the nhs outcomes framework 2014/15...outcomes frameworks, sits at the heart of the health and care...

The NHS Outcomes Framework 2014/15

November 2013

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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.

http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825

https://www.gov.uk/government/publications/liberating-the-nhs-white-paper


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.

https://www.gov.uk/government/publications/nhs-mandate-2014-to-2015

http://www.england.nhs.uk/wp-content/uploads/2013/04/ppf-1314-1516.pdf

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,


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.

https://www.gov.uk/government/publications/education-outcomes-framework-for-healthcare-workforce


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

https://www.gov.uk/government/policy-advisory-groups/outcomes-framework-technical-advisory-group


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.


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.


Domain 2 – Enhancing quality of life for people with long-term conditionsSummary of indicators being developed

Indicator TitleStatus in

last refreshCurrent status



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


• 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.


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




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.


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.


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




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.


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.

https://www.gov.uk/government/publications/nhs-future-forum-recommendations-to-government-on-nhs-modernisation

https://www.gov.uk/government/publications/caring-for-our-future-reforming-care-and-support


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



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


• 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)


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]


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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


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

)

the nhs outcomes framework 2014/15...outcomes frameworks, sits at the heart of the health and care...

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