the nhs outcomes framework 2014/15...outcomes frameworks, sits at the heart of the health and care...
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The NHS Outcomes Framework 2014/15
November 2013
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Published to gov.uk, in PDF format only.
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Contents
Introduction 2
Background 3
Assessing progress 4
Changes across each domain 7
Next steps in developing the NHS Outcomes Framework 17
Annex A: Timeliness of data for assessment of NHS Outcomes Framework 2013/14 19
Annex B: NHS Outcomes Framework at a glance 21
Annex C: Adult Social Care Outcomes Framework at a glance 23
Annex D: P ublic Health Outcomes Framework at a glance 25
2 The NHS Outcomes Framework 2014/15
Introduction
The NHS Outcomes Framework, alongside the Adult Social Care and Public Health outcomes frameworks, sits at the heart of the health and care system. The NHS Outcomes Framework:
i. provides a national overview of how well the NHS is performing;
ii. is the primary accountability mechanism, in conjunction with the Mandate, between the Secretary of State for Health and NHS England;1 and
iii. drives up quality throughout the NHS by encouraging a change in culture and behaviour focused on health outcomes not process.
This document is being published alongside the Mandate for 2014/15. It is also accompanied by a Technical Appendix which provides detailed information about the indicators still being developed for the framework.
This document provides an update on the progress that has been made to develop existing indicators in the NHS Outcomes Framework and does not commit to adding any new indicators into the framework. Instead, the intention is to review the framework next year as part of the process to refresh the NHS Outcomes Framework 2015/16.
In previous years all the detail for each indicator in the NHS Outcomes Framework
1 Legally known as the National Health Service Commissioning Board
was published in the corresponding Technical Appendix which was not regularly updated. This led to some inconsistencies and inaccuracies emerging throughout the year between the Department of Health’s Technical Appendix and the information published by the Health and Social Care Information Centre (HSCIC). In order to avoid any of these problems, and to ensure consistency, all of the technical detail for the live indicators in the NHS Outcomes Framework for 2014/15 will be published in one document on the HSCIC website in the spring of 2014 on their data portal: http://www.hscic.gov.uk/indicatorportal.
As indicators in the NHS Outcomes Framework become live this document will be updated by the HSCIC with previous versions saved for reference.
Finally, in accordance with its statutory duties, the Department of Health has continued to make tackling health inequalities a priority to promote equality across the equality strands protected in the Equality Act 2010. Progress in this regard is discussed in a corresponding updated equality analysis document.
Background 3
Background
Measuring and publishing information on health outcomes helps drive improvements to the quality of care people receive.2 The White Paper: Liberating the NHS3 outlined the Coalition Government’s intention to shift the NHS from a focus on process targets to a focus on measuring health outcomes.
The NHS Outcomes Framework was developed in December 2010, following public consultation, and has been updated every year to ensure that the most appropriate measures are included. Over this time the Department of Health has been improving the framework by refining existing measurement indicators and developing new indicators.
2 High quality care for all: NHS Next Stage Review (2008) Available at: http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825
3 https://www.gov.uk/government/publications/liberating-the-nhs-white-paper
Indicators in the NHS Outcomes Framework are grouped around five domains, which set out the high-level national outcomes that the NHS should be aiming to improve. For each domain, there is a small number of overarching indicators followed by a number of improvement areas. These improvement areas include both sub-indicators (for outcomes already covered by the overarching indicators but meriting independent emphasis), and complementary indicators (extending the coverage of the domain). The domains focus on improving health and reducing health inequalities, namely by:
Domain 1 Preventing people from dying prematurely;
Domain 2 Enhancing quality of life for people with long-term conditions;
Domain 3 Helping people to recover from episodes of ill health or following injury;
Domain 4 Ensuring that people have a positive experience of care; and
Domain 5 Treating and caring for people in a safe environment and protecting them from avoidable harm.
4 The NHS Outcomes Framework 2014/15
Assessing progress
The NHS Outcomes Framework forms an essential part of the way in which the Secretary of State for Health holds NHS England to account.
The Mandate4 to NHS England is structured around the five domains of the NHS Outcomes Framework and, as such, progress against objectives in the Mandate will be assessed using the NHS Outcomes Framework. Furthermore, there is a specific objective in the Mandate for NHS England to demonstrate progress against the five domains and all of the indicators in the NHS Outcomes Framework including, where possible, by comparing our services and outcomes with the best in the world.
4 https://www.gov.uk/government/publications/nhs-mandate-2014-to-2015
It is for NHS England, working with clinical commissioning groups and others, to determine how best to deliver improvements against the Mandate and how they do this is set out in their annual business plan.5
The Department of Health will hold NHS England to account and is continually reviewing progress against the Mandate objectives. To support openness and transparency, the intention is to publish updates measuring NHS England’s progress, including against the indicators in the NHS Outcomes Framework. In assessing NHS England’s performance, success will be measured not only by the average level of improvement but also by progress in reducing health inequalities and unjustified variation.
5 The latest version of this can be seen at: http://www.england.nhs.uk/wp-content/uploads/2013/04/ppf-1314-1516.pdf
Example – Enhancing the quality of life for people with long-term conditions
The Mandate sets an objective to make measurable progress towards making the NHS among the best in Europe at supporting people with ongoing health problems to live healthily and independently, with much better control over the care they receive.
In order to assess progress against this objective, the Department of Health would expect to see progress against indicators in Domain 2 – Enhancing quality of life for people with long-term conditions.
For example, the Department of Health would expect improvement against indicator 2 – Health related quality of life for people with long-term conditions. This indicator is based on the GP Patient Survey, and includes responses from people with Alzheimer’s disease, cancer, diabetes and long-term mental health problems.
Assessing progress 5
Example – continued
An improvement in indicator 2 would mean that, on average, people with long-term conditions perceive their own health to have improved. In particular, they would:
1. have fewer problems walking about; and/or
2. have fewer problems washing or dressing themselves; and/or
3. have fewer problems in performing their usual activities (work, study, housework, family or leisure activities); and/or
4. have less pain or discomfort; and/or
5. be less anxious or depressed.
Furthermore, this indicator will also allow us to explore variation in outcomes for people with long-term conditions across the country, and to analyse inequalities between outcomes for different groups of patients. These groups include age, gender and ethnicity.
Timely reporting of data
In order to ensure the Department of Health is robustly holding NHS England to account for the outcomes they achieve, work is taking place with HSCIC and others to improve the timeliness of the NHS Outcomes Framework data. See Annex A for a table detailing how long it takes for data to become available in the framework and published on the HSCIC indicator portal.6
For some indicators this can take a considerable amount of time. In each refresh of the NHS Outcomes Framework, the Department of Health intends to provide an update on the progress that has been made to reduce the time it takes to publish data for the indicators.
More information can be found in the Technical Appendix.
6 https://indicators.ic.nhs.uk/webview/
NHS Outcomes Framework and the wider health and care system
Alignment of the three outcome frameworks
The NHS Outcomes Framework sits alongside the outcomes frameworks for adult social care (see Annex C) and public health (see Annex D). These other frameworks reflect the different delivery systems and accountability models for public health and adult social care but have the same overarching aim of improving the outcomes that matter to people. In 2013 the Department of Health has continued to work to align the frameworks to encourage collaboration and integration, both in terms of how shared and complementary indicators are presented across all three frameworks, and through an increased and more systematic use of shared and complementary indicators.
These three outcome frameworks are supported by an Education Outcomes Framework (EOF) which sets the education and training outcomes for the health and care system as a whole. The EOF has an enabling role across the whole system and aims to measure progress in education,
6 The NHS Outcomes Framework 2014/15
training and workforce development and the consequential impact on the quality and safety of services for patients and service users.7
Alignment between the outcomes frameworks has been agreed as a design principle for all future development of the frameworks and the Department of Health remains committed to improving alignment between the outcomes frameworks, where appropriate, in recognition of the joint contribution of health and social care to improving outcomes. Progress on aligning the outcomes frameworks will be reported in the forthcoming Secretary of State’s Annual Report for 2012/13.
Clinical Commissioning Group Outcome Indicator Set
NHS England has developed the Clinical Commissioning Group Outcomes Indicator Set (CCG OIS)8 to support the NHS Outcomes Framework.
The CCG OIS comprises NHS Outcomes Framework indicators that can be measured at clinical commissioning group level and additional indicators developed by NICE and HSCIC. These provide clear, comparative information to support clinical commissioning groups and Health and Wellbeing Boards to identify local priorities and demonstrate progress on improving outcomes, as well as delivering public transparency about local health services. Where possible, indicators in the NHS Outcomes Framework will be included in the CCG OIS.
7 https://www.gov.uk/government/publications/education-outcomes-framework-for-healthcare-workforce
8 This was formerly known as the Commissioning Outcomes Framework. The title changed to avoid confusion with the NHS Outcomes Framework and make it clear that the indicators relate to outcomes from commissioned services, not commissioning itself.
Changes across each domain 7
Changes across each domain
This section describes the progress made to develop the NHS Outcomes Framework by providing an update on the 20 indicators whose development was incomplete in last year’s refresh. We expect development of 15 of these 20 indicators to be complete before March 2015.
In order to support development of indicators in the NHS Outcomes Framework, the Department of Health established the Outcomes Framework Technical Advisory Group (OFTAG). This group provides independent expert advice on the NHS Outcomes Framework. Further information about the OFTAG is available on the Gov.uk website.9
This year, changes to NHS Outcomes Framework have been kept to an essential minimum to provide stability to the NHS. Some indicators are now live and work is ongoing to develop the remaining indicators, subject to identification of satisfactory data sources.
9 https://www.gov.uk/government/policy-advisory-groups/outcomes-framework-technical-advisory-group
8 The NHS Outcomes Framework 2014/15
Domain 1 – Preventing people from dying prematurelySummary of indicators being developed
Indicator TitleStatus in last
refreshCurrent status
Status in NHS OF 2014/15
Date of first data release
1a.ii
Potential Years of Life Lost (PYLL) from causes considered amenable to health care - children and young people
In development Live Live Mar-13
1.4.i-ivSurvival from cancer (all indicators)
In development Live Live Feb-14
1.6.iiiFive year survival from all cancers in children
PlaceholderIn
developmentLive Feb-14
1.7
Excess under 60 mortality in adults with learning disabilities
Placeholder Placeholder In development
Estimated 2014/15
(Depending if data source is appropriate)
• Live – Indicator development is complete. Where available, the data for live indicators are published on the Health and Social Care Information Centre (HSCIC) Indicator Portal (https://indicators.ic.nhs.uk/webview/);
• In development – Some elements of the indicator definition require further development;
• Placeholder – A need to measure this outcome has been identified, and one or more potential sources have been identified, but an indicator is yet to be developed, and publication on the HSCIC Indicator Portal is not imminent.
Development of Domain 1 indicators
A number of the indicators announced last year are now live and ready for inclusion in the NHS Outcomes Framework 2014/15. This now means that Domain 1 has much better
coverage of children’s outcomes across the domain. It also means that there is now only one indicator (1.7) still to be developed.
Changes across each domain 9
1a.ii Potential Years of Life Lost (PYLL) from causes amenable to healthcare (children and young people)
The overarching indicator for Domain 1 is now live. It includes two measures, one for adults and one for children and young people.
Cancer survival indicators
The new indicators for cancer survival are expected to be published in February 2014, including:
• 1.4.i One-year survival from all cancers;
• 1.4.ii Five-year survival from all cancers;
• 1.4.iii One-year survival from breast, lung and bowel cancer combined; and
• 1.4.iv Five-year survival from breast, lung and bowel cancer combined.
These indicators have been developed by the London School of Hygiene and Tropical Medicine (LSHTM) and are composite indicators building on the previous six cancer survival indicators.
Despite the change, the Department of Health will still be able to monitor survival for breast, lung and bowel cancers individually as these will continue to be reported by the ONS.10
Until the new data becomes available, data from previous indicators will continue to be reported using the old definitions.
Finally, it is also expected that the data for 1.6.iii Five-year survival from all cancers in children will be released in March 2014. This indicator relates to children under 15 years. The adult cancer survival indicators have historically covered ages 15-99, but cancer
10 subject to current ONS consultation: http://www.ons.gov.uk/ons/about-ons/get-involved/consultations/consultations/statistical-products-2013/index.html
contributes to a significant proportion of childhood deaths.
1.7 Excess under 60 mortality in adults with learning disabilities
Work is still ongoing to develop the learning disability indicator with NHS England, Public Health England and the HSCIC to identify an appropriate data source. A test data extract on learning disabilities from the General Practice Extraction Service (GPES) has been commissioned from the HSCIC. This is expected to be available in early 2014 and will be used to see if it provides relevant data that could be used to underpin the indicator.
In addition to this, the Department of Health is also exploring with NHS England, PHE and the HSCIC if better use could be made of existing data sources on people with learning disabilities by linking different datasets to give, as a minimum, data on age, sex and cause of death. The Department of Health will provide an update on progress by March 2014.
10 The NHS Outcomes Framework 2014/15
Domain 2 – Enhancing quality of life for people with long-term conditionsSummary of indicators being developed
Indicator TitleStatus in
last refreshCurrent status
Status in NHS OF 2014/15
Date of first data release
2Health related quality of life for people with long-term conditions
In development
Live Live Sept-13
2.1Proportion of people feeling supported to manage their condition
In development
Live Live Sept-13
2.4Health related quality of life for carers
In development
Live Live Sept-13
2.6.ii
A measure of the effectiveness of post-diagnosis care in sustaining independence and improving quality of life for people with dementia
Placeholder Placeholder PlaceholderEstimated 2016/17
• Live – Indicator development is complete. Where available, the data for live indicators are published on the Health and Social Care Information Centre (HSCIC) Indicator Portal (https://indicators.ic.nhs.uk/webview/);
• In development – Some elements of the indicator definition require further development;• Placeholder – A need to measure this outcome has been identified, and one or more potential sources have been identified, but an
indicator is yet to be developed, and publication on the HSCIC Indicator Portal is not imminent.
Development of Domain 2 indicatorsA number of the indicators announced last year are now live and ready for inclusion in the NHS Outcomes Framework 2014/15. This includes indicator 2 Health related quality of life for people with long-term conditions the overarching indicator for Domain 2. This indicator, as well as, 2.1 Proportion of people feeling supported to manage their condition and 2.4 Health-related quality of life for carers, provide a picture of the NHS’s contribution to improving the quality of life for those affected by long-term conditions. As set out in the example above, these indicators are vital to holding NHS England to account for progress against the Mandate. Only
the dementia indicator 2.6.ii remains to be developed.
2.6.ii A measure of the effectiveness of post-diagnosis care in sustaining independence and improving quality of life for people with dementiaThe Department of Health has commissioned a research team at the London School of Hygiene and Tropical Medicine to investigate the potential for a routine Patient-Reported Outcome Measure for dementia, including where necessary a measure for completion by a relevant person other than the patient. The study will investigate whether such a measure is methodologically robust, acceptable and cost-effective. Indicator 2.6.ii will be developed in line with findings from this study, which will report in mid-2015.
Changes across each domain 11
Domain 3 – Helping people to recover from episodes of ill health or following injurySummary of indicators being developed
Indicator Title Status in last refresh Current status Status in NHS
OF 2014/15 Date of first data release
3.1.vAccess to psychological therapies
In development In development Live May 2014
3.3 Survival from major trauma In development In development Live May 2014
3.4
Proportion of stroke patients reporting an improvement in activity/lifestyle on the Modified Rankin Scale at 6 months
In development In development Live Estimated autumn 2014
• Live – Indicator development is complete. Where available, the data for live indicators are published on the Health and Social Care Information Centre (HSCIC) Indicator Portal (https://indicators.ic.nhs.uk/webview/);
• In development – Some elements of the indicator definition require further development;• Placeholder – A need to measure this outcome has been identified, and one or more potential sources have been identified, but an
indicator is yet to be developed, and publication on the HSCIC Indicator Portal is not imminent.
Development of Domain 3 indicatorsSince last year there has been significant progress in developing Domain 3. This includes developing an indicator (3.1.v) regarding the Improving Access to Psychological Therapy programme, in line with the objective in the Mandate to ensure parity of esteem between people with mental health conditions and the population as a whole. Development of the remaining indicators is expected to be complete before autumn 2014.
3.1.v Access to psychological therapies
As announced in the 2012/13 NHS Outcomes Framework, progress has been made in defining an appropriate indicator that will reflect total health gain generated by NHS psychological therapies, as assessed
by patients using Improving Access to Psychological Therapies (IAPT) services (Indicator 3.1.v).
This measure will use patient-reported, condition-specific recovery scales, which are collected at each IAPT session and recorded in the patient-level IAPT dataset. Contextual information, such as rate of access to services, will also be presented alongside the indicator to aid interpretation.
IAPT data are collected monthly and reported quarterly, one quarter after collection. Various equalities characteristics of IAPT clients are collected in the dataset, including age, gender, ethnicity and sexual orientation. This means that the indicator will provide a relatively timely, rich mechanism for monitoring changes in outcomes from psychological therapies provided under the IAPT programme.
12 The NHS Outcomes Framework 2014/15
Finally, Children and Young People’s IAPT is implementing a transformation programme to Child and Adolescent Mental Health Services (CAMHS) and the IAPT severe mental illness project has launched a small number of demonstration sites. Once appropriate data becomes available, consideration will be given as to how to expand this indicator to include a broader range of clients.
3.3 Survival from major trauma
This indicator measures the number of people alive 30 days after suffering a major injury from an accident or incident. The Department of Health and NHS England have been working with the Trauma Audit Research Network (TARN) to produce an indicator of the proportion of people who recover from major trauma.
3.4 Proportion of stroke patients reporting an improvement in activity / lifestyle on the Modified Rankin Scale at six months
This indicator measures the extent to which people have recovered 6 months after suffering a stroke. The initial set of data is expected to become available in autumn 2014. This will allow further refinement of the indicator.
Changes across each domain 13
Domain 4 – Ensuring that people have a positive experience of careSummary of indicators being developed
Indicator Title Status in last refresh Current status Status in NHS
OF 2014/15Date of first data release
4.c Friends & Family test Placeholder In development In development Estimated 2015
4.8
Improving children and young people’s experience of healthcare
Placeholder In development In development To be determined
4.9Improving people’s experience of integrated care
Placeholder In development In development Estimated 2015
• Live – Indicator development is complete. Where available, the data for live indicators are published on the Health and Social Care Information Centre (HSCIC) Indicator Portal (https://indicators.ic.nhs.uk/webview/);
• In development – Some elements of the indicator definition require further development;• Placeholder – A need to measure this outcome has been identified, and one or more potential sources have been identified, but an
indicator is yet to be developed, and publication on the HSCIC Indicator Portal is not imminent.
Development of Domain 4 indicatorsIn Domain 4 a number of the indicators that were placeholders in 2013/14 are now in development as data sources have been identified. Furthermore over the next year we will be reviewing how we measure patient experience, looking at the questions patients are asked on their experience through to the metrics used to define levels of good and poor experience.
4.c Friends and Family test
The first set of data from the NHS Friends and Family test was released in July 2013.11 A key advantage of the Friends and Family test is that it allows hospital trusts to gain real time feedback on their services down to individual ward level and increases the transparency of NHS data to drive up choice and quality.
11 http://www.england.nhs.uk/2013/07/30/nhsfft/
As announced in the NHS Outcomes Framework 2013/14, an indicator related to the Friends and Family test will be included in the framework. In the first instance this will cover A&E services and inpatient wards; although consideration will also be given to whether it is possible to include maternity services and other services currently rolling out the Friends and Family test.
The first set of Friends and Family test data contained wide variations in the numbers of respondents and more data is required for us to set out the precise details of this indicator, but the intention is to have this indicator ready for the NHS Outcomes Framework in 2015/16.
In the meantime, however, patients and the public can find easily searchable data for the Friends and Family test on the NHS Choices website: http://www.nhs.uk.
14 The NHS Outcomes Framework 2014/15
4.8 Improving children and young people’s experience of healthcareWork is progressing to develop indicator 4.8 to measure children and young people’s experience of healthcare. This indicator will be based on the paediatric outpatient survey developed by The Picker Institute in conjunction with Sheffield Children’s NHS Foundation Trust. This outpatient survey is currently run voluntarily by a number of NHS Trusts and repeated annually to gain useful insights into their patients’ views of services.
4.9 Improving people’s experience of integrated careIn response to findings of the NHS Future Forum12 that too often patients and users experience fragmented services, failures in communication and poor transitions between services, the Care and Support White Paper13 restated the Department of Health’s commitment to measure and understand people’s experience of integrated care.
The focus of the development of new questions for this measure was that they should reflect what is important to the public in experiencing integrated care – which patients and users have defined to be ‘person-centred coordinated care’. In January 2013, the Department of Health commissioned an options appraisal, which recommended that a set of new questions be developed and inserted into existing patient and service user surveys. Following this, work to identify and develop appropriate questions was commissioned from The Picker Institute and the University of Oxford, with work conducted over the summer. Eighteen questions were proposed as potential candidates for insertion into up to seven surveys.
12 https://www.gov.uk/government/publications/nhs-future-forum-recommendations-to-government-on-nhs-modernisation
13 https://www.gov.uk/government/publications/caring-for-our-future-reforming-care-and-support
The Department of Health subsequently worked with a number of stakeholders, including NHS England and local government, to shortlist a smaller sub-set of questions that could feasibly be considered for inclusion. The final list of questions and those selected for further testing is included in the Technical Appendix. These shortlisted questions are undergoing further cognitive testing within the context of specific surveys, and further work will be undertaken with NHS England to ensure that a selection of the questions are suitable for further testing for use in the GP Patient Survey. Depending on the outcome of these processes, the questions may be further refined and modified, and not all questions will necessarily be included in all surveys. In addition, due consideration will be given to the way that existing survey questions may be put to best use in measuring patient’s experience of integrated care, as part of a new indicator or for other purposes. The availability of baseline data depends on which surveys are ultimately selected for question inclusion, with the earliest possible date being summer of 2014.
Going forward, more detailed work will be necessary to determine the feasibility of question insertion and/or existing question modification, and to agree the definition and form of a new indicator. This measure is complementary with the Adult Social Care Outcomes Framework, and while some commonality between the two measures is desirable, the two indicators need not be identical. From 2016, the Public Health Outcomes Framework will also be updated to reflect the progress on measuring integrated care.
Changes across each domain 15
Domain 5 – Treating and caring for people in a safe environment and protecting them from avoidable harmSummary of indicators being developed
Indicator Title Status in last refresh Current status
Status in NHS OF 2014/15
Date of first data release
5.cHospital deaths attributable to problems in care
Placeholder In development Live
Estimated to be live by April 2014
and frequency and timing of data yet to be
decided.
5.1Deaths from venous thromboembolism (VTE) related events
In development In development Live Estimated before
March 2015
5.3Proportion of patients with category 2, 3 and 4 pressure ulcers
In development In development Live Estimated before
March 2015
• Live – Indicator development is complete. Where available, the data for live indicators are published on the Health and Social Care Information Centre (HSCIC) Indicator Portal (https://indicators.ic.nhs.uk/webview/);
• In development – Some elements of the indicator definition require further development;• Placeholder – A need to measure this outcome has been identified, and one or more potential sources have been identified,
but an indicator is yet to be developed, and publication on the HSCIC Indicator Portal is not imminent.
Development of Domain 5 indicatorsWork continues to develop and improve Domain 5 including by developing an indicator looking at hospital deaths attributable to problems in care. Further work is needed to develop the remaining indicators, but they should all become live during 2014/15.
5.c Deaths in hospital from problems in care
This indicator was included as a placeholder in the NHS Outcomes Framework refresh for 2013/14. We are now in the process of developing this indicator based on a recurrent programme of retrospective case record reviews, whereby clinical experts
retrospectively review healthcare records and assess the quality as well as safety of the care provided to patients who died in hospital. This approach has been identified as the most sensitive for assessing overall avoidable harm in care.14
The intention is to commence the national programme of retrospective case record reviews in 2014 with a view to publishing results as early as possible after March 2015.
It is hoped that the methodology behind this indicator can be extended in due course to capture non-hospital deaths, and to cover severe harm not only death.
14 It is based upon the approach taken by Hogan et al (2012)
16 The NHS Outcomes Framework 2014/15
5.1 Deaths from venous thromboembolism (VTE) related events
Indicator 5.1 has changed from a measure of the ‘incidence of healthcare-related VTE’ to ‘deaths from VTE related events’. Such deaths are those where VTE is specified on the Medical Certificate of Cause of Death (MCCD) as being one of the conditions leading to, or directly causing death. Distinguishing between healthcare and community related VTE has proved unreliable in the originally intended data source – Hospital Episode Statistics. Measuring death as the outcome should also drive efforts to improve the prevention, detection and treatment of VTE before it causes death.
5.3 - Proportion of patients with category 2, 3 and 4 pressure ulcers
The indicator title has notionally changed from ‘Incidence of newly-acquired category 2, 3 and 4 pressure ulcers’ as it was incorrectly published in 2013/14. The proposed indicator methodology based on point-prevalence was correctly published.
The intended data source is the NHS Safety Thermometer, although we are exploring whether there is a better measure of prevalence of pressure ulcers currently available. As such, we are taking into account the recommendations on pressure ulcer reporting from the Tissue Viability Society15 as well as those from the HSCIC Indicator Assurance Service on the suitability of the NHS Safety Thermometer.
It is envisaged that an indicator will be developed in 2014/15, depending on the outcome of the assessment outlined above.
15 Dealey. C et al (2012) Achieving consensus in pressure ulcer reporting Journal of Tissue Viability Volume 21, 72–83.
Next steps in developing NHS Outcomes Framework 17
Next steps in developing the NHS Outcomes Framework
In the first NHS Outcomes Framework, published in 2010, the Department of Health indicated that there would be a review of the framework within 5 years. In line with this aspiration, it is our intention to conduct a review next year. There will be two parts to this review.
Firstly, a sub-group of the Outcomes Framework Technical Advisory Group has been established to advise the Department of Health and NHS England on improving the coverage of the NHS Outcomes Framework. This review will look at the scope of the NHS Outcomes Framework and how far it provides an overview of the NHS as a whole as well as looking at whether specific groups are adequately covered.
This review will be conducted through a systematic, outcome-driven approach. Selecting areas for which a desired outcome is required and identifying a suitable indicator to measure the desired outcome. This will include looking at how to improve the breadth of the NHS Outcomes Framework to better cover:
• different life stages;
• health conditions;
• vulnerable groups;
• the range of services the NHS provides; and
• integration across services.
Secondly, the Department of Health intends to review the future direction of the NHS Outcomes Framework to consider the impact it has had on the NHS and to ensure that the framework aligns with the objectives and long-term ambitions set out in the Mandate.
In addition to the above, the Department of Health will continue work with the Outcomes Framework Technical Advisory Group to:
• finalise indicator definitions so that we can continue to publish robust data on the HSCIC indicator portal;
• develop the ‘placeholder’ indicators to identify appropriate sources of data; and
• align the measures and processes across the outcomes frameworks for adult social care and public health.
If you would like to contact anyone about the NHS Outcomes Framework please email: [email protected]
18 The NHS Outcomes Framework 2014/15
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pos
itive
exp
erie
nce
of c
are
Impr
ovem
ent a
reas
3aE
mer
genc
y ad
mis
sion
s fo
r acu
te c
ondi
tions
that
sho
uld
not u
sual
ly re
quire
ho
spita
l adm
issi
on3b
Em
erge
ncy
read
mis
sion
s w
ithin
30
days
of d
isch
arge
from
hos
pita
l (P
HO
F 4.
11*)
1a P
oten
tial Y
ears
of L
ife L
ost (
PYL
L) fr
om c
ause
s co
nsid
ered
am
enab
le to
he
alth
care
iA
dults
iiC
hild
ren
and
youn
g pe
ople
1bLi
fe e
xpec
tanc
y at
75
i Mal
esii
Fem
ales
Impr
ovem
enta
reas
4a P
atie
nt e
xper
ienc
e of
prim
ary
care
iGP
ser
vice
s
iiG
PO
ut-o
f-hou
rs s
ervi
ces
iiiN
HS
den
tal s
ervi
ces
4b P
atie
nt e
xper
ienc
e of
hos
pita
l car
e4c
Frie
nds
and
fam
ily te
st
Impr
ovin
g ou
tcom
es fr
om p
lann
ed tr
eatm
ents
3.1
Tota
l hea
lth g
ain
as a
sses
sed
by p
atie
nts
for e
lect
ive
proc
edur
esiH
ip re
plac
emen
t iiK
nee
repl
acem
ent i
iiG
roin
her
nia
ivV
aric
ose
vein
s
vP
sych
olog
ical
ther
apie
s
Prev
entin
g lo
wer
resp
irato
ry tr
act i
nfec
tions
(LR
TI) i
n ch
ildre
n fr
om b
ecom
ing
serio
us
Impr
ovem
ent a
reas
Red
ucin
g pr
emat
ure
mor
talit
y fr
om th
e m
ajor
cau
ses
of d
eath
1.1
Und
er 7
5 m
orta
lity
rate
from
car
diov
ascu
lar d
isea
se (P
HO
F 4.
4*)
1.2
Und
er 7
5 m
orta
lity
rate
from
resp
irato
ry d
isea
se (P
HO
F 4.
7*)
1.3
Und
er 7
5 m
orta
lity
rate
from
live
r dis
ease
(PH
OF
4.6*
)1.
4U
nder
75
mor
talit
y ra
te fr
om c
ance
r(P
HO
F 4.
5*)
iOd
iiFi
ilf
ll
Impr
ovem
ent a
reas
Impr
ovin
g pe
ople
’s e
xper
ienc
e of
out
patie
nt c
are
4.1
Pat
ient
exp
erie
nce
of o
utpa
tient
ser
vice
s
Impr
ovin
g ho
spita
ls’ r
espo
nsiv
enes
s to
per
sona
l nee
ds4
2R
it
iti
t’
ld
3.2
Em
erge
ncy
adm
issi
ons
for c
hild
ren
with
LR
TI
Impr
ovin
g re
cove
ry fr
om in
jurie
s an
d tr
aum
a3.
3 S
urvi
val f
rom
maj
or tr
aum
a
Impr
ovin
g re
cove
ry fr
om s
trok
e3
4P
ropo
rtion
ofst
roke
patie
nts
repo
rting
anim
prov
emen
tin
activ
ity/li
fest
yle
onth
e
Red
ucin
g pr
emat
ure
deat
h in
peo
ple
with
ser
ious
men
tal i
llnes
s1.
5 E
xces
s un
der7
5 m
orta
lity
rate
in a
dults
with
ser
ious
men
tal i
llnes
s (P
HO
F 4.
9*)
Red
ucin
gde
aths
inba
bies
and
youn
gch
ildre
n
iOne
-and
iiFi
ve-y
ear s
urvi
val f
rom
all
canc
ers
iiiO
ne-a
ndiv
Five
-yea
r sur
viva
l fro
m b
reas
t, lu
ng a
nd c
olor
ecta
l can
cer
4.2
Res
pons
iven
ess
to in
-pat
ient
s’ p
erso
nal n
eeds
Impr
ovin
g ac
cess
to p
rimar
y ca
re s
ervi
ces
4.4
Acc
ess
to i
GP
ser
vice
s an
d ii
NH
Sde
ntal
ser
vice
s
Impr
ovin
g pe
ople
’s e
xper
ienc
e of
acc
iden
t and
em
erge
ncy
serv
ices
4.3
Pat
ient
exp
erie
nce
ofA
&E
ser
vice
s
3.4
Pro
porti
on o
f stro
ke p
atie
nts
repo
rting
an
impr
ovem
ent i
n ac
tivity
/life
styl
e on
the
Mod
ified
Ran
kin
Sca
le a
t 6 m
onth
s
Impr
ovin
g re
cove
ry fr
om fr
agili
ty fr
actu
res
3.5
Pro
porti
on o
f pat
ient
s re
cove
ring
to th
eir p
revi
ous
leve
ls o
f mob
ility/
wal
king
abi
lity
at i
30 a
nd ii
120
days
Hl
ild
lt
thi
id
dft
illi
j
Red
ucin
g de
aths
in b
abie
s an
d yo
ung
child
ren
1.6
i Inf
ant m
orta
lity
(PH
OF
4.1*
)ii
Neo
nata
l mor
talit
y an
d st
illbirt
hsiii
Five
yea
r sur
viva
l fro
m a
ll ca
ncer
s in
chi
ldre
n
Red
ucin
g pr
emat
ure
deat
h in
peo
ple
with
a le
arni
ng d
isab
ility
1.7
Exc
ess
unde
r60
mor
talit
yra
tein
adul
tsw
itha
lear
ning
disa
bilit
y
Impr
ovin
g w
omen
and
thei
r fam
ilies
’ exp
erie
nce
of m
ater
nity
ser
vice
s4.
5 W
omen
’s e
xper
ienc
e of
mat
erni
ty s
ervi
ces
Impr
ovin
g th
e ex
perie
nce
of c
are
for p
eopl
e at
the
end
of th
eir l
ives
4.6
Ber
eave
d ca
rers
’ vie
ws
on th
e qu
ality
of c
are
in th
e la
st 3
mon
ths
of li
fe
Hel
ping
old
er p
eopl
e to
reco
ver
thei
r ind
epen
denc
e af
ter i
llnes
s or
inju
ry3.
6 iP
ropo
rtion
of o
lder
peo
ple
(65
and
over
) who
wer
e st
ill a
t hom
e 91
day
s af
ter d
isch
arge
from
hos
pita
l int
o re
able
men
t/ re
habi
litat
ion
serv
ice
(AS
CO
F 2B
[1]*
) ii
Pro
porti
on o
ffere
d re
habi
litat
ion
follo
win
g di
scha
rge
from
acu
te o
r co
mm
unity
hos
pita
l (A
SC
OF
2B[2
]*)
Enh
anci
ng q
ualit
y of
life
for p
eopl
e w
ith lo
ng-te
rm
cond
ition
s21.
7 E
xces
s un
der 6
0 m
orta
lity
rate
in a
dults
with
a le
arni
ng d
isab
ility
Impr
ovin
g ex
perie
nce
of h
ealth
care
for p
eopl
e w
ith m
enta
l illn
ess
4.7
Pat
ient
exp
erie
nce
of c
omm
unity
men
tal h
ealth
ser
vice
s
Impr
ovin
g ch
ildre
n an
d yo
ung
peop
le’s
exp
erie
nce
of h
ealth
care
4.8
Chi
ldre
n an
d yo
ung
peop
le’s
exp
erie
nce
of o
utpa
tient
ser
vice
s
Impr
ovin
gpe
ople
’sex
perie
nce
ofin
tegr
ated
care
Ove
rarc
hing
indi
cato
r2
Hea
lth-re
late
d qu
ality
of l
ife fo
r peo
ple
with
long
-term
con
ditio
ns (A
SC
OF
1A**
)
Impr
ovem
ent a
reas
Impr
ovin
g pe
ople
s ex
perie
nce
of in
tegr
ated
car
e 4.
9P
eopl
e’s
expe
rienc
e of
inte
grat
ed c
are
(AS
CO
F 3E
**)
Trea
ting
and
carin
g fo
r peo
ple
in a
saf
e en
viro
nmen
t and
pr
otec
ting
them
from
aoi
dabl
eha
rm5
NH
SO
utco
mes
Ensu
ring
peop
le fe
el s
uppo
rted
to m
anag
e th
eir c
ondi
tion
2.1
Pro
porti
on o
f peo
ple
feel
ing
supp
orte
d to
man
age
thei
r con
ditio
n
Impr
ovin
g fu
nctio
nal a
bilit
y in
peo
ple
with
long
-term
con
ditio
ns2.
2E
mpl
oym
ent o
f peo
ple
with
long
-term
con
ditio
ns (A
SC
OF
1E**
, PH
OF
1.8*
)
prot
ectin
g th
em fr
om a
void
able
har
m5 Ove
rarc
hing
indi
cato
rs5a
Pat
ient
saf
ety
inci
dent
s re
porte
d5b
Saf
ety
inci
dent
s in
volv
ing
seve
re h
arm
or d
eath
5c
Hos
pita
l dea
ths
attri
buta
ble
to p
robl
ems
in c
are
NH
S O
utco
mes
Fram
ewor
k 20
14/1
5at
agl
ance
Red
ucin
g tim
e sp
ent i
n ho
spita
l by
peop
le w
ith lo
ng-te
rm c
ondi
tions
2.3
iUnp
lann
ed h
ospi
talis
atio
n fo
r chr
onic
am
bula
tory
car
e se
nsiti
ve
cond
ition
s
iiU
npla
nned
hos
pita
lisat
ion
for a
sthm
a, d
iabe
tes
and
epile
psy
in u
nder
19
s
Enha
ncin
gqu
ality
oflif
efo
rcar
ers
Red
ucin
g th
e in
cide
nce
of a
void
able
har
m5.
1 D
eath
s fro
m v
enou
s th
rom
boem
bolis
m (V
TE) r
elat
ed e
vent
s5.
2 In
cide
nce
of h
ealth
care
ass
ocia
ted
infe
ctio
n (H
CA
I)i M
RS
A
Impr
ovem
ent a
reas
at a
gla
nce
Alig
nmen
t with
Adu
lt So
cial
Car
e O
utco
mes
Fra
mew
ork
(ASC
OF)
an
d/or
Publ
icH
ealth
Out
com
esFr
amew
ork
(PH
OF)
Enha
ncin
g qu
ality
of l
ife fo
r car
ers
2.4
Hea
lth-re
late
d qu
ality
of l
ife fo
r car
ers
(AS
CO
F 1D
**)
Enha
ncin
g qu
ality
of l
ife fo
r peo
ple
with
men
tal i
llnes
s2.
5E
mpl
oym
ent o
f peo
ple
with
men
tal i
llnes
s (A
SC
OF
1F**
& P
HO
F 1.
8**)
Enha
ncin
g qu
ality
of l
ife fo
r peo
ple
with
dem
entia
Sii
C. d
iffic
ile5.
3 P
ropo
rtion
of p
atie
nts
with
cat
egor
y 2,
3 a
nd 4
pre
ssur
e ul
cers
5.4
Inci
denc
e of
med
icat
ion
erro
rs c
ausi
ng s
erio
us h
arm
Impr
ovin
g th
e sa
fety
of m
ater
nity
ser
vice
s5.
5 A
dmis
sion
of f
ull-t
erm
bab
ies
to n
eona
tal c
are
and/
or P
ublic
Hea
lth O
utco
mes
Fra
mew
ork
(PH
OF)
*
Indi
cato
r is
shar
ed
**
Indi
cato
r is
com
plem
enta
ry
Indi
cato
rsin
italic
sar
epl
aceh
olde
rspe
ndin
gde
velo
pmen
tori
dent
ifica
tion
2.6
iEst
imat
ed d
iagn
osis
rate
for p
eopl
e w
ith d
emen
tia(P
HO
F 4.
16*)
ii
A m
easu
re o
f the
effe
ctiv
enes
s of
pos
t-dia
gnos
is c
are
in s
usta
inin
g
in
depe
nden
ce a
nd im
prov
ing
qual
ity o
f life
(AS
CO
F 2F
**)
Del
iver
ing
safe
car
e to
chi
ldre
n in
acu
te s
ettin
gs5.
6 In
cide
nce
of h
arm
to c
hild
ren
due
to ‘f
ailu
re to
mon
itor’
Indi
cato
rs in
ital
ics
are
plac
ehol
ders
, pen
ding
dev
elop
men
t or i
dent
ifica
tion
20 The NHS Outcomes Framework 2014/15
Cexnn
A
Enh
anci
ng q
ualit
y of
life
for p
eopl
e w
ith c
are
and
supp
ort n
eeds
1 Ove
rarc
hing
mea
sure
1A.
Soc
ial c
are-
rela
ted
qual
ity o
f life
** (N
HS
OF
2)
Out
com
e m
easu
res
Peop
le m
anag
e th
eir o
wn
supp
ort a
s m
uch
as th
ey w
ish,
so
that
are
in c
ontr
ol o
f wha
t, ho
w a
nd w
hen
supp
ort
isde
liver
edto
mat
chth
eirn
eeds
is d
eliv
ered
to m
atch
thei
r nee
ds.
1B.
Pro
porti
on o
f peo
ple
who
use
ser
vice
s w
ho h
ave
cont
rol o
ver t
heir
daily
life
New
def
initi
on fo
r 201
4/15
:1C
. Pro
porti
on o
f peo
ple
usin
g so
cial
car
e w
ho re
ceiv
e se
lf-di
rect
ed s
uppo
rt, a
nd th
ose
rece
ivin
gdi
rect
paym
ents
rece
ivin
g di
rect
pay
men
ts
Car
ers
can
bala
nce
thei
r car
ing
role
s an
d m
aint
ain
thei
r des
ired
qual
ity o
f life
.1D
. C
arer
-rep
orte
d qu
ality
of l
ife **
(NH
SO
F 2.
4)
Peop
le a
re a
ble
to fi
nd e
mpl
oym
ent w
hen
they
wan
t, m
aint
ain
a fa
mily
and
soc
ial l
ife a
nd c
ontr
ibut
e to
co
mm
unity
life
, and
avo
id lo
nelin
ess
or is
olat
ion.
1EP
tif
dlt
ithl
idi
bilit
iid
lt*
*(P
HO
F1
8N
HS
OF
22)
1E.
Prop
ortio
n of
adu
lts w
ith a
lear
ning
dis
abili
ty in
pai
d em
ploy
men
t ** (
PH
OF
1.8,
NH
SO
F 2.
2)1F
. P
ropo
rtion
of a
dults
in c
onta
ct w
ith s
econ
dary
men
tal h
ealth
ser
vice
s in
pai
d em
ploy
men
t ** (
PH
OF
1.8,
NH
SO
F2.
5)1G
. P
ropo
rtion
of a
dults
with
a le
arni
ng d
isab
ility
who
live
in th
eir o
wn
hom
e or
with
thei
r fam
ily *
(PH
OF
1.6)
1HP
ropo
rtion
ofad
ults
inco
ntac
twith
seco
ndar
ym
enta
lhea
lthse
rvic
esliv
ing
inde
pend
ently
with
ofw
ithou
tsup
port
1H.
Pro
porti
on o
f adu
lts in
con
tact
with
sec
onda
ry m
enta
l hea
lth s
ervi
ces
livin
g in
depe
nden
tly, w
ith o
f with
out s
uppo
rt **
(PH
OF
1.6)
1I. P
ropo
rtion
of p
eopl
e w
ho u
se s
ervi
ces
and
thei
r car
ers,
who
repo
rted
that
they
had
as
muc
h so
cial
con
tact
as
they
w
ould
like
. ** (
PHO
F 1.
18)
Ens
urin
gth
atpe
ople
have
apo
sitiv
eex
perie
nce
ofca
rean
dsu
ppor
t3
Ens
urin
g th
at p
eopl
e ha
ve a
pos
itive
exp
erie
nce
of c
are
and
supp
ort
3 Ove
rarc
hing
mea
sure
Peop
lew
hous
eso
cial
care
and
thei
rcar
ers
are
satis
fied
with
thei
rexp
erie
nce
ofca
rean
dsu
ppor
tser
vice
sPe
ople
who
use
soc
ial c
are
and
thei
r car
ers
are
satis
fied
with
thei
r exp
erie
nce
of c
are
and
supp
ort s
ervi
ces.
3A.
Ove
rall
satis
fact
ion
of p
eopl
e w
ho u
se s
ervi
ces
with
thei
r car
e an
d su
ppor
t3B
. O
vera
ll sa
tisfa
ctio
n of
car
ers
with
soc
ial s
ervi
ces
New
mea
sure
for2
014/
15:3
EIm
prov
ing
peop
le’s
expe
rienc
eof
inte
grat
edca
re**
(NH
SO
F4
9)N
ew m
easu
re fo
r 201
4/15
: 3E.
Impr
ovin
g pe
ople
s ex
perie
nce
of in
tegr
ated
car
e (N
HS
OF
4.9)
Out
com
e m
easu
res
Car
ers
feel
that
they
are
resp
ecte
d as
equ
al p
artn
ers
thro
ugho
ut th
e ca
re p
roce
ss.
3C.
The
prop
ortio
n of
car
ers
who
repo
rt th
at th
ey h
ave
been
incl
uded
or c
onsu
lted
in d
iscu
ssio
ns a
bout
the
pers
on th
ey
care
for
Peop
lekn
oww
hatc
hoic
esar
eav
aila
ble
toth
emlo
cally
wha
tthe
yar
een
title
dto
and
who
toco
ntac
twhe
nth
eyPe
ople
kno
w w
hat c
hoic
es a
re a
vaila
ble
to th
em lo
cally
, wha
t the
y ar
e en
title
d to
, and
who
to c
onta
ct w
hen
they
ne
ed h
elp.
3D.
The
prop
ortio
n of
peo
ple
who
use
ser
vice
s an
d ca
rers
who
find
it e
asy
to fi
nd in
form
atio
n ab
out s
uppo
rt
Peop
le, i
nclu
ding
thos
e in
volv
ed in
mak
ing
deci
sion
s on
soc
ial c
are,
resp
ect t
he d
igni
ty o
f the
indi
vidu
al a
nd
ensu
re s
uppo
rt is
sen
sitiv
e to
the
circ
umst
ance
s of
eac
h in
divi
dual
.
This
info
rmat
ion
can
beta
ken
from
the
Adu
ltS
ocia
lCar
eS
urve
yan
dus
edfo
rana
lysi
sat
the
loca
llev
elTh
is in
form
atio
n ca
n be
take
n fro
m th
e A
dult
Soc
ial C
are
Sur
vey
and
used
for a
naly
sis
at th
e lo
cal l
evel
.
Adu
lt So
cial
Car
e O
utco
mes
Fra
mew
ork
2014
/15
2
At a
gla
nce
Del
ayin
g an
d re
duci
ng th
e ne
ed fo
r car
e an
d su
ppor
t2 Ove
rarc
hing
mea
sure
s2A
. P
erm
anen
t adm
issi
ons
to re
side
ntia
l and
nur
sing
car
e ho
mes
, per
100
,000
pop
ulat
ion
Out
com
e m
easu
res
Eb
dh
tht
itt
hth
bth
lthd
llbi
thh
tth
ilif
dEv
eryb
ody
has
the
oppo
rtun
ity to
hav
e th
e be
st h
ealth
and
wel
lbei
ng th
roug
hout
thei
r life
, and
can
acc
ess
supp
ort a
nd in
form
atio
n to
hel
p th
em m
anag
e th
eir c
are
need
s.
Earli
er d
iagn
osis
, int
erve
ntio
n an
d re
able
men
t mea
ns th
at p
eopl
e an
d th
eir c
arer
s ar
e le
ss d
epen
dent
on
inte
nsiv
ese
rvic
esin
tens
ive
serv
ices
.
2B.
Prop
ortio
n of
old
er p
eopl
e (6
5 an
d ov
er) w
ho w
ere
still
at h
ome
91 d
ays
afte
r dis
char
ge fr
om h
ospi
tal i
nto
reab
lem
ent/r
ehab
ilitat
ion
serv
ices
* (N
HS
OF
3.6i
-ii)
New
mea
sure
for 2
014/
15: 2
D. T
he o
utco
mes
of s
hort
-term
ser
vice
s: s
eque
l to
serv
ice.
Plac
ehol
der 2
E: T
he e
ffect
iven
ess
of re
able
men
t ser
vice
s
Whe
n pe
ople
dev
elop
car
e ne
eds,
the
supp
ort t
hey
rece
ive
take
s pl
ace
in th
e m
ost a
ppro
pria
te s
ettin
g, a
nd
enab
les
them
to re
gain
thei
r ind
epen
denc
e.
2C.
Del
ayed
tran
sfer
s of
car
e fro
m h
ospi
tal,
and
thos
e w
hich
are
attr
ibut
able
to a
dult
soci
al c
are
Ce
ayed
tas
es
oca
eo
osp
ta,a
dt
ose
ca
eat
tbu
tab
eto
adu
tsoc
aca
e
Plac
ehol
der 2
F: D
emen
tia –
A m
easu
re o
f the
effe
ctiv
enes
s of
pos
t-dia
gnos
is c
are
in s
usta
inin
g in
depe
nden
ce a
nd
impr
ovin
g qu
ality
of l
ife**
(NH
SO
F 2.
6ii)
Saf
egua
rdin
g ad
ults
who
se c
ircum
stan
ces
mak
e th
em v
ulne
rabl
e an
d pr
otec
ting
from
av
oida
ble
harm
4 Ove
rarc
hing
mea
sure
4A.
The
prop
ortio
n of
peo
ple
who
use
ser
vice
s w
ho fe
el s
afe
** (P
HO
F 1.
19)
Out
com
e m
easu
res
Ever
yone
enj
oys
phys
ical
saf
ety
and
feel
s se
cure
.Pe
ople
are
free
from
phy
sica
l and
em
otio
nal a
buse
, har
assm
ent,
negl
ect a
nd s
elf-h
arm
.P
lt
td
fib
lf
idbl
hdi
di
ji
Peop
le a
re p
rote
cted
as
far a
s po
ssib
le fr
om a
void
able
har
m, d
isea
se a
nd in
jurie
s.Pe
ople
are
sup
port
ed to
pla
n ah
ead
and
have
the
free
dom
to m
anag
e ris
ks th
e w
ay th
at th
ey w
ish.
4B.
The
prop
ortio
n of
peo
ple
who
use
ser
vice
s w
ho s
ay th
at th
ose
serv
ices
hav
e m
ade
them
feel
saf
e an
d se
cure
Plac
ehol
der 4
C: P
ropo
rtio
n of
com
plet
ed s
afeg
uard
ing
refe
rral
s w
here
peo
ple
repo
rt th
ey fe
el s
afe
Alig
ning
acro
ssth
eH
ealth
and
Car
eSy
stem
Alig
ning
acr
oss
the
Hea
lth a
nd C
are
Syst
em
* Ind
icat
or s
hare
d**
Indi
cato
r com
plem
enta
ry
Shar
ed in
dica
tors
:The
sam
e in
dica
tor i
s in
clud
ed in
eac
h ou
tcom
es fr
amew
ork,
refle
ctin
g a
shar
ed ro
le in
mak
ing
prog
ress
C
ompl
emen
tary
indi
cato
rs:
A s
imila
r ind
icat
or is
incl
uded
in e
ach
outc
omes
fram
ewor
k an
d th
ese
look
at t
he s
ame
issu
e
Annex D 21
Dexnn
APu
blic
Hea
lth
Out
com
esFr
amew
ork
2013
-201
6At
a g
lanc
e
Obj
ecti
ve
Hea
lthc
are
publ
ic h
ealt
h an
d pr
even
ting
pre
mat
ure
mor
talit
y4 Re
duce
d nu
mbe
rs o
f peo
ple
livin
g w
ith
prev
enta
ble
ill h
ealth
and
peo
ple
dyin
g
Obj
ecti
veHea
lth
prot
ecti
on3 Th
e po
pula
tion’
s he
alth
is p
rote
cted
fro
m
maj
or in
cide
nts
and
othe
r th
reat
s, w
hils
t d
hlh
l
Obj
ecti
veHea
lth
impr
ovem
ent
2 Peop
le a
re h
elpe
d to
live
hea
lthy
lifes
tyle
s,
mak
e he
alth
y ch
oice
s an
d re
duce
hea
lth
l
Obj
ecti
veImpr
ovin
g th
e w
ider
de
term
inan
ts o
f hea
lth
1 Impr
ovem
ents
aga
inst
wid
er f
acto
rs
whi
ch a
ffec
t hea
lth a
nd w
ellb
eing
and
h
lhl
VISI
ON
To im
prov
e an
d pr
otec
t the
nat
ion’
s he
alth
and
wel
lbei
ng a
nd im
prov
e th
e he
alth
of
the
poor
est
fast
est
Out
com
e 1)
Inc
reas
ed h
ealth
y lif
e ex
pect
ancy
, i.e
. tak
ing
acco
unt
of th
e he
alth
qu
ality
as
wel
l as
the
leng
th o
f life
Out
com
e 2)
Red
uced
diff
eren
ces
in li
fe e
xpec
tanc
y an
d he
alth
y lif
e ex
pect
ancy
be
twee
n co
mm
uniti
es (
thro
ugh
grea
ter
impr
ovem
ents
in m
ore
disa
dvan
tage
d co
mm
uniti
es)
Out
com
e m
easu
res
Alig
nmen
t acr
oss
the
Hea
lth
and
Care
Sys
tem
*Ind
icat
or s
hare
d w
ith th
e N
HS
Out
com
es
Fram
ewor
k.**
Com
plem
enta
ry to
indi
cato
rs in
the
NH
S O
utco
mes
Fra
mew
ork
† In
dica
tor
shar
ed w
ith th
e A
dult
Soci
al C
are
Out
com
es F
ram
ewor
k††
Com
plem
enta
ry to
indi
cato
rs in
the
Adu
lt So
cial
Ca
re O
utco
mes
Fra
mew
ork
Indi
cato
rs in
ital
ics
are
plac
ehol
ders
, pen
ding
de
velo
pmen
t or
iden
tific
atio
n
Indi
cato
rs
pp
py
gpr
emat
urel
y, w
hils
t re
duci
ng t
he g
ap b
etw
een
com
mun
ities
4.1
Infa
nt m
orta
lity*
(N
HSO
F 1.
6i)
4.2
Toot
h de
cay
in c
hild
ren
aged
54.
3 M
orta
lity
rate
from
cau
ses
cons
ider
ed
prev
enta
ble
** (N
HSO
F 1a
)4.
4 U
nder
75
mor
talit
y ra
te f
rom
all
card
iova
scul
ar d
isea
ses
(incl
udin
g he
art
dise
ase
and
stro
ke)*
(NH
SOF
1.1)
4.5
Und
er 7
5 m
orta
lity
rate
fro
m c
ance
r*
(NH
SOF
1.4i
)4.
6 U
nder
75
mor
talit
y ra
te f
rom
live
r di
seas
e* (N
HSO
F 1.
3)4.
7 U
nder
75
mor
talit
y ra
te f
rom
res
pira
tory
di
seas
es*
(NH
SOF
1.2)
4.8
Mor
talit
y ra
te fr
om c
omm
unic
able
di
seas
es4.
9 Ex
cess
und
er 7
5 m
orta
lity
rate
in a
dults
w
ith s
erio
us m
enta
l illn
ess*
(N
HSO
F 1
.5)
4.10
Sui
cide
rat
e
Indi
cato
rs
redu
cing
hea
lth in
equa
litie
s
3.1
Frac
tion
of m
orta
lity
attr
ibut
able
to
part
icul
ate
air
pollu
tion
3.2
Chla
myd
ia d
iagn
oses
(15-
24 y
ear
olds
)3.
3 Po
pula
tion
vacc
inat
ion
cove
rage
3.4
Peop
le p
rese
ntin
g w
ith H
IV a
t a la
te
stag
e of
infe
ctio
n3.
5 Tr
eatm
ent
com
plet
ion
for
TB3.
6 Pu
blic
sec
tor
orga
nisa
tions
with
boa
rd
appr
oved
sus
tain
able
dev
elop
men
t m
anag
emen
t pl
an3.
7 Co
mpr
ehen
sive
, agr
eed
inte
r-ag
ency
pl
ans
for
resp
ondi
ng t
o he
alth
pro
tect
ion
inci
dent
s an
d em
erge
ncie
s
Indi
cato
rs
ineq
ualit
ies
2.1
Low
birt
h w
eigh
t of
term
bab
ies
2.2
Brea
stfe
edin
g 2.
3 Sm
okin
g st
atus
at
time
of d
eliv
ery
2.4
Und
er 1
8 co
ncep
tions
2.5
Child
dev
elop
men
t at
2 –
2 ½
yea
rs
2.6
Exce
ss w
eigh
t in
4-5
and
10-
11 y
ear
olds
2.7
Hos
pita
l adm
issi
ons
caus
ed b
y un
inte
ntio
nal a
nd d
elib
erat
e in
jurie
s in
ch
ildre
n an
d yo
ung
peop
le a
ged
0-14
and
15
-24
year
s2.
8 Em
otio
nal w
ell-b
eing
of l
ooke
d af
ter
child
ren
2.9
Smok
ing
prev
alen
ce –
15 y
ear o
lds
(Pla
ceho
lder
)2.
10 S
elf-
harm
2.
11 D
iet
2.12
Exc
ess
wei
ght
in a
dults
2.13
Pro
port
ion
of p
hysi
cally
act
ive
and
inac
tive
adul
ts
Indi
cato
rs
heal
th in
equa
litie
s
1.1
Child
ren
in p
over
ty1.
2 Sc
hool
rea
dine
ss1.
3 Pu
pil a
bsen
ce1.
4 Fi
rst
time
entr
ants
to
the
yout
h ju
stic
e sy
stem
1.5
16-1
8 ye
ar o
lds
not i
n ed
ucat
ion,
em
ploy
men
t or
trai
ning
1.6
Adu
lts w
ith a
lear
ning
dis
abili
ty /
in
cont
act
with
sec
onda
ry m
enta
l hea
lth
serv
ices
who
live
in s
tabl
e an
d ap
prop
riate
acc
omm
odat
ion†
(ASC
OF
1G
and
1H)
1.7
Peop
le in
pris
on w
ho h
ave
a m
enta
l ill
ness
or
a si
gnifi
cant
men
tal i
llnes
s 1.
8 Em
ploy
men
t fo
r th
ose
with
long
-ter
m
heal
th c
ondi
tions
incl
udin
g ad
ults
with
a
lear
ning
dis
abili
ty o
r w
ho a
re in
con
tact
w
ith s
econ
dary
men
tal h
ealth
ser
vice
s *(
i-N
HSO
F2.
2)††
(ii-A
SCO
F1E
)**(
iii-N
HSO
F4.
11 E
mer
genc
y re
adm
issi
ons
with
in 3
0 da
ys
of d
isch
arge
fro
m h
ospi
tal*
(N
HSO
F 3b
)4.
12 P
reve
ntab
le s
ight
loss
4.13
Hea
lth-r
elat
ed q
ualit
y of
life
for
olde
r pe
ople
4.14
Hip
frac
ture
s in
peo
ple
aged
65
and
over
4.15
Exc
ess
win
ter
deat
hs4.
16 E
stim
ated
dia
gnos
is r
ate
for
peop
le w
ith
dem
entia
* (N
HSO
F 2.
6i)
inac
tive
adul
ts2.
14 S
mok
ing
prev
alen
ce –
adul
ts (o
ver
18s)
2.15
Suc
cess
ful c
ompl
etio
n of
dru
g tr
eatm
ent
2.16
Peo
ple
ente
ring
pris
on w
ith s
ubst
ance
de
pend
ence
issu
es w
ho a
re p
revi
ousl
y no
t kn
own
to c
omm
unity
tre
atm
ent
2.17
Rec
orde
d di
abet
es2.
18 A
lcoh
ol-r
elat
ed a
dmis
sion
s to
hos
pita
l 2.
19 C
ance
r di
agno
sed
at s
tage
1 a
nd 2
2.20
Can
cer
scre
enin
g co
vera
ge2.
21 A
cces
s to
non
-can
cer
scre
enin
g pr
ogra
mm
es2.
22 T
ake
up o
f the
NH
S H
ealth
Che
ck
prog
ram
me
–by
thos
e el
igib
le2.
23 S
elf-
repo
rted
wel
l-bei
ng2.
24 In
jurie
s du
e to
falls
in p
eopl
e ag
ed 6
5 an
d ov
er
NH
SOF
2.2)
(ii
ASC
OF
1E)
(iiiN
HSO
F 2.
5)††
(iii-A
SCO
F 1F
)1.
9 Si
ckne
ss a
bsen
ce r
ate
1.10
Kill
ed a
nd s
erio
usly
inju
red
casu
altie
s on
Eng
land’s
road
s1.
11 D
omes
tic a
buse
1.
12 V
iole
nt c
rime
(incl
udin
g se
xual
vi
olen
ce)
1.13
Re-
offe
ndin
g le
vels
1.14
The
per
cent
age
of th
e po
pula
tion
affe
cted
by
nois
e 1.
15 S
tatu
tory
hom
eles
snes
s 1.
16 U
tilis
atio
n of
out
door
spa
ce fo
r ex
erci
se /
hea
lth r
easo
ns1.
17 F
uel p
over
ty1.
18 S
ocia
l iso
latio
n†
(ASC
OF
1I)
1.19
Old
er p
eopl
e’s
perc
eptio
n of
co
mm
unity
saf
ety
†† (A
SCO
F 4A
)
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