2009/137 Report To: Report From: Authors: NHS Cornwall and Isles of Scilly Primary Care Trust Board Amanda Fisk, Acting Director of Commissioning & Strategic Development Jane Pike, Associate Director for Commissioning (Performance) Diane Allen, Performance Support Officer Leah Parker, Head of Commissioning Children's Services Date: 27 January 2010 Subject: Vital Signs Report 2008/09 and Statement on Disabled Children 1.0 Purpose 1.1 The Department of Health has requested that Primary Care Trusts publish a report to show performance against the Vital Signs Indicators in 2008/09, and also to provide a statement on local services for Disabled Children. 2.0 Executive Summary The Vital Signs 2008/09 Report indicates: Above expected performance in Vital Signs 3,8,9,10,15,21 and 32; Performance as expected in Vital Signs 1, 2, 4, 5, 6, 11, 12, 13, 14, 18, 19, 20, 22, 23, 24, 25, 27, 28, 29, 30, 31, 33, 34, 36, 37 and 38; Performance below expected in Vital Signs 7 and 35. 3.0 Recommendation The Board is recommended to resolve to: Note the comments of this report.
4.0 Impact Statements Statement Type Standards for Better Health domain: Standards for Better Health statement: Strategic Objective: Assurance Framework reference: Assurances: Positive Description Accessible and responsive care, Governance. Performance: HCOs enable all members of the population to access services equally and offer choice in access. HCOs ensure that patients with emergency health needs are able to access care promptly. Will contribute to the delivery of all strategic objectives. Performance:- All Sections priorities from 2008/09 strategic plan. Vital signs in which performance above expected: VS 3 Access to primary care VS 8 All age all cause mortality rate per 100,000 population (females) VS 9 All age all cause mortality rate per 100,000 population (males) VS 10 Cardiovascular disease (CVD) mortality rate (people aged 75 or less) VS15 Under 18 conception rate per 1,000 females aged 15 to 17 VS 21 Chlamydia screening (as a proxy for Chlamydia prevalence) VS 32 Adults receiving direct payments/individual budgets per 100,000 population Vital signs in which performance as expected: VS 1 Clostridium Difficile VS 2 Proportion of patients seen within 18 weeks for admitted pathways VS 4 Proportion of women screened for breast cancer (aged 53-70) VS 5 Patients waiting no more than 31 days for subsequent cancer treatments VS 6 Proportion of patients with suspected cancer waiting less than 62 days VS11 Cancer mortality rate (people aged 75 or less) VS 12 Suicide and injury of undetermined intent mortality rate VS 13 Smoking quit rates VS 14 Proportion of women assessed by 12 weeks of pregnancy VS 18 Proportion of children who complete immunisation by recommended ages VS 19 Proportion of infants breastfed at 6-8 weeks VS 20 Commissioning a comprehensive child and 2
adolescent mental health service VS 22 Number of drug users recorded as being in effective treatment VS 23 Self reported experience of patients VS 24 NHS staff survey scores-based measures of job satisfaction VS 25 Access to primary dental services VS 27 Adults (aged 18 and over) assisted to live independently VS 28 Number of delayed transfers of care per 100,000 population (aged 18 and over) VS 29 Timeliness of social care assessment VS 30 Timeliness of social care packages VS 31 Proportion of all deaths that occur at home VS 33 Proportion of carers receiving a carer s break or a specific service for carers VS 34 Proportion of total admissions that have ambulatory care sensitive diagnoses VS 36 Rate of hospital admissions per 10,000 population for alcohol related harm VS 37 Rate of deliberate or unintended injuries to people aged under 19 (per 10,000) VS 38 Proportion of patients with diabetes in whom the last HbA1c is 7.5 or less from QOF Assurances: Negative Assurances: Gaps Legal issues: Financial issues: Equality and Diversity Impact: Patient and Public Involvement: Environmental Impact: Health & Safety Impact: Vital signs in which performance below expected: VS 7 Implementation of the stroke strategy VS 35 Vascular risk score None. None identified. None. None identified. No specific involvement in report. None identified. None identified. 3
NHS CORNWALL AND ISLES OF SCILLY Vital Signs Report 2008/09 and Statement on Disabled Children TABLE OF CONTENTS Page No. TABLE OF CONTENTS SECTION 1 VITAL SIGNS REPORT 2008/09 - INTRODUCTION - SUMMARY OF PERFORMANCE - AREAS IN WHICH PERFORMANCE WAS ABOVE EXPECTED - AREAS IN WHICH PERFORMANCE WAS BELOW EXPECTED 5 5 10 17 SECTION 2 STATEMENT OF EXISTING AND SERVICE PLANS FOR CHILDREN WITH A DISABILITY - INTRODUCTION - NHS CORNWALL & ISLES OF SCILLY AND PARTNER AGENCIES STRATEGIC DIRECTION - WHAT HAVE WE ALREADY ACHIEVED - SUMMARY OF OUR ACTIONS SHORT BREAKS COMMUNITY EQUIPMENT WHEELCHAIRS PALLIATIVE CARE - OTHER DEVELOPMENTS OF RELEVANCE TO THE AIMING HIGH AGENDA - REFERENCES 19 19 20 20 21 21 21 22 22 APPENDIX 1 DISABLED CHILDRED AND YOUNG PEOPLE AUDIT 2009 23 4
NHS CORNWALL AND ISLES OF SCILLY Vital Signs Report 2008/09 and Statement on Disabled Children 1. VITAL SIGNS REPORT Introduction 1.1 The Department of Health has requested, under the provisions of the NHS Operating Framework, that each primary care trust publishes a report which shows performance in 2008/09 against the Vital Signs indicators. 1.2 This section of the report shows the performance in 2008/09 of NHS Cornwall and Isles of Scilly against the Vital Signs Indicators, benchmarked against England averages, and in comparison to expected levels of performance. 1.3 This benchmarking analysis should be considered in conjunction with the 2008/09 Annual Health Check, which measures actual performance against nationally and locally agreed standards, rather than national averages. 1.4 In order to maintain a focus on the Vital Signs throughout the year, NHS Cornwall & Isles of Scilly has incorporated the standards as an integral element of its performance framework, and key Vital Signs indicators are included within the performance report and scorecard submitted to the Primary Care Trust Board each month. 1.5 A multi-agency approach to the attainment of the Vital Signs is also maintained throughout the year, through the work undertaken by NHS Cornwall & Isles of Scilly in conjunction with its local partner organisations, through the Local Area Agreement and Comprehensive Area Assessment processes. 1.6 Vital Signs indicators are grouped into three tiers: Tier 1 National Requirements Tier 2 National Priorities for Local Delivery Tier 3 Local Action priorities Summary of Performance 1.7 The performance of NHS Cornwall & Isles of Scilly in 2008/09 against the 35 Vital Signs indicators for which the comparative performance has been assessed can be summarised as follows: Performance better than expected for 7 indicators Performance in expected range for 26 indicators Performance below expected for 2 indicators 1.8 NHS Cornwall & Isles of Scilly s performance for 2008/09 in respect of each of the 3 tiers was as follows: 5
Tier 1 86% achieved as or above expected Tier 2 100% achieved as or above expected Tier 3 92% achieved as or above expected 1.9 The Vital Signs for which NHS Cornwall & Isles of Scilly s performance was above expected were: VS 3 Access to primary care VS 8 All age all cause mortality rate per 100,000 population (females) VS 9 All age all cause mortality rate per 100,000 population (males) VS 10 Cardiovascular disease (CVD) mortality rate (people aged 75 or less) VS15 Under 18 conception rate per 1,000 females aged 15 to 17 VS 21 Chlamydia screening (as a proxy for Chlamydia prevalence) VS 32 Adults receiving direct payments/individual budgets per 100,000 population 1.10 The Vital Signs for which NHS Cornwall & Isles of Scilly s performance was as expected were: VS 1 Clostridium Difficile VS 2 Proportion of patients seen within 18 weeks for admitted pathways VS 4 Proportion of women screened for breast cancer (aged 53-70) VS 5 Patients waiting no more than 31 days for subsequent cancer treatments VS 6 Proportion of patients with suspected cancer waiting less than 62 days VS11 Cancer mortality rate (people aged 75 or less) VS 12 Suicide and injury of undetermined intent mortality rate VS 13 Smoking quit rates VS 14 Proportion of women assessed by 12 weeks of pregnancy VS 18 Proportion of children who complete immunisation by recommended ages VS 19 Proportion of infants breastfed at 6-8 weeks VS 20 Commissioning a comprehensive child and adolescent mental health service VS 22 Number of drug users recorded as being in effective treatment VS 23 Self reported experience of patients VS 24 NHS staff survey scores-based measures of job satisfaction VS 25 Access to primary dental services VS 27 Adults (aged 18 and over) assisted to live independently VS 28 Number of delayed transfers of care per 100,000 population (aged 18 and over) VS 29 Timeliness of social care assessment VS 30 Timeliness of social care packages VS 31 Proportion of all deaths that occur at home VS 33 Proportion of carers receiving a carer s break or a specific service for carers VS 34 Proportion of total admissions that have ambulatory care sensitive diagnoses VS 36 Rate of hospital admissions per 10,000 population for alcohol related harm 6
VS 37 Rate of deliberate or unintended injuries to people aged under 19 (per 10,000) VS 38 Proportion of patients with diabetes in whom the last HbA1c is 7.5 or less from QOF 1.11 The Vital Signs for which NHS Cornwall & Isles of Scilly s performance was below expected were: VS 7 Implementation of the stroke strategy VS 35 Vascular risk score 1.12 Table 1 on the next page sets out the details of the absolute and comparative performance of NHS Cornwall & Isles of Scilly against the Vital Signs indicators in 2008/09. 7
Table 1: Absolute and comparative performance of NHS Cornwall & Isles of Scilly against the Vital Signs indicators in 2008/09 Cornwall And Isles Of Scilly Primary Care Trust Vital Signs Performance Group Below expected As expected Above expected Tier 1 VS 1 Clostridium Difficile VS 2 Proportion of patients seen within 18 weeks for admitted pathways VS 3 Access to primary care VS 4 Proportion of women screened for breast cancer (aged 53-70) VS 5 Patients waiting no more than 31 days for subsequent cancer treatments VS 6 Proportion of patients with suspected cancer waiting less than 62 days VS 7 Implementation of the stroke strategy 81.87% NA NA 92.47% NA NA 91.28% NA NA 79.93% 79.37% F 96.94% NA NA 89.90% NA NA 22.22% NA NA Tier 2 VS 8 All age all cause mortality rate per 100,000 population (females) VS 9 All age all cause mortality rate per 100,000 population (males) VS 10 Cardiovascular disease (CVD) mortality rate (people aged 75 or less) VS 11 Cancer mortality rate (people aged 75 or less) VS 12 Suicide and injury of undetermined intent mortality rate VS 13 Smoking quit rates VS 14 Proportion of women assessed by 12 weeks of pregnancy VS 15 Under 18 conception rate per 1,000 females aged 15 to 17 VS 16 Obesity among primary school aged children (reception year) VS 17 Obesity among primary school aged children (year 6) VS 18 Proportion of children who complete immunisation by recommended ages VS 19 Proportion of infants breastfed at 6-8 weeks VS 20 Commissioning a comprehensive child and adolescent mental health service VS 21 Chlamydia screening (as a proxy for chlamydia prevalence) VS 22 Number of drug users recorded as being in effective treatment VS 23 Self reported experience of patients VS 24 NHS staff survey scores-based measures of job satisfaction VS 25 Access to primary dental services 462.99 NA F 650.17 NA F 64.08 NA F 109.79 NA F 10.14 NA F 913.90 NA F 86.31% NA NA 33.10 40.60 F DNR 10.49% F DNR 19.51% F 88.58% 87.01% F 67.69% 85.15% F 87.50% NA NA 25.51% 15.72% F 86.93% 84.62% F 316.68 NA NA 3.67 NA NA 51.54% NA NA Tier 3 VS 26 NHSLA standards, risk management assessment levels VS 27 Adults (aged 18 and over) assisted to live independently VS 28 Number of delayed transfers of care per 100,000 population (aged 18 and over) VS 29 Timeliness of social care assessment VS 30 Timeliness of social care packages VS 31 Proportion of all deaths that occur at home VS 32 Adults receiving direct payments / individual budgets per 100,000 population VS 33 Proportion of carers receiving a 'carer's break' or a specific service for carers VS 34 Proportion of total admissions that have ambulatory care sensitive diagnoses VS 35 Vascular risk score VS 36 Rate of hospital admissions per 10,000 population for alcohol related harm VS 37 Rate of deliberate or unintended injuries to people aged under 19 (per 10,000) VS 38 Proportion of patients with diabetes in whom the last HbA1c is 7.5 or less from QOF 1A NA NA 293.88 NA NA 17.73 NA NA 85.84% NA NA 93.13% NA NA 21.97% NA NA 272.32 NA NA 28.92% NA NA 12.31% NA NA 0.00% NA NA 122.37 NA F 146.10 NA F 68.75% 66.01% F 8
1.13 Graph 1 shows the overall percentages of Vital Signs against which NHS Cornwall & Isles of Scilly performed above the expected level, as expected and below the expected level in 2008/09. Graph 1: Summary of performance against expected levels for NHS Cornwall & Isles of Scilly in 2008/09 Performance with comparator group Above expected As expected Below expected 0% 10% 20% 30% 40% 50% 60% 70% 80% Percentage of indicators 9
Areas in which performance was above expected 1.14 The 7 areas in which NHS Cornwall & Isles of Scilly was assessed as having performed above expected are set out in Tables 2 to 8 below, in the context of the performance of the other primary care trusts in the NHS South West area. 1.15 The position for Access to Primary Care for all primary care trusts across the NHS South West area is set out in Table 2: Table 2: VS 3 Access to Primary Care VS 3 Access to primary care Trust Performance Group Below expected As expected Above expected Bath and North East Somerset Primary Care Trust Bournemouth And Poole Teaching Primary Care Trust Bristol Primary Care Trust Cornwall And Isles Of Scilly Primary Care Trust Devon Primary Care Trust Dorset Primary Care Trust Gloucestershire Primary Care Trust North Somerset Primary Care Trust Plymouth Teaching Primary Care Trust Somerset Primary Care Trust South Gloucestershire Primary Care Trust Swindon Primary Care Trust Torbay Care Trust Wiltshire Primary Care Trust 89.15 NA NA 89.13 NA NA 85.41 NA NA 91.28 NA NA 90.58 NA NA 92.42 NA NA 87.28 NA NA 90.57 NA NA 87.14 NA NA 92.25 NA NA 85.63 NA NA 82.35 NA NA 90.96 NA NA 86.44 NA NA 1.16 Sixty-eight out of seventy GP practices in NHS Cornwall & Isles of Scilly had offered extended opening hours and this significantly exceeds the 50% target set nationally. 10
1.17 The position for All age all cause mortality rate per 100,000 population (females) for all primary care trusts across the NHS South West area is set out in Table 3: Table 3: VS 8 All age all cause mortality rate per 100,000 population (females) VS 8 All age all cause mortality rate per 100,000 population (females) Trust Performance Group Below expected As expected Above expected Bath and North East Somerset Primary Care Trust Bournemouth And Poole Teaching Primary Care Trust Bristol Primary Care Trust Cornwall And Isles Of Scilly Primary Care Trust Devon Primary Care Trust Dorset Primary Care Trust Gloucestershire Primary Care Trust North Somerset Primary Care Trust Plymouth Teaching Primary Care Trust Somerset Primary Care Trust South Gloucestershire Primary Care Trust Swindon Primary Care Trust Torbay Care Trust Wiltshire Primary Care Trust 425.35 NA A 483.83 NA D 504.61 NA G 462.99 NA F 435.72 NA D 402.73 NA B 466.93 NA B 439.83 NA B 493.22 NA G 436.95 NA C 430.89 NA A 469.38 NA C 459.92 NA G 440.77 NA A 1.18 Work by NHS Cornwall & Isles of Scilly Primary Care Trust fits with the World Class Commissioning strategic outcomes increasing life expectancy and reducing health inequalities. Changes occur over a long period of time and are as a result of work with partners in local authority, community and voluntary sector. Measures taken by NHS Cornwall & Isles of Scilly Primary Care Trust in 2008/09 include: Within the Local Area Agreement work has been started with GPs to provide debt advice, and in conjunction with partners an advice leaflet Feeling the Pinch has been produced; Work on cancer prevention reducing smoking, high uptake of screening for cervical and breast cancer for early treatment; Work on improved uptake of statins and drugs to control hypertension. 11
1.19 The position for All age all cause mortality rate per 100,000 population (males) for all primary care trusts across the NHS South West area is set out in Table 4: Table 4: VS 9 All age all cause mortality rate per 100,000 population (males) VS 9 All age all cause mortality rate per 100,000 population (males) Trust Performance Group Below expected As expected Above expected Bath and North East Somerset Primary Care Trust Bournemouth And Poole Teaching Primary Care Trust Bristol Primary Care Trust Cornwall And Isles Of Scilly Primary Care Trust Devon Primary Care Trust Dorset Primary Care Trust Gloucestershire Primary Care Trust North Somerset Primary Care Trust Plymouth Teaching Primary Care Trust Somerset Primary Care Trust South Gloucestershire Primary Care Trust Swindon Primary Care Trust Torbay Care Trust Wiltshire Primary Care Trust 583.82 NA A 681.79 NA D 778.94 NA G 650.17 NA F 599.37 NA D 582.32 NA B 629.62 NA B 632.44 NA B 713.07 NA G 636.01 NA C 588.96 NA A 724.68 NA C 677.26 NA G 637.08 NA A 1.20 Work by NHS Cornwall & Isles of Scilly Primary Care Trust fits with the World Class Commissioning strategic outcomes increasing life expectancy and reducing health inequalities. Changes occur over a long period of time and are as a result of work with partners in local authority, community and voluntary sector. Measures taken by NHS Cornwall & Isles of Scilly Primary Care Trust in 2008/09 include: Within the Local Area Agreement work has been started with GPs to provide debt advice, and in conjunction with partners an advice leaflet Feeling the Pinch has been produced; Work to prevent cancer prevention such as reducing smoking; Work on improved uptake of statins and drugs to control hypertension. 12
1.21 The position for Cardiovascular disease (CVD) mortality rate (people aged 75 or less) for all primary care trusts across the NHS South West area is set out in Table 5: Table 5: VS 10 Cardiovascular disease (CVD) mortality rate (people aged 75 or less) VS 10 Cardiovascular disease (CVD) mortality rate (people aged 75 or less) Trust Performance Group Below expected As expected Above expected Bath and North East Somerset Primary Care Trust Bournemouth And Poole Teaching Primary Care Trust Bristol Primary Care Trust Cornwall And Isles Of Scilly Primary Care Trust Devon Primary Care Trust Dorset Primary Care Trust Gloucestershire Primary Care Trust North Somerset Primary Care Trust Plymouth Teaching Primary Care Trust Somerset Primary Care Trust South Gloucestershire Primary Care Trust Swindon Primary Care Trust Torbay Care Trust Wiltshire Primary Care Trust 47.11 NA A 55.59 NA D 80.15 NA G 64.08 NA F 60.75 NA D 50.02 NA B 57.75 NA B 52.94 NA B 86.75 NA G 55.89 NA C 53.87 NA A 73.15 NA C 67.71 NA G 57.41 NA A 1.22 A variation in mortality rate from the expected may not reflect an overall trend. Actions taken to reduce cardiovascular disease are unlikely to change the mortality rate in the same year. In 2008/09 measures taken in Cornwall & Isles of Scilly include: Improvements in diagnostic echocardiography waiting times; Achieving targets for thrombolysis call to needle times; Reduction in waiting times in cardiology and cardiac surgery; Improved prescribing of statins and antihypertensives in primary care; Increase in smoking cessation services. 13
1.23 The position for Under 18 conception rate per 1,000 females aged 15 to 17 for all primary care trusts across the NHS South West area is set out in Table 6: Table 6: VS 15 Under 18 conception rate per 1,000 females aged 15 to 17 VS 15 Under 18 conception rate per 1,000 females aged 15 to 17 Trust Performance Group Below expected As expected Above expected Bath and North East Somerset Primary Care Trust Bournemouth And Poole Teaching Primary Care Trust Bristol Primary Care Trust Cornwall And Isles Of Scilly Primary Care Trust Devon Primary Care Trust Dorset Primary Care Trust Gloucestershire Primary Care Trust North Somerset Primary Care Trust Plymouth Teaching Primary Care Trust Somerset Primary Care Trust South Gloucestershire Primary Care Trust Swindon Primary Care Trust Torbay Care Trust Wiltshire Primary Care Trust 26.60 28.74 A 40.85 37.97 D 54.70 49.47 G 33.10 40.60 F 32.50 37.97 D 27.90 33.33 B 31.20 33.33 B 31.80 33.33 B 50.00 49.47 G 35.80 38.04 C 33.50 28.74 A 46.50 38.04 C 57.40 49.47 G 31.50 28.74 A 1.24 Although the Primary Care Trust is performing well against the National Comparator Group, NHS Cornwall & Isles of Scilly did not achieve the vital signs target of 25.3 conceptions per 1,000 females aged 15 17. 1.25 Measures being taken to further improve performance are: Increasing availability/choice of contraception includes Long Acting Reversible Contraception and C Card Scheme; Provision of Young People Sexual Health/Contraceptive Clinics dedicated clinics focusing teenage pregnancy hotspot areas; Providing support to schools and parents with 2 dedicated trained personnel in sexual relationships education; Delivering services to rural communities with a mobile sexual health/information and guidance unit. 14
1.26 The position for Chlamydia screening (as a proxy for Chlamydia prevalence) for all primary care trusts across the NHS South West area is set out in Table 7: Table 7: VS 21 Chlamydia screening (as a proxy for Chlamydia prevalence) VS 21 Chlamydia screening (as a proxy for chlamydia prevalence) Trust Performance Group Below expected As expected Above expected Bath and North East Somerset Primary Care Trust Bournemouth And Poole Teaching Primary Care Trust Bristol Primary Care Trust Cornwall And Isles Of Scilly Primary Care Trust Devon Primary Care Trust Dorset Primary Care Trust Gloucestershire Primary Care Trust North Somerset Primary Care Trust Plymouth Teaching Primary Care Trust Somerset Primary Care Trust South Gloucestershire Primary Care Trust Swindon Primary Care Trust Torbay Care Trust Wiltshire Primary Care Trust 15.41 14.25 H 19.40 14.25 H 21.76 14.25 H 25.51 15.72 F 12.00 13.55 G 13.48 14.25 H 17.35 13.55 G 17.53 17.03 D 15.54 16.62 E 15.85 16.62 E 17.72 16.62 E 11.41 16.61 C 17.07 16.62 E 20.95 15.72 F 1.27 NHS Cornwall & Isles of Scilly have historically performed well against this target. Further measures to improve performance against a rising target are: Embed Chlamydia screening in mainstreams services which include primary care and community pharmacies. 15
1.28 The position for Adults receiving direct payments/individual budgets per 100,000 population for all primary care trusts across the NHS South West area is set out in Table 8: Table 8: VS 32 Adults receiving direct payments/individual budgets per 100,000 population VS 32 Adults receiving direct payments / individual budgets per 100,000 population Trust Performance Group Below expected As expected Above expected Bath and North East Somerset Primary Care Trust Bournemouth And Poole Teaching Primary Care Trust Bristol Primary Care Trust Cornwall And Isles Of Scilly Primary Care Trust Devon Primary Care Trust Dorset Primary Care Trust Gloucestershire Primary Care Trust North Somerset Primary Care Trust Plymouth Teaching Primary Care Trust Somerset Primary Care Trust South Gloucestershire Primary Care Trust Swindon Primary Care Trust Torbay Care Trust Wiltshire Primary Care Trust 128.64 NA NA 138.50 NA NA 105.69 NA NA 272.32 NA NA 177.32 NA NA 126.51 NA NA 98.02 NA NA 150.80 NA NA 114.47 NA NA 169.37 NA NA 139.67 NA NA 107.01 NA NA 249.81 NA NA 81.15 NA NA 16
Areas in which performance was below expected 1.29 There were only 2 areas in which NHS Cornwall & Isles of Scilly were assessed as having performed below expected, and these are set out in Tables 9 to 10 below: 1.30 The position for Implementation of stroke strategy for all primary care trusts across the NHS South West area is set out in Table 9: Table 9: VS 7 Implementation of stroke strategy VS 7 Implementation of the stroke strategy Trust Performance Group Below expected As expected Above expected Bath and North East Somerset Primary Care Trust 17.91 NA NA Bournemouth And Poole Teaching Primary Care Trust Bristol Primary Care Trust Cornwall And Isles Of Scilly Primary Care Trust Devon Primary Care Trust Dorset Primary Care Trust Gloucestershire Primary Care Trust North Somerset Primary Care Trust Plymouth Teaching Primary Care Trust Somerset Primary Care Trust South Gloucestershire Primary Care Trust Swindon Primary Care Trust Torbay Care Trust Wiltshire Primary Care Trust 51.35 NA NA 63.25 NA NA 22.22 NA NA 42.91 NA NA 49.68 NA NA 46.61 NA NA 32.47 NA NA 58.55 NA NA 65.32 NA NA 54.88 NA NA 42.86 NA NA 57.58 NA NA 49.03 NA NA 1.31 This indicator relates to the measurement of the amount of time stroke patients spend on a stroke ward. Measures being taken by NHS Cornwall & Isles of Scilly in 2009/10 to improve performance include:- Direct admission for stroke patients to a stroke ward rather than via an assessment unit at main providers; Increased rehabilitation beds to provide more capacity and improve patient flow; Dedicated stroke ward with increased number of beds at Royal Cornwall Hospitals Trust; There is a need to develop early supported discharge for stroke patients at seven days to release acute stroke bed capacity. 17
1.32 The position for Vascular risk score for all primary care trusts across the NHS South West area is set out in Table 10: Table 10: VS 35 Vascular risk score VS 35 Vascular risk score Trust Performance Group Below expected As expected Above expected Bath and North East Somerset Primary Care Trust Bournemouth And Poole Teaching Primary Care Trust Bristol Primary Care Trust Cornwall And Isles Of Scilly Primary Care Trust Devon Primary Care Trust Dorset Primary Care Trust Gloucestershire Primary Care Trust North Somerset Primary Care Trust Plymouth Teaching Primary Care Trust Somerset Primary Care Trust South Gloucestershire Primary Care Trust Swindon Primary Care Trust Torbay Care Trust Wiltshire Primary Care Trust 100.00 NA NA 90.91 NA NA 0.00 NA NA 0.00 NA NA 70.09 NA NA 0.00 NA NA 93.98 NA NA 72.00 NA NA 0.00 NA NA 86.67 NA NA 100.00 NA NA 85.71 NA NA 38.10 NA NA 45.16 NA NA 1.33 In 2009/10 measures being taken to address this are: Piloting of the vascular checks programme to identify those people with at 10 year risk of a cardiac event of greater than 20%; Creating a register of at risk patients identified through the vascular checks programme; Treating risk factors as appropriate; Analysing results particularly in terms of inequalities before rolling the programme out across Cornwall; Data mechanisms are being implemented. 18
2. STATEMENT OF EXISTING AND SERVICE PLANS FOR CHILDREN WITH A DISABILITY Introduction 2.1 As part of the Vital Signs Annual Review 2008-09 the Department of Health requires NHS Cornwall and Isles of Scilly to undertake an assessment of Disabled Children s Services (see Appendix 1) and state our existing and service plans for children with a disability covering short breaks, community equipment, wheelchairs and palliative care. There follows a brief statement giving an introduction to these plans, our strategic direction and a summary of our actions, either alone or in partnership with the Local Strategic Partnerships (LSPs). 2.2 The Government s Child Health Strategy Healthy Lives, Brighter Futures was published in February 2009, and confirmed the funding available in baselines to improve services for disabled children. 2.3 The Department of Health have set out the funding position and described the associated outcomes that the funding supports, along with the action required by s. This process builds on the 2009/10 NHS Operating Framework, which highlighted children and implementation of the Child Health Strategy as a priority area for the NHS. 2.4 This document emphasises the need to ensure that high quality, timely and accessible support is available for children and young people with acute or additional health needs and their families. It confirmed that 340m nationally is included in baseline allocations for disabled children for the period 2008-09 to 2010-11, to support implementation of Aiming High for Disabled Children and the Children s Palliative Care Strategy, Better Care, Better Lives. This is in addition to the previously announced revenue funding for Local Authorities ( 340m), over the same period. 2.5 The Healthy Lives, Brighter Future funding allocation for NHS Cornwall and Isles of Scilly is 3,471,000 over 3 years (2008 2011) and includes 306,000 for Palliative care. NHS Cornwall and Isles of Scilly and partner agencies strategic direction 2.6 Cornwall Children s Trust has expressed it s commitment to improve outcomes for children and young people with a disability living in Cornwall through the development of effective, integrated multi-agency planning and service delivery. 2.7 In line with the vision of Every Child Matters agenda and the National Service Framework for Children, Young People & Maternity services we want to see: Children and young people who are disabled or who have complex health needs, supported to participate in family and community activities and facilities. 19
Health, education and social care services organised around the needs of children and young people and their families, with co-ordinated multiagency assessments leading to prompt, convenient, responsive and highquality multi-agency interventions that maximise the child s ability to reach his or her full potential. Children and young people and their families actively involved in all decisions affecting them and in shaping local services. NHS Cornwall & Isles of Scilly Public Health Directorate have been collecting and collating data to inform the Disabled Children s Health Equity Audit; expected publication date 31 March 2010. What have we already achieved? 2.8 Considerable progress has already been made in improving local services for disabled children and young people which has been greatly enhanced by the involvement of Parents and Carers, voluntary and independent sector organisations working in partnership with statutory agencies. Recent developments include: Review of Paediatric Therapy Services undertaken and business case developed Waiting list for children s wheelchairs reduced Commissioned Postural management therapy post Development of an Easy Read Your Way to Health for young people and adults with a Learning disability to support the transition through health services Consultation started on the AHDC Core Offer in relation to all services for disabled children and young people and the Full Service Offer in relation to short breaks Joint review of residential short break provision by health and local authority The extension and development of paediatric community nursing services Development of sibling support, both on group and individual basis, across the county and presentation by siblings of disabled children and young people of their needs to key stakeholders Summary of our actions: Short breaks 2.9 NHS Cornwall and Isles of Scilly are fully engaged with Cornwall Council Children s Schools and Families Services, to commission an increased range of quality services and to deliver the Full Service Offer. During 2007/08 NHS Cornwall and Isles of Scilly commissioned the Parent Carer Council to undertake a consultation exercise with the parents and carers of severely disabled children and young people using the Cornwall Partnership Trust and Children, Schools and Families Services residential short breaks units. The exercise established that the referrals valued highly including the residential component to the range of provision commissioned. The findings have informed NHS Cornwall & Isles of Scilly commissioning intentions, in 20
particular the development of a new service specification which will increase the number of nights available and improve the model of provision in line with what the families have told us. Community equipment 2.10 NHS Cornwall and Isles of Scilly and Cornwall Council continue to support the development of new commissioning models for community equipment. 2.11 NHS Cornwall & Isles of Scilly are working in partnership with the Council to ensure that the equipment services that we commission are more integrated. The Primary Care Trust has increased it s spend on children s community equipment in 2009/10. The development of joint children s Community Equipment Budgets will enable an integrated response between health and social care to meeting the needs of children and supports therapists across organisations to respond holistically to the needs of individual children. 2.12 Cornwall and Isles of Scilly has prioritised the communication needs of disabled children. The Primary Care Trust provided funding to enable the Alternative Augmentative Communication Occupational Therapy capacity to increase and meet the needs of the children and young people who would benefit from utilising highly specialist communication equipment. Wheelchairs 2.13 NHS Cornwall & Isles of Scilly has increased our investment in wheelchair services, across age groups in 2009/10. In accordance with Aiming High for Disabled Children, children and young people are always assessed holistically with input from a paediatric therapist and other involved parties will be present during assessment. The service is able to provide for assessments to take place at a local venue; we will be seeking to develop assessments through the school environment in order to encapsulate their full requirements including transport and access to education. All standard wheelchairs are now provided within 15 working days of assessment, with all standard provision referral to treatment being well within 8 weeks. Powered wheelchairs are well within 18 weeks referral to treatment when provided within Cornwall, through Cornwall s service. We are currently reviewing the level and model of provision for children s physiotherapy and occupation therapy services, which work closely with the wheelchair service. Palliative Care 2.14 Our initial focus for the development of services for children with palliative care needs has been on improving the way we meet the needs of those with the most complex conditions. NHS Cornwall & Isles of Scilly are implementing the NHS Children s Continuing Care Framework to ensure that the decision making processes is informed through a Complex Cases Panel, chaired by a Consultant Community Paediatrician and with representation from the fields of nursing, occupational therapy, physiotherapy and social care. We have also appointed a Commissioning manager who is also a Children s Nurse to commission individually tailored packages of care in accordance with the 21
family s needs and wishes. The feedback from families using these services to the changes that are being implemented has been very positive. 2.15 NHS Cornwall and Isles of Scilly are working with existing providers to understand the need and demand for hospice services both residential and in reach. 2.16 NHS Cornwall and Isles of Scilly commissioners are working with the strategic partners on the Isles of Scilly to understand the level of need for disabled children on the islands and create innovative approaches to ensuring that these can be met. Other developments of relevance to the Aiming High agenda 2.17 These are: Children in Care Nursing Team Specialist Epilepsy Nursing Special School Nursing Young Carers CAMHS References: DH, Healthy Lives, Brighter Futures http://www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyan dguidance/dh_094400 on 17-09-09 DCSF, Aiming High for Disabled Children (AHDC). http://www.dcsf.gov.uk/everychildmatters/healthandwellbeing/ahdc/ahdc/ on 17-09- 09 DH, Better Care, Better Lives http://www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyan dguidance/dh_083106 on 17-09-09 DCSF Parental experience of services for disabled children. http://www.dcsf.gov.uk/rsgateway/db/str/d000846/index.shtml http://www.dcsf.gov.uk/rsgateway/db/str/d000846/ni54overall2008-09.xls on 17-09-09 22
APPENDIX 1 CHILDREN AND YOUNG PEOPLE WITH DISABILITIES, COMPLEX AND PALLIATIVE CARE NEEDS PERFORMANCE NARRATIVE. s have an important role to play in commissioning services for children and young people with disabilities, complex and palliative care needs, ensuring an integrated approach which improves outcomes. s, as members of Children s Trusts, will be working with partners to identify the needs of this client group and commission appropriate services. This framework seeks to facilitate this process and to identify the NHS contribution to specific elements of these services for which additional national baseline funding was received by s for 2008/09 to 2010/11. Some additional information on these services (community equipment, wheelchairs, short breaks and palliative care) is/will be available in the national children s services mapping dataset. To view relevant information available already through this route go to www.childrensmapping.org.uk Data pertaining to the national indicator about parental experience of services for children with disabilities will be available for 21 s by September 2009 and for the remaining s by December 2009. This framework may be completed in the context of that indicator and as a tool to help identify actions and developments which may improve performance against it.
NAME OF : NHS Cornwall and Isles of Scilly Commissioning arrangements: Describe the aspects of services for children with disabilities, complex and palliative care needs which you commission jointly within your Children s Trust arrangements The makes an active contribution to the Children s Trust Board. Joint commissioning is emerging in Cornwall and current action learning sets are exploring areas for joint commissioning. The is currently working with Cornwall Council to create an integrated community equipment service which will improve the provision of, and access to, community equipment for children and young people. The was an active participant in the recent review of Cornwall s Integrated Community Equipment Service (ICES) and will be responding to recommendations that will improve the service delivered to children with disabilities, complex and palliative care needs. To date, the has invested in equipment not otherwise available through the store, making this equipment available for loan through the store. We are in the process of strengthening our joint commissioning arrangements for children with disabilities, complex health and palliative care needs through the reformation of a Disabled Children and Young People Partnership Group with membership from senior managers from across the Cornwall Children s Trust Describe any collaborative commissioning arrangements with other s for aspects of service (eg high cost low volume provision such as specialist equipment, specialist palliative care services, etc) The uses a number of methods to seek the views of children and young people with disabilities, complex and palliative care needs and their carers: We actively seek information from service providers around feedback from service users and have begun to build this requirement in to our service contracts. The is part of the regional palliative care network and is looking at ways in which palliative care services can be improved in the future across a regional area. Currently formulating palliative care strategy additional capacity will provide the concentration to drive this forward.
How is the identifying and responding to the views of children and young people with disabilities, complex and palliative care needs and their carers? Within the Children s Trust arrangements there are a number of forums though which service users and their carer are invited to support service improvement through the influencing of commissioning arrangements. This includes service user groups, parent involvement in the commissioning of Short Breaks provision, and public consultation events. Commissioning Stakeholder consultation was undertaken in partnership with Cornwall Council (CC) regarding Aiming High to identify what was needed in respect of short breaks. Furthermore, all services are expected to complete regular stakeholder consultation to identify and respond to the views of Children and Young People (CYP) and their parents/carers. Specific Palliative Care consultation undertaken, commissioning management on Early Support Steering group which deals with issues relating to early pathway development. Care coordinators from contact a family employed to scope the need for care co-ordinators as part of the NHS SW Operating Framework minimum guarantee. - SCOPE has been commissioned to develop and deliver participation on specific relevant areas and have to date consulted with parents/carers and their children and young people on wheelchair provision and therapy services. - Stepping into Shoes were commissioned to develop two journalistic DVD. The first DVD highlighted the experiences of young people accessing acute hospital services. The second DVD explored the experiences of three young people with long term conditions, Duchennes Muscular Dystrophy, Diabetes and Cystic Fibrosis. - Cornwall s Parent Carer Council have been commissioned to consult parents and carers on Palliative Care and facilitated a Children s Palliative stakeholder event in July 2009. - Arts for Health commissioned to develop a Siblings engagement DVD informed Aiming High for Disabled Children - Therapy service user engagement The new disabled children s therapy service specification embeds the requirement that providers actively gauge and respond to the needs and views of children and young people with disabilities. 25
SERVICE NEED 1a. 24 hour a day, 7 day a week community children s nursing service enabling children/young people to be cared for in their preferred setting PLEASE INDICATE WHETHER THE COMMISSIONS THIS SERVICE, RELECTING CURRENT EXPENDITURE CCN services do not provide 24/7 cover for children with Palliative Care needs and for children assessed as meeting full Continuing Care criteria. WHAT ARE THE LOCAL SERVICE GAPS? Are these identified in the Children and Young People s Plan? Locally identified gaps in service include: The need to improve access to multi-agency service provision for young people with Autistic Spectrum Condition. The likely impact of the children s continuing care guidance (expected n Dec 2009) and the expectation that there will be a need to increase access to nursing provision. Commissioners have identified a need to improve discharge planning to reduce average lengths of stay NARRATIVE ON PLANNED DEVELOPMENTS IN 2009/10 INCLUDING NEW INVESTMENT TO SUPPORT THIS The new CYPP plan strategic priority 8 seeks to improve the outcomes for Children with Disabilities, life limiting and life threatening conditions and is an agreed key priority. NARRATIVE ON PLANNED DEVELOPMENTS IN 2010/11 INCLUDING NEW INVESTMENT TO SUPPORT THIS Our initial focus for the development of services for children with palliative care needs has been on improving the way we meet the needs of those with the most complex conditions. We are implementing the NHS Children s Continuing Care Framework ensuring that a robust decision making processes is develop to include representation from the fields of clinical, nursing, occupational therapy, physiotherapy and social care. We have also appointed a Continuing Care Commissioning manager who is also a Registered Children s Nurse to commission individually tailored packages of care in accordance with the family s needs and wishes. The additional investment in this amounts to approximately 45,000 a year. The feedback from families using these services to the changes that are being implemented has been very positive. The increase in meeting the Continuing care services is in the region of 750,000 2009/2010 and 500,000 2010/2011, 26
SERVICE NEED PLEASE INDICATE WHETHER THE COMMISSIONS THIS SERVICE, RELECTING CURRENT EXPENDITURE WHAT ARE THE LOCAL SERVICE GAPS? Are these identified in the Children and Young People s Plan? for children on paediatric wards. These gaps in service are well documented within the Children s Trust arena but are not included within the limited number of priorities included within the Children and Young People s Plan. NARRATIVE ON NARRATIVE ON PLANNED PLANNED DEVELOPMENTS IN 2010/11 DEVELOPMENTS IN INCLUDING NEW INVESTMENT 2009/10 TO SUPPORT THIS INCLUDING NEW INVESTMENT TO SUPPORT THIS projections indicate that this will not be sufficient investment to reduce cost pressures, discussions on going with Annual Operating Planning process. NHS Cornwall and Isles of Scilly are working with existing providers to understand the need and demand for hospice services both residential and in reach. A business case will propose the commissioning of hospice service and it is envisaged that this one component is between 200,000 and 300,000 recurring. There is also a perceived lack of psychological services for children with Palliative care needs 27
SERVICE NEED 1b. Year on year reduction in delayed transfers of care due to unmet equipment or community nursing needs PLEASE INDICATE WHETHER THE COMMISSIONS THIS SERVICE, RELECTING CURRENT EXPENDITURE Community equipment service Because the Community Loan service currently tracks equipment we have (Equipment is provided based on need. Commissioners receive alerts if there is insufficient equipment in the store for urgent requests.) WHAT ARE THE LOCAL SERVICE GAPS? Are these identified in the Children and Young People s Plan? CCN Service- There have been a very few cases of delayed transfers of transitional care due to adult community teams not having essential equipment. A few delayed discharges for children may occur for large packages of care under Children s Continuing Care, but are minimised through the commissioning of services directly from two dedicated providers. Commissioners reduce delays through utilising agency care on NARRATIVE ON NARRATIVE ON PLANNED PLANNED DEVELOPMENTS IN 2010/11 DEVELOPMENTS IN INCLUDING NEW INVESTMENT 2009/10 TO SUPPORT THIS INCLUDING NEW INVESTMENT TO SUPPORT THIS Community equipment service The community equipment store, which on the children s side was subject to an interim arrangement, has recently been reviewed. Recommendations are soon to be considered by the relevant partner boards. CCN Service - Review CCC processes in specific relation to ensuring new national guidelines for transition to adult services are in place. Community Equipment Service - Continue to develop the equipment store, across the whole pathway from hospital to home, to enable patients to stay independent within their own homes for longer. CCN Service - Implementation of new Children s Continuing Care processes which include transition 28
SERVICE NEED 2a. Powered wheelchairs for children and young people PLEASE INDICATE WHETHER THE COMMISSIONS THIS SERVICE, RELECTING CURRENT EXPENDITURE Since 1 April 2009, all requests for wheelchairs standard and powered have come through Cornwall s Referral Management Centre. Unless special seating is required, all assessments for wheelchairs WHAT ARE THE LOCAL SERVICE GAPS? Are these identified in the Children and Young People s Plan? occasion as the CC team may need to recruit staff to cover new packages of care. This is because the CCC team cannot keep a full team at times when there are insufficient cases requiring cover. Continued review and assessment of the developing service model will inform the gaps that may continue to exist NARRATIVE ON NARRATIVE ON PLANNED PLANNED DEVELOPMENTS IN 2010/11 DEVELOPMENTS IN INCLUDING NEW INVESTMENT 2009/10 TO SUPPORT THIS INCLUDING NEW INVESTMENT TO SUPPORT THIS Revision of the eligibility criteria for provision of wheelchairs prior to the changes from 1 April 2009, and best practice has resulted in earlier provision of powered wheelchairs for children and young people with life limiting and/or degenerative or Further development of wheelchair services within Cornwall. Investigation and provision of special seating within Cornwall. 29
SERVICE NEED PLEASE INDICATE WHETHER THE COMMISSIONS THIS SERVICE, RELECTING CURRENT EXPENDITURE powered and nonpowered are commissioned from assessors within Cornwall, with provision through local providers who have met the stipulated accreditation and quality standards. Children with complex seating needs are referred to the Disablement Services Centre in Plymouth. WHAT ARE THE LOCAL SERVICE GAPS? Are these identified in the Children and Young People s Plan? NARRATIVE ON NARRATIVE ON PLANNED PLANNED DEVELOPMENTS IN 2010/11 DEVELOPMENTS IN INCLUDING NEW INVESTMENT 2009/10 TO SUPPORT THIS INCLUDING NEW INVESTMENT TO SUPPORT THIS deteriorating conditions. Cornwall s wheelchair service supports requests for powered provision from Whizz Kidz where the child or young person s needs would be better met by a more sophisticated powered wheelchair. In almost all circumstances the funds the maintenance and repairs for powered wheelchairs provided by Whizz Kidz. 30
SERVICE NEED 2b. The provision of equipment for individual children/young people in more than one domestic setting if requested. 3a. Non Powered wheelchairs for children and young people PLEASE INDICATE WHETHER THE COMMISSIONS THIS SERVICE, RELECTING CURRENT EXPENDITURE Should a child require equipment in two domestic settings this will depend on the type and cost of the equipment. Mobile oxygen concentrators, feeding pumps and disposable equipment are provided to meet the needs of the child in more than one setting See 2a. WHAT ARE THE LOCAL SERVICE GAPS? Are these identified in the Children and Young People s Plan? Provision of equipment is dependent on availability and cost. Priority is given to primary residence so there may be times when a second domestic setting cannot access high cost equipment. NARRATIVE ON NARRATIVE ON PLANNED PLANNED DEVELOPMENTS IN 2010/11 DEVELOPMENTS IN INCLUDING NEW INVESTMENT 2009/10 TO SUPPORT THIS INCLUDING NEW INVESTMENT TO SUPPORT THIS There are no plans to review this at this time. There are no plans to review this at this time. 31