CCG Outcomes Indicator Set - December 2012

Key Facts

This release reports a number of local level indicators mainly based upon the NHS Outcomes Framework. It draws on a variety of data sources to provide users with the ability to compare at CCG level, including:

• Mortality (Primary Care Mortality Database)

• Hospital Episodes Statistics

• GP Patient Survey

• GP registered population, extracted directly from GP systems

This initial publication consists of a list of 15 indicators compiled in collaboration with NICE, supported by the NHS Commissioning Board and the Department of Health and assured through the Indicator Assurance Service.

This release encompasses indicators in the following areas:

• Potential Years of Life Lost (PYLL)

• Mortality

• Emergency hospital admissions

• Emergency re-admissions to hospital

• Patient Reported Outcomes Measures (PROMS)

• Patient Experience

It is anticipated that further CCG indicators will be released at the end of March 2013.

The indicators presented here relate to four of the five NHS Outcomes Framework domains - preventing people from dying prematurely; enhancing the quality of life for people with long-term conditions; helping people to recover from episodes of ill health or following injury and ensuring that people have a positive experience of care.

This is the first time that these indicators have been presented by CCG although some have already been published at Local Authority (LA) level.

• Potential Years of Life Lost due to amenable causes are given for each CCG. Conditions considered amenable to healthcare should not result in premature deaths where timely and effective healthcare is available. The concept of 'amenable' mortality generally relates to deaths under the age of 75 and figures are reported for males and females separately.

• Mortality rates in the under 75s from cancer, respiratory disease and cardiovascular disease form part of the set of indicators aimed at reducing premature mortality from the major causes of death. Some variation can be observed, for example in 2011 the lowest rate of mortality due to cardiovascular disease was 31 per 100,000 while the highest rate was 126.

• Five indicators are intended to measure the effective management of a range of conditions within primary care settings.

These indicators focus upon emergency admissions for adults aged 19 and over due to:

• Chronic ambulatory care sensitive conditions

• Acute conditions that should not usually require hospitalisation

• Alcoholic liver disease

Two similar indicators are included for children and young people under the age of 19:

• Emergency admissions for asthma, diabetes and epilepsy

• Lower respiratory tract infections (LRTIs)

These emergency admissions rates also show variation across the CCGs. For example, in 2011-12 the ambulatory care admission rates per 100,000 adults vary from 219 in one area to 2169 in another while the comparable indicator for children has minimum and maximum values of 73 and 747 respectively.

• In recognition of the importance of seeking patient feedback on the quality and effectiveness of their experience, treatment and care, this release includes Patient Reported Outcome Measures (PROMs) for four elective procedures:

• Hip replacement

• Knee replacement

• Groin hernia treatment

• Varicose veins surgery

• Patient feedback of Primary Care is collected in the GP Patient Survey; patient experience of GP Out-of-Hours services is reported in this release with more indicators expected in subsequent publications.

Cautionary notes on interpretation

• The exact number and composition of the new CCGs is still under review but is expected to be confirmed by April 2013. These indicators have been calculated for the 212 interim CCGs as reported on 6 July 2012.

• The data is aggregated to CCG level using each individual's GP practice code. Because CCGs also have responsibility for the healthcare of people within a defined geographical area (http://www.connectingforhealth.nhs.uk/systemsandservices/data/ods/ccginterim; downloaded on 6 July 2012), those patients not registered with a GP have been allocated to their CCG of residence using the postcode of their usual address. For further details, please refer to the relevant specifications.

• CCG indicators require careful interpretation and ought not to be viewed in isolation, but instead should be considered alongside other indicators and alternative sources such as patient feedback, staff surveys and similar material. When evaluated together, these will help to provide a holistic view of CCG outcomes and provide a more complete overview of the impact of each CCG's processes on outcomes.

• Similar indicators exist in NHS Outcomes Framework and are also published in the Compendium of Population Health Indicators. However, different standardisation has been used for the CCG indicators:

• The NHS Outcomes Framework mortality and PYLL indicators are directly standardised by age and sex to the European Standard Population to facilitate international comparisons whereas the CCG indicators are directly standardised by age and sex to the England population.

• Direct standardisation by age and sex has also been used in the calculation of the CCG level emergency admissions indicators while the NHS Outcomes Framework uses indirect standardisation.

• A number of factors outside the control of the NHS and CCGs, such as the socio-economic mix of local populations, may contribute to the variation shown by these indicators. These can vary by region, and may include environmental factors such as air quality, occupational hazards and deprivation. Differences in case-mix (beyond that accounted for by standardisation), such as comorbidities and other potential risk factors may also contribute to variation.

• Some hospital admissions may be potentially avoidable through better treatment in primary care. Likewise, emergency readmissions may be avoidable with more effective treatment and healthcare guidance while the patient remains in hospital, and / or more effective post-discharge follow-up care and support.

• The patterns of providing care may vary between organisations and regionally in terms of: the extent and availability of treatment in primary care settings; referral policies and practices; hospital outpatient facilities / walk-in clinics; and hospital inpatient admission policies and practices.

• There may be local variation in data quality, particularly in terms of diagnostic and procedure coding.

The latest Excel and CSV data files, indicator specifications and data quality statements for all indicators are available from the most recent CCG Outcomes Indicator Set. A link is provided in the resources section below.