NHSPN headline indicator summary - 18 Jul 14/media/Confederation/Files/public acce… ·...

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Headline NHSPN indicators 18 July 2014 Edition 7

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New in this edition New this month

• New format and more explanation about slides Updated data

• Friends and family test results • PROMs data • VTE assessment • RTT data and elective volumes • Diagnostic waiting time data

For more information about the data underlying the visualisations in this presentation, please contact [email protected]

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Contents Headline NHSPN indicators ...................................................................................................................................................................................................................................... 1

New in this edition ................................................................................................................................................................................................................................................ 2

Independent sector performance ........................................................................................................................................................................................................................ 5

Patient experience .................................................................................................................................................................................................................................................... 6

Friends and family test performance .................................................................................................................................................................................................................... 7

Friends and family test – performance of all providers ........................................................................................................................................................................................ 8

Friends and family test – the top 50 performers .................................................................................................................................................................................................. 9

Friends and family test response rates ............................................................................................................................................................................................................... 10

Clinical quality ......................................................................................................................................................................................................................................................... 11

CQC standards 2012–13 ..................................................................................................................................................................................................................................... 12

CQC compliance rates – hospital care standards ............................................................................................................................................................................................... 13

CQC compliance rates – community healthcare standards ................................................................................................................................................................................ 14

CQC compliance rates – independent ambulances ............................................................................................................................................................................................ 15

Patient outcomes and safety .................................................................................................................................................................................................................................. 16

Patient Reported Outcome Measures (PROMs) ................................................................................................................................................................................................. 18

Rate of assessment for VTE (blood clots) ........................................................................................................................................................................................................... 19

Infection control data ......................................................................................................................................................................................................................................... 20

Efficiency indicators ................................................................................................................................................................................................................................................ 21

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Referral to treatment times ................................................................................................................................................................................................................................ 22

Top 50 providers by referral to treatment time for trauma and orthopaedic care ............................................................................................................................................ 23

Percentage of patients treated within 18 weeks ................................................................................................................................................................................................ 24

Typical waiting times .......................................................................................................................................................................................................................................... 25

Average waiting times by specialty .................................................................................................................................................................................................................... 26

Waiting times for 95% of patients ...................................................................................................................................................................................................................... 27

Diagnostic waiting times ..................................................................................................................................................................................................................................... 28

Numbers of patients treated .................................................................................................................................................................................................................................. 29

Numbers of patients treated by independent providers .................................................................................................................................................................................... 30

Elective admissions and GP referrals (1) ............................................................................................................................................................................................................ 32



Acute elective patients treated by independent sector and NHS organisations ................................................................................................................................................ 35

Patients treated by the independent sector by specialty ................................................................................................................................................................................... 36

Diagnostic tests carried out by independent sector by modality ....................................................................................................................................................................... 37

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Independent sector performance The NHS Partners Network is the trade association representing the widest range of independent sector providers of NHS clinical services ranging through acute, diagnostic, primary and community care, as well as dental services. Our members are drawn from both the “for profit” and “not for profit” sectors and include large international hospital groups and small specialist providers. All are committed to working in partnership with the NHS and to the values set out in the NHS Constitution. This document gives an overview of the performance of independent sector providers of care to NHS patients. It focuses on care sectors represented by NHSPN members and the indicators available cover five broad domains of quality:

• Patient experience • Clinical quality • Patient outcomes and safety • Efficiency indicators • The contribution of the sector shown by numbers of patients treated

All the visualisations shown in this document are based on publicly available data published by organisations such as NHS England, Public Health England, the NHS Health and Social Care Information Centre and the Care Quality Commission. Not all data collected for traditional NHS organisations and independent sector providers can be compared easily. Historic differences in the way NHS and independent sector providers have been regulated have often required independent providers to collect different information from their NHS counterparts. As the range of information is increasingly harmonised, we hope to be able to produce more comparative information published by third parties such as the organisations listed above.

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Patient experience

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Friends and family test performance The Government’s preferred measure of patient satisfaction, the Friends and Family Test (FFT), applies equally to traditional NHS and the independent sector. Collected monthly since April 2013, independent providers consistently score around 90 on the FFT with the NHS consistently averaging around 70. At present, acute inpatient care is the only area where the FFT is collected by both independent and NHS providers however NHS England is in the process of rolling out the FFT across all NHS care by April 2015.

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Friends and family test – performance of all providers Independent providers cluster at the ‘high end’ of performance. The graph below shows the performance of all providers that collect the FFT for inpatient acute care and which produce a minimum response rate of 25% amounting to at least 25 patients per month. Green bars represent independent organisations and blue bars show NHS hospitals.

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Friends and family test – the top 50 performers The graph below shows the top 50 hospitals as measured by patients in their response to the FFT for acute inpatient care.

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Friends and family test response rates Response rates to the FFT are used by the CQC to measure NHS Trusts’ report culture. On average NHS organisations and independent providers share a similar response rate.

The data that underpins all the FFT graphs above is available at: http://www.england.nhs.uk/statistics/statistical-‐work-‐areas/friends-‐and-‐family-‐test/friends-‐and-‐family-‐test-‐data/

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Clinical quality

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CQC standards 2012–13 The CQC is currently introducing a new approach to regulating independent and NHS organisations. This will go live across all areas of care from April 2015. We hope that this will allow a fair and appropriate comparison between all providers of health and social care. The existing regime is based on compliance with a set of standards defined by the CQC. The CQC has assessed all providers against these outcome measures for the past three years. In general the IS complies with more outcome measures than its NHS peers. The graphs that follow show the rate at which independent and NHS organisations comply with CQC standards. We have shown all relevant standards for the care areas covered by NHS Partners Network members, i.e.:

• hospital care standards • community healthcare standards • independent ambulances

The graphs show compliance levels and rates of major and moderate breaches. Data is available for all providers inspected by the CQC and has been published in headline form in its annual ‘state of care’ report. We have obtained more granular detail through FOI requests.

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CQC compliance rates – hospital care standards

Compliance rates with hospital care standards (higher rates are better)

Major and moderate breaches (lower rates are better)

Green bars show independent organisations; blue bars indicate NHS providers

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CQC compliance rates – community healthcare standards


Major and moderate breaches (lower rates are better)

Green bars show independent organisations; blue bars indicate NHS providers

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CQC compliance rates – independent ambulances


Green bars show independent organisations; the CQC did not publish comparable information for NHS ambulances for 2012-‐13, nor is information on breach rates available

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Patient outcomes and safety

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Patient outcomes and safety Indicators that relate to outcomes and safety for which it is reasonable to make comparisons between independent sector organisations and their NHS counterparts include:

• Patient Reported Outcome Measures (PROMs); and • Rate of assessment for VTE (blood clots)

Infection control information is also an important indicator. Because Public Health England analyses information collected for the independent sector and the NHS organisations on a different basis, its view is that like-‐for-‐like comparison should not be made. For completeness, we have published rates for independent sector providers in the pages that follow. These show that independent providers have very low rates of healthcare-‐acquired infections.

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Patient Reported Outcome Measures (PROMs) Patient Reported Outcome Measures (PROMs) are collected for a range of elective procedures, including hip & knee replacements and cataract surgery. The Health and Social Care Information Centre (NHSCIC) publishes casemix-‐adjusted health gain by provider every six months. The NHSCIC produces PROMs data on a relatively low number of NHS and independent sector organisations. However, for these organisations the average case-‐mix adjusted weighted average health gain for patients was 18.2 for those treated by independent providers and 16.8 for NHS organisations in the most recent six-‐month period available:

Source: NHS Health and Social Care Information Centre (http://www.hscic.gov.uk/catalogue/PUB13956

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Rate of assessment for VTE (blood clots) All providers of acute adult inpatient care are required to provide information on the percentage of admitted patients who are risk-‐assessed for venous thromboembolism (blood clots). The graph below shows data for the past year. The average rate for independent providers is 98.3% compared with 95.8% of NHS organisations.

Source: http://www.england.nhs.uk/statistics/statistical-‐work-‐areas/vte

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Infection control data Infection control information that allows direct comparisons between the NHS and independent sector is not available. In 2009, the Health Protection Agency, now part of Public Health England, which has responsibility for collecting infection-‐control data, published its rationale for why independent sector infection-‐control information cannot yet be compared with NHS information here. Despite this lack of comparative information, Public Health England data makes it clear that there are very low healthcare acquired infection rates in the independent sector. During the six months between Apr and September 2013, the total number of reported infections across the entire independent estate (NHS-‐funded and privately funded care) was just:

• 7 cases of MRSA bacteraemia infections • 41 cases of C. difficile • 19 cases of MSSA bacteraemia • 78 cases of E. coli bacteraemia

Public Health England has not published a denominator number of bed days for this six-‐month period, but the baseline number of adjusted bed days for the previous 12 months (Apr 2012 to Mar 2013 was 1,812,950). Source: Public Health England (http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/HCAI/EpidemiologicalDataHCAI/hcaiISreportingintro/)

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Efficiency indicators

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Referral to treatment times Referral to treatment times show that patients are treated earlier by independent sector providers compared with those treated by NHS organisations. Waiting times are an important indicator of organisational efficiency and for patients deciding where to choose treatment. Mean and median waiting times are generally shorter across most specialties for both inpatients and outpatients treated by independent providers compared with their NHS peers.

• Outpatients treated in May by independent providers had on average (mean) waited for 5.3 weeks compared with 10 days longer if treated by NHS organisations • Inpatients treated by independent providers during May waited an average (mean) of 9.4 weeks compared with patients waiting an additional seven days when

treated by NHS organisations • Median waiting times were similarly lower for patients treated by independent providers • 95% of outpatients treated by independent sector organisations were treated within 11.7 weeks, with NHS organisations taking 15.9 weeks to treat the same

proportion of outpatients • 95% of inpatients treated by independent sector organisations were treated within 15.4 weeks, with NHS organisations taking 22.7 weeks to treat the same

proportion of outpatients – over four weeks above the 18 week commitment http://www.england.nhs.uk/statistics/statistical-‐work-‐areas/rtt-‐waiting-‐times/ NB the minimum thresholds adopted by NHS England for their calculations of median values disproportionately reduce the number of available results for independent sector providers for specialty-‐level outpatient RTT data during May. It is therefore not possible to produce a chart for the top 50 RTT outpatient performers (see p. 23) using the values calculated by NHS England accurately reflects performance of all providers. We are investigating other alternatives which may lead to the production of a comparable chart for next month’s figures.

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Top 50 providers by referral to treatment time for trauma and orthopaedic care The graphs below show the organisations with the shortest times for patients waiting for treatment for trauma and orthopaedic care. We have selected this specialty as it is the largest area of care by volume and percentage share to which the independent sector contributes.

NB, see note on page 22 about the availability of specialty-‐level RTT data for outpatient waiting times.

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Percentage of patients treated within 18 weeks The graphs below show the proportion of patients seen within the 18-‐week referral to treatment commitment enshrined within the NHS constitution.

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Typical waiting times Median waiting times illustrate the typical experience of most patients when waiting for care.

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Average waiting times by specialty The graphs below show a weighted average of inpatient and outpatient waiting times by specialty.

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Waiting times for 95% of patients It is likely that there will be a small number of patients for whom treatment takes a significantly longer than expected amount of time. The graphs below show the maximum waiting time for 95% of patients, i.e. the longest period that most patients can reasonably expect to have to wait.

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Diagnostic waiting times The graph below shows mean waiting times for diagnostic tests by modality. MRI scans and non-‐obstetric-‐ultrasound are the most frequently provided diagnostic tests by independent organisations.

Source: http://www.england.nhs.uk/statistics/statistical-‐work-‐areas/diagnostics-‐waiting-‐times-‐and-‐activity

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Numbers of patients treated

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Numbers of patients treated by independent providers Elective care is critically dependent on independent sector provision. Around 19% of all hip and knee replacements are now carried out by the independent sector and in some areas of the country this figure is far higher. Health outcomes and safety are closely linked to experience treating significant volumes of patients. As well as NHS patients many independent sector providers also treat large numbers of privately-‐funded patients as well. The graphs in the section that follows show a steady increase in the number and proportion of procedures carried out by independent providers since 2011 when easily comparable statistics were first published. However, the overall number of NHS patients treated by independent organisations remains a small fraction of total NHS volumes.

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Ramsay Health Care UKBMI Healthcare

Care UKSpire Healthcare

Circle HealthNuffield Health

Aspen HealthcareHealthcarel Managment Trust

108,114

32,99557,588

69,34675,610

31,2714,759

493

Independent NHS Providers

Independent NHS Hospitals

Other treatments and proceduresCataract surgery

Gastroscopy (Diagnostic Endoscopy of Stomach)Arthroscopy of the knee

Colonoscopy (Diagnostic Endoscopy of Colon)Knee ReplacementHip Replacement

Repair of Inguinal HerniaJoint Injections for Pain

Skin Lesion RemovalDiagnostic flexible sigmoidoscopy, includes forceps biopsy

Extraction of wisdom teethCarpal tunnel release

Bladder Examination - Diagnostic Endoscopy (Cystoscopy)Epidural Injection

Spinal Injection (facet joint injection or paravertebral block)Shoulder Surgery

Spinal injection (dorsal root block)Gallbladder Surgery (Cholecystectomy)

Bowel therapeutic endoscopy (colonoscopy)Haemorrhoid treatment

136,475

10,375

13,808

33,407

25,433

18,317

26,610

14,520

12,844

12,144

11,044

4,179

8,976

7,313

7,306

6,727

5,017

3,956

8,550

7,214

5,961

Top Independent NHS Procedures

April 2011

May 2011

June 2011

July 2011

August 2011

September 2011

October 2011

Novem

ber 2011

Decem

ber 2011

January 2012

February 2012

March 2012

April 2012

May 2012

June 2012

July 2012

August 2012

September 2012

October 2012

Novem

ber 2012

Decem

ber 2012

January 2013

February 2013

March 2013

April 2013

May 2013

June 2013

July 2013

August 2013

September 2013

34,259

30,570

33,763

31,413

31,780

31,787

31,881

30,833

32,584

25,589

33,298

32,419

29,000

27,577

28,954

26,454

30,106

25,216

26,975

24,293

24,800

20,60726

,975

24,680

24,562

21,930

22,527

22,479

21,274

18,290

Average = 27,563

Independent NHS Activity

Nottingham NHS Treatment CentreSouthampton NHS Treatment Centre

Emersons Green NHS Treatment CentreYorkshire Clinic

Shepton Mallet NHS Treatment CentreNorth East London Treatment Centre

Rivers HospitalSt Mary's NHS Treatment Centre

Spire Liverpool HospitalNuffield Health Leeds HospitalDevizes NHS Treatment Centre

Fulwood Hall HospitalSpire Hull & East Riding Hospital

Fitzwilliam HospitalTees Valley HospitalSpringfield Hospital

Duchy HospitalThe Oaks Hospital

Cobalt Treatment CentreBodmin Treatment centre

Nuffield Health Tees HospitalWoodland Hospital

BMI Beardwood HospitalEuxton Hall Hospital

Will Adams NHS Treatment Centre

28,64916,234

4,995

4,778

4,419

4,379

5,378

4,418

8,906

4,693

4,437

4,193

9,787

8,126

6,760

4,000

5,134

6,402

7,351

5,321

4,951

4,471

7,611

6,191

4,231

Top Indepependent Hospitals for NHS Treatment

4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88 91 94 97 100

103

Female

Male

Independent NHS Age and Sex Profile

Independent Provision of NHS-funded Elective Surgery (c) PHIN 2014. Numbers show discharges in the 12 months to 30 September 2013 except as indicated. HES data published withpermission of HSCIC. All data is available under licence from HSCIC.

BritishAny other White background

IndianPakistani

Any other Asian backgroundIrish

Any other ethnic groupAfrican

CaribbeanBangladeshi

Any other Black backgroundAny other mixed background

ChineseWhite and Black Caribbean

White and AsianWhite and Black African

Not statedNull

72.4%

17.9%

1.4%

1.0%

0.7%

0.6%0.5%

0.5%

0.3%

0.2%

0.1%

0.1%0.1%

0.1%

0.1%

0.1%

0.1%

3.8%

Ethnic Profile

Least Deprived

9

7

8

6

5

4

3

2

Most deprived

Null

12%

11%

11%

11%

10%

10%

9%

9%

8%

8%

0%

IMD Decile

380,176

Episodes over latest 12 months

TRAUMA & ORTHOPAEDICS

GENERAL SURGERYGASTROENTEROLOGY

OPHTHALMOLOGYPAIN MANAGEMENT

GYNAECOLOGYUROLOGY

ORAL SURGERYCOLORECTAL SURGERY

DERMATOLOGYANAESTHETICS

Other Specialties

41,525

39,378

89,350

33,281

7,159

6,778

9,977

7,187

3,517

6,300

4,090

7,974

Independent NHS Specialties

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Elective admissions and GP referrals (1) Analysis of quarterly hospital activity data (http://www.england.nhs.uk/statistics/statistical-‐work-‐areas/hospital-‐activity/quarterly-‐hospital-‐activity/) shows that the number of patients treated by the independent sector is steadily growing.

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Elective admissions and GP referrals (2) Despite the growth in independent sector provision, it is clear that traditional NHS providers still dominate overall provision for NHS patients.

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Elective admissions and GP referrals (3) The overall percentage of patients treated by the independent sector has grown in accordance with the increasing number of patients choosing independent providers.

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Acute elective patients treated by independent sector and NHS organisations For most specialties, independent sector provision represents a small proportion of overall care. However, in some specialties, notably trauma & orthopaedics and ophthalmology, the proportion of care provided by independent organisations has reach significant levels.

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Patients treated by the independent sector by specialty The pie charts below show the proportion of all independent sector care by specialty.

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Diagnostic tests carried out by independent sector by modality

The pie chart below shows the range of diagnostic tests provided by independent sector organisations.

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