NHS North West

The following tables show regional performance, where data is available, on the key indicators and milestones and can be used to assess how well NHS North West is delivering the national priorities

Notes

* National data may not be directly comparable with regional data

** Where different plans are set by each organisation it may not be appropriate to show them

Click on the table heading to see the description and rationale for that indicator

Glossary

HPA – Health Protection Agency http://www.hpa.org.uk/

DH – Department of Health http://www.dh.gov.uk/en/index.htm

IC - Information Centre http://www.ic.nhs.uk/

CQC – Care Quality Commission www.cqc.org.uk

Healthcare Associated Infection

Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C.Diff) infections are a significant patient safety issue. They can cause illness and, sometimes, death. It can be very distressing for patients who acquire an infection in hospital or in the community, for their family and friends and for staff who treat them.

The Department of Health recognises that it may not be possible to achieve zero infections as there are some infections that cannot be prevented. The ultimate aim is for zero preventable infections.

The Healthcare Associated Infection data show the total number of MRSA bacteraemia and number of C.Diff infections reported against the planned number for the year to date.

Patient Experience

Adult Inpatient Survey
Patient centred care and improving patient experience are high priorities.

The table shows results from the annual adult inpatient survey, which is one of a suite of surveys which make up the NHS National Patient Survey Programme, aggregated to regional level. The survey is conducted using a postal self-completion survey approach, and is conducted among a sample of recent patients who have spent at least one night in hospital.

The Adult Inpatient Survey data show results from the annual adult inpatient survey. The scores are out of 100. A higher score indicates a better performance.

Mixed Sex Accommodation
All providers of NHS funded care are expected to eliminate mixed-sex accommodation (MSA), except where it is in the overall best interest of the patient.

The MSA breach rate is the number of breaches of mixed-sex accommodation sleeping accommodation per 1,000 Finished Consultant Episodes. An MSA breach rate indicator has been developed because a simple count of the number of MSA breaches does not provide a fair comparison across healthcare providers. Raw numbers alone do not take into account the size of an organisation.

The MSA data show the MSA breach rate; a lower rate indicates fewer breaches.

Ambulance Quality

Faster response times improve health outcomes and experience for patients with immediately life-threatening conditions.

Category A incidents are where the incident is classified as immediately life-threatening. The standard measures emergency response times. A response can be an emergency ambulance, a rapid response vehicle equipped with a defibrillator to provide treatment at the scene or an approved first responder equipped with a defibrillator.

Further, patient outcomes can be improved by ensuring patients with immediately life-threatening conditions receive a response at the scene which is able to transport the patient in a clinically safe manner, if they require such a response. For the purposes of the Category A 19-minute standard, transport is defined as a fully equipped ambulance vehicle (car or ambulance) able to transport the patient in a clinically safe manner.

The Ambulance Quality data show the proportion of Category A incidents where an emergency response arrived within 8 minutes and the proportion where an ambulance response arrived within 19 minutes.

Referral to Treatment waiting times

Patients’ rights to access services within maximum waiting times under the NHS Constitution continue. The referral to treatment time is the time between a patient’s referral to a consultant-led or assessment service and when their first treatment starts or when it is agreed that treatment is unnecessary or unwanted.

Some patients are admitted for treatment, either as a day patient or an inpatient; they are classed as admitted patients. Some have treatment as an outpatient or do not have treatment; they are classed as non-admitted patients. Waiting times are also measured for patients for whom treatment has not yet started and are still waiting.

The Referral to Treatment waiting times data show the time by which 95% of patients have started their first treatment or agreed there will be no treatment, or the length of time 95% of patients whose treatment has not yet started have waited.

Accident and Emergency Quality

International literature suggests increases in adverse outcomes for patients who have been in Accident & Emergency departments (A&E) for more than 4-6 hours. Longer lengths of stay in A&E are associated with poorer health outcomes and patient experience as well as transport delays, treatment delays, ambulance diversion and patients leaving without being seen.

It is critical that patients receive the care they need in a timely fashion, so that patients who require admission are placed in a bed as soon as possible, patients who need to be transferred to other healthcare providers receive transport with minimal delays, and patients who are fit to go home are discharged safely and rapidly.

The Accident and Emergency Quality data show the proportion of patients who spend less than four hours from arrival at A&E to admission, transfer or discharge.

Cancer waiting times

Patients’ rights to access services within maximum waiting times under the NHS Constitution continue include access to cancer services. Shorter waiting times can help to ease patient anxiety and, at best, can lead to earlier diagnosis, quicker treatment, a lower risk of complications, an enhanced patient experience and improved cancer outcomes.

Ensuring that all cancer patients receive the appropriate treatment, delivered to a high standard, is critical to improving cancer outcomes. The quality of treatment has already improved significantly, with more widespread and rapid access to the latest forms of surgery, radiotherapy and drugs and there must be equitable access to treatment.
Different stages of a patient’s journey are assessed separately to ensure high standards throughout. The different stages are:

Two week wait
Two week wait services are a vital component of the patient pathway, they ensure fast access to diagnostic tests, supporting the provision of an earlier diagnosis and therefore assist in improving survival rates for cancer. It remains important for patients with cancer or its symptoms, to be seen by the right person, with appropriate expertise, within two weeks to ensure that the receive the best possible survival probability and a lower level of anxiety than if they were waiting for a routine appointment.

The Cancer waiting times - two week wait data show

• the proportion of people seen by a specialist within two weeks of an urgent GP referral for suspected cancer; and
• the proportion of people urgently referred for breast symptoms (where cancer was not initially suspected) who were seen within two weeks of referral

31-day wait
Maintaining these standards will ensure that cancer patients receive all treatments within their package of care within clinically appropriate timeframes, thus providing a better patient experience, with a service focussed on a patient’s wishes, whilst improving survival and mortality rates.

The Cancer waiting times 31-day wait data show

• the proportion of people receiving first treatment for cancer (all cancers) within 31 days from diagnosis;
• the proportion of people receiving surgery as a subsequent treatment within 31-days, including patients with recurrent cancer;
• the proportion of people receiving an anti-cancer drug regimen (chemotherapy) as a subsequent/adjuvant treatment within 31-days, including patients with recurrent cancer; and
• the proportion of people receiving radiotherapy as a subsequent/adjuvant treatment within 31-days during a given period, including patients with recurrent cancer

62-day wait
Maintaining these standards will ensure that a cancer patient will move along their pathway of care at a clinically appropriate pace, thus providing a better patient experience, with a service focussed on a patients ‘ wishes, whilst improving survival and mortality rates.

The Cancer waiting times 62-day wait data show

• the proportion of people receiving first definitive treatment for cancer within 62-days following an urgent GP referral for suspected cancer ;
• the proportion of people receiving first definitive treatment for cancer within 62-days following referral from an NHS Cancer Screening Service; and
• the proportion of people receiving first definitive treatment for cancer within 62-days of a consultant decision to upgrade their priority status

Venous Thromboembolism (VTE) risk assessment

VTE is a condition in which a blood clot (thrombus) forms in a vein. Blood flow through the affected vein can be limited by the clot, and may cause swelling and pain. Venous thrombosis occurs most commonly in the deep veins of the leg or pelvis; this is known as a deep vein thrombosis (DVT). An embolism occurs if all or part of the clot breaks off from the site where it forms and travels through the venous system. If the clot lodges in the lung a potentially serious and sometimes fatal condition, pulmonary embolism (PE) occurs. DVT and PE are the commonest manifestations of venous thrombosis.

VTE is a significant cause of mortality, long-term disability and chronic ill health. All patients should be risk assessed on admission to hospital.

The VTE data show the proportion of patients who receive a VTE risk assessment on admission to hospital.

Stroke Care

There are approximately 110,000 strokes per year in England, around a third of whom die. Stroke is the largest single cause of adult disability and there are around 300,000 people in England living with moderate to severe disabilities as a result of stroke.

Good care on a dedicated stroke unit is the single most effective way to improve outcomes for people with stroke.

Early initiation of treatment for Transient Ischaemic Attacks (TIAs) or minor strokes can reduce the number of people who go on to have a major stroke by 80%.

The Storke Care data show the proportion of patients admitted to hospital with a stroke who spend at least 90% of that time on a dedicated stroke unit and the proportion of people referred with a suspected TIA, who are at high risk of stroke, who are assessed and treated within 24 hours.

Access to NHS Dentistry

There is a need to ensure access to dental services for anyone who actively seeks it.

The Access to NHS Dentistry data show the number of people who have accessed NHS dental services within the past 24 months.

Access to Maternity Services

Women who access maternity care late have poorer outcomes. Early access allows pregnant women and their families to discuss with the maternity team what services are available locally and the choices that are right for them from an early stage in their pregnancy.

All women should be able to access maternity care for a full health and social care assessment of their needs, risks and choices by 12 completed weeks of pregnancy so that a women’s plan of care can be tailored to address any identified needs and ensure women receive the right care at the right time and also help with identifying families who may need ongoing support with parenting.

The Access to maternity Services data show women who receive a health and social care assessment within 12 complete weeks of pregnancy as a proportion of all women who receive the assessment.

Mental Health

Early Intervention in Psychosis
Psychosis is a debilitating illness with far-reaching implications for the individual and his/her family. It can affect all aspects of life; education and employment, relationships and social functioning, physical and mental wellbeing. Without support and adequate care, psychosis can place a heavy burden on carers, family and society at large. Early treatment is crucial because the first few years of psychosis carry the highest risk of serious physical, social and legal harm

The Early Intervention in Psychosis data show the number of new cases of psychosis served by early intervention teams

Crisis Resolution / Home Treatment
A crisis resolution home treatment team provides intensive support for people in mental health crises in their own home: they stay involved until the problem is resolved. It is designed to provide prompt and effective home treatment, including medication, in order to prevent hospital admissions and give support to informal carers.

The Crisis Resolution / Home Treatment data show the number of home treatment episodes; an episode of home treatment starts on the first day on which care is delivered to the patient at home (home means the current place of residence which could include, for example, hostel accommodation) and ends with discharge from the CR/HT team’s care.

Care Programme Approach (CPA)
Reduction in the overall rate of death by suicide is supported by arrangements for securing appropriate care for all those with mental ill health. This includes actions to reduce risk and social exclusion and improve care pathways; it includes action to follow up quickly all those on the care programme approach who are discharged from a spell of in-patient care.

The Care Programme Approach (CPA) data show the proportion of people under adult mental illness specialties on CPA who were followed up within 7 days of discharge from psychiatric in-patient care.

Improving Access to Psychological Therapies
The Improving Access to Psychological Therapies programme aims to improve access to evidence based talking therapies in the NHS through an expansion of the psychological therapy workforce and services. It was created to offer patients a realistic and routine first-line treatment, combined where appropriate with medication which traditionally had been the only treatment available.

The Improving Access to Psychological Therapies data show the number of people who are moving to recovery as a proportion of those who have completed a course of psychological treatment

Smoking Quitters

Smoking is one of the most significant contributing factors to life expectancy, health inequalities and ill health, particularly cancer, coronary heart disease and respiratory disease. Reducing smoking is therefore a key improvement area. Evidence-based NHS stop smoking support is highly effective both in cost and clinical terms. Many smokers will need to make multiple attempts to quit before achieving long-term success; it is important that those who are motivated receive repeat interventions following a relapse.

To measure the success of NHS Stop Smoking Services data is collected on a number of areas including the number of clients who report that they are not smoking four weeks after setting a quit date.

The Smoking Quitters data show the number successfully quit (self-report) per 100,000 of population aged 16 and over.

Breastfeeding

Breastfeeding protects the health of babies and mothers, and reduces the risk of illness. Breast milk is the best form of nutrition for infants, and exclusive breastfeeding is recommended for the first six months (26 weeks) of an infant’s life. Thereafter, breastfeeding should continue for as long as the mother and baby wish, while gradually introducing the baby to a more varied diet.

In recent years, research has shown that infants who are not breastfed are more likely to have infections in the short-term such as gastroenteritis, respiratory and ear infections, and particularly infections requiring hospitalisation. In the longer term, evidence suggests that infants who are not breastfed are more likely to become obese in later childhood, which means they are more likely to develop type 2 diabetes, and tend to have slightly higher levels of blood pressure and blood cholesterol in adulthood. For mothers, breastfeeding is associated with a reduction in the risk of breast and ovarian cancers. A recent study also suggests a positive association between breastfeeding and parenting capability, particularly among single and low-income mothers.

In 2005 around 78% of women in England breastfed their babies after birth, however, a third of these women had stopped soon after so that only 50% of all new mothers were breastfeeding by week 6 and 26% by 6 months.

The Breastfeeding data show the proportion of babies due a 6-8 week check who are recorded as being totally or partially breastfed.

Cervical Screening

Cervical screening has prevented an epidemic that would have killed about one in 65 of all British women born since 1950 and culminated in about 6,000 deaths per year in this country. About 80% or more of these deaths, up to 5,000 per year, are likely to be prevented by screening.

In 2009-10, only 44.6% of test results were sent to women within two weeks of the sample being taken. However, over 13% of women had to wait over 6 weeks for their result. Waiting so long for results, especially for a test for abnormalities which may lead to cancer, causes anxiety in women. It may also deter women from being screened next time they are invited. That is why the Cancer Reform Strategy (December 2007) said that all women should receive cervical screening test result within 14 days.

The Cervical Screening data show the proportion of women who had a test result letter delivered within two weeks of the test.

Diabetes Care

Diabetic retinopathy is the most common cause of blindness in working age people in England. If untreated, 50% of those who develop proliferative diabetic retinopathy will lose their sight within two years, and some of these within 12 months. Early detection of sight threatening diabetic retinopathy and treatment (usually with laser therapy) halves the risk of blindness.

The Diabetes Care data show the proportion of people who have been offered screening for diabetic retinopathy, as part of a systematic programme that meets national standards, during the last 12 months.