The indicator updates for this month relate largely to infant and child health and waiting times. For more in depth analysis of child health, we are publishing a report Focus on: Emergency hospital care for children and young people’ later this month. (Sign up here to receive notification of this publication). We have also updated our interactive charts showing data on waiting times. Some highlights from these key performance indicators are flagged each month in our ‘latest data’ posts which cover the release of NHS England’s Combined Performance Summary data. You can read last week’s post here.
Infants and children
The infant mortality rate is based on the number of children that die between birth and age one, per 1,000 live births. It is often used as a measure of healthcare quality, though the rate can also be influenced by factors external to a healthcare setting.
In the first year of life risk factors for mortality include low birth weight and prematurity (Callaghan, 2006). The Marmot Review: Fair Society, Healthy Lives noted that a range of other factors, such as birth outside marriage, a mother being under the age of 20 and deprivation, were also associated with increased infant mortality. These findings demonstrate the key role social, economic and environmental factors play in infant mortality.
Infant mortality rates have fallen in England over the past 30 years. Improvements in general healthcare, midwifery and neonatal intensive care partially explain this fall (National Children’s Bureau, 2014). Despite the impressive improvements in child health, in recent decades the UK has a higher rate of mortality compared to many European OECD countries. The infant mortality rate has been decreasing in most OECD countries. The UK has a relatively high rate of infant mortality with almost four deaths per 1000 live births in 2014.
Immunisation programmes provide protection not only to vaccinated individuals but also to the wider, unvaccinated, population through ‘herd immunity’. Herd immunity occurs when a high proportion of the population is vaccinated, making it difficult for a disease to spread since there are few susceptible people (Vaccines today, 2016).
Currently the European Region of the World Health Organization (WHO) recommends at least 95% of the population of children are immunised against diseases preventable by immunisation (specifically, diphtheria, tetanus, pertussis, polio, Hib, measles, mumps and rubella). The routine childhood immunisation programme for the UK includes these immunisations recommended by WHO as well as a number of others as defined by the Department of Health. In the UK and England vaccine coverage for these diseases has generally been above 90%.
Pregnancy, birth and the early weeks of a child’s life are a crucial period for the future of the child and the family. For babies, this period has a major influence on their physical, social, emotional and language development (Wave Trust, 2013). It is therefore vital that families in England are supported by high quality maternity services.
The total number of births is increasing year on year. According to ONS data, in 2000 there were 604,441 births in England and Wales, compared to 697,852 in 2015. Women are also giving birth later in life and there has been a steady increase in the average age of mothers at the birth of their child in England and Wales from 27.3 years in 1964 to 30.3 years in 2015 (ONS, 2016). Due to the above trends, a higher proportion of births involve more complex care, which requires risks to be managed and more interventions (NAO, 2013).
The latest data available is for 2012 and shows the rate of admission within 28 days of birth in England is 6.1 admissions per 100 full term births.
Referral, diagnosis and transfers
Swift referral and prompt diagnosis are key determinants of care quality. Shorter waits allow patients quicker access to the treatments they need. The NHS constitution stipulates that patients with a referral from a GP should start their treatment within 18 weeks. As of June 2015, the target was that at least 92% of patients should spend less than 18 weeks waiting for treatment. From 2012/13 the target for diagnostic waits was that no more than 1% of patients should wait six weeks or longer for a diagnostic test.
Timely transfer to other areas of care is another essential part of the treatment process. The current high rates of bed occupancy, as well as social care cuts, put extra pressure upon the NHS. Delayed transfers of care (DTOCs) have risen recently. One explanation for this is the increasing number of patients that are ready to leave hospital but are unable due to lack of support or availability of social care.
The latest data show an increasing trend in how long patients wait for referral to treatment. For example, median wait times from referral to decision to treat for people admitted, non-admitted and those on incomplete pathways increased by around 1 week between January 2014 and 2017. However, the proportion of people receiving diagnostic tests within 6 and 13 weeks has remained relatively steady. Since early 2008 the proportion of patients waiting between 6 and 13 weeks for a diagnostic test has consistently been below 5%, though is still below target.
Accident & Emergency
The maximum four-hour wait in A&E is a requirement for all NHS hospitals. The proportion of people seen in less than 4 hours has been declining in recent years. As of quarter three of 2016/17 performance against the 95% target had fallen to 82%, the worst level since the introduction of the target.
For an in-depth analysis of what's causing increasing A&E waits, see the QualityWatch report Focus on: A&E attendances.
Appropriate call handling and quick response times by ambulance services are key components of performance. Effective call handling and swift responses to emergency calls not only influence outcomes but can also reduce the support people need later on.
Category A (Red 1 and Red 2) ambulance calls are those that are classed as life threatening and the national standard sets out that 75% of these calls should receive a response within eight minutes. There has been a steady decline in the number of Red 1 and Red 2 calls attended within eight minutes over the past few years. For example, in January 2013, 73.5% of Red 1 calls were attended within 8 minutes, but this declined to 66.7% in January 2017.