NHS Yorkshire and the Humber Monthly QIPP Resource Pack March 2010

1. NHS Yorkshire and the Humber Monthly QIPP Resource Pack March 2010

2. Introduction This is the fourth QIPP monthly resource pack. The pack has three components: BETTER FOR LESS EXAMPLES:We have worked with you to develop practical examples of schemes which have been developed locally and have potential to deliver better quality at lower cost. This month the ‘better for less’ example focuses on treatment in hospital of fractured neck of femur. URGENT CARE ‘HOT TOPIC’:Each month we will produce one ‘hot topic’ briefing which provides more detailed analysis on a subject relevant to QIPP. This month the hot topic is urgent care. The analyses presented here are designed to offer insight and raise questions about variation in performance. They need to be interpreted in the local context. QIPP METRICS: We have developed a set of metrics to help understand system health in the tighter financial climate. We will publish these metrics monthly although some of the indicators will only be updated quarterly. The purpose is to offer insight and improve understanding of how the system delivering with lower growth. The next resource pack will be published week commencing 5th April. The hot topic will be planned care. If you have any questions or comments on the pack, please contact Ian Holmes. (Ian.holmes@yorksandhumber.nhs.uk)

3. 1) Healthy Ambitions: Better for Less

4. Better for Less – Fractured neck of femur Because looking after hip fracture patients well is a lot cheaper than looking after them badly. Better quality care can be delivered at reduced cost with patients, clinicians, fracture services and those responsible for patients all seeing the benefits. • Why Fractured neck of femur? • Across Yorkshire and the Humber there are over 30,000 fragility fractures each year. • Fractured neck of femur is the most serious consequence of falls in the elderly, with a mortality rate of 10% one month after falling and 30% at one year. • The care and rehabilitation of patients with hip fractures is a central challenge for UK trauma services, but the quality and cost effectiveness of such care varies considerably across the region. • The average length of a super spell is 28 days although this varies from 17 to 40 days across trusts. Reducing the number of pre-operative bed days is central to quick and full recovery. • These patients are among the most frail to be admitted to hospital and their outcomes depend critically on how their care is managed. Avoidable delays, incomplete assessment and lack of attention to important details will result in poorer outcomes.

5. Better for Less – Fractured neck of femur • What is the picture in Y&H? • There were around 5,600 fractured necks of femur in 2007-08. • The cost to our healthcare system is around £56m, including £36m in emergency admissions. • There are currently large variations in average length of stay and re-admissions rates for fractured neck of femur. • Around 12% of patients discharged from hospital following emergency admissions for FNOF are re-admitted as an emergency within 28 days. There is a 3-fold variation in re-admission rates across PCTs in our region. • There is a greater than 2 fold variation on average length of stay for fractured neck of femur HRGs in providers across our region. • What is the challenge? • Despite a well established evidence base, best practice has not been adopted consistently across our region. The cost of poor care far outweighs that of providing good care. • Only 68% of fragility fractures are treated in surgery within 48 hours of admission. This adds up to 3 days to total length of stay. • Care and rehabilitation services for patients with a hip fracture are a central challenge for trauma services; and those that can provide good care for these patients will cope well with the range of other fragility fractures encountered.

6. Better for Less – Fractured neck of femur • How could we provide better for less? • The evidence-base for hip fracture shows that prompt effective multi-disciplinary management can improve quality and reduce costs. • Best practice is well defined: • Commissioners reflect blue book expectations in their contracts and monitoring mechanisms • Commissioners should seek to implement a comprehensive falls care pathway • Providers need to ensure compliance with standards described in the blue book. • Commissioners and providers should utilise NHS Institute ‘focus on fractured neck of femur’ resource pack and consider using these as a means to improve the care pathway. • A local case study – Barnsley FT • The trust has established a programme of training for nursing assistants to enable staff to continue mobilising patients over weekend when physiotherapy staff are not available. • These competencies include risk assessment, understanding documentation, walking aids and mobility re-education. • Implementing a best practice approach in Barnsley FT has reduced average length of stay from 20 days to 14 days, equal to 1,650 and £380,000 based on the excess bed day tariff. • For further information visit: • www.healthyambitions.co.uk • Or contact: • Tim.barton@yorksandhumber.nhs.uk

7. Yorkshire and the Humber Quality Observatory 2) Hot topic: Urgent Care

8. Yorkshire and the Humber Quality Observatory Contents 1) Overview 2) Community provision 3) Ambulance Services 4) Hospital Provision Urgent Care - contents 5) Annexes

9. Yorkshire and the Humber Quality Observatory Section 1 1) Overview 2) Community provision 3) Ambulance Services 4) Hospital Provision Urgent Care - overview 5) Annexes

10. Yorkshire and the Humber Quality Observatory Purpose This information pack is the fourth of a series ‘hot topics’ that will be produced by the SHA to support organisations in developing their understanding of some of the challenges and opportunities presented by the QIPP agenda. While recognising that it may raise more questions than answers, we hope it will stimulate thought and debate within organisations and health communities.Clearly the data presented need to be interpreted in the local context. The analysis has been set out by service setting, but organisations will want to understand performance and develop solutions across traditional boundaries. We would be delighted to receive comments on the contents together with any ideas for further urgent care analysis. Urgent Care - overview

11. 5% 14% 81% Yorkshire and the Humber Quality Observatory Overview Relative spend on urgent care services: As a region we spend over £900m per annum on urgent and emergency care from a total allocation of £8bn. Ensuring that patients receive the right care at the right time in the right setting can deliver improved outcomes for patients and reduced costs for commissioners. In 2008/09 alone there were almost 700,000 calls to the Yorkshire Ambulance Service, 1.5m attendances at major A&Es and 550,000 emergency admissions. Many of these urgent care events were acute exacerbations of chronic diseases such as COPD and cardio-vascular disease. Hospital provision accounts for a relatively small proportion of activity yet represents almost 81% of costs. Where clinically appropriate, shifting care upstream to planned non-acute settings and teleservices such as NHS Direct could result in the earlier delivery of high quality and cost-effective care. Community provision: GP Services NHS Direct Pharmacies Ambulance services 14% 81% Hospital provision: A&E Non-elective activity Source: Healthcare Commission, PSSRU unit costs of health and social care 2008 Urgent Care - overview See annex for sources

12. GP Out of hours service Yorkshire and the Humber Quality Observatory The urgent and emergency care pathway The urgent and emergency care system is complex. Patients can present at a range of contact points, which may result in their condition being resolved or a referral to another service. While there are well-defined care pathways for some conditions such as cardiac care and trauma, commissioning clear pathways through urgent care for other frequent conditions such as falls and COPD could reduce the multiple hand-offs within the emergency care system which impair patient experience and increase costs. There are significant productivity gains which can be realised by streamlining and rationalising existing services and using patient engagement to ensure patients are aware of the most appropriate care setting for their needs. WIC Urgent Care – community provision 999 Ambulance Service GP Practice A&E Pharmacy NHS Direct Admission

13. Yorkshire and the Humber Quality Observatory Service demand Nationally, the demand for emergency services is growing faster than would be expected based on the growth in the size and average age of the population. The uptake of relatively new services such as Walk In Centres has continued, but this has not reduced the demand for GP consultations, ambulances and emergency admissions. While calls to NHS Direct have decreased recently, visits to their website have increased. Non-elective activity across our region has increased by 3.6% between 2006/07 and 2008/09, though this masks regional variation across trusts. 3 PCTs have experienced reductions in non-elective activity. There is no relationship between recent activity growth and population growth within PCTs. See annex for sources Elective and non-elective activity by PCT Urgent Care - overview

14. Yorkshire and the Humber Quality Observatory Section 2 1) Overview 2) Community provision 3) Ambulance Services Urgent Care – community provision 4) Hospital Provision 5) Annexes

15. Yorkshire and the Humber Quality Observatory Community provision overview Access to general practice in-hours services is available for one third of each week, PCTs are responsible for ensuring out of hours care is available for their populations all day at weekends and bank holidays as well as between 6.30pm and 8.00am on weekdays. Lower-cost Teleservices such as NHS Direct and GP out of hours (OOH) offer an alternative to dialling 999 or attending A&E in urgent situations, but their utilisation depends on the extent to which patients are aware of these services and whether they think the services as offer convenient and high quality care. Extended pharmacy opening hours and the expanding clinical role of pharmacists also offer a means for delivering community care that can help patients monitor and practice self-care, especially for chronic conditions. Whilst data is not available for pharmacy use as a source of urgent care, 1.4m contacts are made across our region with GP OOH services. Urgent Care – community provision Are patients aware of alternatives to calling 999 or attending A&E? What incentives are in place to avoid patients defaulting to these two services which are open 24/7 and always say “Yes”? Source: PSSRU Unit costs of health and social care 2009 * Pharmacy cost per patient related activity

16. Yorkshire and the Humber Quality Observatory Pharmacy Use of 100 hour pharmacies can help PCTs in effectively delivering their OOH services. Pharmacies can help manage patients with LTCs and provide support for self-care. Provision of 100 hour pharmacies per head of population is greater than the national average in Yorkshire & the Humber. More than 10% of pharmacies in Hull and Kirklees are open 100 hours. North Yorkshire and York and East Riding have the lowest proportion of 100 hour pharmacies. A likely cause of this is the number of dispensing GPs in these areas. With a largely rural population, dispensing GPs are an important feature of the healthcare economy in North Yorkshire & York. General Pharmaceutical Services Bulletin, NHS Prescription Services Urgent Care – community provision General Pharmaceutical Services Bulletin, NHS Prescription Services

17. Yorkshire and the Humber Quality Observatory Use of NHS Direct Nationally, NHS Direct is a significant point of access for telephone consultations and triage. In Yorkshire over 500,000 calls were received in 2008/09*. The rate of calls per 100,000 population for each PCT varies between less than 6% in Doncaster and more than 13% in Bradford & Airedale. There is some regional variation in the proportion of calls that are referred to other services such as primary care or 999, some of which is attributable to casemix and acuity. Kirklees and Calderdale report the lowest proportion of calls closed within NHS Direct without referral, and these two PCTs also record the lowest satisfaction for GP out of hours care in the region. To what extent is NHS Direct integrated with the provision of other urgent care services and teleservices? Urgent Care – community provision *excludes calls with no demographic information

18. Yorkshire and the Humber Quality Observatory Demographic breakdown of NHS Direct callers Within Yorkshire, NHS Direct receives relatively few calls from ethnic minorities. This is in line with underlying demographics of populations. Callers are predominantly of white origin, and females aged 16-44 years old are the biggest user group. Patient segmentation and social marketing are effective tools to understand variation in the use of urgent care services and encourage the use of cheaper teleservices. Urgent Care – community provision *excludes calls with no demographic information

19. Yorkshire and the Humber Quality Observatory Awareness of general practice out of hours services Nationally, 67% of patients are aware and know how to contact GP OOH services. The average is the same across Yorkshire and the Humber although there is variation above and below the average by PCT. Across our region, 14% of respondents to the survey reported trying to access GP OOH services. 81% of survey respondents in Yorkshire & the Humber reported finding it easy to contact OOH services by telephone, above the national average. Only two-thirds of patients know how to contact a GP OOH service, though patients find these services convenient when they are aware of them. Urgent Care – community provision

20. Yorkshire and the Humber Quality Observatory Perceived quality of general practice out of hours services Nationally, 64% of respondents reported that speed of care they received from GP OOH services was about right; Yorkshire & the Humber is slightly above average with 67%providing this response. 68% of respondents in Yorkshire & the Humber rated their overall satisfaction with care received from their OOH service as good. There is some regional variation in results with a range from 76% of respondents reporting their level of satisfaction as good in Doncaster to 58% in Calderdale. Doncaster is one of the 3 PCTs that have reported a decrease in non-elective admissions Other PCTs such as Kirklees and Calderdale perform below average by the questions presented here. Urgent Care – community provision

21. Yorkshire and the Humber Quality Observatory GP out of hours quality and prices Primary care OOH investment 2008/09 Primary care commissioning Quality & productivity Calculator There is large variation in investment in out of hours services per 100,000 population across the region although most PCTs are above the national average. North Yorkshire & York has the 8th highest level of OOH investment per 100,000 population nationally while 3 PCTs fall into the lowest quartile of investment nationally. A high level of investment in 2008/09 does not necessarily translate into a high proportion of patients rating GP out of hours services as good. There may however be a lag between the period in which investment this being reflected in services. National average SHA average Urgent Care – community provision

22. Yorkshire and the Humber Quality Observatory Use of OOH and other urgent care services Lower awareness of GP OOH services is associated with higher use of NHS Direct within Yorkshire and the Humber. After adjusting for need, there is also a relationship between ratings of GP OOH care and attendance at A&E. For the quartile of PCTs scoring lowest in the GP patient survey, attendance at A&E is 38% higher than for areas with the best perceived OOH services. Broken down by type of attendance, the difference is most significant for major services. What factors other than quality of OOH services can account for this difference? Urgent Care – community provision A&E attendances per head of resident population, for PCTs in top & bottom 25% for ratings of GP OOH care

23. Yorkshire and the Humber Quality Observatory Use of OOH and other urgent care services National rankings for OOH and emergency spend Primary Care Commissioning Quality & Productivity Calculator This chart ranks investment in out of hours services per head of population against secondary care emergency admissions expenditure per head of population across all 152 PCTs in England. Comparisons are made on a per capita basis per weighted population. PCTs with very low OOH investment and high emergency spend may want to carry out further analysis to better understand this relationship. Urgent Care – community provision Rank 1 = lowest investment, Rank 152 = highest investment.

24. Yorkshire and the Humber Quality Observatory Section 3 1) Overview 2) Community provision 3) Ambulance Services Urgent Care – ambulance services 4) Hospital Provision 5) Annexes

25. Yorkshire and the Humber Quality Observatory Growth in emergency ambulance calls Annual ambulance calls scaled to 100 in 2002/03 Calls to the Yorkshire Ambulance Service (YAS) have increased by over 40% between 2002/03 and 2008/09. This is slightly lower than the England average growth rate which was around 50% over the same period. The step change in the level of calls between 2006/07 and 2007/08 results from a data collection change, the latter years include urgent calls from GPs that were previously collected separately. However, between 2007/08 and 2008/09 YAS experienced growth in calls of 7%, which was more than twice the average rate for England and the third highest of any ambulance trust in the country. Growth in emergency & urgent ambulance calls (2007/08 to 2008/09) Urgent Care – ambulance services

26. Yorkshire and the Humber Quality Observatory Case mix and deprivation Casemix of calls to the Yorkshire Ambulance Service, 2008/09 The pie chart illustrates the casemix of calls made to YAS in 2008/09. A relatively small proportion of conditions account for a large proportion of activity - Falls and back injuries and breathing problems (including conditions such as COPD) account for almost 1/3 of all calls. Are commissioners and providers targeting interventions at the conditions accounting for the majority of recorded ambulance activity? Are services such as falls units open out of hours to provide alternatives to conveying falls to A&E? The demand for ambulances is significantly higher in more deprived areas of Yorkshire. This may be due to increased need for healthcare in general, as well as specific issues such as the reduced access to private transport to A&E or awareness of alternatives to dialling 999. Are interventions being focussed on spearhead and deprived areas that account for disproportionately higher demand for ambulances? Yorkshire Ambulance Service Urgent Care – ambulance services

27. Yorkshire and the Humber Quality Observatory Incidence and conveyance rates YAS has a low ranking of incident to call rates, although the rate is slightly above the national average. There is relatively little variation across ambulance trusts in England with the exception of London. Around 80% of calls require an ambulance to attend. Once an emergency response has been sent to the scene, YAS has a relatively high conveyance rate. Could more ambulance incidents be handled by clinical telephone advice (hear and treat) or referral to other healthcare tele-services? What is the cost to a PCT of the ambulance staffing and vehicle provision that will be needed if the trend of increasing ambulance demand continues? Urgent Care – ambulance services

28. Yorkshire and the Humber Quality Observatory Ambulance services Ambulance incidents by call category By PCT, there is variation in the level of ambulance activity and the type of calls made to the ambulance service. Per head of population, North Lincolnshire has the greatest of category C calls per head (not immediately life threatening). A&E attendances where primary diagnosis “Nothing abnormal detected” A&E HES Data NHS Information Centre* Urgent Care – ambulance services In some areas, a high proportion of those A&E attendances with a primary diagnosis of “nothing abnormal detected” are brought in by ambulance, over 50% in Scarborough. What support has been offered to paramedics to enable them to treat patients at the scene rather than conveying? *Experimental dataset, data not available for all providers

29. Yorkshire and the Humber Quality Observatory Ambulance services – patient satisfaction Patient satisfaction with ambulance services in Yorkshire and the Humber is consistently high although satisfaction was consistently lower in 2009 than the previous years. Waiting time for an ambulance /other help to arrive remains one of the weaker attributes of the ambulance service. Ambulance Service satisfaction by service users - 2009 Urgent Care – annexes Yorkshire and the Humber patient polling, September 2009

30. Yorkshire and the Humber Quality Observatory Section 4 1) Overview 2) Community provision 3) Ambulance Services Urgent Care – hospital provision 4) Hospital Provision 5) Annexes

31. Yorkshire and the Humber Quality Observatory A&E services overview Yorkshire & the Humber falls in the middle of SHAs in terms of the overall demand for demand for A&E services. There is some regional variation in the growth in demand for A&E services over the last 5 years. In particular Sheffield Teaching Hospitals has had the highest growth in demand (2.3%p.a.) and the demand for major A&E services in Leeds Teaching Hospitals has the lowest (-1.2% p.a.). How can we better understand the needs of frequent attenders at A&E in your area? What measures have been taken to improve access to GPs in and out of hours as an alternative to A&E? Urgent Care – hospital provision

32. Yorkshire and the Humber Quality Observatory Variation by type of A&E unit Major (Type I) A&Es are consultant-led, open 24 hours a day, and account for the majority of A&E attendances. The average tariff price for an A&E attendance is £88, and reducing the 2 million attendances seen each year in A&E could deliver substantial cost savings if reductions are matched by reductions in staffing. Making patients aware of alternatives to A&E can also improve patient experience and reduce waiting times. Urgent Care – hospital provision

33. Yorkshire and the Humber Quality Observatory Impact of location of A&E Departments For certain A&E Departments across the region, populations within 5 miles seem to be higher users of the service than those living further away. North Yorkshire & York has areas of the lowest A&E attendance per 1,000 population. (No data was available for Bradford, Kingston upon Hull and Doncaster, these areas also have the lightest shading.) Per 1,000 persons, A&E attendance is higher for those that live within a 1 mile radius of an A&E Department. Populations living within 10 miles of A&E have higher attendance than the regional average. Urgent Care – hospital provision

34. A&E attendances by population groups As with ambulance services, demand for A&E is higher amongst more deprived populations. More deprived populations are also more likely to attend A&E if they live closer. This relationship is true for all groups however distance to A&E has a relatively small impact for the least deprived populations. ACORN classifies populations based on demographic and lifestyle variables (see annex for categories). Asian communities (K) have the highest level of A&E attendances relative to the level that would be expected as indicated by the index bars. Categories with bars higher than the red line have greater than expected A&E attendances. Struggling families (N) have the highest proportion of A&E attendances as shown by the A&E% bars. Urgent Care – hospital provision Yorkshire and the Humber Quality Observatory

35. Yorkshire and the Humber Quality Observatory A&E attendances The NHS plan set out that no one should wait more than 4 hours in A&E before being discharged, admitted or transferred. The number of patients admitted via A&E sharply increases in the last 10 minutes before the 4 hour target. Providers in Yorkshire & the Humber perform better than the national average in dealing with a higher proportion of A&E attenders more quickly after they arrive. In certain cases, A&E is the best setting for patients to wait for test results or for observation before an informed decision to admit can be made. However, a better understanding of this admission profile at the local level may drive improvements in patient experience (patients admitted in the last 10 mins are older on average) and the delivery of cost-effective care (e.g. avoiding unnecessary admissions). Urgent Care – hospital provision

36. Yorkshire and the Humber Quality Observatory Treatment of patients attending A&E Destination of patients leaving A&E The following analysis is based on the Experimental A&E HES dataset, not all providers in Y&H are included. There are data quality and coverage issues. There is wide variation in the destination of patients leaving A&E. The destination of patients reflects treatment at A&E as well as links within the healthcare economy. Doncaster refers the most patients to a GP, Leeds has the highest rate of admittance for patients attending A&E. A&E HES data It should be noted that the Sheffield Hospitals receive a different casemix of patients. Urgent Care – hospital provision Trusts record the level of emergency admissions with zero overnight stay. Across Yorkshire & the Humber, around 15% of admissions result in no overnight stay. It does not appear to be the case that trusts admitting patients close to the 4 hour target have higher levels of admission with no overnight stay.

37. Yorkshire and the Humber Quality Observatory A&E Attendance against national targets Higher demand for A&E is associated with poorer performance against the 4 hour A&E waiting time target. Periods of high demand over summer heatwaves and winter pressures highlight this relationship. Poorer waiting time performance is associated with increased demand and increased bed demand. This emphasises how effective bed management strategies can deliver improved patient experience in A&E for patients awaiting admission. Urgent Care – hospital provision

38. Yorkshire and the Humber Quality Observatory Emergency admissions In 2008/09, there were over 550,000 emergency admissions in Yorkshire & the Humber. The 10 highest volume HRGs account for almost 20% of all emergency admissions. Chest pain in adults over 70 accounts for over 3% of emergency admissions, the highest proportion of all conditions. Almost 30% of emergency admissions of the highest volume activity are for adults over age 65. Urgent Care – hospital provision

39. Yorkshire and the Humber Quality Observatory Emergency admissions Emergency hospital admissions: All conditions, rate per 100,000 population Emergency admissions in our region have consistently been above the national average although the gap has narrowed in recent years. Only 3 PCTs in Yorkshire & the Humber have hospital admissions below the national average. On average, each emergency admission costs approximately £1,400. Therefore, early identification and management of patients is key to reducing costs and increasing quality. Urgent Care – hospital provision

40. Yorkshire and the Humber Quality Observatory Readmissions and avoidable admissions Emergency admissions relative to expected level Across the patch there is scope for a reduction in emergency admissions for Ambulatory Care Sensitive (ACS) long-term health conditions. Such conditions can usually be managed in the community without hospitalisation. As a region, Y&H has an admission rate for ACS conditions 5% below the expected level for our population, there is however large variation across the patch with a range of 16% more admissions than expected to 30% less than expected. There is scope for savings of almost £14.3m across the region by reducing emergency admissions to the level of PCTs performing in the top quartile. NHS Institute: Better Care, Better Value (2009,Q2) Emergency readmissions as a proportion of all emergency admissions Urgent Care – hospital provision National average Y&H average Readmissions within 14 days could suggest that there are unplanned admissions that could be avoided. Reducing readmissions in line with PCTs performing in the top quartile would generate savings to PCTs of almost £12.5m across the region (Trusts will only realise these savings if capacity is reduced accordingly). NHS Institute: Better Care, Better Value (2009,Q1)

41. Yorkshire and the Humber Quality Observatory Non-elective pre-operative bed days Ratio of Non-elective pre-operative bed days to number of spells Better Care, Better Value reports the level of non-elective pre-operative bed days as a ratio of the number of spells; a lower value represents better performance. Several providers in our area have ratios worse than the national average on this indicator. Rapid treatment of patients admitted with emergency conditions not only reduces acute bed days but can be important in producing better outcomes. Reducing non-elective pre-operative bed days to the level of trusts performing in the top quartile nationally would generate savings to PCTs of almost £79.4m across Yorkshire & the Humber. Trusts will only realise savings by reducing capacity accordingly. NHS Institute Better Care, Better Value (2009, Q2) National average Urgent Care – hospital provision

42. Yorkshire and the Humber Quality Observatory Contents 1) Overview 2) Community provision 3) Ambulance Services 4) Hospital Provision Urgent Care – annexes 5) Annexes

43. Yorkshire and the Humber Quality Observatory Key Contacts Kevin Reynard – Senior Clinical Leader for Acute Care (Kevin.Reynard@Lth.nhs.uk) Ian Holmes – Associate Director, Economics and System Management, NHS Y&H (Ian.Holmes@Yorksandhumber.nhs.uk) Helen Mercer – Economist, NHS Y&H (Helen.mercer@yorksandhumber.nhs.uk) Sivakumar Anandaciva (Sivakumar.Anandaciva@dh.gsi.gov.uk) Jake Abbas – Deputy Director, YHPHO (Ja18@york.ac.uk) Urgent Care – annexes

44. Yorkshire and the Humber Quality Observatory Annex Sources of activity for the urgent and emergency care services charts in overview: DATA SOURCE NHS Direct NHS Direct Ambulances KA34 Data collection A&E Attendances QMAE data collection Emergency Admissions HES GP consultations QResearch Population figures ONS PCT populations and unified weighted population ACORN Classification by CACI Urgent Care – annexes

45. Yorkshire and the Humber Quality Observatory 3) QIPP Metrics

46. Yorkshire and the Humber Quality Observatory QIPP metrics - overview We have developed an initial set of metrics so we can begin to track how health systems are functioning in a tighter financial climate. These focus on productivity, but also on outcomes and other measures of system health. The dashboard will be developed for next months pack to include non-acute provider information and more PCT analyses. As we develop a time series of data we will also analyse how different metrics interact and impact on each other. If you have any comments on these metrics and how they could be developed please contact forrest.frankovitch@yorksandhumber.nhs.uk

47. Yorkshire and the Humber Quality Observatory QIPP metrics (1)

48. Yorkshire and the Humber Quality Observatory QIPP metrics (2)

49. Yorkshire and the Humber Quality Observatory QIPP metrics (3)

50. Yorkshire and the Humber Quality Observatory QIPP metrics (4)