Vital Signs Report

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					                   Vital Signs Performance for 2008/9
                                   and
                   Our Actions for 2009/10 and 2010/11



Part 1 – Vital Signs Performance

Introduction

The NHS Operating Framework 2008-09 introduced a list of indicators or Vital
Signs‟ across a range of services. They were developed to encourage and
enable partnership working between Primary Care Trusts (PCTs) and local
authorities to deliver joint outcomes.

The NHS Operating Framework 2009/10 committed to the publication of
performance against the Vital Signs to reflect the 2008/09 position. The
attached data sheets contain details of the actual performance of NHS North
East Essex and comparison to others. This comparative data was provided by
the Care Quality Commission (CQC) and helps provide an insight into what
we do really well in our area as well as the instances where other PCTs have
proved it is possible to deliver even better results.

This report is intended to enable local review of the 2008/09 position, provide
an opportunity to update on the action taking place during 2009/10 and
facilitate an informed debate with partners, service users and the wider
community on the priorities and service improvements for the coming financial
year (2010/11).

What did we do really well?

The attached report provides details of our performance against the vital sign
relative to others. The report highlights that we performed better than
expected on the following indicators.
     Reducing rates of Clostridium Difficile
     Proportion of patients with suspected cancer waiting less than 62 days
     Increasing the coverage of Chlamydia screening (as a proxy for
        chlamydia prevalence)
     Timeliness of social care assessment
     Reducing rates of hospital admissions per 10,000 population for
        alcohol related harm
     Reducing rates of deliberate or unintended injuries to people aged
        under 19 (per 10,000)




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A more full account of our work during 08-09 can be found in our Annual
Report which was presented at our Annual General Meeting on the 15th
September.




What are the key issues for this year?

National Priorities

We are working to improve performance against all vital signs as well as local
priorities such as those identified as key World Class Commissioning
Outcomes.

Brief details are provided below on a few specific areas highlighted in the
CQC comparison report, or that we expect to be reported by the CQC in
October as part of the Annual Health Check are:-


Proportion of          The NHS has made a commitment that from the 1st
patients seen within   January 2009 no one waits more than 18 weeks from
18 weeks for           referral to the start of hospital treatment or other
admitted pathways      clinically appropriate outcome (where it is clinically
                       appropriate and patients or patients chose to delay
                       their treatment). We are pleased to report that we have
                       achieved the national standard for our eligible non-
                       admitted or out patients. For admitted patients whilst
                       waiting times have fallen significantly and we achieved
                       the 18 week standard for 88.49% of patients from
                       January – March 2009 there is a greater proportion of
                       patients waiting longer in this area for treatment than in
                       most other areas of the East of England.

                     We are working closely with our providers to ensure
                     that all our patients benefit from the commitment to
                     reduced waits.
Women who have       Our main provider is working to introduce a new
seen a midwife or    maternity IT system during this year to ensure
maternity healthcare improved information is available in the future.
professional by 12
weeks: data quality
Childhood obesity    Preliminary data relating to our obesity recording rates
rates Year 6 pupils  for the last school year show a marked improvement
(data quality)
Access to primary    The GP Patient Survey results give us an
care                 understanding of the patients‟ views of how the
                     services in each of the GP practice areas meet local
                     needs. We have used this knowledge to develop


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                    localised improvement plans with our GPs tailored to
                    meet the specific needs of their patients. As from April
                    this survey will now be repeated quarterly allowing us
                    to get an even better understanding of our patients‟
                    attitudes and experiences.

Stroke Care         In order to achieve our ambition to significantly
                    increase the number of stroke patients who spent at
                    least 90% of their time on a stroke unit, 12 additional
                    rehabilitation beds will be opened at Colchester
                    Hospital University Trust in November 2009. This is
                    intended to be an interim arrangement whilst we
                    undertake a review of community rehabilitation services
                    (including stroke) to develop and deliver a new model
                    of care. With this interim arrangement in place it is
                    planned that 90% target will be achieved by March
                    2010.
Proportion of       Locally we have a lot of work to do to improve the rate
individuals who     if immunisations and we are particularly focused on
complete            increasing the uptake of the MMR vaccinations. We
immunisations by    have been talking to our patients and providers about
recommended ages    the best way to do this and are taking the following
                    actions:-

                       Commissioning a Domiciliary Immunisation Team to
                        offer MMR advice & vaccinations (age 2y & 5y) in
                        the child's home. This approach is in response to
                        parents requests for easier access to vaccinations
                        & access to health professionals to discuss their
                        anxieties regarding the MMR.
                     Has changed the way Practices are notified of their
                        MMR uptake
                     Implementing a rolling programme of immunisation
                        training in line with Department of Health /Health
                        Protection Agency recommendations to ensure all
                        vaccinators are advocating the MMR.
Access to primary   Good progress is being made in the number of patients
dental services     accessing a dentist in the previous 24 months with the
                    PCT ranked 6th in the region. Overall the number of
                    patients seen in 24 months since June 2008 has
                    increased by 5.3%, from 167,787 in June 2008, to
                    176,639 in June 2009. This can largely be attributed to
                    the free treatment initiative run by NHS North East
                    Essex earlier in the year. In February, the PCT ran an
                    innovative initiative “Free February”, where people
                    could access free dental care. The number of patients
                    seen was over 6,000. A “how to guide” has now been
                    produced by NHS East of England based on the PCTs
                    experience.



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                      However there is much work to be done to ensure that
                      we reach our target milestone of 196,510 by March
                      2010.

                   Feedback from our patients tells us that there is one
                   issue is patient perception around expected recall
                   intervals for check-ups. In order to respond to this we
                   will be running a media campaign focussing on the
                   positive element of not visiting the dentist every six
                   months if not deemed necessary by your dentist. We
                   will also be hosting a Dental Development Forum in
                   early October, focussing on this and we are calling on
                   our Dental Advisors to lead discussion on this issue
                   with their peers.
Teenage conception We are committed to doing even more to drive rates of
rates per 1,000    teenage pregnancy down and work closely in
females aged 15-17 partnership with others to do this. Much effort over the
                   past six months has been spent on not only
                   strengthening local direction and activity, but working
                   with our strategic and delivery partners across Essex.
                   This has been helped greatly by the appointment of a
                   county-wide Co-ordinator and the development of a
                   Joint Teenage Pregnancy Commissioning Plan.
Experience of      To ensure we remain focussed on improving the
patients           experience of our patients and respond quickly we
                   have established a dedicated Patient Experience team
                   within the PCT. A Patient Experience Strategy has
                   been developed which details our approach to
                   improving the experience patients have of all the NHS
                   services provided in North East Essex.
NHS Staff          Every year we undertake a staff survey and our Staff
Satisfaction       Survey Working Group have been using the results
                   from last years survey to understand more about our
                   organisation and identify areas where we can do better.
                   We want to be a provider of choice as we rely on our
                   staff to deliver high quality services for our patients and
                   communities.

Local Priorities

One of our biggest challenges continues to be reducing health inequalities
across North East Essex. There is a 13.3 year difference in average life
expectancy between Pier Ward and Alresford Ward with Pier having the 7th
lowest life expectancy nationally. The factors that contribute to this are
multifaceted and can only be tackled alongside our partners. In November
the findings of the Comprehensive Area Assessment for Essex will be
published and this is one area of our work with partners that we expect to be
highlighted within the report.




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Comprehensive Area Assessment, or CAA, is a new way of assessing local
public services in England. It examines how well councils are working
together with other public bodies to meet the needs of the people they serve.
It's a joint assessment made by a group of six independent watchdogs.


Communities and Existing Services

We are targeting a Local Enhanced Service (LES) at GP practices serving
more deprived populations to ensure patients who are at high risk of heart
disease due to material deprivation are assessed and receive appropriate
interventions.

This is supported by targeted use of health trainers. To address lifestyle risks
we have targets at a local level for addressing risk factors such as smoking.
We recognise the difficulty in engaging some socially excluded population
groups with health services and have developed a number of outreach
schemes to assess and manage people in their communities. This includes
joint working with Essex County Council in a number of areas.

Priorities and Service Improvements for 2010/11

The PCT is currently revising the 5 Year Strategy in light of the changing
economic environment and the known reduction in funding growth from
2010/11 and beyond. Fully integrated to this revision, will be the outcome of
our work with partner organisations and stakeholders on our Quality,
Innovation, Productivity and Prevention (QIPP) work and our development
and application of an investment and disinvestment prioritisation
methodology. Our strategy when formed in draft later this calendar year will
specifically state what priorities and service improvements we will be taking
forward and where these particularly aim to improve our vital sign
performance in future years.

Where to get further information

Monthly reports on our progress against the vital signs and our operational
plan are received by the Finance and Performance (F&P) Committee on
behalf of the Board. The F&P chair provides an update from each of these
meetings at the public Board meetings.

The Care Quality Commission will publish the results of the Annual Health
Check 2008-09 for all PCTs on their website www.cqc.org.uk on the 15th
October 2009.

Full details of our plans for this year and the next 5 years can be viewed on
the PCT website www.northeastessexpct.nhs.uk . Specific reading includes
our Operational Plan 2009-10 and the 5 year strategy.

Information on our work with the Essex Partnership can be found online at
www.essexpartnership.org . Key documents include the Local Area


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Agreement 2008-11 , The Essex Strategy 2008-18, the Joint Strategic Needs
Assessment, or JSNA and the Community Wellbeing Strategy.




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Part II: Our Plans for children with a disability

The Department of Health has made it a requirement for all PCTs to report on
their specific plans for children with a disability covering short breaks,
community equipment, wheelchairs and palliative care.

Background

Aiming High for Disabled Children (AHDC) was launched in May 2007 and is
the transformation programme for disabled children‟s services in England. It
aims to deliver three priority areas:

      Access and empowerment
      Responsive services and timely support
      Improve service quality and capacity.

To support the implementation of the vision, additional Government funding
has been made available to Local Authorities and Primary Care Trusts.

The Department of Health‟s Child Health Strategy, „Healthy Lives, Brighter
Futures‟, published in February this year, confirmed health funding to support
the implementation of AHDC and the children‟s palliative care strategy
„Better Care Better Lives‟.

In Essex, a multi - agency strategic group was established in 2007 led by the
Local Authority to develop the county vision for children and young people
with disability and prepare to meet the AHDC readiness criteria by spring
2009.

Essex was successful in being one of the first areas to achieve this in
February 2009.

Children with a Disability


The Thomas Coram Research Unit has estimated that the number of disabled
children in England is likely to be in the region of between 288,000 and
513,000, with the average proportion being between 3.0% and 5.4% of the
population.
Applying these figures to the population of North East Essex, this suggests
that between 1,883 and 3,389 children has some form of disability.
There has been some analysis carried out by the ONS in relation to the health
of children and young people using the general household survey (GHS) and
the Family Fund Trust‟s (FFT) register of applicants. The following tables
show the data derived from this work as prevalence rates by age band for
mild and serious disability.

Table 5: Age-specific prevalence rates (per 100,000 aged 0-19 yrs) with a
long standing illness or disability, 2000



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      0 to 4              5 to 9              10 to 14            15 to 19
      Prevalence Estimate Prevalence Estimate Prevalence Estimate Prevalence Estimate
Boys 14%         1,107    25%        2,254    18%        1,859    20%        1,851
Girls 13%        995      18%        1,516    19%        1,723    16%        1,521
          Source: General Household Survey, 2000

          Table 6: Age-specific prevalence rates (per 10,000 aged 0 to 19 years) of
          severely disabled population by sex. 2000

      0 to 4              5 to 9              10 to 14            15 to 19
      Prevalence Estimate Prevalence Estimate Prevalence Estimate Prevalence Estimate
Boys 15%         1,186    12%        1,082    8%         744      3%         308
Girls 8%         612      5%         421      4%         363      2%         190
          Source: unpublished analysis of Family Fund Trust statistics.

          Locally, effective methods of collecting and sharing information across
          agencies have presented significant challenges. The partnership is
          developing an information sharing protocol and currently uses information
          from the SENCAN (Education) database for baseline numbers of children and
          young people registered as having severe and complex needs. At 02/02/09
          this was 2,494 across Essex, with 591 in North East Essex. The PCT has
          initiated a data collection exercise to compare information from our systems to
          validate the numbers and inform a needs analysis of children and young
          people with disabilities locally.

          Short Breaks

          NHS North East Essex is working with the Local Authority, third sector and
          parents to deliver the Aiming High for Disabled Children agenda. We are
          engaged through the Children‟s Trust Arrangements in both the Essex
          Children with Disability Strategy Group and the Essex Children with Disability
          Joint Commissioning Group.

          To date together we have developed our vision:

          „ Our vision for children and young people with disabilities in Essex is that they
          will enjoy, achieve and participate through a wide range of short break
          activities and opportunities that are personalised and support „Me Time‟. This
          means „Me Time‟ for the disabled child or young person, siblings and for
          parents/carers‟

          The implementation is based on what children, young people with disabilities
          and their families have said through formal consultation would make a
          difference. This includes developing current short break opportunities,
          encouraging new provision, increasing the accessibility of personal assistants
          and improving inclusivity within communities, leisure activities and universal
          services. For some children and young people, the individualised planning
          will be supported through the „Team around the Child‟ partnership approach



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and for others it will involve less specialist provision and more universal and
community leisure activities.

AHDC is embedded within the multi-agency CWD Strategy 2009-2011 and
the 2009-10 action plan.
The detailed AHDC project plan includes:

      Developing an increased range and diversity of short break provision
      Stimulating the market to include community leisure activities and
       developing universal accessibility
      Supporting children, young people and parent participation and
       engagement
      Creating a fair and transparent mechanism that facilitates the match
       between needs and available resources
      Refreshing the good practice of Early Support and Unified Planning
       processes
      Innovating, re-designing, diversifying, capacity building in priority areas
       for children with disabilities, consistent with the ambitions contained in
       strategic plans for the County and more locally in North East Essex
      Data collection and information sharing across agencies and
       geographical areas, to facilitate seamless services and care
      Workforce development to ensure staff are competent, capable and
       able to respond flexibly and appropriately to needs



Children’s Palliative Care

The PCT has funded an increase in the Children‟s Community Nursing
Service to increase access to 7 days / week. We have commissioned a review
of the current service model to inform further development to meet the goals
in „Better Care; Better Lives.‟
In 08-09 the PCT provided grant funding to both Little Haven and EACH
Hospices and has plans for further funding, in partnership with the other
Essex PCTs. The Southend, Essex Thurrock and Essex Palliative Care
Network had its inaugural meeting in July this year. We will be working
through this group to undertake needs analysis and mapping of current
provision, to inform the development of palliative care services and pathways
across Essex. We currently commission a service from Essex Southend &
Thurrock Integrated Care Children‟s Respite Service (EPIC), through a
consortium agreement, with South East Essex PCT as coordinating
commissioner. Discussion with our fellow commissioners will continue to
develop the current arrangements when the existing contract ends in March
2010.

In 2008, a North East Essex Children‟s continuing Care Case Manager was
recruited to coordinate the timely assessment and review of continuing care
requests.




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A multi-agency children‟s panel receives requests for continuing care funding.
Decision making is based on the draft Children‟s Continuing Care Framework,
which ensures a full assessment of the child‟s/young person‟s needs,
including the use of a decision support tool and a fully transparent process.

Through the review of the Children‟s Trust arrangements in Essex, joint
commissioning is being progressed, in order to drive up the quality, capacity,
range and consistency of services for all children and young people, including
children with disability and those with complex health needs.

Further plans are in development to increase investment in the Specialist
Health Care Tasks Service, to ensure that children and young people can
access short break provision, as carers are trained in managing their complex
health needs.

NHS North East Essex plans to increase the provision of short breaks,
including undertaking further local needs analysis and aligning investment
with the AHDC project plan. In 2008 we contributed funding to the „Cool 2
Care‟ project to increase the availability of vetted and trained personal
assistants that families are able to fund through direct payments, allowances
or private means.

Community Equipment & Wheelchairs

North East Essex Wheelchair Service currently has a dedicated specialist
Paediatric Occupational Therapist, therefore children are regularly seen by
the same Therapist either in clinic, at home or in school. Recent investment
by North East Essex PCT has cleared a long standing waiting list, where there
would have been financial restrictions previously for powered wheelchairs.
At present we have no children waiting for powered wheelchairs. There is
open access and funding available once a clinical decision has been made
with the agreement of the family for equipment required.
There is no lower age limit for powered chairs for children. The Wheelchair
service have a very close working relationship with local charities and the
education department who part fund equipment when it is also required for
education or to enhance quality of life/ social need. Due to this partnership
working and funding available there is no restrictions on the type of equipment
considered this also applies to manual wheelchairs and buggies.
Increasing staff time to allow annual review for every child. At present children
are only seen when new equipment is required or for adjustment to present
equipment.
Workshops linked with whiz kids to offer further active training post handover
of equipment.

“Community Equipment - NHS is to work with partners to ensure there is
timely and comprehensive assessment of the disabled child, taking account of
clinical, social and educational needs and the needs of the family and carers:
and to improve the timely provision of equipment.”




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The Physiotherapists and Occupational Therapists within the Paediatric
Rehabilitation Service are highly skilled at assessing for appropriate
equipment to enable children to achieve their optimal functional performance
in all activities of daily living.

Therapists assess children‟s equipment requirements in schools and also
within the home environment.

Occupational Therapists assess children at home for seating, toileting and
bathing equipment, postural positioning equipment and minor adaptations.
They are often the first practitioners to undertake assessment for equipment
in a child‟s home environment and will then refer to Social Care Services for
O.T. assessment for major adaptations if required in the home environment.

Consideration of whether it would be reasonable and practical to integrate
Social care O.T.‟s for Children with the Paediatric Rehabilitation service in
order to gain specialist skills working with children will be progressed with a
view to waiting list reduction and increased efficiency/effectiveness of
services.

Timely access to assessment for provision of equipment from Paed Rehab
O.T.‟s is assured for children who require such equipment through
prioritisation against needs.

Some challenges exist in managing workload and dialogue between provider
services and commissioning has been initiated with a view to agreeing ways
to resolve these issues.

We will evaluate further investment to support continued delivery to 18 week
targets and develop other improvements in services.




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