Vital Signs Performance for 2008/9
Our Actions for 2009/10 and 2010/11
Part 1 – Vital Signs Performance
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
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
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)
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
What are the key issues for this year?
We are working to improve performance against all vital signs as well as local
priorities such as those identified as key World Class Commissioning
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
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
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
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
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
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
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
However there is much work to be done to ensure that
we reach our target milestone of 196,510 by March
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
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.
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
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
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
Agreement 2008-11 , The Essex Strategy 2008-18, the Joint Strategic Needs
Assessment, or JSNA and the Community Wellbeing Strategy.
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.
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
Essex was successful in being one of the first areas to achieve this in
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
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
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.
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
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
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
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
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
In 2008, a North East Essex Children‟s continuing Care Case Manager was
recruited to coordinate the timely assessment and review of continuing care
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
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
Workshops linked with whiz kids to offer further active training post handover
“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.”
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
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.