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2. Performance Against NHSScotland Targets for 2007/08

Health of the Population

Introduction

One of the main challenges to health and wellbeing is the existence of persistent health inequalities in Scotland. Better Health, Better Care explains that NHSScotland is putting health inequalities at the heart of its agenda, targeting resources on services that support disadvantaged people - particularly those with complex needs.

In working towards achieving progress on improved health outcomes and reduced health inequalities, the Scottish Government recognised the challenges in developing an appropriate approach to setting targets and monitoring performance. This was particularly important in the context of the new National Performance Framework and Single Outcome Agreements (see Appendix A). A review of Health Improvement Performance Management was established as a result. This work produced proposals for new HEAT targets, which were adopted for 2008/09 (see Appendix B). Further proposals were produced for 2009/10 (see Appendix C). This Annual Report provides information on the NHS performance against the 2007/08 HEAT targets.

Progress against the 2007/08 NHSScotland targets for health improvement is set out in the charts and narrative that follow. In summary, progress has been achieved in relation to the targets for health inequalities, childhood vaccinations, teenage pregnancies, smoking rates and P1 dental disease. For suicide rates, there has been no significant change across Scotland. In addition to the key targets, the Scottish Government agreed with NHSScotland that the reduction of alcohol consumption and an increase in levels of physical activity were also priorities, but as these were not within the direct influence of NHSScotland, they should not be the subject of performance measures - new targets and associated measures were put in place for 2008/09.

The detailed results and discussion for each of the HEAT targets are presented below.

Health Inequalities

What is the target?

To reduce health inequalities by increasing the rate of improvement for the most deprived communities by 15 per cent across a range of indicators including Coronary Heart Disease ( CHD), cancer, adult smoking, smoking during pregnancy, teenage pregnancy and suicides in young people.

Why is it important?

Deprived populations have considerably higher levels of mortality from Coronary Heart Disease ( CHD). This relationship is evident for all ages, but is strongest in the 0-64 age group, for whom death from CHD in the 10 per cent most deprived areas is 1.9 times more likely than for Scotland overall. CHD also shares risk factors with the other 'big killers', so by targeting CHD, we can target these too. NHSScotland has since agreed the key contribution it can make to achieving progress towards this outcome of reduced inequality in premature CHD mortality, and for 2009/10 a new target for targeted health checks will be introduced.

Performance Target - on track The performance measure used to assess progress toward this target is the level of CHD mortality in the most deprived areas. There has been significant improvement year-on-year with the measure dropping from 162.4 per year in 1998-2000 to 117.7 per year in 2004-2006.

Adult Smoking Rates

What is the target?

To reduce adult (16+) smoking rates from 26.5 per cent (2004) to 22.0 per cent (2010).

Why is this important?

Smoking has an enormous influence on the health of people in Scotland. Despite recent reductions in smoking levels, and early evidence of the positive impact this has in people's health, there are still relatively high levels of smoking in Scotland, particularly amongst certain groups of people. It is particularly important to reduce levels of smoking amongst the young, the deprived and pregnant women. NHSScotland has since agreed the key contribution it can make to achieving progress towards the outcome of reduced smoking related illness as providing effective smoking cessation services, for which a new target was set in 2008/09.

Following the successful implementation of the ban on smoking in public places in 2006, The Scottish Government consulted on an ambitious programme of measures designed specifically to protect and dissuade young people from starting to smoke and to deter adults from encouraging and enabling them to smoke. The work done on developing tobacco policy in 2007 led to the rise in the age of sale for tobacco from 16 to 18 and the publication of our smoking prevention action plan. As committed in the action plan, legislation will be introduced next year to further restrict tobacco displays in retail outlets and to introduce a registration scheme for all tobacco retailers.

Performance Target - on track Over the last eight years there has been an over five percentage point reduction in the smoking rate. The smoking rate in Scotland has reduced from 26.5 per cent in 2004 to 24.7 per cent in 2007.

Childhood Vaccinations

What is the target?

The target is for 95 per cent uptake for all childhood vaccinations on an ongoing basis.

Why is this important?

Children in Scotland are protected through immunisation against many serious infectious diseases. Vaccination programmes aim both to protect the individual and to prevent the spread of these illnesses within the population. As a public health measure, immunisations have been hugely effective in reducing the burden of disease. A fall in immunisation rates is a public health concern as it increases the likelihood of disease transmission and complications arising from outbreaks of infectious diseases.

Performance Target - almost met across all vaccinations. Some remaining challenges for MMR1. The performance measure used to track this target relates to the percentage uptake of MMR1 at age 5 years. The uptake of MMR1 at age 5 years in March 2008 was 94.3 per cent. MMR1 for two year olds current performance is 91 per cent. The target to have 95 per cent uptake at two years is being achieved for all other primary immunisations (Diphtheria, Tetanus, Pertussis, Polio, Hib and MenC).

Suicide Rate

What is the target?

To reduce the suicide rate between 2002 and 2013 by 20 per cent.

Why is this important?

The levels and trends in number of suicides is a key indicator of mental health within the population, and while the numbers are small, they demonstrate real challenges in some areas, and particularly demonstrate significant inequalities for younger males across Scotland. Setting and achieving this target supports a range of wider work and training around improving services for people in poor mental health, ultimately resulting in reduced levels of suicide. NHSScotland has since agreed the key contribution it can make to achieving progress towards the outcome of reduced suicides, and has agreed a complimentary target relating to suicide prevention training for frontline staff from 2008/09.

Performance Target - on track The performance measure relates to deaths caused by intentional self harm and events of undetermined intent expressed as a rate per 100,000 population per year. The rate was 16.3 per year per 100,000 population in 2007, showing a drop when compared to the baseline of 17.8 per year per 100,000 population in 2002.

Primary 1 Dental Disease

What is the target?

60 per cent of 5 year old children (P1) will have no signs of dental disease by 2010.

Why is this important?

Dental health is widely used as an 'indicative measure' of children's general health. This is because it reflects a key 'outcome' of good parental care during the pre-school period. Dental decay is almost totally preventable. Disorders of teeth, tongue and mouth are the most common reasons for elective admissions of children to hospital in Scotland and account for significant pain and discomfort to the child and for absence from school.

Performance Target - on track Between 2003 and 2006 the proportion of Primary 1 children free of dental decay has improved by 9.5 percentage points: from 44.6 per cent in 2003 to 54.1 per cent in 2006.

Teenage Pregnancy Rate

What is the target?

To reduce by 20 per cent the pregnancy rate (per 1,000 population) in 13-15 year olds from 8.5 in 1995 to 6.8 by 2010.

Why is this important?

The target measures the pregnancy rate (per 1,000 population) in 13-15 year olds. The focus of the target is to reduce unintended or unwanted pregnancies amongst this group, acknowledging that for some young people this is a positive life decision. With a higher rate of teenage pregnancy than most other western European countries, reducing unintended teenage pregnancy is a national target for the Scottish Government, and is not therefore included as a HEAT target in future years. Teenage pregnancy is also linked to deprivation with the rates of teenage pregnancy in deprived areas more than treble those of the least deprived areas.

Performance Target - On track overall, but increase in latest year. The level of teenage pregnancies has remained around 7 per 1,000 girls per year for much of this decade. Provisional statistics for 2006 show 8.1 pregnancies per 1000 13-15 year olds.

Efficiency and Productivity, Resources and Workforce

Introduction

As NHSScotland has an annual budget of over £10 billion, it is important that it is as efficient as possible in everything it does. Resources should be deployed in the most appropriate way in order to support frontline care. The focus of action to improve efficiency and productivity is upon improving outcomes for patients in terms of clinical success, experience of care and ultimately quality of life. To achieve these outcomes, however, it is essential that we concentrate on the way in which our services are designed and delivered.

In early 2008, the Scottish Government established a new Efficiency and Productivity Programme in partnership with NHSScotland. This Programme will pull together the wide range of existing expertise, improvement and analytical tools and help NHSScotland achieve even higher levels of efficiency savings and levels of productivity through sharing best practice, and identifying and agreeing other approaches to supporting a greater focus on the most effective measures, including through revised or new HEAT targets, where appropriate.

Progress against the 2007/08 HEAT targets for efficiency and resources is presented in the charts and narrative below. In summary, in 2007/08 NHSScotland achieved all its financial targets. Progress towards universal utilisation of Community Health Index ( CHI) continued. When compared to the previous year, levels of sickness absence remained stable across NHSScotland. NHSScotland is expected to exceed its target of £531 million of efficiency savings for the three-year period that ended in March 2008 by £79 million. To support this continuing priority a number of specific targets for increased consultant-related productivity were introduced in the 2008/09 HEAT targets (see Chapter 4: Financial Performance and Appendix B).

Financial Performance

What are the targets?

Health Boards are required to operate within their Revenue Resource Limit ( RRL); their Capital Resource Limit ( CRL) and meet their Cash Requirement. They are also required to meet their efficiency savings target. The RRL and CRL targets measure forecast surplus/deficit for the financial year against the respective Revenue and Capital Resource Limits.

Why is it important?

Health Boards have an obligation to operate within their allocated funds and ensure value for money.

Performance Target - met. While the overall position for NHSScotland in 2007/08 was financial balance, there were some variations between territorial Boards. Only one Board experienced a cumulative overspend - however this was forecast, managed and action has been taken for future years.

Sickness Absence

What is the target?

Health Boards to achieve a sickness absence rate of 4 per cent by 31 March 2008. This target is part of wider action to achieve efficiency savings across NHSScotland, reported in more detail in Chapter 4: Financial Performance.

Why is it important?

Sickness absence in NHSScotland can result in cancelled appointments and procedures, increased pressure on staff and patients, increased costs of employing bank and agency staff and reduced efficiency.

Performance Target - sickness absence target not met. Right direction, but needs faster progress. Reducing the number of days lost to NHSScotland through sickness absence across the NHS workforce continues to be a significant challenge. Rates of monthly sickness absence fluctuated around 5 per cent throughout 2007/08. NHSScotland Efficient Government target met for 2007/08 - see chapter 4: Financial Performance.

Universal Utilisation of Community Health Index ( CHI)

What is the target?

Universal utilisation of Community Health Index ( CHI).

Why is it important?

The CHI number is a unique identifier for every individual, and provides the basis for NHSScotland to link information across the range of services provided. Use of the CHI number in every document or record for every patient increases quality, speed and efficiency of all health services, and introduces the ability to share information more effectively.

Performance Target - on track. The performance measure is based on laboratory requests that include a CHI number, expressed as a percentage of all laboratory requests made. Over this year performance has improved from 88 per cent to 96 per cent (against a planned level of 98 per cent by March 2009).

Access to Services and Waiting Times

Introduction

Better Health, Better Care sets out the importance of improving the quality of healthcare by making access to primary care easier and delivering the quickest treatment ever available in NHSScotland. Providing services that fit in with the day-to-day lives of patients will help improve access and patient experience as shorter waits can:

• lead to earlier diagnosis and better outcomes;
• reduce worry and uncertainty for patients;
• help tackle inequalities by reducing variations between hospitals and Health Boards; and
• save time, energy and resources that are expended in dealing with backlogs for diagnosis and treatment.

Progress against the 2007/08 targets for access is set out in the charts and narrative that follow. The overall picture is of excellent progress being made in delivering or exceeding planned levels of performance towards the range of challenging access targets, or in some cases, sustaining high levels of performance where targets have already been achieved (48 hour access to GPs, inpatient and outpatient waiting times, accident and emergency triaging, cataract surgery, hip surgery, cardiac intervention and key diagnostic tests). The 2 month target for cancer waiting times was almost met. The ambulance Category A response times did not achieve planned performance, but did demonstrate significant improvement over the year, against a background of increasing demand.

The introduction of New Ways of measuring waiting times and a set of much more stretching waiting times targets resulted in a new suite of more challenging HEAT targets for 2008/09 and beyond.

48 Hour Access to a GP

What is the target?

To ensure that anyone contacting their GP surgery has guaranteed access to a GP, nurse or other healthcare professional within 48 hours from April 2004.

Why is it important?

Often a patient's first contact with the NHS is through their GP. It is vital, therefore, that every member of the public has fast and convenient access to their local primary care services to ensure better outcomes and experiences for patients. From 2009/10, this target will be extended to cover advance booking, and the related performance measure will be monitored through the results of a new survey, which directly measures patients' experience of getting access to primary care services.

Performance Target - met. The measure is percentage of practices reporting to meet the requirements for access to a GP, nurse or other healthcare professional within 48 hours through the Directly Enhanced Services ( DES) payment. GP practices report that they are achieving this target.

Ambulance Response

What is the target?

To respond to 75 per cent of Category A calls within 8 minutes in Quarter 4 of 2007/08 (mainland Health Boards only).

Why is it important?

Patients in situations categorised as potentially immediately life threatening (Category A) need the ambulance service to respond as quickly and safely as possible in order to maximise the outcome for the patient both in health and in experience terms.

Performance Target - not met. Progress has been made against the Category A response time performance measure with the proportion responded to within 8 minutes increasing from 62 per cent in April 2007 to 68 per cent in March 2008. The Ambulance Service is now working to deliver this target from April 2009.

Accident and Emergency Treatment

What is the target?

By the end of 2007, no patient will wait more than 4 hours from arrival to admission, discharge or transfer for accident and emergency treatment.

Why is it important?

A patient arriving at Accident and Emergency (A&E) requires to be seen quickly to optimise safety and quality, and patient experience reasons.

Performance Target - met. The performance measure is the proportion of patients seen waiting no more than 4 hours from arrival to admission, discharge or transfer for accident and emergency treatment (the standard is 98 per cent over the calendar month). The target has been effectively delivered with the proportion of patients dealt with within 4 hours increasing from 84 per cent in April 2006 to 98 per cent in December 2007.

First Outpatient Appointments

What is the target?

By the end of 2005, no patient will wait longer than 6 months from GP referral to an outpatient appointment, reducing to 18 weeks from 31 December 2007.

Why is it important?

In 2007/08, there were almost 1.39m first outpatient attendances at NHSScotland hospitals, an increase of around 2 per cent over the previous year. A key concern for patients and NHSScotland is the wait between referral from primary care to the start of any necessary hospital treatment. Reducing this wait is one of the top priorities of the Scottish Government. Getting access to outpatient assessment, diagnostic tests and inpatient care as quickly as possible is important as, in many cases, this is likely to have an impact on the health outcomes of patients. Faster access also reduces stress for the individuals who require these services and for their families. Reducing backlogs and queues also leads to greater efficiency across the range of services involved, as well as a better healthcare experience for patients.

Performance Target - met. The number of people waiting over 18 weeks for an outpatient appointment was 14,244 in December 2006. NHSScotland delivered this target that no patient would wait longer than 18 weeks as planned in December 2007.

Inpatient or Day Case Waiting Time

What is the target?

No patient with a guarantee should wait longer than 6 months for inpatient or day case treatment from 31 December 2005, reducing to 18 weeks from 31 December 2007.

Why is it important?

There were almost 800,000 elective inpatients and day cases discharged from NHSScotland hospitals in 2007/08. As for outpatients, it is a top priority to ensure that these patients have the fastest access to treatment possible, to maximise health outcomes, and to reduce stress on the patients and their families. It must be remembered that many patients, such as emergency cases, are seen and treated right away, without ever having to wait.

In the past, a number of patients were assigned an Availability Status Code ( ASC) to reflect that they were not available or ready for treatment, and should not be counted against the national waiting times target. A new way of measuring waiting times, which is more clear and consistent and will ensure that hospital waiting times targets apply to those patients previously excluded, was introduced in January 2008. In preparation for this, Health Boards had to ensure that the numbers of patients with ASCs was reduced.

Performance Target - met early and sustained. On 31 March 2003 there were over 20,000 patients waiting longer than 18 weeks for treatment. From 31 December 2006 effectively no patients waited longer than18 weeks. NHSScotland effectively delivered this target one year early. The number of patients with an ASC (who were not covered by waiting times targets) reduced from 34,373 on 31 December 2006 to 7,691 on 31 December 2007. ASCs were abolished on 1 January 2008, at which point waiting times statistics started to deduct periods of unavailability.

Cataract Surgery

What is the target?

By the end of 2007, the maximum wait for cataract surgery will be 18 weeks from referral to completion of treatment.

Why is it important?

A key concern for patients and NHSScotland is the wait between referral from primary care to the start of any necessary hospital treatment. Reducing this wait is one of the top priorities of the Scottish Government.

Performance Target - met early. The performance is measured in two stages: referral to outpatient appointment; and decision to treat to inpatient appointment. The planned number of weeks in each stage varies by Health Board but the sum of both stages must be 18 weeks for all Boards. The cataract outpatient performance measure was delivered in December 2007 with the number of patients waiting over the local target reducing from 665 in May 2007 to zero in December 2007. The cataract inpatient/day cases treatment performance measure was effectively delivered in December 2007. The total number of patients waiting longer than the local target dropped from a local maximum of 828 in August 2007 to 3 in December 2007.

Hip Surgery

What is the target?

By end of 2007 the maximum wait for admission to a specialist unit for hip surgery, following a fracture, will be 24 hours.

Why is it important?

It is important for hip surgery to take place as soon as possible after a hip fracture to achieve the optimal clinical outcome for patients.

Performance Target - effectively met. The performance measure is the proportion of hip fractures operated on within 24 hours. In April 2006 performance was at 80.4 per cent. This target has been effectively delivered with performance in December 2007 at 97.1 per cent compared to the target of 98 per cent.

Cancer Waiting Times

What is the target?

The maximum wait from urgent referral to treatment for all cancers is 2 months; women who have breast cancer and need urgent treatment will get it within one month where appropriate.

Why is it important?

When a patient has an urgent referral for cancer treatment, it is imperative that treatment begins as quickly as possibly, for optimal outcomes and minimal stress for the patients.

Performance Target - the 'all cancer target' was almost met, but the breast cancer target was not met. The first performance measure concerns the 62 day, urgent referral to treatment part of the target. The target was to reach 95 per cent of urgent referrals beginning treatment within this time from the January-March 2008 quarter. Performance was 94.1 per cent in this quarter. The second measure concerns the 31 day urgent referral to treatment for the breast cancer part of the target. The target was to reach 98 per cent, however, the figures stood at 83.2 per cent for women referred during 2007. This was the first time that data were published for this measure.

Cardiac Waiting Times

What is the target?

By the end of 2007, the maximum wait for cardiac intervention will be 16 weeks from GP referral through rapid access chest pain clinic or equivalent and no patient will wait more than 16 weeks for treatment after they have been seen as an outpatient by a heart specialist and the specialist has recommended treatment.

Why is it important?

A key concern for patients and NHSScotland is the wait between referral from primary care to the start of any necessary hospital treatment. Reducing the whole journey either through a rapid access chest pain clinic, or as an outpatient, is one of the top priorities of the Scottish Government.

Performance Target - effectively met. The performance is measured in two stages: the wait to cardiac investigation (angiography) and the subsequent wait for treatment (cardiac intervention). The planned number of weeks in each stage varies by Health Board and forms their local target. The angiography stage of the target (typically four to five weeks) was effectively delivered in December 2007, when only six patients were waiting over the local target. The treatment stage of the target (typically around 10 weeks) was also delivered in December 2007, when there were no patients waiting over the local target.

Diagnostic Tests

What is the target?

By the end of 2007 patients will wait no more than 9 weeks for any MRI or CT scans and other key diagnostic tests.

Why is it important?

Tests help patients to get an accurate diagnosis and the right treatment. Delays in getting a test or reporting the results means that patients have symptoms for longer and treatment may be less effective. Reducing diagnostic waiting times is important in supporting service improvement and continuing improvement in overall waiting times for patients.

Performance Target - met. The performance is measured by the number of patients waiting over 9 weeks for MRI, CT, barium studies, ultrasound non-obstetric upper and lower endoscopy, colonoscopy and cystoscopy. The number of patients waiting over 9 weeks for key diagnostic scans fell from 2,668 in December 2006 to 110 in December 2007, and the number of patients waiting over 9 weeks for key diagnostic scopes dropped from 4,624 in July 2006 to zero in December 2007.

Treatment and Quality of Service

Introduction

Better Health, Better Care acknowledges that the NHS in Scotland is improving, with shorter waiting times and reducing mortality from the major killer diseases, but the speed of this improvement should be accelerated, with an emphasis on safety, reliability and integration.

In 2007/08, patient safety and patient experience programmes were established across NHSScotland to support the service in delivering real, measurable improvements in the quality of outcomes for patients. In addition, these programmes will also support greater levels of productivity and efficiency which will in turn impact positively on economic growth, productivity and participation, underpinning the achievement of the Scottish Government's Purpose.

Progress against the 2007/08 targets for treatment is set out in the charts and narrative that follow. Most targets were on track except emergency admissions of older people where only established levels of performance were broadly maintained. There were two new targets introduced in 2007/08 for which early data are now available - psychiatric hospital re-admissions, which is on track and the new NHS Quality Improvement Scotland ( QIS) Clinical Governance and Risk Management Standards measurement for which there is now baseline information for 2007/08.

Delayed Discharge

What is the target?

The number of people waiting more than 6 weeks to be discharged from hospital into a more appropriate care setting will be reduced by 50 per cent from April 2006 to April 2007 and to zero by April 2008.

Why is it important?

When a patient has been declared as fit to move to the next stage of care, it is essential that Health Boards and local authorities should together ensure that the individual is discharged to a safe and appropriate destination as quickly as possible. This is important for the wellbeing of the individuals themselves, but also for the efficiency and effectiveness of the health and care services. The joint working across public bodies required to achieve this target continues to be a priority, so this target has become a standard for NHSScotland for 2008/09 onwards.

Performance Target - met. The number of people waiting more than 6 weeks to be discharged from hospital into a more appropriate care setting was zero at April 2008, compared to 498 in April 2006. The number of patients delayed in short-stay beds was also zero in April 2008.

Multiple Emergency admissions (older People)

What is the target?

By 2008/09, we will reduce the proportion of older people (aged 65+) who are admitted as emergency inpatients two or more times in a single year by 20 per cent compared with 2004/05, and reduce by 10 per cent emergency inpatient bed days.

Why is it important?

Older people admitted regularly to hospital as an emergency are more likely to be delayed there once their treatment is complete. This, in turn, is particularly bad for their health and independence. This indicator aims to reduce the number of older people with multiple emergency admissions to hospital. A reduction in this indicator would demonstrate the positive effect of alternatives such as more proactive care and management of conditions in the community. It would also lead to a general improvement in the health of over 65s. Achieving the target requires close working between a range of public bodies, and consideration is being given to the most appropriate target for 2009/10 onwards.

Performance Target - at risk of not being met. The first performance measure relates to multiple emergency admissions. These have increased over recent years from 4,336 per 100,000 population aged over 65 in 2003 to 4,764 per 100,000 population aged over 65 in 2007. Emergency bed days of older people has increased slightly over recent years from 2.80 million in 2003 to 2.83 million in 2006 although this is a slower rate than the rise in the population over 65. In 2007 emergency bed days dropped by 1.4 per cent despite the population over 65 increasing by 1 per cent.

Cervical Screening

What is the target?

At least 80 per cent of women aged 20-60 have attended for cervical screening in the last 5 1/2 years.

Why is it important?

Early detection of cervical cancer increases the likelihood of a quick and total recovery.

Performance Target - met and sustained. The standard of 80 per cent has been met since 1995 although this has decreased from 86.7 per cent in 1999/2000 to 82.5 per cent in 2006/07.

QIS Clinical Governance and Risk Management

What is the target?

NHS Quality Improvement Scotland ( QIS) clinical governance and risk management standards improving.

Why is it important?

QIS sets important standards for quality and safety across NHSScotland, and all Health Boards are supported to achieve and surpass these in order to maximise the quality of service, and the resultant outcomes for all patients. QIS published Clinical Governance and Risk Management Standards and undertook reviews of all Health Boards. The outcome of these reviews enabled a baseline to be set for each Board. All Boards are required by this target to demonstrate continuous improvement in terms of clinical governance and risk management. Accordingly, each Health Board set a trajectory for improvement. NHSQIS will commence a further round of reviews on 2009/10 to determine the level of progress achieved across NHSScotland.

Healthcare Associated Infection

What is the target?

To reduce all Staphylococcus aureus bacteraemia (including MRSA) by 30 per cent by 2010.

Why is it important?

Acquiring a healthcare associated infection ( HAI) is a dangerous and distressing experience for patients already in hospital. Proper procedures can significantly reduce the risk of these infections being spread. Reflecting the importance attached to tackling HAI in Scotland, a new HEAT target has been announced for 2009/10 (see Annex C) which requires health boards to reduce the rate of C.Difficile for the over 65s by 30 per cent, by 2011.

Performance Target - on track. The measure records the number of identifications of Staphylococcus aureus bacteraemias (including MRSA and MSSA) as detailed in Health Protection Scotland's Scottish Surveillance of Healthcare Associated Infection Programme ( SSHAIP) protocols. The baseline for this target is 2005/06, during which there were 2,774 infections. In 2007 there were 2,531 infections, an improvement of 8.8 per cent.

Use of Anti-depressants

What is the target?

To reduce the annual rate of increase of Defined Daily Dose ( DDD) per capita of anti-depressants to zero by 2009/10.

Why is it important?

It is recognised that although the use of anti-depressants is appropriate in many cases, increasingly it is expected that other interventions will be used to greater effect.

Performance Target - on track. The prescribing of anti-depressants has been increasing continuously since 1994. The rate of the increase peaked from 2001 to 2002 at 7.7 per cent per year. Since then it has been steadily reducing to 1.3 per cent per year from 2005 to 2006.

Psychiatric Readmissions

What is the target?

Reduce the number of readmissions within one year for those that have had a psychiatric hospital admission of over 7 days by 10 per cent by the end of December 2009. Includes all psychiatric specialties except learning disabilities; admissions can be elective/emergency but not an inter-hospital transfer.

Why is it important?

Health and social care services are working together to provide good quality support and care in the community. Reduced levels of readmissions to psychiatric hospitals is a key indicator that these services are being provided appropriately, both before leaving hospital after the first admission, and subsequently in the community.

Performance Target - on track. The number of patients readmitted within 1 year of an episode in a psychiatric hospital of seven days or more declined up to 2004. Data are not yet available to report on performance after this period.

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