that are unequally distributed between population sub-groups.

In our example the 5 sub-groups, A to E, were of equal size and demographic structure. Given that this is unlikely to occur in the real world, two adjustments are required – population weighting and age and sex direct standardisation of mortality rates.

In this report, the population subgroups are defined by local deprivation quintile. Local deprivation quintiles divide a PCT into 5 areas. The first deprivation quintile contains the 20% of areas (lower super output areas) with the lowest levels of deprivation as defined by the Index of Multiple Deprivation 2004. The second deprivation quintile contains the next 20% of areas with the next lowest levels of deprivation and so on.

The Index of Disparity is a relatively new measure proposed by Jeffrey Pearcy, National Center for Health Statistics, in 2002. This report uses a relative population weighted version of the Index of Disparity. The formula used to derive the relative population weighted index of disparity is shown below.

For the 5 deprivation quintiles

rpwID =

∑ |xi - xp|.pi --------------2 ∑ xp

Where; 1 < i < 5 xi - directly standardised mortality rate of deprivation quintile i xp– population weighted average of the directly standardised mortality rates for all quintiles pi - the proportion of the population in deprivation quintile i Confidence intervals are derived using a bootstrapping method 51

Appendix D – Editorial Group : Terms of Reference An editorial group has been established to ensure that the indicators and analytical methods used in West Midlands Quarterly Health Improvement report provide a comprehensive, timely and robust assessment of PCT performance on health improvement, whilst minimising the data collection requirements on healthcare organisations.

The Editorial Group will meet on a quarterly basis to review feedback from the Public Health Observatory about issues relating to the production of the report and from PCTs about the indicators and analytical methods. The group will be responsible for determining which indicators should be included in future reports and the analytical methods that should be employed. The Editorial Group should aim to strike the best possible balance between the competing requirements of the report, namely; 

Comprehensiveness – the report should aim to provide a overview of progress against selected health improvement objectives within the influence of PCTs



Comprehensibility – the report should initially focussed on a PCT audience and in particular to Board Level and WCC pertinent reports. The contents of the report can be fed into Quality Observatory and (subject to editorial scrutiny) for Quality Accounts.



Timely – indicators should provide feedback on performance as quickly as possible



Robust – indicators should reflect performance as accurately and comparably as possible and acknowledge limitations in the data

Minimise data collection requirements - where possible the report should use data that can derived from existing national or local datasets. New collection systems should be established as a last resort and should be designed to minimise the administrative burden on healthcare organisations.

A workplan for the Editorial Group will be developed and maintained, setting out the timetable for indicator development and review. Tasks will be shared between group members according to their expertise, interest and capacity. The Editorial Group will not be responsible for reviewing draft reports.

Core Membership Lola Abudu (Chair) – West Midlands SHA Stacey Croft (Production) – West Midlands Public Health Observatory Andrew Bull – NHS Birmingham East and North Andy Hood – NHS Walsall Babatunde Olowokure – Health Protection Agency Gavin Rudge – University of Birmingham Helen Onions – Telford & Wrekin PCT John Denley – South Birmingham PCT

Kam Mavi – NHS Walsall Lorraine Simmonds – West Midlands SHA Mohammed Mohammed – University of Birmingham Ben Parfitt – West Midlands SHA Peter Fryers – Worcestershire PCT Rachel Halliwell – South Staffordshire PCT Stuart Bourne – Worcestershire PCT

Last Updated: April 2009

52

Appendix E â&#x20AC;&#x201C; Purpose of the Quarterly Health Improvement Report The quarterly Health Improvement Report aims to provide a regular, comprehensive and easily understood overview of the performance of PCTs in improving the health of its population. The report will grow and change to incorporate new measures and improved analytical and presentational techniques as determined by the Editorial Board.

The SHA anticipates that the PCT Chief Executive will respond to the draft report, detailing ď&#x201A;ˇ corrections to data items ď&#x201A;ˇ information about the arrangements that are in place or corrective actions that are planned to take to bring about improvement for those measures where the PCT has received a poor (red) assessment. This information will form part of the final report.

The SHA anticipates that the final report will be considered by PCT Boards. In addition, the PCT may wish to use the report to provide feedback to local services (both in-house and commissioned) and prioritise service improvement and redesign initiatives.

The report will also be used by NHS West Midlands to assess performance of PCTs. Results presented in the report will inform the PCT risk ratings which are used by the SHA to determine levels of intervention.

The final Quarterly Health Improvement Report will be presented to the SHA Board and will be made available on the public SHA website.

53

Appendix F – PCT Responses : Corrective Action Ref

Indicator

3

Child and Maternal Health Breast Feeding Initiation

3.5b

Childhood Vaccinations MenC

3.5c

Childhood Vaccinations MMR

4

Lifestyles

4.2

4.3

GUM Waiting Times

Health Trainers Service Development

BEN - Comments on Performance

The performance for Q1 2010 shows an increase of 1.5% in comparison to Q4 2009 at 91.4%. There is continuing data collection & reporting issues – to try and understand the issues the PCT will undertake an audit of childhood immunisation data submitted to CHIS to identify issues that come to light.

There is a significant increase of 2.7% uptake MMR at 2yrs in the 1st quarter of 2010 in comparison to Q4 performance 2009 at 84.7%.

The PCT has invested in additional training of HV teams with X3 master class workshops being held in November to help increase the confidence & competence of staff involved in promotion of immunisations, as HV teams in NHS BEN do not get involved with immunisation administration. An immunisation defaulter pathway has been established to address the involvement of HV teams in targeting double DNA MMR attendance at 2yrs.

There are ongoing issues in the data collection and reporting methods to CHIS and the PCT has commissioned a data cleansing process which takes place each quarter increasing performance by 6-9%.

The narrative which indicates NHS Birmingham East and North is not achieving target relates to patients being seen within clinic. The original „target‟ for patients seen within 48hrs was 95% to support the 100% of patients offered an appointment within 48hrs. It should be noted that since the GUM access target became an operational standard there has been no national target for „seen‟ only patients being „offered an appointment. In agreement with NHS West Midlands Strategic Programme Lead for Sexual Health the target for „seen‟ was locally agreed at 90% (PCT performance 89.6%). The PCT aim to ensure an understanding of local service capacity in support of this we have commissioned an additional service in an area with poor accessibility and evident unmet need. However, the PCT understands that services will need to meet the needs of patients unwilling to be seen within 48hrs.

The up to date position is that on the DCRS database for Birmingham East North Health Trainer service is 482 referrals to 11th November 2010. We have been assured by the Provider that by end of November 2010 they will be in the position of achieving 600 referrals. We understand that there are a further 21 referrals to be inputted on to the DCRS system as of 9.11.10. There are a further 25 referral appointments booked and a further 30 referrals being allocated to the BEN Health Trainer team.

54

Ref

Indicator

BEN - Comments on Performance There have been various staffing issues which have resulted in the capacity of the team to be reduced by 50% since the last Quarter. To ensure that achievement of targets the Provider will be increasing resource in the Health Trainer Team so that performance is back on track for the next Quarter.

5

5.2

5.3

Long Term Conditions

QoF Clinical Score

Blood Pressure Management for CHD Patients (QOF CHD6)

All practices scoring below 900 points in 2009-10 are being escalated as poorly performing practices; as a result practices are being investigated and contacted by Primary Care Contracting to understand and address this poor performance, in order of lowest score first. It should be noted that two practices, Y02567 & Y02794, opened partway through the year and should be discounted to avoid distorting PCT averages.

Our performance has improved by 13 percentage points since the last quarter (from 62.4% to 75.4%). We are still monitoring all practices for this target and are in the process of working with emerging consortia leads to address a Pan Birmingham approach. Furthermore we are in the process to manage performance and support practices proactively using contractual levers. This is being addressed by primary care commissioning.

We have recently entered into an agreement with Pfizer who supply OSKIS tool – a cardiovascular metabolic tool - where the GPs have an opportunity to:  overall cleanse and support practices in improving data  find gaps / omissions e.g. in recording data  ensure treatment and review, in a systematic use existing pathways check prevalence and increase where possible e.g. add to registers  case finding patients not added to the appropriate register ,  Liaise with medicine management as necessary This tool is likely to further improve our performance for this indicator.

Our performance has improved by 12 percentage points since the last quarter (from 60.3% to 72.4%).

5.5

Blood Pressure Management for Stroke Patients (QOF Str6)

We are working on improving this target by addressing relevant clinical pathways.

We are below the West Midland‟s average due to variation in secondary prevention / management of stroke through GP QOF targets.

55

Ref

Indicator

BEN - Comments on Performance Furthermore, we are:  

5.7

Blood Pressure Management for Hypertension Patients (QOF BP5)

sending out an urgent communication to all NHS BEN GPs regarding BP management. contacting the emerging consortia leads to hold urgent discussions on the potential effects of this poor performance through QIPP.

The PCT figures for September 2010 as viewed on QMAS are 39.7%. Service improvements planned as discussed at the last primary care commissioning group included contacting emerging consortia leads to be offered the cardiovascular metabolic tool, where the GPs have an opportunity to :  overall cleanse and support practices in improving data  use tool find gaps / omissions e.g. absent blood tests or recorded data  ensure treatment and review, in a systematic use existing pathways check prevalence and increase where possible e.g. add to registers  case finding CVD patients not added to the appropriate register ,  Liaise with medicine management as necessary A paper indicating the action plan was addressed at the last GP clinical group. In addition this tool allows practices to increase prevalence, patients who have BP above 150/90 not on hypertensive register to be included also patients identified on medications for hypertension not on register to be included.

Our performance has improved by1 4.6 percentage points since the last quarter (from 51.5% to 66.1%).

5.11

5.12

Cholesterol Management for Diabetics (QOF DM17)

Blood Pressure Management CKD Patients (QOF CKD3)

The PCT continue to monitor this target, although current performance reported in the report (66.1%) is actually 66.3% as viewed on QMAS. We have recently introduced regular Diabetes LES review whereby we are sending practices their performance on key diabetes indicators and this will further improve the performance. We are also discussing the latest NICE‟s Diabetes Quality Standards with the GPs & Clinical leads in order to redesign the pathways.

Our performance has improved by 10 percentage points since the last quarter (from 48.8% to 58.8%).

The PCT continue to monitor this target and as a result our current performance has improved but we are continuing to support service improvement by working with clinical champions in general practice.

56

Ref

Indicator

BEN - Comments on Performance We are reviewing uptake of CKD Module within Birmingham Own Health and planning end of year QOF assessments with primary care commissioning. Also the ABLE peer educator model (a better life through empowerment) is planning an evaluation to further understand the impact of their interventions.

Service improvements planned as discussed at the last primary care commissioning group included contacting GP in localities to be offered the cardiovascular metabolic tool, where the GPs will have an opportunity to:  overall cleanse and support practices in improving data  use tool find gaps / omissions e.g. absent blood tests or recorded data  ensure treatment and review, in a systematic use existing pathways check prevalence and increase where possible e.g. add to registers  case finding CVD patients not added to the appropriate register ,  identify high CVD risk patients for review using key QOF indicators  Liaise with medicine management as necessary A paper indicating the action plan was addressed at the last GP clinical group - increasing prevalence for this indicator (enhanced case finding), identifying whether GFR<60 not on disease registers this tool allows practices increase check patients qualify to be included.

CVD Lead has also recently facilitated a West Midland‟s Renal Network workshop on CKD Quality Standards (QIPP) where the network will provide an improvement plan for CKD per se.

6

Older People

6.4

Falls Programmes

Due to change in clinical lead in Falls the reporting mechanism was lost. Tony Dickinson, SHA, has now discussed this with Maureen Clark, Head of Intermediate care, and a new system is in place.

6.5

Falls Assessments

See above

7

Primary Care 57

Ref

Indicator

7.4

Ethnicity Recording (QOF Rec21)

7.5

Child Access to NHS Dentistry

7.6

Adult Access to NHS Dentistry

Ref

Indicator

3

Records 21 indicator is continuing to incentivise practices to improve their registration processes, with practice clinical systems reporting daily on progress of this indicator.

The BEN score is continuing to improve and to „close the gap‟ on the West Midlands average.

The trust is currently out to tender for additional primary care dental activity across the local health economy. The intention is to attract new patients to access NHS dentistry and improve the oral health of our residents. In order to support local practices with their advertising campaigns to attract new patients, the dental team are in the process of distributing NHS banners to dental practices advertising that they are „taking on new patients‟.

COVENTRY - Comments on Performance

Child and Maternal Health Breast Feeding Initiation

3.8

6-8 Week Breast Feeding Prevalence

3.11

Antenatal continuity of carer

4

Lifestyles

4.1

BEN - Comments on Performance

Stop Smoking Returns

    

Infant Feeding team in place (including breastfeeding peer support workers); Measures to improve recording status in place through Health Visiting services.

Data also monitored through Coventry Health Improvement Programme.

Baby Friendly Initiative Trainer now in post and training audit and data collection commenced.

Infant Feeding Strategy will be completed by January 2011.

The new manager has completed an audit trail of how this target is reported, and it appears the auditors were not recognising the buddy arrangements in place to achieve continuity. This has now been corrected and it is expected to be back on track for next quarter.

Increasing accessibility to services, through the involvement in any willing provider contract, aims to increase the number of 4 week quitters to meet the target. Additional new providers are able to deliver services from Q3 again increasing accessibility and hence number of 4 week quitters.

58

Ref

Indicator

COVENTRY - Comments on Performance

5

Long Term Conditions

5.1

Expert Patients Programmes

5.2

QoF Clinical Score

A Protected Learning Time session is arranged for later this month to communicate the latest QOF figures

5.7

Blood Pressure Management for Hypertension Patients (QOF BP5)

5.10

Blood Pressure Management for Diabetics (QOF DM12)

5.12

Blood Pressure Management CKD Patients (QOF CKD3)

Information streams are being developed via the Primary care Performance Group so that quality of care for these patient groups is available to GPs. These issues are also addressed at QOF visits; outliers receive visits offering support from the newly appointed Medical Director for Performance management in Primary Care.

HbA1c in DM and BP in DM- information streams are now being developed as part of a newly formed Primary Care Performance Group so that GPs receive a regular analysis of different aspects of QOF. So far analysis of CHD quality has been fed back to GPs and this includes the QOF indicators for management of HbA1c, BP and cholesterol in diabetics. The PCT is also commissioning an audit from MSDi to allow GPs to see what proportion of their patients receive evidence based practice for CHD, DM and COPD. Information streams are being developed via the Primary care Performance Group so that quality of care for these patient groups is available to GPs. These issues are also addressed at QOF visits; outliers receive visits offering support from the newly appointed Medical Director for Performance management in Primary Care.

6

Older People

.

HCS is not currently releasing the data in time for submission to WMPHO for this report

Coventry PCT worked across cluster with Warwick regarding publicity.

Posters and leaflets were sent to GPs, Pharmacies, Opticians and Dentists.

6.2

Flu Vaccinations

The Communications Team also sent out poster/leaflets to the following:  Coventry City Council  17 Libraries  Age Concern  Walk in Centre  Coventry and Warwickshire Phlebotomy Service  Walsgrave Hospital  Carer Centre in Coventry 59

Ref

Indicator

COVENTRY - Comments on Performance ď&#x201A;ˇ ď&#x201A;ˇ

6.4

Falls Programmes

6.5

Falls Assessments

7

Primary Care

7.1

QoF Total Score

7.3

Smoking Status Recording (QOF Rec23)

Ref

Indicator

3

The Coventry Job Centre Wayside and Parkside House.

A proposal for a Community Falls Service, which will address the issues impacting upon these measures, was considered by the Business Case Group in September. The proposal, which contains four options, was considered on the value for money and cost effectiveness demonstrated and has been deferred for further development A proposal for a Community Falls Service, which will address the issues impacting upon these measures, was considered by the Business Case Group in September. The proposal, which contains four options, was considered on the value for money and cost effectiveness demonstrated and has been deferred for further development.

A Protected Learning Time session is arranged for later this month to communicate the latest QOF figures.

Smoking status-This continues to be flagged up at QOF visits

DUDLEY - Comments on Performance

Child and Maternal Health Breast Feeding Initiation

3.3

Breast Feeding Initiation

Having already implemented a number of initiatives (e.g. CUBA training for frontline staff), Dudley PCT is now implementing a breastfeeding buddy support service in the community and maternity hospital to promote breastfeeding from the start of pregnancy and support new mothers to initiate and continue to breastfeed for as long as possible.

3.8

6-8 Week Breast Feeding Prevalence

Please see above.

3.5c

Childhood Vaccinations MMR

Quarter 1 uptake is down on Q4 2009/2010, the reasons for this are as yet unknown. All GP performance, particularly waiting lists is being closely monitored.

3.11

Antenatal continuity of carer

Dudley Borough is in the process of developing a multi-agency antenatal care pathway which aims to enhance early booking and continuity of care.

60

Ref

Indicator

4

Lifestyles

4.3

Health Trainers Service Development

5

Long Term Conditions

5.10

Blood Pressure Management for Diabetics (QOF DM12)

6

Older People

6.2

Flu Vaccinations

7

Primary Care

7.5

Child Access to NHS Dentistry

DUDLEY - Comments on Performance

There are nine trained and qualified health trainers in post. They are now building their client base and starting to accept referrals.

PCT Primary Care Performance Management team will be taking this up with relevant practices during current performance management visits.

The PCT remains extremely concerned about the continued poor performance of GP Providers on this programme. For this season (2010 -11) there has been a new LES introduced which includes a target of 75% for all Providers. Additionally there is planned close performance monitoring of Providers and individual tailored support to the 15 Providers who have previously performed worst in recent seasons.

GPs are being given 3 reminders to submit data to the ImmForm site (Although Dudley usually gets 100% submissions). The PCT is also requesting additional uptake data in December so that we can track which Practices are on target and which are not. Failing Providers will have their Contracts to provide this programme in future seasons reviewed in February 2011.

Campaign launched to target children reaching the age of 3 to highlight the importance of attending a dentist.

61

Ref

Indicator

3

Child and Maternal Health Breast Feeding Initiation

3.8

6-8 Week Breast Feeding Prevalence

3.5c

Childhood Vaccinations MMR

4

Lifestyles

4.2

GUM Waiting Times

HEART OF BIRMINGHAM - Comments on Performance Drop in prevalence is due to temporary drop in data collection coverage as we work to implement a more sustainable system. This is because Failsafe activity has been suspended â&#x20AC;&#x201C; this will be reinstated in December in a more limited form.

The active patient management programme to increase the uptake of MMR is ongoing. There has been an increase as predicted for this quarter and we are now close to achieving the target.

Ongoing implementation of the Electronic Patient Record System (EPR) is currently presenting a data integrity issue meaning that reporting is not currently reflecting actual performance which currently stands at above 98%.

This issue is being addressed, in the short term, by retraining the service. In the medium term, the IT process for recording 48 hour access will be redesigned to overcome the issue.

62

Ref

2.6

Indicator

Breast Cancer Screening Round Length

HEREFORDSHIRE - Comments on Performance The capacity issues in previous months are still having an impact throughout August. This has been reviewed in detail as part of a wider Breast Screening Service review for Hereford and Worcester. The review has identified that extra capacity is required if the Herefordshire part of the joint service is to improve upon and maintain the 2 week waiting time target. Further discussions are being held with Worcestershire NHS Trust provider on an alternative model of provision that would improve access and treatment. HHT have now appointed a registrar (to start in January) who will be able to relieve the current pressure on two week clinic appointments in Hereford.

As part of the proposals to develop a new model of breast screening across Herefordshire and Worcestershire, a separate work stream for Herefordshire has been established and it is anticipated that capital monies may be made available via the Cobalt appeal for provision of a static digital screening unit in Hereford. The model for mobile digital screening across the two counties is also under active discussion.

3

3.8

3.5c

3.9

Child and Maternal Health Breast Feeding Initiation

6-8 Week Breast Feeding Prevalence

Childhood Vaccinations MMR

Childhood Weight Management Programmes

All Children‟s Centres county- wide have now adopted a peer support programme delivered by the Infant Feeding Adviser for accessible and sustained support. This contributes to the Action Plan for the UNICEF Baby Friendly initiative and extending the good practice of the LPSA breast feeding project.

Future commissioning decisions will be determined following the submission of a business case containing an evaluation of the pilot scheme and the outcomes achieved.

The PCT has recently appointed an Immunisation Nurse to follow up parents who don‟t bring their children for vaccination in particularly targeting the deprived neighbourhoods and clusters of unimmunised children.

The nurse will arrange specific domiciliary and outreach vaccine clinics in a bid to improve the uptake by targeting these hard to reach areas. A social marketing campaign has been launched and MMR road shows are being arranged commencing in early next year.

No data was submitted for July – September as there were no programmes running during this period.

The MEND commissioned programmes are under review and more weight management programmes need to be commissioned. The expected delivery has slowed down due to staff changes but one is running currently and one planned for Q4.

63

Ref

Indicator

3.10

Completed health and social assessment before 13 weeks

3.11

Antenatal continuity of carer

4

Lifestyles

4.3

Health Trainers Service Development

6

Older People

6.4

6.5

Falls Programmes

Falls Assessments

HEREFORDSHIRE - Comments on Performance There are concerns over why the perinatal inst. data does not match that data submitted to the DoH as part of the VSMR quarterly return. The reason why the DoH data is not being used to inform this report is unclear? ( To be reviewed with WMPI) The rotation of midwives between acute and community has affected performance against this indicator.

As part of a wider maternity service review a decision has been taken to end the rotation practice and stabilise current services.

Performance is less than expected due to staff leaving the service, including the co-ordinator and recruitment is currently held back. This provides an opportunity for service review and planning in order to improve performance for Q4 and during 2011-2012.

Changes in service lead have led to requests for data/information being sent to the wrong person. This has highlighted a need for systemic review of the data/information requests made of the service and how they are managed to mitigate the risk of this occurring again.

Changes in service lead have led to requests for data/information being sent to the wrong person. This has highlighted a need for systemic review of the data/information requests made of the service and how they are managed to mitigate the risk of this occurring again.

64

Ref 3

Indicator

NORTH STAFFORDSHIRE - Comments on Performance

Child and Maternal Health Breast Feeding Initiation

3.8

6-8 Week Breast Feeding Prevalence

3.5c

Childhood Vaccinations MMR

4

Lifestyles

4.3

Health Trainers Service Development

5

Long Term Conditions

Reported performance is not accurate due to incompleteness of data. This is an issue of data not been entered within the timescale required for quarterly reporting. This issue is being performance managed. It is likely that performance is significantly better than reported as a significant proportion of the data inputted late relates to babies who are continuing to breast feed.

Actions to increase and sustain numbers of MMR vaccinations have been implemented and there has been improved performance during Q3 & 4.

The Health Trainer Service was decommissioned. Signposting and access to lifestyle services will be supported as part of our approach to NHS Health Checks and raising awareness of the signs and symptoms of cancer (early detection programme).

Commissioning of the Expert Patient Programme (EPP) is being considered within the context of the PCT prioritisation process.

5.1

Expert Patients Programmes

In support of the objectives and principles of the EPP, the PCT has commissioned an innovative patient education and empowerment programme, which will be provided via telephonic coaching for people with long term conditions. This service will be commissioned from the 1st December 2010.

65

Ref 3

3.8

Indicator

SANDWELL - Comments on Performance

Child and Maternal Health Breast Feeding Initiation 6-8 Week Breast Feeding Prevalence

Q2: 6-8 weeks breastfeeding data: Improvement on previous quarter regarding data completeness which now stands at 95%.

Improvement on previous quarter on 6-8 week breast feeding prevalence from 16.3% to 25.8% 

3.5c

Childhood Vaccinations MMR

 

3.9

Childhood Weight Management Programmes

3.10

Completed health and social assessment before 13 weeks

3.11

Antenatal continuity of carer

3.12

Smoking in Pregnancy (At Booking)

4

Lifestyles

We have a LES in place to help support practices in providing MMR1 and 2 to those children who have not received it up until the age of 18 years.

Will start administering Hib/menC, PCV and MMR at 54 weeks. Passed via our Executives, the PGD has been changed to reflect this. Currently looking at our SystmsOne to change when these children are called.

All outliers for immunisations are called by both the immunisation team and the contracts team.

The „WellFIT‟ weight management programme has been developed by Sandwell PCT. Post piloting, three 20-week rolling programmes were established from February 2010. From Oct 2010, nine further programmes have been established. There are currently 12 programmes set to run continuously during 2011-2012, targeting 168 families to complete 75% of a 20 week programme (336 direct beneficiaries including a child (6-13 yrs) and additional family member). Planning is also now in process to establish community-led delivery in future expansion & roll out of WellFIT (2012-13).

Should the definition be: Early booking - This indicator measures how many women have a completed health and social care assessment of needs, risks and choices by 12 completed weeks of pregnancy (national vital signs definition) for each PCT. Data Source: Perinatal Institute All Trusts are performing well below the 75% target. As a result – the definition for continuity of carer is being reviewed as it is recognised very widely that this is an unachievable target. The current definition requires a woman to be seen for 75% of her care by the same midwife. This automatically excludes the majority of women who are require shared care or who attend hospital for clinic appointments

Due to the difficulties and capacity issues of the Midwifery Services in Sandwell, the referral pathway is being reviewed to ensure pregnant smokers are signposted to the correct services

66

Ref

Indicator

4.1

Stop Smoking Returns

Ref

Indicator

2.6

Breast Cancer Screening Round Length

3

Child and Maternal Health Breast Feeding Initiation

3.8

6-8 Week Breast Feeding Prevalence

3.5c

Childhood Vaccinations MMR

3.9

Childhood Weight Management Programmes

SANDWELL - Comments on Performance From April 2010, Sandwell opted to deliver cessation services under the new market rules and tariffs. This innovative process has taken time to embed and consequently affected our target. However, nine new Providers entered the market at the end of October and therefore we have the potential to support more smokers to quit smoking before the end of March 2011.

SHROPSHIRE - Comments on Performance The performance for breast screening round length has improved significantly since the winter of 2009/10.

At this time the SHA and cancer intelligence unit (Sue Morgan & Olive Lewis respectively) were contacted to confirm that the impact of an initiative 3 years previously was going to lead to performance issues. It was agreed that performance would fall to allow for this activity „hump‟ to be overcome with the target performance being recovered by A2 2010/11, so that the necessary stability in the target performance in readiness for implementing the age extension and digital mammography in January 2011 would be met. A copy of the agreed breast screening recovery plan from the PCT‟s operational plan 2010/11 is available.

SaTH maternity services, primary care, community nursing and Children‟s Centres are currently working towards UNICEF Baby Friendly status. A new public health lead for this target has been identified and a focused task and finish group has been organised to improve performance against this target. An Action Plan will have been developed and being implemented by next quarter report.

The year to date actual is now 93.2% and it is hoped that the steady increase will continue on the basis of corrective actions as follows: a systematic approach is being maintained by Immunisation Facilitators in Shropshire to address this issue on a practice by practice basis. Regular contact is being maintained with practices which developed large queues for MMR vaccinations earlier in the year to ensure non recurrence of problems. The latest evidence from the DOH parental attitudes tracking survey indicates that parental confidence in MMR is returning and this positive message will be central to the planning of a well focused local campaign to be developed later this year. Efforts are also continuing to promote MMR uptake via training updates and briefings to all immmunisers. Proposals for an MMR catch up initiative in GP practices have also been included in the Commissioners Planning Priorities list for Shropshire PCT for consideration for 2011-2012.

A new school nurse led weight management service has been developed and the service will be piloted from January 2011. Children and their families will be identified through the National Child Measurement 67

Ref

Indicator

SHROPSHIRE - Comments on Performance Programme and will be offered support from trained school nurses for a 12 month period. A target figure of 18 families has been set for recruitment onto the service. Due to the fact that the intervention lasts 12 months, Shropshire‟s quarterly return against this indicator will remain at 0 until Q4 2011/12. However, updates on the numbers of families recruited and progress made will be provided each quarter until then.

4

Lifestyles 

4.1

Stop Smoking Returns

4.3

Health Trainers Service Development

5

Long Term Conditions

5.1

Expert Patients Programmes

5.7

Blood Pressure Management for Hypertension Patients (QOF BP5)

5.11

Cholesterol Management for Diabetics (QOF DM17)

Developing communications strategy with providers and comms team – pre-resolution campaign in December; Health Bus at all Shrewsbury Town Football Club home matches; initiating links with all sports leagues  Additional provider awarded contract to deliver stop smoking and stop smoking in pregnancy services  3 additional clinics established in Supermarkets and colleges in Shrewsbury  Smoking status recorded in outpatients departments and all smokers given brief intervention to quit  Midwives referring all smokers (opt out process) to stop smoking in pregnancy service The PCT is investing additional resources via its Health Checks Programme to enable a health trainers service to be offered within GP surgeries

We have had several patients attend the EPP within Shropshire; we have paid out approximately £60,000.

Steve Wyatt and Yasir Khan at the SHA submit the figures to us monthly and we are able to view these ourselves on the HCS portal.

There is a national problem with Practices using EMIS PCS which a number of ours are therefore no QOF data has been up dated to QMAS for these 14 practices. EMIS believe there will be a patch for this in January 2011.

Achievement as at September 2010 is 36.65% (slightly up on the figure for September 2009 of 35.87%). A number of practices have not submitted their clinical achievement and are therefore registering as having zero for this indicator – excluding these practices the average is 37.32%. Practices‟ individual achievement for this indicator ranges from 27.22% to 50.92% for this period. Practices work towards end of year submission date of 31st March – end of year achievement for 2009-10 was 76.61% with only 6 practices not achieving full QOF points for the indicator. Control of blood pressure for CHD patients is a PCT priority and is being looked at as part of the 2010-11 QOF assessment process.

There is a national problem with Practices using EMIS PCS which a number of ours are therefore no QOF data has been up dated to QMAS for these 14 practices. EMIS believe there will be a patch for this in 68

Ref

Indicator

5.12

Blood Pressure Management CKD Patients (QOF CKD3)

6

Older People

6.2

Flu Vaccinations

7

Primary Care

7.3

Smoking Status Recording (QOF Rec23)

SHROPSHIRE - Comments on Performance January 2011.

Achievement as at September 2010 is 64.87% (slightly down on the figure for September 2009 of 65.69%). A number of practices have not submitted their clinical achievement and are therefore registering as having zero for this indicator – excluding these practices the average is 65.78%. Practices‟ individual achievement for this indicator ranges from 51.46% to 78.85% for this period. Practices work towards end of year submission date of 31st March – end of year achievement for 2009-10 was 84.38% with all bar one practice achieving full QOF points for the indicator.

There is a national problem with Practices using EMIS PCS which a number of ours are therefore no QOF data has been up dated to QMAS for these 14 practices. EMIS believe there will be a patch for this in January 2011.

Achievement as at September 2010 is 58.94% (slightly down on the figure for September 2009 of 59.28%). A number of practices have not submitted their clinical achievement and are therefore registering as having zero for this indicator – excluding these practices the average is 59.19%. Practices‟ individual achievement for this indicator ranges from 38.08% to 84.13% for this period. Practices work towards end of year submission date of 31st March – end of year achievement for 2009-10 was 70.12% - 29 practices achieved full QOF points for this indicator. CKD3 is discussed as part of the 2010-11 QOF assessment process.

The latest monthly figures for uptake in relation to the current seasonal flu campaign are regarded as encouraging with uptake reaching 48.1% in October with 4 months remaining to February 2011 for practices to provide final data on uptake. Corrective actions directed at improving uptake from 09/10 have included: providing training and promotional updates for GP practice staff, staff from residential care homes and community nursing staff aimed at systematically increasing uptake. There has been an excellent response to training with over a hundred staff attending seasonal flu updates in Shropshire. The PCT Communications team have also delivered a high impact 3 week campaign on Beacon FM (targeting, primarily under 65 year olds ) and a poster campaign and leaflet campaign have also been undertaken .This has been complimented by PR (in press and other radio) and highly visible communications on the PCT websites.

There is a national problem with Practices using EMIS PCS which a number of ours are therefore no QOF data has been up dated to QMAS for these 14 practices. EMIS believe there will be a patch for this in January 2011.

69

Ref

Indicator

7.4

Ethnicity Recording (QOF Rec21)

7.6

Adult Access to NHS Dentistry

SHROPSHIRE - Comments on Performance Achievement as at September 2010 is 78.16% (an improvement on the figure for September 2009 of 76.84%). A number of practices have not submitted their non clinical achievement and are therefore registering as having zero for this indicator – excluding these practices the average is 78.57%. Practices‟ individual achievement for this indicator ranges from 63.53% to 88.97% for this period. Practices work towards end of year submission date of 31st March – end of year achievement for 2009-10 was 82.44% only 8 practices achieved full QOF points for this indicator. This indicator is being discussed with practices as part of the 2010-11 QOF assessment process, in order that good practice and ideas can be shared with practices who struggle to do well in recording smoking status for patients who do not routinely attend the surgery.

There is a national problem with Practices using EMIS PCS which a number of ours are therefore no QOF data has been up dated to QMAS for these 14 practices. EMIS believe there will be a patch for this in January 2011.

Achievement as at September 2010 is 89.93% (slightly down on the figure for September 2009 of 90.32%). A number of practices have not submitted their non clinical achievement and are therefore registering as having zero for this indicator – excluding these practices the average is 90.11%. Practices‟ individual achievement for this indicator ranges from 6.69% to 100% for this period. Practices work towards end of year submission date of 31st March – end of year achievement for 2009-10 was 91.62% 23 practices achieved full QOF points for this indicator. Practices must achieve 100% in order to achieve the one QOF point available for this indicator and some practices choose not to work towards achieving this. This indicator is being discussed with practices as part of the 2010-11 QOF assessment process, in order that good practice and ideas can be shared with other practices. The importance of recording ethnicity will be discussed also.

The PCT is on target when measured against the vital sign trajectory. The vital sign target is agreed with the SHA and is based on an estimate of demand using the national patient survey results for access to dental services.

The PCT has invested a further £430k in new patient activity in 2010-11.

70

Ref 3

3.8

Indicator

SOLIHULL - Comments on Performance

Child and Maternal Health Breast Feeding Initiation

6-8 Week Breast Feeding Prevalence

ď&#x201A;ˇ

The number of deliveries has increased significantly at the main provider unit (following closure of the local maternity unit) and this has had an impact on initiation rates; midwifery staffing issues have also contributed to this problem. The decline in initiation rates will have an impact on the prevalence rate.

ď&#x201A;ˇ

Funding for Community breastfeeding support workers has been withdrawn; therefore the initiative for providing home support has been reduced. A recruitment freeze has prevented Peer support employment in the community.

Corrective action:-

3.5c

Childhood Vaccinations MMR

3.9

Childhood Weight Management Programmes

3.11

Antenatal continuity of carer

4

Lifestyles

Currently training Volunteer Peer supporters who will be available to offer breastfeeding support in Children Centres.

Some initial work on identifying those GP practices whose performance is low has been carried out. This will now be turned into an action plan through a newly constituted Vaccination and Immunisation Group The SHINE weight management programme is continuing to be provided in collaboration with the council.

VSP 06 performance is currently 85.3% which is slightly above trajectory

The service has suffered from staffing issues during this quarter however a range of planned activity should have a positive effect on performance. These include: 4.3

Health Trainers Service Development

Promotion of the service through: - PLT event in December; Routinely attending Practice Nurse meetings; Re-establishment of referral links / pathways with new CVD lead; Development of Integrated Lifestyles Services so that referrals are routinely made from Lifestyles Services into health trainer services; A new pilot with IAPT team to encourage service use following stress management sessions; Health Trainers 71

Ref

Indicator

SOLIHULL - Comments on Performance playing a major role in Let‟s Get Moving programme.

5

Long Term Conditions

5.1

Expert Patients Programmes

5.3

Blood Pressure Management for CHD Patients (QOF CHD6)

5.5

Blood Pressure Management for Stroke Patients (QOF Str6)

6

Older People

6.4

Falls Programmes

6.5

Falls Assessments

7

Primary Care

7.5 Child Access to NHS Dentistry

This programme is being reviewed.

The change in performance is under investigation – delays in updating GP information systems until year end has previously been assumed to be the cause however performance is good in other aspects of primary care management (e.g. cholesterol management).

It is also believed that performance will be improved by implementation of the NHS Health Checks programme.

The change in performance is under investigation – delays in updating GP information systems until year end has previously been assumed to be the cause however performance is good in other aspects of primary care management (e.g. cholesterol management).

It is also believed that performance will be improved by implementation of the NHS Health Checks programme.

Staffing issues have adversely affected capacity within the programme; business case in development/discussion regarding expansion of the service within the Care Trust Transformation Programme.

Staffing issues have adversely affected capacity within the programme; business case in development/discussion regarding expansion of the service within the Care Trust Transformation Programme.

The VSB18 plan data has been refreshed from April 2010 onwards Dental access performance against the revised trajectories to August 2010 for Solihull are “green” on the DoH RAG rating 72

Ref

Indicator

SOLIHULL - Comments on Performance

And Solihull ranks 2nd in the West Midlands for performance against profile for this period

7.6 Adult Access to NHS Dentistry

The quarterly GP questionnaire included „dental access‟; the results indicate that Solihull is one of the very few PCTs in England where “100% of the people who tried to get an NHS dental appointment in the last 3 months were able to” In October 2010 some 15 (of 18) dental practices in Solihull were accepting new NHS patients, the majority within 1 week The new dental practice will open in Shirley in January 2011 The „Dental Access Campaign” continues A „Health Equity Audit‟ is being undertaken to determine if there are any “gaps” in provision in relation to oral health needs.

73

Ref 3

Indicator

Child and Maternal Health Breast Feeding Initiation

3.5b

Childhood Vaccinations MenC

3.5c

Childhood Vaccinations MMR

3.11

Antenatal continuity of carer

4

Lifestyles

4.2

SOUTH BIRMINGHAM - Comments on Performance

Gum Waiting Times

3rd Men C dose given at 12 months.

Data management issues: Upgraded Child Health Information System (CHIS) commissioned implementation begun by city-wide project team.

Joint project with CHIS, selection of GP practices, led by public health, to improve information management systems in relation to the clinical pathway, including identifying children who DNA and develop improved systems to encourage attendance.

MMR given at 13 months. Included in actions as above, in addition the new CHI system will appoint children for one appointment, and merge current 12 / 13 month appointments, aiming to improve attendance and uptake. Developing service specification to improve current training provision for registered immunisers.

This indicator has been difficult to achieve from the outset. Issues arise because workload is distributed between community midwifery teams (data recording may also be an issue). The IfH Project 2C project board recommend that this indicator should include continuity with two midwives from Q2 (Sept 10) onwards. The PCT are working with Public Health colleagues at HoBtPCT to develop a bespoke localised measure of community midwifery services in order to support targeted action to improve overall performance across B&S Cluster. Performance is monitored through scheduled contracting arrangements and through the BWHFT Local Implementation Group with community midwifery team leaders.

The narrative which indicates NHS South Birmingham is not achieving target relates to patients being seen within clinic. The original „target‟ for patients seen within 48hrs was 95% to support the 100% of patients offered an appointment within 48hrs. It should be noted that since the GUM access target became an operational standard there has been no national target for „seen‟ only patients being „offered an appointment. In agreement with NHS West Midlands Strategic Programme Lead for Sexual Health the target for „seen‟ was locally agreed at 90% which the PCT is delivering. The PCT aim to ensure an understanding of local service capacity and demand which captures efforts made locally by providers to reconfigure services and commission services to meet the needs of patients unwilling to be seen within 48hrs.

74

Ref

Indicator

5

Long Term Conditions

5.1

Expert Patients Programmes

6

Older People

6.5

Falls Assessments

7

Primary Care

7.3

Smoking Status Recording (QOF Rec23)

SOUTH BIRMINGHAM - Comments on Performance

Decision made in July by NHSB Pct to decommission courses for the financial year 2010/11. Therefore there is no determined recovery plan for this financial year

The reduction in the number of falls assessments appears to be due to the fact that not all the assessments being carried out by our provider services are being captured and submitted; we are working with our provider to address this issue.

There is a QOF clinician workshop taking place on 9th November 2010, which all GPS in South Birmingham have been invited too. This is an area that will be on the agenda.

This indictor will also be discussed with the QOF assessors, so guidance can be disseminated down.

75

Ref Indicator 3

SOUTH STAFFORDSHIRE - Comments on Performance

Child and Maternal Health Target for 2010/11 remains at 91.5%.

3.5c

Childhood Vaccinations MMR

Uptake continues to improve.

Currently 20 practices with queues of more than 10 patients are holding extra clinics to offer supplementary appointments to those children with incomplete immunisation status.

Childhood weight management services have been commissioned by 4/5 PBC consortia across South Staffordshire. Services are provided across tiers 1 to 3 i.e. from prevention to treatment. Some areas i.e.

South East Staffordshire (Tamworth and Lichfield) are currently under development.

3.9

Childhood Weight Management Programmes

Each local service has an implementation / steering group bringing partners together to develop local services. These groups are led by the professional leads for school nursing and dietetics. A range of partners are involved including school nurses, school sports partnership representatives, local authority leisure colleagues and PCT staff etc. A childrenâ&#x20AC;&#x;s gym has been set up in one PBC area â&#x20AC;&#x201C; this work will be evaluated as innovative practice.

The poor uptake of services by children identified as overweight/obese through the National Child Measurement Programme remains a challenge.

3.11

Antenatal continuity of carer

4

Lifestyles

The Staffordshire Healthy Weights group has developed a county wide strategy and delivery plan. A multi-agency workshop was held to re-energise efforts to reduce childhood obesity. We are planning to hold front line practitioner sessions to raise awareness of childhood healthy weights services.

Productive community midwifery tool being utilised to assess midwifery work and will be used for workforce planning. Target is being reviewed regionally.

SSCPT have implemented tariff, third round currently in progress - interest from a further 6 providers. 13 Stop Smoking providers awarded contracts in round 1 but only 4 of these are currently delivering.

4.1

Stop Smoking Returns

Impact on target due to some providers not yet operational. 7 out of 13 active for Stop Smoking Services, and 6/13 deliver Stop Smoking in Pregnancy.

Q1 & Q2 data still not complete due to current constraints on the HCS database. All providers due to submit all data, including backlog, by 12th November refresh; however we are confident that by end Q3 we should be able to report more accurately and will be on target.

76

Ref Indicator 6

SOUTH STAFFORDSHIRE - Comments on Performance

Older People The Care Pathway used embraces the National Service Framework Standard Six, NICE guidance in both Falls and Osteoporosis as well RCP guidelines. The Falls and Bone Health Assessment Tool is now used over the majority of the South Staffordshire PCT area.

6.4

Falls Prevention Programmes

6.5

Falls Assessments

7

Primary Care

Numbers are gradually increasing but where we fall down is gathering the evidence to support that osteoporosis screening has taken place to complete the falls assessment as some PBC areas choose not to have direct access to Bone Mineral Density assessment; however discussions on implementing the pathway are still ongoing with these PBCs. See above

The report to April notes significant improvement in adult access (51.2%) but shortfall compared to WM average. The access for this PCT has been improved significantly via a programme of procurement and opening of four new practices earlier this year, as well as local additional activity commissioned in year.

7.6

Adult Access to NHS Dentistry

Adult access since 2006 has increased significantly from 45.8% to 51.2% (in same time, West Midlands 53.9% to 53.7% and England 51.6% to 51.5%). This is reflected in the increase in patients seen in prior 24 months which at over 26,000 patients increased since March 2006 is the largest increase amongst West Midlands PCTs and the fourth largest nationally.

Further modest increases in adult access are expected as the new practices reach capacity, however it is unlikely that the PCT will reach the WM average as the challenging financial climate makes it unlikely that any further investment in capacity will be possible.

77

Ref

Indicator

3

Child and Maternal Health Breast Feeding Initiation

3.8

6-8 Week Breast Feeding Prevalence

3.5c

Childhood Vaccinations MMR

STOKE ON TRENT - Comments on Performance

There continue to be data issues with this indicator which are being worked through. We will be resubmitting the figures and we expect to be on target.

For MMR we continue to set a challenging target of over 95% in line with WHO recommendations which supports high uptake levels to ensure herd immunity for vulnerable groups (i.e. those with cancer or immunosuppression where vaccination is not possible). We do continue to set high immunisation targets to promote high standards and vaccination uptake figures are regularly shared with all the immunisers.

Recently we have ratified a V+I training policy for all immunisers to ensure best practice standards are followed.

Actions currently undertaken to increase this level: The current PCT Q2 figures is 93.7% (children aged 2) -this has stayed static from Jan-March 10.

The average mean since July 09 has risen significantly from July to September 09 but we acknowledge that we need to promote uptake in this group to achieve 95% to achieve herd immunity. This is a National problem.  We have now completed the MMR catch up programme but we do monitor uptake rates at a GP practice level on a quarterly and annual basis and these are shared with the GP practices.  COVER data is now available down to a GP practice level - information recording the numbers of children vaccinated is shared with all current immunisers within the organisation. GP practices are contacted where concerns are identified and action plans put in place. Best practice guidance on improving vaccine uptake has been shared with individual practices and recommendations have been disseminated in the Vaccination and Immunisation (V+I) Newsletter in October 10. Poor vaccination uptake is particularly relevant for the hard to reach groups. A Childhood V+I Policy has been ratified within the PCT and a defaulter‟s care pathway has been agreed for the hardest to reach children to be vaccinated at home by the Health Visitors.  Regular information regarding vaccination uptake levels are disseminated widely within the organisation via the V+I Newsletter (produced quarterly)  COVER data is now shared with all immunisers at the V+I childhood immunisation updates and initial training.  We have started monitoring GP Practices as part of the Quality Improvement Framework and a baseline of all vaccination rates per GP Practice has been undertaken. GP Practices who are below average will be expected to produce comprehensive action plans to show how they will improve vaccination uptake rates.

78

Ref

Indicator

3.11

Antenatal continuity of carer

5

Long Term Conditions

5.1

Expert Patients Programmes

6

Older People

6.4 & 6.5

Falls Programmes & Falls Assessments

Ref

Indicator

STOKE ON TRENT - Comments on Performance We are currently monitoring this as part of the PEER data set for the West Midlands Perinatal Institute.

Significant additional investment has been agreed in community midwifery which has improved our performance (current caseloads 1:100 as recommended via Birth Rate Plus and Maternity Matters); the Head of Midwifery is driving the target. In addition there is national debate about the appropriateness of this target and it is expected to be amended to Continuity of Care (i.e. more than one midwife).

A change in staffing has meant that there is currently no lead for EPP. A meeting will be taking place between the PCT and the SHA to determine who will lead and once this issue is resolved the return will start to be completed again as soon as possible.

Due to staff absences at the Joint Commissioning Unit a new lead has taken this over and they attended the last regional falls meeting. The data collection tool has been amended and work is being carried out to ensure collection is more streamlined and timely in the future. In addition the following actions are now being taken to improve performance: - New Falls leads have been put in place - Meetings have taken place to look at current issues and agree a way forward - Ensuring there is strategic direction - A refreshed Stoke-on-Trent Falls and Bone Strategy Group has been reconvened - A Falls Co-ordinator post has been extended until March 2011.

TELFORD AND WREKIN - Comments on Performance

3

Child and Maternal Health Breast Feeding Initiation

3.4

Development and implementation of a NHS Telford and Wrekin tobacco control commissioning plan (see Smoking During Pregnancy 4.1 for detail). Including a Stop Smoking in Pregnancy Tariff payment; offering a 4 week and delivery quit (SATOD) payment.

Implementation of the NICE Public Health Guidance 26: Quitting Smoking in Pregnancy and Following 79

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Indicator

TELFORD AND WREKIN - Comments on Performance Childbirth, which includes asking the smoking status of all pregnant women at booking and every subsequent visit. Taking CO readings for all Women and referring to local NHS Stop Smoking services using an „opt out‟ system.

Corrective actions: 1. The implementation of a robust data cleansing exercise that identifies: • Unvaccinated children ensuring that these children are reappointed for vaccination • Children who have transferred out of the Telford and Wrekin borough (on confirmation, these children are removed from the local Child Health Register) • Children who have already received vaccination and an update of the Child Health Register.

3.5c

Childhood Vaccinations MMR

2. The reduction of the numbers of children waiting for a vaccination appointment by increasing the number of appointments and clinics per practice.

3. The delivery of an in-home service for children who are difficult to reach and difficult to engage with.

The impact of this measure is expected to reach full effect by quarter 3 of 2010/11.

3.11

3.12

Antenatal continuity of carer

Smoking in Pregnancy (At Booking)

Consideration of the systems performance for all early childhood immunisations demonstrates quarter on quarter improvement. The exception to this was quarter 4 of 2009/10 which was adversely affected by the swine flu immunisation programme.

From the first of November we will be submitting most of the data electronically enabling our data clerk to concentrate on the information required for continuity and IUGR. I believe we will have a greater confidence in the data from November on wards. We do collect on the „sema‟ system including names of the midwives conducting community visits and therefore we will be doing some comparison analysis.

Development and implementation of a NHS Telford and Wrekin tobacco control commissioning plan (see 4.1 for detail). Including a Stop Smoking in Pregnancy Tariff payment.

Implementation of the NICE Public Health Guidance 26: Quitting Smoking in Pregnancy and Following Childbirth, which includes asking the smoking status of all pregnant women at booking and every subsequent visit. Taking CO readings for all Women and referring to NHS Stop Smoking services using an „opt out‟ system.

80

Ref

Indicator

4

Lifestyles

4.1

Stop Smoking Returns

TELFORD AND WREKIN - Comments on Performance Development and implementation of a NHS Telford and Wrekin tobacco control commissioning plan.

The following are the key areas the of development and implementation within the commissioning plan: Smoking cessation:  Tariff stop smoking services- commenced  Market development – commenced  Telephone signposting – commenced  Provision of drugs – NHS T&W leading on the development of a regional protocol. Handling fee to go to the provider as from 1st April 2011.

Process  Tobacco Alliance – commenced and active  Commissioning partnership – met, agreed aims and objectives  Marketing - commenced and ongoing  Social marketing – embedded within service development  Monitoring of contract performance – commenced and part of lifestyle consortium Tobacco Control  Stop Young inflow – to be embedded as part of Smokefree Alliance  Smokefree communities (de-normalising smoking) – to be embedded as part of Smokefree alliance  Getting quitters – commenced  Brief intervention training and delivery for smoking- starting within SaTH. Regional E-learning package under development.

NHS Telford and Wrekin are also driving more smokers into services via the local delivery of QIPP The main actions being implemented locally to meet the regional objectives outlined in the QIPP workstream for tobacco control are: • Smoking cessation tariff implemented from 1stApril 2010 • Publicity and awareness raising campaigns (including social marketing techniques) - commenced July 2010. Stop smoking Telford website launch September 2010.

• Delivery of a hospital based smoking cessation brief intervention programme including „stop before your op‟. New service specification signed off. New quarterly monitoring incorporated.

• Development of text messaging service using general practice patient database to identify and offer support to smokers • Deliver on the National Support Team for Health Inequalities tobacco control recommendations • Identify smokers using long term conditions work and risk stratification • Identify smokers through Health Check programme and offer brief intervention and referral 81

Ref

Indicator

TELFORD AND WREKIN - Comments on Performance • Ensure brief intervention and referral is embedded in all care pathways through Getting Healthy Staying Healthy • Training and workforce development for delivery of brief interventions for smoking. Commenced within SaTH • Development of a brief intervention e-learning package. To be operational from November 2010 • Development of a coherent and effective smoke free alliance. Re-launched March 2010, terms of reference to be signed off by October 2010 • Develop local central telephone number for sign posting to smoking cessation providers. Has been agreed and will be reviewed in 6 months time • Smoke free workplace to be a key priority for „Well@Work‟ in locality with exemplar leadership by NHS. Health Trainers continue to support the NHS Health Check Programme ensuring personalised plans are developed for „at risk‟ individuals and supporting onward referral to appropriate support services.

Plans are in place to commission from January a „single point of access‟ for Lifestyle Risk Management Services (LRMS). The „single point of access‟ is a component of the Getting Healthy Staying Healthy Pathway. Health Trainers (2WTE) will be recruited to work alongside clinical staff within the „triage hub‟ and will:

4.3

Health Trainers Service Development

  

Respond to and triage all lifestyle related enquires Provide a clear seamless pathway into and between LRMS and onward referral to specialist services as required Provide a SPOA for professionals to access health information and be able to refer clients and patients into a SPOA for LRMS.

This local approach for Health Trainers Service Development supports delivery of recommendations from the Health Inequalities National Support Team.

82

Ref 3

3.8

Indicator

WALSALL - Comments on Performance

Child and Maternal Health Breast Feeding Initiation

6-8 Week Breast Feeding Prevalence

Full referral pathways have been agreed by all relevant partner organisations which have been a number of months in development due to safety of practice and clinical governance considerations (as with any new service). The full referral pathways for automatic referral of lactating women into the service (We are able now to offer opt out of service-rather than opt in due to the newly agreed pathways) is now in operation from the 1st November 2010. In the first two weeks of the pathway referrals have gone up to anticipated levels. Service users who have had intervention from the breastfeeding peer support team during Q2 have an average of 65% breastfeeding rate at 6-8 weeks against the Q1 (April-June) Walsall overall 6-8 week prevalence rate of 28.3% (WMPHO HIP Report Q1). This means that the quality of the service intervention is making a huge impact on clientâ&#x20AC;&#x;s breastfeeding continuance in Walsall. Therefore due to increasing referrals under the new pathway, impact should be apparent in the next Quarter (Q3) reporting.

NB. Breastfeeding 6-8 week Coverage: DH are looking for a Q2 figure of 31.9% for Walsall - so the differential between the Q2 prevalence 6-8 rate is less than shown on the draft report

3.11

Antenatal continuity of carer

4

Lifestyles

This metric has been reviewed by the IfH Project Board who have agreed to amend how this metric is measured from Q3 2010/11 onwards. From this point, continuity will be measured on visits from two professionals from the same team rather than the same person as previously recorded. We are working with our local hospital to assess what impact this change will make on performance.

The data used is Q1 2010/11 data. Also the target trajectory being used is flat. We have locally adopted the DH recommended trajectory of 20%, 20%, 30%, and 30% across the 4 quarters. Therefore our target figure at Q1 was 191.9 quitters per 100,000. Our refreshed activity figure at Q1 was equivalent to 179.1 quitters per100,000 4.1

Stop Smoking Returns

All activity data submitted to HCS under the tariff arrangement is to be refreshed during November and we anticipate improved numbers as a result.

An action plan has developed to address the gap, working with partners and practitioners to raise the number of referrals into Stop Smoking services. These include local advertising and update of health 83

Ref

Indicator

WALSALL - Comments on Performance information websites in Walsall; discussions with primary care leads and partners about referral pathways; introduction of automatic referral for patients attending outpatients clinics within the local hospital trust.

Stop smoking service providers are being encouraged to provide additional services in key areas and target groups. Where appropriate they can work together to maximise the numbers receiving support from their services.

Ref

Indicator

2.6

Breast Cancer Screening Round Length

3

Child and Maternal Health Breast Feeding Initiation

WARWICKSHIRE - Comments on Performance Current performance is significantly higher than the West Midlands average

3.8

6-8 Week Breast Feeding Prevalence

3.9

Childhood Weight Management Programmes

The PCT has put some actions in place to up the momentum. All staff are being trained to a national standard - however, the first cohorts of people trained are just being audited on their competencies. As more staff are trained and more peer support programmes take place, it is anticipated that the prevalence will increase. Improvements have already been noted across the county in breastfeeding initiation rates, particularly in the North of the county where rates have traditionally been lower.

As part of this yearâ&#x20AC;&#x;s BEST programme and to meet this required target, the PCT has put to tender a bid for providers to deliver these and contracts should go live from January 2011.

3.11

Antenatal continuity of carer

At 41.6%, performance is now significantly higher than the WM average and also higher than the Q1 figure of 36.2%. The Maternity Clinical Network are currently working to improve performance on this indicator.

4

Lifestyles

4.3

Health Trainers Service Development

5

Long Term Conditions

The Warwickshire target is 173 assessments per month based on 27 wte health trainers, the current establishment is 4.72 and currently in post 3.11. All heath trainer resources have been located in Nuneaton and Bedworth our Spear head areas. The figures are expected to increase slightly once the existing vacancy is filled.

84

Ref

Indicator

5.1

Expert Patients Programmes

5.11

Cholesterol Management for Diabetics (QOF DM17)

6

Older People

6.4

Falls Programmes

WARWICKSHIRE - Comments on Performance Please see narrative above in 4.3 Current performance is significantly higher than the West Midlands average and the latest performance represents a slight improvement on 09/10 figures.

The rate of falls prevention programmes for July to Sept was 15.5 per 10,000. This compares with a WM average of approximately 30.

The rate of falls assessments for July to Sept 2010 was 29.2 per 10,000. This compares with a WM average of over 100.

6.5

Falls Assessments The PCT is just starting to have discussions about providing the falls service countywide, within existing resources. This is a very complex process and may take some time to set up

7

Primary Care

7.1

QoF Total Score

7.4

Ethnicity Recording (QOF Rec21)

7.5

Child Access to NHS Dentistry

Ref

Indicator

The downward trend is consistent with the overall trend across the region. However performance remains above West Midlands average.

The Ethnicity DES incentivises the recording of Ethnicity and 1st language for all registered patients. As more practices are enrolled it is anticipated that rates will increase.

At 69.7% performance continues to remain higher than the West Midlands average

WOLVERHAMPTON - Comments on Performance

3

Child and Maternal Health Breast Feeding Initiation

3.4

Q1 data has been resubmitted as had not included the new GP Practice code format "Y02".

Smoking During Pregnancy Resubmitted Q1 data: (SATOD) ď&#x201A;ˇ No of women to have been smoking at time of delivery (SATOD) = 139, previously 135 85

Ref

Indicator

WOLVERHAMPTON - Comments on Performance 

No of women known not to have been smoking at time of delivery (SATOD) = 612, previously 607

Q2 data:  No of women to have been smoking at time of delivery (SATOD) (numerator) = 144  No of women known not to have been smoking at time of delivery (SATOD) = 631 3.5a

Childhood Vaccinations Dtap

3.5b

Childhood Vaccinations MenC

Q2 data will not be available until end of November.

Performance has been highlighted at the PCT‟s Professional Executive Committee and to the Trust Board.

Workshops are going to be set up with practices that have been highlighted as poor performing. These will be run by Public Health, Primary Care Contracting Team and supported by a General Practitioner (PEC member) who has volunteered to come and discuss how they have tackled their issues in the past.

A general letter is going out from our Director of Public Health to all our General Practitioners about the poor Immunisation uptake all over Wolverhampton and suggestions for improvement (sharing good practice).

3.5c

Childhood Vaccinations MMR

3.10

Completed health and social assessment before 13 weeks

In the interim, the PCT is taking the following measures:  Continued support for all new practice nurses with training  Update training for all immunisers is already being arranged for next year to cover all aspects of immunising, documentation and data entry  Promotional information has been sent out to practices encouraging them to read and display  The new Immunisation Coordinators‟ newsletter continues to update all Wolverhampton immunisers about current issues and will be another form of communication to express our concerns about the falling Immunisation status of Wolverhampton

Q1 data resubmitted as had not included the new GP Practice code format "Y02".

Resubmitted Q1 data:  Number of maternities Q1 (VSMR Line 7101) = 751, previously 742 Q2 data now available: 86

Ref

Indicator

WOLVERHAMPTON - Comments on Performance ď&#x201A;ˇ

3.11

Antenatal continuity of carer

4

Lifestyles

4.1

Stop Smoking Returns

Ref

Indicator

2.6

Breast Cancer Screening Round Length

3

Child and Maternal Health Breast Feeding Initiation

Completed assessments before 13 wks (VSMR Line 7101) = 775

Although current performance is below the target trajectory of 75.0% it is significantly higher than the West Midlands average.

This indicator was set as part of Project 2c -and is a West Midlands Perinatal Institute (WMPI) identified target as part of this project.

There has been discussion between Commissioners, Providers and WMPI about the difficulties in achieving this target although Wolverhampton is one of the better performing areas.

The conclusion to these discussions is that the denominator within this target will change to incorporate ante-natal visits by 2 midwives as opposed to measuring the number of visits by the â&#x20AC;&#x153;same midwife".

This proposal is awaiting final confirmation.

The service has noticed a decline in clients since the national advertising campaign ceased.

The service is developing a local marketing plan to encourage access.

It is also working with GP practices to identify smokers and encourage them to access the stop smoking service.

WORCESTERSHIRE - Comments on Performance During the Q2 period, the service was unable to achieve round length targets due to increasing numbers of women eligible for screening and lack of capacity in the static unit to offer access at Bromsgrove. The situation has now been resolved by bringing a mobile screening trailer to the POWCH site for a period of six weeks. The service is now achieving round length targets for Bromsgrove and Redditch women.

87

Ref

Indicator

3.8

6-8 Week Breast Feeding Prevalence

3.9

Childhood Weight Management Programmes

3.11

Antenatal continuity of carer

4

Lifestyles

4.1

Stop Smoking Returns

WORCESTERSHIRE - Comments on Performance We achieved an increase to 43.6% for Q2.

Corrective action:  Continue implementation of Baby Friendly accreditation in Acute Trust, PCT and Children‟s Centres (Stage 2 achieved for WHAT, Stage 1 achieved for PCT/LA). Complete BFI training for all staff including any catch up. Commence roll out for GP practices  Early review of pilot breastfeeding support worker service undertaken (commenced in March 10).

BFSWs were contacting all breastfeeding mums within 48 hours of discharge from maternity unit & providing support & regular contact for up to 6 weeks. Now refocused to 1) contact under 25s antenatally & all others postnatally within 48 hours and 2) to tackle the above average drop off rate within first 2 weeks in Worcestershire BFSWs to focus additional contact/support within first 2 weeks and minimal support 2-6 weeks.  Step up roll out of “Worcestershire Welcomes Breastfeeding” to ensure a network of quality assured breastfeeding friendly premises offering positive support to breastfeeding mothers. Currently 130 premises have been accredited.  Breastfeeding initiation and continuation data analysis and mapping to be reviewed and considered

by IfH Project 2c LIG and local Infant Feeding Group  Review breastfeeding support & supporting activities undertaken by Health Visiting service.

In previous years we have always reported “zero” for the summer quarter as programmes were only running during school terms, however we ran the first in-house FRESH pilot over the summer holidays we had 7 children complete, out of 10 initially starting.

This is one of the 5KPIs now reported from the PEER dataset. The regional target is for 75% of community visits to be with the same midwife. This is challenging for some areas as depends on working practices. The PEER dataset allows for minimum of 2 named midwives within a team as the continuity of visits. However, WAHT organise their community midwife teams into teams of 3 midwives, such that a pregnant women could see 1of any 3 named midwives. This is due to the large number of part-time midwives and large rural geographical caseloads in this county.

It is likely to be Q3 before we have a realistic view of the impact of tariff on our smoking quit rates due to the cumbersome nature of the changes. There is an opportunity for tariff providers to submit any late data from April to date with their 12th November return to HCS. Many of our tariff providers have been slow to 88

Ref

4.3

Indicator

Health Trainers Service Development

WORCESTERSHIRE - Comments on Performance activate the contracts, mainly due to data management issues that are taking time to resolve with HCS. These are being worked on with the consortium as a whole and have been more complex than anticipated. Meanwhile we are doing all we can to support new providers, and are also pushing forward with our communications strategy which is using social marketing methods to reach our harder to reach groups.

The Health Trainer Service moved from a pilot phase to a countywide programme on the 1st August 2010.

The new service has more than doubled the number of health trainers now in post (11.3). However, this still falls short of the target of 31 Health Trainers that was originally identified for Worcestershire. The new service is operated on a tariff system, which should increase the numbers of referrals into the programme.

89