PSA 25

The NHS Operating Framework and Vital Signs

The Operating Framework for 2008/09 describes the business processes required throughout the system to support delivery against the national priorities. PCTs are required to develop an operation plan that:

• Describes local targets, how they have been agreed and how they will be achieved
• Defines success
• Detail milestones
• Detail LAA content on health outcomes

The Operating Framework , published at the end of last year, introduced a new approach to planning and managing our priorities, both nationally and locally - the Vital Signs. The planning guidance, published in February 2008, explains how organisations can use the Vital Signs to develop local operational plans to deliver against national priorities and how to select - or even create - local priorities. The document sets out how performance will be managed against each of the three tiers of the Vital Signs

Tiers

The Operating Framework sets out three tiers of 'vital signs'.

• Tier 1 - applies to all PCTs and details the 'must dos'. This will involve central monitoring and performance management by SHAs
• Tier 2 - are national priorities, agreed locally and signed off by the SHAs
• Tier 3 - are local actions to be agreed at local level and not performance managed

The 'vital signs' includes an alcohol indicator 'Rate of hospital admissions per 100,000 population for alcohol related harm':

• Vital Signs Operational Plans
  This planning guidance explains how organisations can use the Vital Signs to develop local operational plans to deliver against national priorities and how to select - or even create - local priorities....
• Vital Signs Poster
  This planning guidance tool accompanies the Operational Framework 2008/9-2010/11.

Alcohol-related admissions trends data

DH provides quarterly and annual admissions trend data for every PCT against each of the conditions which are significantly (>20%) attributable to alcohol. These data will indicate existing trends in alcohol related ill-health for every PCT and provide a baseline against which PCTs can measure delivery of the indicator.

Technical Information and Definition for Vital Signs Indicator VSC26, National Indicator Set NI39 and Public Service Agreement Indicator 25.2 are available on Local Alcohol Profiles for England.

• Local Alcohol Profiles for England
  Web based resource to support Joint Strategic Needs Assessment. The North West Public Health Observatory (NWPHO) has produced the first local alcohol profiles set covering a range of indicators ranging...

PSA and the NHS Vital Signs Indicator

Public Service Agreement (PSA 25) is the first ever PSA to target alcohol admissions. PSA 25 Indicator 2: The number of alcohol-related hospital admissions will,

"drive the reduction of the harms caused to health and well-being by frequent consumption of harmful levels of alcohol. But it will also measure the impact of prevention interventions: when they are improved, hospital admission for specific chronic and acute conditions are expected to slow in the short, medium and long term." PSA Delivery Agreement 25, Oct 2007

The Vital Signs Indicator (VSC 26) for the NHS from April 2008 will measure change in the rate of alcohol admissions. This will encourage the NHS to identify at an earlier stage those patients who might be drinking too much, so they can get the help they need.

Reducing alcohol admissions is included in the National Indicator Set for Local Authorities and Local Authority Partnerships (NIS 39).

This is the best indicator to demonstrate levels of alcohol misuse and related ill-health for conditions with a significant association with alcohol. Hospital Episode Statistics (HES) data are considered to be sensitive to prevention interventions and will form the basis for measuring the impact of local actions. Improved prevention and treatment interventions will have a direct impact on the rate of alcohol admissions.

Previously, published HES data showed that the top three reasons for alcohol admissions were alcoholic liver disease, alcohol poisoning and mental and behavioral disorders. There were 207,000 admissions for these reasons in 2006/7, rising at around 20,000 admissions a year.

Based on robust international research, VSC 26 has been expanded to include a number of conditions that are fully or partially attributable to alcohol consumption. The total number of alcohol admissions in 2006/7 using these attributable fractions is 811,000 and is currently rising by around 80,000 admissions a year.

Although the use of all attributable fractions will appear to represent a significant increase in current alcohol related admission estimates (from approximately 200k to 800k p.a.), This is not a real increase in the overall hospital admission rates. Instead, the percentage of all NHS admissions attributed to alcohol is revised from approximately 1.5% to approximately 6%.

If rising at the trend rate, alcohol related hospital admissions are projected to increase by 25% over the PSA period, or roughly 80,000 per year. Based on existing PCT plans, where these include this indicator, plus an assessment of the impact of central Government decisions, this predicted 25% increase is currently expected to become an 11% increase by 2010-11, meaning delivery of a 14% reduction over three years against the current trend.

This would translate into a total of 140,000 admissions avoided over the PSA period, with the overall rate rising at only 40,000 per year at the end of the period rather than the 80,000 forecast.

• National Indicator NI39
  This extract taken from: National Indicators for Local Authorities and Local Authority Partnerships: Handbook of Definitions Annex 1: Stronger and Safer Communities provides the definitions, rationales...
• PSA Delivery Agreement 25 : reduce the harm caused by alcohol and drugs
  This strategic government publication describes the PSA 25 vision, measurement and delivery strategy. For further publications relating to PSA 25 see the LAA National Indicator pages on this site....

Further information can be found on the following pages:

• Alcohol Harm Data
• Supporting PCT's
• High Impact Changes
• National Indicators and NI 39
• Primary Care
• National Support Team

Useful Links:

• National Indicator Publications
  National Indicators for Local Authorities and Local Authority Partnerships: Handbook of Definitions. This publication below gives final detailed definitions for 198 national indicators following consultation...
• Audit Commission National Indicators
  All effective organisations measure their performance in order to know how well they are doing and to identify opportunities for improvement. The Audit Commission aims to stimulate significant improvement...