By:	Roger Gough

Cabinet Member for Education and Health Reform

To:	Kent Health and Wellbeing Board

Date:	28th January 2015

Subject:	Assurance Framework

Classification:	Unrestricted

Summary: This section outlines changes for some of the indicators and highlights those raising concerns or showing increasing good performance. Outcome 1: Every child has the best start in life. There has been a decrease in the proportion of women with a smoking status at time of delivery; from 15.2% (2011/12) to 13.0% (2013/14) Kent is now 1% higher than national proportions. (Indicator 1.1) Breastfeeding initiation rates have continued to decrease to 71.3% in 2013/14 and remain worse than national who are at 74%. (Indicator 1.2) Outcome 2: Effective prevention of ill health by people taking greater responsibility for their health and wellbeing. The proportions of women having Breast and cervical cancer screenings continues to decrease; however both remain above national coverage rates. (Indicators 2.8 & 2.9) Outcome 4: People with mental health issues are supported to “live well”. Indicator 4.6 measures the number of all people entering prison who are identified as having a substance dependence, and of these people how many had not accessed community substance misuse treatment services prior to entry. For Kent nearly 60% of those entering prison with an identified substance dependence had not previously accessed community treatment services. Nationally it was nearly 50%. The rate of male suicides in Kent has slowly been increasing from 2008-10, the most recent reporting period now shows Kent with a higher rate (14.6 per 100,000) than both the national male suicide rate (13.8 per 100,000) and the Kent female suicide rate (4.1 per 100,000). (Indicator 4.9) Stress Indicators All trusts have experienced decreases in the proportion of people being either discharged, admitted or transferred within four hours of arrival at A&E during December 2014. All Trusts in December were below the 95% target, with just Dartford & Gravesham NHS trust operating above national levels. No Trusts reported any patients with greater than 12 hours between decision to admit and admission. Please refer to Section 5 for a detailed outline of bed occupancy, A&E discharges, admissions or transfers within 4 hours and delayed days. For Decision: The Health and Wellbeing Board is asked to Discuss the contents of this report and implications at local levels Discuss areas of joint working to avoid further crisis in the health and social care system Ask members to report back at the next meeting their findings and key learnings from the above.

1.	Introduction

This report aims to provide the Kent Health and Wellbeing Board with performance figures on a suite of indicators based on Kent’s Health and Wellbeing Strategy; it is arranged on the 5 Outcomes with additional stress indicators.

2.	Progress since the last report

Since the previous report a new Health and Wellbeing board Strategy report has been produced, new metrics were included and there have been added into the report.

Key to KPI Ratings used

GREEN	Target has been achieved or exceeded, or in comparison to National
AMBER	Performance was at an acceptable level within the target or in comparison to National
RED	Performance is below an acceptable level, or in comparison to National
Performance has improved relative to the previous period
Performance has worsened relative to the previous period
Performance has remained the same relative to the previous period

Data quality note: All data is categorised as management information. All results may be subject to later change.

Report Prepared by

Malti Varshney, Consultant in Public Health

Malti.varshney@kent.gov.uk

Anne Tidmarsh, Director of Older People Services

Anne.Tidmarsh@kent.gov.uk

Helen Groombridge, Performance Officer Public Health

Helen.groombridge@kent.gov.uk

Mark Gilbert, Commissioning and Performance Manager Public Health

Mark.gilbert@kent.gov.uk

Mark Lemon, Strategic Business Advisor, Business Strategy and Support

Mark.lemon@kent.gov.uk

3.	Indicator executive summary

The following tables provide a visual summary of the indicators within each outcome domain. Where an indicator has not been RAG rated this indicates that there is no current specified target at this stage or there has not been a National RAG comparison made in the Public Health Outcomes Framework (PHOF).

Outcome 1: Every child has the best start in life

There have been updated published figures since the previous report for the number of pregnant women with a smoking status at time of delivery (1.1) breastfeeding Initiation rates (1.2) SEN figures (1.9 & 1.10) and CAMHS (1.11, 1.12 & 1.13).

Indicator Description	Known Target	Previous status	Recent status	DoT	Recent time period
1.1 Reducing the number of pregnant women with a smoking status at time of delivery (PHOF)	12.0% (national)	15.2% (r)*	13.0% (r)	2013/14
1.2 Increasing breastfeeding initiation rates (PHOF)	73.9% (national)	72.1% (r)	71.3% (r)	2013/14
1.3 Increasing breastfeeding continuance at 6-8 weeks (PHOF)	47.2% (national)	**	40.8% (r)	-	2012/13
1.4 Reducing conception rates for young women aged under 18 years old (rate per 1,000. PHOF)	27.7% (national)	31.0 (a)	25.9 (a)	2012
1.5 Improving MMR vaccination uptake of two doses at 5 years old (PHOF)	90%	90.5% (g)	92.2% (g)	2012/13
1.6 Increasing school readiness: all children achieving a good level of development at end of Year R (% of all eligible children. PHOF)	51.7% (national)	-	63.4% (g)	-	2012/13
1.7 Reducing the proportion of 4-5 year olds with excess weight	22.2% (national)	21.7% (g)	21.7% (a)	2012/13
1.8 Reducing the proportion of 10-11 year olds with excess weight	33.3% (national)	32.7% (g)	32.7% (a)	2012/13
1.9 Increasing the proportion of SEND assessments within 26 weeks (Stress indicator. KCC MIU)	90%	92.9% (g)	92.4% (g)	August 2014***
1.10 Reducing the number of Kent children with SEND placed in independent of out of county schools (Stress indicator. KCC MIU)	-	604	599	August 2014***
1.11 Reducing CAMHS average waiting times from routine assessment from referral (Stress indicator. South East CSU)	to be confirmed	13 weeks	12 weeks	November 2014
1.12 Reducing the number waiting for routine CAMHS treatment (Stress indicator. South East CSU)	to be confirmed	380	170	November 2014
1.13 Having an appropriate CAMHS caseload for patients, open at any point during the month (Stress indicator. South East CSU)	8,408	8,470 (r)	8,683 (r)	November 2014
1.14 Reducing unplanned hospitalisation rates for asthma (Primary diagnosis) in people aged under 19 years old (rate per 100,000. KMPHO)	-	14.8	14.6	2013/14
1.15 Reducing unplanned hospitalisation rates for diabetes (Primary diagnosis) in people aged under 19 years old (rate per 100,000. KMPHO)	-	7.6	7.3	2013/14
1.16 Reducing unplanned hospitalisation rates for epilepsy (Primary diagnosis) in people aged under 19 years old (rate per 100,000. KMPHO)	-	9.4	8.8	2013/14

*Refers to 2011/12 as 2013/14 figures for Kent were suppressed. ** Figures suppressed for Kent. *** Rolling 12 month figures

For Kent, the percentage of women with a smoking status at time of delivery has decreased from 15.2% (2011/12) to 13.0% (2013/14) this has led to a reduction in the gap between Kent and national rates with Kent 1% higher in 2013/14. Breastfeeding initiation rates have continued to decrease from 2011/12 to 2013/14 from 72.5% to 71.3% and remain worse than national which consistently are at 74%. Partnership work is continuing between the NHS Area Team and Public Health Kent to improve recording mechanisms surrounding breastfeeding continuation rates; the current focus is on identifying where problems occur in the system and finding mid to long term solutions Indicators 1.7 and 1.8 on excess weight in children have changed their RAG from Green to Amber even though the proportions have not changed as the national figures have both decreased making the difference between Kent and National no longer better (green) but similar (amber).

Outcome 2: Effective prevention of ill health by people taking greater responsibility for their health and wellbeing

New indicators have been added on life expectancy from the Public Health Outcomes Framework, the 3 indicators are split by gender and are on life expectancy and birth, health life expectancy and the range in years of life expectancy across the social gradient within each local authority from most to least deprived (Slope Index of inequality).

Indicator Description	Target	Previous status	Recent status	DoT	Recent time period
2.1 Increasing life expectancy at birth (PHOF):
Male (years)	79.2 (national)	79.4 (g)	79.9 (g)	2010-12
Female (years)	83.0 (national)	83.2 (g)	83.4 (g)	2010-12
2.2 Increasing healthy life expectancy at Birth (PHOF):
Male (years)	63.4 (national)	63.6 (a)	63.5 (a)	2010-12
Female (years)	64.1 (national)	65.5 (g)	66.0 (g)	2010-12
2.3 Reducing the slope index for health inequalities (PHOF):
Male (years)	9.2 (national)	7.8	7.1	2010-12
Female (years)	6.8 (national)	4.7	4.8	2010-12
2.4 Reducing the proportion of adults with excess weight (PHOF)	63.8% (national)	-	64.6% (a)	-	2012
2.5 Increasing the proportion of people quitting having set a quit date with smoking cessation services (KCC Public Health)	52%	57% (g)	51% (a)	Q1 2014/15
2.6 Increasing the proportion of people receiving a NHS Health Check of the eligible population (KCC Public Health. The target is for the specific quarter)	12.7% (Q2)	11.2% (g)	14.8% (g)	Q2 2014/15
2.7 Reducing alcohol related admissions to hospital (per 100,000. PHOF)	637 (national)	557 (g)	565 (g)	2012/13
2.8 Increasing the proportion of eligible women screened adequately in the breast cancer screening programme (PHOF)	75.9% (national)	78.2% (g)	77.6% (g)	2014
2.9 Increasing the proportion of eligible women screened adequately in the cervical cancer screening programme (PHOF)	74.2% (national)	77.2% (g)	77.1% (g)	2014
2.10 Reducing the rates of deaths attributable to smoking persons aged 35+ (rate per 100,000. Local Tobacco Control Profiles)	288.7 (national)	285.2 (g)	281.8 (g)	2011-13
2.11 Reducing the under-75 mortality rate from cancer considered preventable (rate per 100,000. PHOF)	83.8 (national)	80.5 (g)	78.2 (g)	2011-13
2.12 Reducing the under-75 mortality rate from respiratory disease considered preventable (rate per 100,000. PHOF)	17.9 (national)	16.6 (a)	16.7 (a)	2011-13
2.13 Reducing the under-75 mortality rate from cardiovascular disease considered preventable (rate per 100,000. PHOF)	50.9 (national)	52.3 (a)	49.3 (a)	2011-13

Healthy life expectancy at birth is a new measure both in this report and reported nationally and under development, currently there are only 2 times frames of figures available, however for males, this is the measure within life expectancy where Kent is Amber compared to national with a very slight decrease. Cancer screening for both breast and cervical cancer has decreased from 2013 to 2014; however both remain above national coverage rates. At district level, all districts have higher coverage rates than national on cervical screening, however for breast screening, Sevenoaks and Thanet have worse levels than national at 75% for both districts compared to Kent at 78% and national at 76%, both districts have had year on year decreases.

Outcome 3: The quality of life for people with long term conditions is enhanced and they have access to good quality care and support

New metrics have been added concerning adults with learning disability (3.5 & 3.7) and adults accessing mental health services (3.6). Metrics surrounding adult social care are currently being reviewed by the directorate working in collaboration with South East CSU to move reporting to cover both those adults supported by KCC and by other means.

Indicator Description	Target	Previous status	Recent status	DoT	Recent time period
3.1 Increasing clients with community based services who receive a personal budget/ direct budget (ASC KCC)
Learning Disability Clients	95%	93.2% (r)	93.1% (r)	November 2014
Mental Health Clients	95%	78.9% (r)	82.6% (r)	November 2014
OPPD Clients	95%	73.9% (r)	73.7% (r)	November 2014
3.2 Increasing the number of people using telecare and telehealth technology (ASC KCC)	3,978	4,041 (g)	4,088 (g)	September 2014
3.3 Increasing the proportion of older people (65+) mostly at risk of long term care and hospital admission, who were still at home 91 days after discharge from hospital in reablement/rehabilitation services (Stress indicator. BCF. ASCOF)	82.5% (national)	-	83.8%	-	2013/14
3.4 Reducing admissions to permanent residential care for older people Stress indicator. BCF. ASC KCC)	110	85 (g)	101 (g)	September 2014
3.5 Increasing the percentage of adults with a learning disability who are known to the council, who are recorded as living in their own home or with their family (PHOF, no published RAG)
Persons	73.5% (national)	71.4%	70.1%	2012/13
Male	73.2% (national)	-	68.7%	-	2012/13
Female	74.0% (national)	-	72.0%	-	2012/13
3.6 Increasing the percentage of adults who are receiving secondary mental health services on the care programme approach recorded as living independently, with or without support (aged 18-69 years. PHOF, No published RAG)
Persons	58.5% (national)	65.6%	81.5%	2012/13
Male	57.3% (national)	63.8%	79.8%	2012/13
Female	59.8% (national)	67.6%	83.5%	2012/13
3.7 Reducing the gap in employment rate between those with a learning disability and the overall employment rate (% point gap. PHOF, No published RAG)	65.1 (national)	66.5	66.1	2013/14
3.8 Increasing the early diagnosis of diabetes – Recorded Diabetes (registered GP Practice aged 17+. PHOF)	6.0% (national)	5.8% (a)	6.0%* (a)	2012/13
3.9 Reducing the number of hip fractures for people aged 65 and over (rate per 100,000. PHOF)	568.1 (national)	599.0 (a)	544.0 (a)	2012/13

* Estimated value

The new metrics published in the Public Health Outcomes Framework surrounding adults with a learning disability and receiving secondary mental health services are presented without comparison to national and therefore remain without a RAG status in this report. However, it should be noted that for Kent adults with a learning disability who are known to the council recorded as living in their own home or with family is just below national proportions in 2012/13 for all three categories of person, males and females (3.5) In contrast, the proportions of Kent adults who are receiving secondary mental health services on the care programme approach recorded as living independently, with or without support, are considerably higher than national levels (3.6)

Outcome 4: People with mental health issues are supported to “live well”

New metrics have been added concerning self-reported wellbeing of adult social care users, carers and general population (4.10, 4.11 and 4.12) and the proportion of people entering prison with substance dependence issues who are not known to community substance misuse services has published figures for the first time (4.7).

Indicator Description	Target	Previous status	Recent status	DoT	Recent time period
4.1 Increasing the crisis response of A&E Liaison within 2 hours	-	82.1%	75.5%	Q2 2014/15
4.2 Increasing the crisis response of A&E liaison, all urgent referrals to be seen within 24 hours	100%	100% (g)	100% (g)	Q2 2014/15
4.3 Increasing access to IAPT (Increasing Access to Psychological Therapies) services	A Kent value is not available but will be reported at CCG level in Local Assurance Reports
4.4 Increasing the number of adults receiving treatment for alcohol misuse (ndtms.net)	To be confirmed	-	1,945	-	2013/14
4.5 Increasing the number of adults receiving treatment for drug misuse (ndtms.net)	To be confirmed	3,364	2,931	2012/13
4.6 Reducing the number of people entering prison with substance dependence issues who are previously not known to community treatment (PHOF)	46.9% (national)	-	57.4% (r)	-	2012/13
4.7 Increasing the successful completion and non-re-presentation of opiate drug users leaving community substance misuse treatment services (PHOF)	7.8% (national)	10.9% (g)	10.3% (g)	2013
4.8 Increasing the employment rate amongst people with mental illness/those in contact with secondary mental health services (ASCOF)	7.0% (national)	7.4%	6.2%	2013/14
4.9 Reducing the number of suicides (rate per 100,000. PHOF)
Persons	8.8 (national)	8.1 (a)	9.2 (a)	2011-13
Males	13.8 (national)	12.6 (a)	14.6 (a)	2011-13
Females	4.0 (national)	4.0 (a)	4.1 (a)	2011-13
4.10 Increasing the percentage of adult social care users who have as much social contact as they would like according to the Adult Social Care Users survey (PHOF)	43.2% (national)	37.5% (r)	44.0% (a)	2012/13
4.11 Increasing the percentage of adult social carers who have as much social contact as they would like according to the Personal Social Services Carers survey (PHOF)	41.3% (national)	-	33.9% (r)	-	2012/13
4.12 Decreasing the percentage of respondents who according to the Annual Population survey have (PHOF):
Low Satisfaction (score 0-4)	5.8% (national)	6.5% (a)	5.6% (a)	2012/13
Low Worthwhile (score 0-4)	4.4% (national)	4.6% (a)	4.0% (a)	2012/13
Low Happiness (score 0-4)	10.4% (national)	11.0% (a)	9.9 (a)	2012/13

There has been a decrease in the number of adults receiving treatment for drug misuse in Kent from 2011/12 to 2012/13, this is an ongoing trend and is being monitored by Kent Drug and Alcohol Action Team who commission substance misuse services in Kent. The number of people entering prison with identified substance dependence issues is monitored in indicator 4.6 which looks at the number of those with identified dependence at entry into prison who have not previously accessed community treatment services. This indicator looks at unmet need. Kent is showing as having a higher proportion (57.4%) unknown to community services compared to national proportions (46.9%). This is the first time the metric has been published and will need further analysis and monitoring to develop the right actions to take. The rate of male suicides in Kent has slowly been increasing from 2008-10, the most recent reporting period now has Kent as higher than the national rate and the Kent female rate as 14.6 per 100,000 to 4.1 per 100,000. Public Health has a suicide prevention strategy and wellbeing programmes specifically targeting men in Kent, an example is the Kent Sheds programme. There has been an equity audit conducted into IAPT which has highlighted that men are not accessing psychological therapies as much as women are, from this, wellbeing programmes are further targeting men, specifically in the workplace.

Outcome 5: People with dementia are assessed and treated earlier and are supported to “live well”

Metrics 5.8 to 5.12 are new to the assurance framework and work is ongoing with Adult Social Care KCC and South East CSU to define and report these figures in future reports. There have been no updates since the previous report.

Indicator Description	Target	Previous status	Recent status	DoT	Recent time period
5.1 Increasing the reported number of dementia patients on GP registers as a percentage of estimated prevalence (South East CSU)	To be confirmed	39.4%	41.5%	2012/13
5.2 Reducing rates of hospital admissions for patients older than 64 years old with a secondary diagnosis of dementia (rate per 1,000. South East CSU)	To be confirmed	25.0	25.1	2013/14
5.3 Reducing rates of hospital admissions for patients older than 74 years with a secondary diagnosis of dementia (rate per 1000. South East CSU)	To be confirmed	49.9	50.5	2013/14
5.4 Reducing total bed-days in hospital per population for patients older than 64 years old with a secondary diagnosis of dementia (rate per 1000. South East CSU)	To be confirmed	231.8	225.7	2013/14
5.5 Reducing total bed-days in hospital per population for patients older than 74 years with a secondary diagnosis of dementia (rate per 1000. South East CSU)	To be confirmed	464.0	452.5	2013/14
5.6 Increase the proportion of patients aged 75 and over admitted as an emergency for more than 72 hours who have been (South East CSU):
Dartford and Gravesham NHS Trust	(a) identified as potentially having dementia	To be confirmed	93%	92%	Q4 2013/14
(b) who are appropriately assessed	To be confirmed	100%	100%
(c) and, where appropriate, referred on to specialist services in England	To be confirmed	97%	100%
East Kent Hospitals University NHS Foundation Trust	(a) identified as potentially having dementia	To be confirmed	99%	100%	Q4 2013/14
(b) who are appropriately assessed	To be confirmed	95%	94%
(c) and, where appropriate, referred on to specialist services in England	To be confirmed	100%	100%
Maidstone and Tunbridge Wells NHS Trust	(a) identified as potentially having dementia	To be confirmed	99%	99%	Q4 2013/14
(b) who are appropriately assessed	To be confirmed	99%	99%
(c) and, where appropriate, referred on to specialist services in England	To be confirmed	100%	100%
Medway NHS Foundation Trust	(a) identified as potentially having dementia	To be confirmed	69%	78%	Q4 2013/14
(b) who are appropriately assessed	To be confirmed	97%	88%
(c) and, where appropriate, referred on to specialist services in England	To be confirmed	85%	91%
5.7 Decreasing the percentage of people waiting longer than 4 weeks to assessment with Memory Assessment Services (South East CSU)	To be confirmed	21.0%	23.4%	Q4 2013/14
5.8 Increasing the proportion of patients diagnosed with dementia whose care has been reviewed in the previous 15 months/12 months (South East CSU)	To be confirmed	76.0%	79.7%	2013/14
5.9 Reducing care and nursing home placement, especially those made at a time of crisis and/or from an acute setting	Under development with Adult Social Care KCC and South East CSU
5.10 Increasing numbers of carers assessments and carers accessing short breaks
5.11 Increasing attendance at Dementia Peer Support Groups
5.12 Increasing number of Dementia Champions

Stress indicators

Indicator Description	Target	Previous status	Recent status	DoT	Recent time period
Children’s: Increasing the proportion of SEND assessments within 26 weeks (indicator 1.9 KCC MIU)	90%	92.9% (g)	92.4% (g)	August 2014***
Children’s: Reducing the number of Kent children with SEND placed in independent of out of county schools (indicator 1.10 KCC MIU)	-	604	599	August 2014***
Children’s: Reducing CAMHS average waiting times from routine assessment from referral (indicator 1.11South East CSU)	to be confirmed	13 weeks	12 weeks	November 2014
Children’s: Reducing the number waiting for routine CAMHS treatment (indicator 1.12 South East CSU)	to be confirmed	380	170	November 2014
Children’s: Having an appropriate CAMHS caseload for patients, open at any point during the month (indicator 1.13 South East CSU)	8,408	8,470 (r)	8,683 (r)	November 2014
Public Health Increasing the population Flu vaccination coverage for those aged 65+. (PHOF)	75%	73.1% (r)	71.4% (r)	2012/13
Public Health Increasing the population Flu vaccination coverage for those at risk individuals. (PHOF)	75%	46.3% (r)	48.7% (r)	2012/13
Acute/Urgent Bed Occupancy Rate – Overnight (NHS England)
Dartford and Gravesham NHS Trust	to be confirmed	95.3%	93.6%	Refer to section 5	Q2 2014/15
East Kent Hospitals University NHS Foundation Trust	to be confirmed	89.7%	87.6%
Maidstone and Tunbridge Wells NHS Trust	to be confirmed	91.4%	91.6%
Medway NHS Foundation Trust	to be confirmed	90.1%	88.9%
Kent and Medway NHS and Social Care Partnership	to be confirmed	92.5%	92.4%
Acute/Urgent A&E attendances within 4 hours (all) from arrival to admission, transfer or discharge (NHS England)
Dartford and Gravesham NHS Trust (all)	95%	95.8% (g)	91.8% (r)	Week ending 28/12/2014
East Kent Hospitals University NHS Foundation Trust (all)	95%	87.3% (r)	89.3% (r)
Maidstone and Tunbridge Wells NHS Trust (all)	95%	84.2% (r)	82.8% (r)
Medway NHS Foundation Trust (all)	95%	75.1% (r)	82.5% (r)
Acute/Urgent Emergency admissions BCF	Awaiting alignment with BCF definitions
Primary Care GP Attendances	To be defined and developed with South East CSU
Primary Care Out of Hours activity
Primary Care 111 NHS Service	Figures only available at Kent, Medway, Surrey and Sussex Level
Social / Community Care Increasing the proportion of older people (65+) mostly at risk of long term care and hospital admission, who were still at home 91 days after discharge from hospital in reablement/rehabilitation services BCF (indicator 3.3 ASCOF)	82.5% (national)	-	83.8%	-	2013/14
Social / Community Care Decreasing the number of delayed bed days BCF (NHS England)	-	2,236	2,427	November 2014
Acute days	-	1,626	1,684
Non-acute days	-	610	743
Social / Community Care Infection control rates	Continuing to be sources with Public Health England
Social / Community Care Reducing admissions to permanent residential care for older people (aged 65+) BCF (People. Indicator 3.4 ASC KCC)	110	85 (g)	101 (g)	September 2014

4. Better Care Fund (BCF) Metrics: BCF Metrics will be referenced in the next Assurance Framework report

5. Stress indicators

Due to the winter pressures on the NHS Acute/Urgent services, the focus of the detailed section of the assurance framework will be on the core metrics which focus on these services; these are bed occupancy rate, A&E attendances within 4 hours discharged, admitted or transferred and delayed days.

Acute/Urgent Bed Occupancy Rate – Overnight (Source: NHS England. 7th January 2015)

Bed occupancy rates look at the number of available beds open overnight and the percentage that are occupied by Trust and speciality.

All five Trusts have not experienced great variances over the previous 3 quarters published however all Trusts continue to operate above the recommended level of 85%; In Q2 2014/15 the occupancy rates varied from between 88% (Medway NHS Foundation Trust) and 94% (Dartford and Gravesham NHS Trust). Q3 2014/15 had not been published at time of writing this report and therefore the effect winter pressure effect for Q3 is not presented here.

Maternity is the only speciality operating under the 85% recommended level; however this speciality is gradually increasing on capacity since Q1 2011/12.

Learning disabilities is consistently operating at 100%, it should be noted that this equated to only 23 beds available in Q2 2014/15 and operates at a much smaller number than the other specialities.

In total there were 3,380 beds available in Q2 2014/15, the majority of which were for General & Acute Speciality (2,642 beds).

Acute/Urgent A&E attendances within 4 hours (all) from arrival to admission, transfer or discharge (Source: NHS England. January 2015)

All trusts have experienced decreases in the proportion of people being either discharged, admitted or transferred with four hours of arrival at A&E during December 2014. None of the Trusts reported any patient spending more than 12 hours from decision to admit to admission.

National proportions for the end of November and December have been added to the individual figures below to provide a comparison of the Trusts against National.

Medway NHS Foundation Trust (MFT):

MFT continues to see less than the targeted 95% within 4 hours and is operating below current National proportions at the end of November and December. The week ending 14th December experienced the lowest proportion within 4 hours at 74.8%, the lowest since the week ending 8th June 2014 and lower than the same time period in 2013.

The table below outlines the figures on attendance and admissions from the week ending the 16th November 2014 to the week ending 28th December 2014.

Although the week ending the 14th December had the lowest proportion within 4 hours, it was the week before (week ending the 7th December) that experienced the highest number of attendances.

The longest number of patients waiting for between 4 and 12 hours was in the week ending 21st December where 189 patients waited.

Improvements were made in the final week of December with a decrease in the number of attendances.

A&E attendances and emergency admissions – MFT

Week Ending	A&E attendances	A&E attendances > 4 hours from arrival to admission, transfer or discharge	Emergency Admissions
Type 1 Departments - Major A&E	Total attendances	Type 1 Departments - Major A&E	Percentage in 4 hours or less (all)	Emergency Admissions via Type 1 A&E	Other Emergency admissions (i.e not via A&E)	No. of patients spending >4 hours but <12 hours from decision to admit to admission
16/11/2014	1,970	1,970	411	79.1%	346	203	147
23/11/2014	2,006	2,006	474	76.4%	347	269	147
30/11/2014	1,906	1,906	285	85.0%	317	269	79
07/12/2014	2,001	2,001	453	77.4%	341	203	179
14/12/2014	1,972	1,972	496	74.8%	318	195	159
21/12/2014	1,961	1,961	489	75.1%	336	310	189
28/12/2014	1,820	1,820	319	82.5%	329	214	66

Maidstone and Tunbridge Wells NHS Trust (MTW):

MTW began a noticeable decrease in proportions from the end of November (23/11/2014) within 4 hours and experienced their lowest proportions in December 2014 compared to any week as far back as November 2013. From the end of November they also operated below national proportions.

The week ending the 28th December had the lowest proportion within 4 hours, it was the week before (week ending the 21th December) that experienced the highest number of attendances.

The longest number of patients waiting for between 4 and 12 hours was in the week ending 21st December where 125 patients waited (same week as MFT).

A&E attendances and emergency admissions – MTW

Week Ending	A&E attendances	A&E attendances > 4 hours from arrival to admission, transfer or discharge	Emergency Admissions
Type 1 Departments - Major A&E	Total attendances	Type 1 Departments - Major A&E	Percentage in 4 hours or less (all)	Emergency Admissions via Type 1 A&E	Other Emergency admissions (i.e not via A&E)	No. of patients spending >4 hours but <12 hours from decision to admit to admission
16/11/2014	2,513	2,513	230	90.8%	669	62	73
23/11/2014	2,466	2,466	76	96.9%	745	74	19
30/11/2014	2,580	2,580	193	92.5%	728	83	46
07/12/2014	2,406	2,406	366	84.8%	691	63	122
14/12/2014	2,515	2,515	326	87.0%	711	57	87
21/12/2014	2,661	2,661	420	84.2%	729	66	125
28/12/2014	2,455	2,455	423	82.8%	762	45	104

Dartford and Gravesham and NHS trust (DG NHS):

DG NHS has not varied greatly from the 95% target, albeit at times below this and tends to have the highest proportions compared to the other Trusts; it has however experienced decreases in the 4 hour target from the week ending 21st December into 28th December.

The highest number of attendances for DG NHS was the week ending the 21st December (the same as MTW) with the lowest percentage in 4 hours the next week of the 28th December.

DG NHS had very minimal numbers of patients waiting between 4 and 12 hours for admission even though it had higher numbers of people being admitted compared to MFT.

A&E attendances and emergency admissions – DG NHS

Week Ending	A&E attendances	A&E attendances > 4 hours from arrival to admission, transfer or discharge	Emergency Admissions
Type 1 Departments - Major A&E	Total attendances	Type 1 Departments - Major A&E	Percentage in 4 hours or less (all)	Emergency Admissions via Type 1 A&E	Other Emergency admissions (i.e not via A&E)	No. of patients spending >4 hours but <12 hours from decision to admit to admission
16/11/2014	1,847	1,847	141	92.4%	573	28	<5
23/11/2014	1,925	1,925	94	95.1%	560	21	0
30/11/2014	1,888	1,888	125	93.4%	564	25	0
07/12/2014	1,906	1,906	128	93.3%	574	17	<5
14/12/2014	1,942	1,942	45	97.7%	582	22	0
21/12/2014	1,974	1,974	82	95.8%	600	26	0
28/12/2014	1,850	1,850	151	91.8%	552	13	7

East Kent Hospitals University NHS Foundation Trust (EKHUFT):

EKHUFT also decreased in December, following a very similar pattern to the national proportion in December.

EKHUFT experiences the highest number of attendance compared to the other Trusts in Kent and Medway, it also has Type 3 attendances. The week ending the 16th November was where EKHUFT experienced the highest number of attendances.

The week ending the 21st December, as with MTW and DG NHS, was the week where the lowest proportion of patients was seen within 4 hours.

Although EKHUFT experienced the highest number of admissions across the Trusts, its numbers of patients waiting between 4 and 12 hours was lower compared to the other trusts (except DG NHS)

A&E attendances and emergency admissions – EKHUFT

Week Ending	A&E attendances	A&E attendances > 4 hours from arrival to admission, transfer or discharge	Emergency Admissions
Type 1 Departments - Major A&E	Type 3 Departments - Other A&E/Minor Injury Unit	Total attendances	Type 1 Departments - Major A&E	Type 3 Departments - Other A&E/Minor Injury Unit	% in 4 hours or less (type 1)	% in 4 hours or less (all)	Emergency Admissions via Type 1 A&E	Emergency Admissions via Type 3 and 4 A&E	Other Emergency admissions (i.e not via A&E)	No. of patients spending >4 hours but <12 hours from decision to admit to admission
16/11/2014	2,805	1,187	3,992	378	41	86.5%	89.5%	790	412	301	6
23/11/2014	2,711	1,100	3,811	257	15	90.5%	92.9%	760	386	360	7
30/11/2014	2,769	1,052	3,821	306	13	88.9%	91.7%	845	361	333	13
07/12/2014	2,789	1,028	3,817	217	22	92.2%	93.7%	791	387	329	16
14/12/2014	2,720	1,065	3,785	344	54	87.4%	89.5%	772	406	290	18
21/12/2014	2,781	1,066	3,847	468	20	83.2%	87.3%	826	409	311	20
28/12/2014	2,574	974	3,548	357	22	86.1%	89.3%	823	402	242	50

Social / Community Care Decreasing the number of delayed days (BCF. Source: NHS England. January 2015)

Published figures on the number of delayed days currently is to November 2014, as with Bed Occupancy rates December figures are not available for reporting.

The delayed days labelled as Acute (type of care the patient receives) continue to form the majority of delayed days in Kent; for November 2014 this was 2,427. Non-acute delayed days have been increasing since August 2014, however this increase is not of significance compared to previous months and for November was only 743 days.

The chart above shows the delayed days each month by the responsible agency for the delay, this is split by NHS, Social care and then both. The majority of the delayed days were attributable to the NHS, however these are currently plateauing; the delayed days attributable to Social Care have increased in November to 767 from 554 in October. The number attributable to both also increased from 11 in October to 54 in November.

The table below outlines the reason categories for delayed days and which responsible agency they can be attributed to.

Delayed Days Reasons and attribution	Attributable to NHS	Attributable to Social Care	Attributable to both
A. Awaiting completion of assessment
B. Awaiting public funding
C. Awaiting further non-acute (including community and mental health) NHS care (including intermediate care, rehabilitation services etc)
D i). Awaiting residential home placement or availability
D ii). Awaiting nursing home placement or availability
E. Awaiting care package in own home
F. Awaiting community equipment and adaptations
G. Patient or Family choice
H. Disputes
I. Housing – patients not covered by NHS and Community Care Act

Source: http://www.england.nhs.uk/statistics/statistical-work-areas/delayed-transfers-of-care/