Figure 1: Domains of the Three Adult Outcomes Frameworks

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1 Outcomes Frameworks across Public Health, Social Care and NHS Relevance to Ealing Health & Wellbeing Strategy 1. Overview For adults there are three outcomes frameworks, one each for public health, NHS and adult social care. These were refreshed in Nov 2012 with technical updates on-going. The frameworks set out high level domain areas for improvement, alongside supporting indicators, to track progress without overshadowing locally agreed priorities. Figure 1: Domains of the Three Adult Outcomes Frameworks 1

2 The three outcomes frameworks cover different areas of the health and care system, each of with their own accountability mechanisms. Therefore, the way in which each outcomes framework is implemented and used to support the improvement in outcomes is different. They help highlight common challenges at the local level across the health and care system, inform local priorities and joint action, whilst reflecting the different accountability mechanisms in place. They are therefore critical to informing the joint strategic needs assessments and the Health & Wellbeing strategy. The refreshed outcome frameworks have common domains where the public health and NHS outcomes frameworks share goals on preventing premature death and the NHS and adult social care share goals on ensuring positive experience of care. The domains are supported by more detailed indicators to track progress. Indicators may be shared or complementary where there are shared goals across outcomes frameworks. Figure 2: Shared or Complementary Indicators Shared indicators Complementary indicators Used where outcomes frameworks have shared responsibility and the same indicator is included in each. For example, the NHS and public health system share responsibility to reduce hospital readmissions within 30 days of discharge from hospital Used where each outcomes framework has different measures that consider the same issue. For example, the NHS Outcomes Framework has an indicator relating to the health-related quality of life for people with long term conditions while the Adult Social Care Outcomes Framework has an indicator that measures social care related quality of life. Whilst there are a large number of indicators in each framework benchmarked at Local Authority level, a number of them are still being developed (i.e. placeholders, indicated in italics) and others are only available annually with a time lag. 2

3 2. The Public Health Outcomes Framework The purpose of the Public Health outcomes framework is to provide transparency and accountability across the public health system, setting out opportunities for local partnerships to improve and protect health and improve services. This is focussed on two high level outcomes: 1. Increased healthy life expectancy (takes account of quality and length of life). 2. Reduced inequalities in life expectancy and healthy life expectancy between communities (through greater improvement in the more disadvantaged). There are 66 public health indicators across the 4 domains: 1. Improving the wider determinants of health 2. Health improvement 3. Health protection 4. Healthcare public health and preventing premature mortality Baseline data is now available for 44 of the 66 public health indicators. Especially under Domain 4, a number of indicators are pending development (placeholders). The original Alcohol related admissions indicator was a placeholder but has been out to consultation and its replacement is not yet finalised. The Public Health Outcomes Indicators are not currently reporting into any local organisation directly. Public Health England will maintain an overview on progress against the indicators at national and regional level. 3

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5 3. The NHS outcomes framework and CCG Outcomes Indicator Set The purpose of the NHS outcomes framework is to: 1. Provide a national overview of how well the NHS is performing 2. Provide an accountability mechanism between the Secretary of State and the NHS Commissioning Board to the effective spend of public money 3. Act as a catalyst to drive quality and outcome measurement across the health and integrated care system Several of the 14 additions in the NHS outcomes framework focus on the patient s and carers experience of care, further to the Francis report (2013). There are now 65 NHS outcomes indicators across the 5 domains of the NHS framework with11 overarching indicators and 6 indicators still in development (placeholders): 1. Domain 1: Preventing people from dying prematurely Overarching Indicator Potential Years of Life Lost from causes amenable to healthcare: adults & children and young people Overarching Indicator Life expectancy at 75, men/women 2. Domain 2: Enhancing quality of life for people with long term conditions Overarching Indicator Health-related quality of life for people with long term conditions 3. Domain 3: Helping People to recover from episodes of ill-health or injury Overaching Indicator Emergency admissions for acute conditions that should not usually require admission Overarching Indicator Emergency re-admissions within 30 days of discharge from hospital 4. Domain 4: Ensuring people have a positive experience of care Overarching Indicator Patient experience of primary care GP services, GP out of hours service, Dental Services Overarching Indicator Patient experience of hospital care Overarching Indicator Friends & family test (placeholder) 5. Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm Overarching Indicator- Patient safety incidents reported Overarching Indicator Safety incidents involving severe harm or death Overarching Indicator Hospital deaths attributable to problems in care (placeholder) A separate outcomes indicator set was published for Clinical Commissioning Groups (CCGs) in Dec The remaining CCG placeholder specifications and baseline data, if available, will be on the HSCIC Indicator Portal by 28 March

6 The CCG reports progress on the CCG outcomes indicators to NHS Commissioning Board. The CCG will also report on progress on NHS outcomes indicators to the NHS Commissioning Board, who will keep an overview at the larger area level. 6

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9 4. The Adult Social Care Outcomes Framework (ASCOF) 2013/14 The purpose of the Adults Social Care Outcomes Framework (ASCOF) is to: 1. Set direction 2. Provide transparency 3. Provide accountability The three main drivers for change for 2013/14 were to aid alignment with the Public Health Outcomes Framework and NHS outcomes framework, start a zero-based review and support councils to deliver the challenge of the Care and Support White Paper published in July The indicators are reported locally on an annual basis as part of the Local Account which goes to LB Ealing Cabinet and are benchmarked nationally. Ten of the indicators can be monitored monthly at local level, to support performance development across Domains 1 &2 but all of the indicators in Domains 3 & 4 are only available annually. 9

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11 5. Childrens & Young People s Outcomes There is no separate Children and Young People s Outcome Framework. A separate outcomes framework for children and young people was discussed nationally in a Forum and in July 2012 made recommendations to include four new outcome indicators within the existing 2012/13 NHS Outcomes Framework as it was updated for 2013/14: time from first NHS presentation to diagnosis or start of treatment integrated care developing a new composite measure effective transition from children s to adult services age-appropriate services, with particular reference to teenagers. The Forum also recommended strengthening patient experience measures and that the Department of Health and the NHS Commissioning Board should incorporate the views of children and young people into existing national patient surveys in all care settings. Within the Public Health Outcomes Framework, the Forum recommended a total of 9 new indicators across each of the domains, including measuring the proportion of mothers with mental health problems, including postnatal depression and the proportion offered appropriate evidence based intervention and support. In addition two new surveys were proposed: a population-based survey of children and young people to look at trends in health and wellbeing; and a survey to support measurement of outcomes for children with mental health problems. The DH published its system wide response to the Forum s recommendations in Feb The NHS Outcomes Framework now includes measurable outcomes to demonstrate improvement in critical areas: for example in infant and perinatal mortality, and through better support to children and young people with asthma, diabetes and epilepsy. A number of improvements recommended by the Forum have now been included in the NHS Outcomes Framework : a new indicator to measure potential years of life lost for children and young people a new indicator to measure cancer survival for children all data will be presented in 5 year age bands up to 25 to enable effective transition to be monitored. The NHS Outcomes Framework has placeholders for developing an indicator for measuring improvements in children and young people s experience of care. The DH is leading work to identify the best ways to capture the patient experience of integrated care across all ages and patient groups, recognising that there will be different patterns of use and behaviour amongst specific groups of young people. The findings will inform the development of outcome measures. 11

12 Nineteen of the 66 indicators in the Public Health Outcomes Framework have a primary focus on maternity, children and young people. A further 21 include younger age groups alongside adults. The Public Health Outcomes Framework domain on the social determinants of health highlights the links between wider social factors and health outcomes. Significant development work is underway on measures of women s experience of maternity services (NHS Outcomes Framework), children and young people s experience of healthcare (NHS Outcomes Framework), child development at 2 2½ years (Public Health Outcomes Framework) and school readiness (Public Health Outcomes Framework). The DH recommends that NICE and the NHS Commissioning Board work with the professional bodies to expand and prioritise Quality Standards work programme as it applies to children and young people. There are 10 quality standards in development with a further 32 identified for potential development. Within Ealing, the Children and Young Peoples Partnership monitors indicators related to Safeguarding, Looked After Children and Health & Wellbeing of Children. 6. Current Shared or Complementary Indicators Across the Three Main Adults Outcomes Frameworks The Chart overleaf shows the intersection between the three adults outcomes (Public Health, NHS, ASCOF) frameworks. 12

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14 7. Implications for Ealing Health & Wellbeing Strategy This paper updates the latest outcomes frameworks and highlights their interrelationship. 1. Proposed accountability for outcomes frameworks Public Health Outcomes Framework annually to be reviewed by Health & Wellbeing Board NHS & CCG Outcomes Framework annually CCG to NCB Adult Social Care annually to LB Ealing Cabinet. 2. Indicators for Priority Areas and Accountability Within Ealing, the Health & Wellbeing Strategy agreed five Priority Areas locally: Early Intervention (0-5 years) reporting to CYPP (Lead Director - Director of Childrens & Social Services) Childhood Obesity - reporting to CYPP (Lead Director Director of Public Health) Alcohol - reporting to DATG and SEP (Lead Director Director of Public Health) Older People & Health Ageing - reporting to Older People s & Long Term Conditions Partnership (Lead Director Director of Adult Social Services) Out of Hospital Services. - reporting to CCG & NHSCB (Lead CCG) The suite of high level indicators available for initial quarterly monitoring of the Health & Wellbeing Strategy is limited. This was recognised by the last meeting of the board. At this stage there is little to recommend additional local indicators for these priority areas and the recommended suite is reiterated below with one modification given the absence of the alcohol admissions indicator currently. It is recommended this suite is reviewed after one year as other placeholders may have been developed by then and the deep dive is pursued as the main review mechanism in year one. 14

15 Annual School readiness Pupil absence Child development at 5 yrs (2-2.5 yrs) Number of children that are a healthy weight and obese Quarterly Breastfeeding NI125 No. 65+ discharged & benefiting from intermediate care/rehabilitation still living at home at 91 days The number of clients successfully exiting alcohol treatment as a percentage change from the baseline year (new) Male & female life expectancy slope of inequality Hip fractures in over 65 yr olds 3. Priority Areas The priority areas for the Health & Wellbeing strategy were developed based upon the profiles, data and JSNA available at the time in These latest updates indicate the Priority areas remain the same, with recommendations from Scrutiny captured within the overarching Priority area. Given annual updates to NHS and Social Care outcomes frameworks these may also need to be reviewed annually. 15