Review of targets and indicators for health and social care in Scotland

Appendix 1 - Current National Indicators

National Performance Framework Indicators

1. Improve children's dental health

Over the past decade there has been an increase in the percentage of Primary 1 children with no obvious tooth decay. Latest figures for 2015/16 show 69.4% of Scottish children in Primary 1 have no obvious dental decay, compared with 54.1% in 2005/06, which is the baseline year.

2. Increase the proportion of babies with a healthy birth weight

The proportion of babies with a healthy birth weight (appropriate for gestational age) increased from 88.9% to 90.1% between 2001 and 2016. Over the same period, the proportion of babies born 'small for gestational age' decreased from 4.2% to 2.5%, while the proportion born 'large for gestational age' increased from 6.8% to 7.4%.

3. Increase the proportion of healthy weight children

In 2016 the proportion of children with a healthy weight was 70%, a decrease of 2 percentage points on 2015 (72%).

4. Increase physical activity

The proportion of adults meeting the latest physical activity recommendations in 2016 was 64%, an increase of one percentage point from 2015.

5. Improved self-assessed general health

Since the baseline year (2008) there has been little change in the proportion of adults who assess their health as good or very good. The level has fluctuated between 73% and 77% over this period, though in the last four years to 2015 has been stable at 74%.

6. Improve mental wellbeing

The mean score fell from 51.0 in 2006 to 50.0 in 2008, and has remained at a similar level since (ranging between 49.7 and 50.0) as in 2015.

7. Reduce premature mortality

In 2016, premature mortality remained very similar to 2015, which was itself the first year-to-year increase on record. However, premature mortality is currently sixteen per cent lower than in 2006, the baseline year. Premature mortality in 2016 is at its third lowest level over the full time series

8. Improve support for people with care needs

The percentage of people receiving personal care at home, rather than in a care home or hospital was decreasing, from 61.8% in 2013 to 61.3% in 2015. The 2016 figure shows an increase to 61.6%, although a change in guidance for one aspect of the measure means caution should be shown when making comparisons.

9. Reduce emergency admissions to hospital

The provisional figure for 2015/16 of 10,559 per 100,000 population represents a 0.4% decrease on 10,599 per 100,000 population in 2014/15.

Between 2014/15 and 2015/16, the rate of emergency admissions increased for the youngest age group (aged 0 to 4). Whereas it decreased for all age groups aged 70 and up.

10. Improve end of life care

There has been little change in the percentage of the last 6 months of life spent at home or in a community setting over the last 6 years. Newly published figures show that in 2015/16, 86.8% of the last 6 months of life was spent in the home or a community setting. This compares with 85.3% in 2010/11. However, the increase from 2014/15 to 2015/16 (0.5%) is the second largest increase in any one year since 2010/11.

11. Improve the quality of health care experience

The healthcare experience score is 82.8 for 2015/16. This is the highest the score has been since the indicator was introduced in 2009/10 and shows an increase of 4.5 from the 2009/10 figure of 78.3. Patient ratings of the quality of their healthcare experience have been improving since 2010/11.

12. Reduce the percentage of adults who smoke

Smoking prevalence has reduced from 28% of adults in the baseline year, 2003, to 21% in 2016. There has been a four percentage point reduction in smoking prevalence since 2012.

13. Reduce alcohol related hospital admissions

The rate of alcohol-related hospital admissions in 2015/16 was 664.5 per 100,000 population. This was 9.6 per 100,000 (1.4%) lower than the 2014/15 figure of 674.1 per 100,000.

Rates of alcohol-related hospital admissions have increased significantly for both men and women since the 1980s, peaking in 2007/8. Rates have fallen by 22% since then, with a small decrease of 9.6 per 100,000 between 2014/15 and 2015/16.

14. Reduce the number of individuals with problem drug use

In 2012/13, there were an estimated 61,500 people, aged 15-64 in Scotland, who were using opiates (includes prescribed and illicit methadone) and/or benzodiazepines illicitly. This compares to 59,600 people in 2009/10.

15. Improve access to local green space

65.4% of adults lived within a 5 minute walk of their nearest greenspace in 2016, compared to 67.2% in 2015.

16. Increase natural capital

The Natural Capital Asset Index was 100.9 in 2015. This suggests that Scotland's stock of natural capital in 2015 is 0.9 percentage points higher than that seen in 2000 but 0.5 percentage points lower than the 2006 base year.

17. Increase the proportion of journeys to work made by public or active transport

The 2016 figure of 30.6% of adults usually travelling to work by public or active transport is 0.6 percentage points below the baseline in 2006 of 31.2%. This figure has stayed relatively constant over recent years at around 30%.

18. Increase the proportion of pre-school centres receiving positive inspection reports

The first post-baseline sample of pre-school centres inspected accounted for 16% of all private, public and voluntary pre-school centres open at September 2013. Of those inspected 94% were evaluated as satisfactory or better in all of the three reference quality indicators, 74% were evaluated as good or better and 32% as very good or better in all three reference quality indicators. Positive criteria were not met in 6% of pre-school centres inspected.

19. Increase the proportion of schools receiving positive inspection reports

The first post-baseline sample of schools inspected accounted for 16% of all publicly funded schools open at September 2013. Of those inspected 90% were evaluated as satisfactory or better in all of the three Reference Quality Indicators, 69% were evaluated as good or better and 24% as very good or better in all three Reference Quality Indicators. Positive criteria were not met in 10% of schools inspected.

The proportion of schools receiving satisfactory or better evaluations in all three Reference Quality Indicators has remained unchanged over the baseline.

20. Increase the proportion of young people in learning, training or work

The proportion of 16-19 year olds participating in education, training or employment was 91.1% from 1st April 2016 – 31st March 2017 compared to 90.4% from 1st April 2015 – 31st March 2016. This is an increase of 0.7 percentage points.

21. Improve children's services

94% of the local authority areas that have been inspected received a positive inspection report in the second cycle of inspections.

22. Reduce crime victimisation rates

The risk of being a victim of crime has decreased from 16.9% in 2012/13 to 14.5% in 2014/15. This represents a decrease of 2.4 percentage points and is 5.9 percentage points lower than the baseline year of 2008/09.

23. Improve access to suitable housing options for those in housing need

95.7% of homeless households were entitled to settled accommodation in 2012-13, compared to 91.0% in 2011-12 and 87.8% in 2010-11.

24. Improve people's perceptions about the crime rate in their area

The public perception of the local crime rate as having stayed the same or improved in the past two years was 75% in 2014/15, compared to 76% in 2012/13 and 65% in 2006, the baseline year for this indicator.

25. Improve people's perceptions of their neighbourhood

The percentage of people who rate their neighbourhood as a very good place to live had changed from 56.3% in 2015 to 56.7% in 2016. This also represents an increase of 5.6 percentage points from 51.1% in the baseline year of 2006.

26. Reduce the proportion of individuals living in poverty

In 2015/16 17% of the population was in relative poverty. This is an increase from 15% in 2014/15.

27. Reduce children's deprivation

The percentage of children who were in combined material deprivation and low income remained steady at 10% in 2015/16.

28. Increase people's use of Scotland's outdoors

48.5% of adults visited the outdoors at least once a week in 2016, a similar proportion to 2015 where 48.6% of adults visited the outdoors at least once a week.

29. Improve the responsiveness of public services

There has been a decrease of 0.5 percentage points in the percentage of respondents who agreed with the statement that they can influence decisions affecting their local area, from 23.6% in 2015 to 23.1% in 2016, which is the latest available data. Since 2007 (the first year these data were collected), there has been an increase of 3.5 percentage points, from 19.6%.

30. Reduce the proportion of employees earning less than the living wage

In 2017 the proportion of employees earning less than the Living Wage was 18.4% a decrease of 1.8 percentage points on the previous year.

Local Delivery Plan ( LDP) indicators and standards

1. Detect Cancer Early

The national baseline for the detect cancer early LDP standard is 23.2% (based on combined calendar years 2010 & 2011). There was a 9.2% increase to 25.5% in the percentage of people diagnosed at stage 1 for breast, colorectal and lung cancer (combined) between the baseline of combined calendar years 2010 & 2011, and 2015 & 2016.

2. Cancer Waiting Times

In the quarter ending June 2017, 86.9 per cent of patients urgently referred with a suspicion of cancer began treatment within 62 days of their referral.

In the quarter ending June 2017, 94.8 per cent of patients diagnosed with cancer started treatment within 31 days of their decision to treat.

3. Dementia Post Diagnostic Support – In development

The standard is to deliver expected rates of dementia diagnosis and that all people newly diagnosed with dementia to receive a minimum of one year of post-diagnostic support and to have a person-centred plan in place at the end of that support period. In 2014/15, 43,409 patients were registered with dementia on QOF.

4. Treatment Time Guarantee

In the quarter ending June 2017, 81.4 per cent of patients were reported as commencing inpatient/day case treatment within 12 weeks.

5. 18 Weeks Referral to Treatment ( RTT)

In June 2017, 84.8 per cent of patients were reported as commencing treatment within 18 weeks.

6. 12 Weeks First Outpatient Appointment

As at 30 June 2017, 74.0% of patients waiting for a new outpatient appointment had been waiting 12 weeks or less.

7. Early Access to Antenatal Services

The standard is at least 80 per cent of pregnant women in each SIMD (Scottish Index of Multiple Deprivation) quintile will have booked for antenatal care by the 12th week of gestation. In 2015/16 the lowest performance in any SIMD quintile at the national level was 85.9 per cent.

8. IVF Waiting Times

In the quarter ending June 2017, 99.8% of eligible patients commenced IVF treatment within 12 months.

9. CAMHS Waiting Times

In the quarter ending June 2017, 80.7% of children and young people were seen within 18 weeks.

10. Psychological Therapies Waiting Time

During the quarter ending June 2017, 12,028 people started treatment for Psychological Therapies in Scotland and 72.4% were seen within 18 weeks . If the data submissions had been complete it is estimated that 77.9% of patients would have been seen within 18 weeks.

11. Clostridium Difficile Infections

In the year ending June 2017, the rate of identifications of CDI cases across NHSScotland was 0.28 per 1,000 occupied bed days among patients aged 15 and over.

12. SAB ( MRSA/ MSSA)

In the year ending December 2016, the rate of SAB cases across NHSScotland was 0.32 per 1,000 acute occupied bed days

13. Drug and Alcohol Treatment Waiting Times

In the quarter ending June 2017, 94.9 per cent of clients who had started their first treatment for drug or alcohol use had waited 3 weeks or less.

14. Alcohol Brief Interventions

In the year ending March 2017, NHS Boards carried out 86,560 interventions, exceeding the Standard of 61,081.

15. Smoking Cessation

In the year ending March 2017 there were 36,502 quit attempts in the most deprived areas, 7,842 were still not smoking at three months, a 'quit rate' of 21.5%, similar to the overall Scotland quit rate of 22.6%. This is below the LDP standard target of around 9,404 three month quits in the most deprived areas.

16. GP Access

In 2015/16, 91.8 per cent of people surveyed responded positively when asked about 48-hour access to an appropriate healthcare professional. In the same year, 76.4 per cent of survey responses were positive for booking an appointment with a GP more than 48 hours in advance.

17. Sickness Absence

In 2016/17, NHSScotland had a sickness absence rate of 5.20 per cent.

18. Accident and Emergency Waiting Times

In September 2017, 93.5 per cent of patients waited less than 4 hours.

19. Financial Performance

All NHS boards met their 2015/16 financial targets.

Health and Social Care Integration Indicators

1. Percentage of adults able to look after their health very well or quite well

In Scotland overall 94% of people felt they could look after their health very well or quite well in 2015/16. This ranged from 90% - 96% between H&SC Partnership areas.

2. Percentage of adults supported at home who agree that they are supported to live as independently as possible

In Scotland overall, 84% of people agreed that they felt supported to live as independently as possible in 2015/16. This is the same level as reported in 2013/14 and varied between H&SC Partnership areas from 78% to 92%.

3. Percentage of adults supported at home who agree that they had a say in how their help, care or support was provided

In Scotland overall, 79% of people agreed that they had a say in how their care and support was provided, which is a 4 percentage point decrease since 2013/14. This varied between H&SC Partnership areas from 72% to 86%.

4. Percentage of adults supported at home who agree that their health and care services seemed to be well co-ordinated

In Scotland overall, 75% of people agreed that the services seemed to be well coordinated in 2015/16 which is a 4 percentage point decrease since 2013/14. This varied between H&SC Partnership areas from 60% to 85%.

5. Percentage of adults receiving any care or support who rate it as excellent or good

In Scotland overall, 81% of people rated their help, care or support services as excellent or good in 2015/16, which is a decrease from 84% in 2013/14. This varied between H&SC Partnership areas from 73% to 88%.

6. Percentage of people with positive experience of care at their GP practice

In Scotland, 87% of patients rated their GP practice as good or excellent in 2015/16, which is the same as in 2013/14. There was a range of 80% to 97% across H&SC Partnership areas.

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

In Scotland overall, 84% of people agreed that the services maintained or improved their quality of life in 2015/16, which is similar to the levels reported in 2013/14. This varied between H&SC Partnerships areas from 77% to 92%.

8. Percentage of carers who feel supported to continue in their caring role

In Scotland in 2015/16, 41% of carers agreed that they felt supported to continue caring, which is a decrease from the 44% reported in 2013/14. This varied between H&SC Partnership areas from 34% to 59%.

9. Percentage of adults supported at home who agree they felt safe

In Scotland overall, 84% of people agreed that they felt safe, in relation to their care and support in 2015/16. This is similar to the results from the 2013/14 survey and varied between H&SC Partnership areas from 79% to 91%.

10. Percentage of staff who say they would recommend their workplace as a good place to work

The percentage of staff who responded positively change from 51% in 2013 to 61% in 2014. However, it should be noted this question changed slightly between the years, with 'workplace' replacing the word 'Board'.

11. Premature mortality rate

Between 1997 and 2013, the rate of mortality amongst those aged under 75 years decreased by 33%.

12. Rate of emergency admissions for adults

Rate of emergency admissions per 100,000 population for adults. This will be based on SMR01 returns for acute hospitals, and SMR04 data for psychiatric hospitals (note that some further work will be undertaken by ISD regarding this data source).

13. Rate of emergency bed days for adults

Rate of emergency bed days per 100,000 population for adults. This will be based on SMR01 returns for acute hospitals, and SMR04 data for psychiatric hospitals (note that some further work will be undertaken by ISD regarding this data source).

14. Readmissions to hospital within 28 days of discharge

Based on the SMR01 acute hospital activity data, this rate is calculated from number of re-admissions to an acute hospital within 28 days of discharge per 1,000 population. The definition of the indicator is still being finalised and may be based on an average across GP practices in order to link directly into GP benchmarking.

15. Proportion of last 6 months of life spent at home or in community setting

The figure has remained at just over 90% for the last few years. Across partnership areas, the proportion of the last six months of life spent at home or in a community setting in 2012-13 varied between 88.1% and 94.7%.

16. Falls rate per 1,000 population in over 65s

Fall rates per 1,000 population have remained steady since 2010/2011.

17. Proportion of care services graded 'good' (4) or better in Care Inspectorate Inspections

The indicator will be the total number of adult care services receiving a grading of 4 or above (i.e. "good", "very good" or "excellent") on all themes as a proportion of the total number of services graded. The indicator will be updated annually and will show the latest gradings for each care service at the end of March each year.

18. Percentage of adults with intensive needs receiving care at home

The latest figure of 61.9% for 2013 shows an increase of 1.5 percentage points compared to 60.4% in 2012 and 57.1% in 2008. It is expected that Integration Authorities will be able to continue to make progress on this.

19. Number of days people spend in hospital when they are ready to be discharged

The number of days people have spent in hospital when they are ready to be discharged has seen a fall from 2014/15 figures and is at a similar rate to that seen in 2013/14.

20. Percentage of total health and care spend on hospital stays where the patient was admitted in an emergency

The underlying data will be sourced from costed health activity data and social care aggregate data. ISD have linked all health activity and resource data that is currently available at individual level (around 70% of health expenditure). This data is available by age, by speciality, by location of care etc., so partnerships can understand emergency admissions for their population or a specific cohort.

21. Percentage of people admitted from home to hospital during the year, who are discharged to a care home

The data would come from SMR01, which contains fields on where people were admitted to hospital from and where they are discharged to. The information is not currently considered of usable quality, so data improvement work will be required by ISD working with NHS Boards before this indicator can be used.

22. Percentage of people who are discharged from hospital within 72 hours of being ready

The development of this indicator by ISD is being led by the Delayed Discharge Task Force. It requires NHS Boards to set up new methods of recording and collecting the required information, and changes to administrative systems, which is expected to take up to twelve months.

23. Expenditure on end of life care

The data will be sourced from costed health activity data as described above under indicator 20. The file also includes death records so it is possible to work backwards from date of death and examine people's pathway of activity and resource in the time before death. For 2015, the indicator will cost the last six months of life in an acute inpatient setting, this can be broken down by age, location of treatment, speciality level and by health and social care partnership.