Mental health quality indicators: background and secondary definitions

Annex A: Overview of Health and Wellbeing Outcomes and Indicators

The National Health and Wellbeing Outcomes are high-level statements of what health and social care partners are attempting to achieve through integration and ultimately through the pursuit of quality improvement across health and social care.

By working with individuals and local communities, Integration Authorities will support people to achieve the following outcomes:

Outcome 1. People are able to look after and improve their own health and wellbeing and live in good health for longer.
Outcome 2. People, including those with disabilities or long term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community.
Outcome 3. People who use health and social care services have positive experiences of those services, and have their dignity respected.
Outcome 4. Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services.
Outcome 5. Health and social care services contribute to reducing health inequalities.
Outcome 6. People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and well-being.
Outcome 7. People using health and social care services are safe from harm.
Outcome 8. People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide.
Outcome 9. Resources are used effectively and efficiently in the provision of health and social care services.

An associated Core Suite of Integration Indicators has been developed in partnership with NHS Scotland, COSLA as well as the third and independent sectors, drawing together measures that are appropriate for the whole system under integration.

A National Health and Wellbeing Outcomes Guidance Framework that applies to integrated health and social care has also been produced:

• Core Suite of Integration Indicators
• National Health and Wellbeing Outcomes Guidance Framework

The National Health and Wellbeing Outcomes provide a strategic framework for the planning and delivery of health and social care services. They focus on the experiences and quality of services for people using those services, carers and their families. More information about the outcomes is available here:

http://www.gov.scot/Publications/2015/02/9966/downloads

Integration Authorities are responsible for planning and delivering a wide range of health and social care services, and are accountable for delivering the National Health and Wellbeing Outcomes. Each Integration Authority is required to publish an annual performance report, which will set out how they are improving the National Health and Wellbeing Outcomes. These reports will all need to include information about the core suite of indicators, supported by local measures and contextualising data to provide a broader picture of local performance.

These indicators have been, or will be, developed from national data sources so that the measurement approach is consistent across all areas. They can be grouped into two types of complementary measures:

Outcome indicators based on survey feedback, to emphasise the importance of a personal outcomes approach and the key role of user feedback in improving quality. While national user feedback will only be available every 2 years, it is expected that Integration Authorities’ performance reports will be supplemented each year with related information that is collected more often.

1. Percentage of adults able to look after their health very well or quite well.
2. Percentage of adults supported at home who agree that they are supported to live as independently as possible.
3. Percentage of adults supported at home who agree that they had a say in how their help, care or support was provided.
4. Percentage of adults supported at home who agree that their health and care services seemed to be well co-ordinated.
5. Percentage of adults receiving any care or support who rate it as excellent or good
6. Percentage of people with positive experience of care at their GP practice.
7. Percentage of adults supported at home who agree that their services and support had an impact in improving or maintaining their quality of life.
8. Percentage of carers who feel supported to continue in their caring role.
9. Percentage of adults supported at home who agree they felt safe.
10. Percentage of staff who say they would recommend their workplace as a good place to work.*

Indicators derived from organisational/system data primarily collected for other reasons. These indicators will be available annually or more often.

11. Premature mortality rate.
12. Rate of emergency admissions for adults.*
13. Rate of emergency bed days for adults.*
14. Readmissions to hospital within 28 days of discharge.*
15. Proportion of last 6 months of life spent at home or in community setting.
16. Falls rate per 1,000 population in over 65s.*
17. Proportion of care and care at home services rated ‘good’ (4) or better in Care Inspectorate Inspections.
18. Percentage of adults with intensive needs receiving care at home.
19. Number of days people spend in hospital when they are ready to be discharged.
20. Percentage of total health and care spend on hospital stays where the patient was admitted in an emergency.
21. Percentage of people admitted from home to hospital during the year, who are discharged to a care home.*
22. Percentage of people who are discharged from hospital within 72 hours of being ready.*
23. Expenditure on end of life care.*

* Indicator under development

The indicators are designed to allow comparison between areas and to look at improvement over time – some relatively long term. It has been agreed that these indicators will not be subject to targets, although local areas may wish to set improvement aims where appropriate.

The core suite of indicators should, of course, be considered within the wider context of health and social care measurement. While they will provide an indication of progress towards the outcomes that can be compared across partnerships and described at a Scotland level, they will not provide the full picture. Local partnerships will need to collect and understand a wide range of data and feedback that helps understand the system at locality level, and manage and improve services.

It would be expected that Integration Authorities can demonstrate that they are using appropriate information in order to continuously improve services - working towards the National Health and Wellbeing Outcomes, as well as wider Community Planning Partnership outcomes and relevant National Outcomes.