There are 23 indicators but four of them (indicators 10, 21, 22 and 23) have not yet been finalised for reporting and one (indicator 20) has not been reported since the pandemic due to data issues. National indicators (NI) 1 to 9 are based on the Scottish Health and Care Experience Survey (HACE) commissioned by the Scottish Government. The primary source of data for indicators 12 through 16 are Scottish Morbidity Records (SMRs), which are nationally collected discharge-based hospital records. For these indicators, calendar year 2022 is used as a proxy for 2022/23 due to the national data for 2022/23 being incomplete. We have done this following guidance issued by Public Health Scotland which was communicated to all Health and Social Care Partnerships. Using more complete calendar year data for 2022 should improve the consistency of reporting between Health and Social Care Partnerships.

Health and Care Experience Survey Indicators

National indicators (NI) 1 to 9 are based on the Scottish Health and Care Experience Survey (HACE) commissioned by the Scottish Government and sent randomly to around 5% of the Scottish population every two years. The next update is due in May 2024. The results of the most recent 2021/22 survey were reported in last year’s Annual Performance Report, reproduced for reference below. Reductions in almost all indicators since 2019/20 suggested the pandemic had affected both local and national responses.

National Indicator (NI)	2021/22 Edinburgh	2021/22 Scotland	2019/20 Edinburgh	2019/20 Scotland	2017/18* Edinburgh	2017/18* Scotland	2015/16* Edinburgh	2015/16* Scotland
NI-1: Percentage of adults able to look after their health very well or quite well	91.6%	90.9%	93.8%	92.9%	93.6%	92.9%	96.1%	94.5%
NI-2: Percentage of adults supported at home who agree that they are supported to live as independently as possible	78.9%	78.8%	77.6%	80.8%
NI-3: Percentage of adults supported at home who agree that they had a say in how their help, care or support was provided	68.9%	70.6%	76.7%	75.4%
NI-4: Percentage of adults supported at home who agree that their health and social care services seemed to be well co-ordinated	64.8%	66.4%	72.6%	73.5%
NI-5: Percentage of adults receiving any care or support who rated it as excellent or good	77.4%	75.3%	82.2%	80.2%
NI-6: Percentage of people with a positive experience of the care provided by their GP practice	73.8%	66.5%	82.5%	78.7%	84.2%	82.6%	86.9%	85.3%
NI-7: Percentage of adults supported at home who agree that their services and support had an impact on improving or maintaining their quality of life	79.2%	78.1%	83.2%	80.0%
NI-8: Percentage of carers who feel supported to continue in their caring role	30.4%	29.7%	33.0%	34.3%	34.8%	36.5%	36.6%	40.0%
NI-9: Percentage of adults supported at home who agreed they felt safe	79.4%	79.7%	86.5%	82.8%

Source: Scottish Government HACE surveys *Please note that 2019/20 and 2021/22 results for indicators 1, 2, 3, 4, 5, 7 and 9 in the Core Suite Integration Indicator update may differ from those recently released in the HACE publication. In addition, results for some indicators are only comparable to 2019/20 and not to results in earlier years.

Indicator 11: Premature mortality rate

While we remain below the Scottish rate, the rate of premature mortality in Edinburgh has increased slightly over the past year, against a backdrop of improving performance across Scotland. Edinburgh remains in the top 50% of partnerships but moved from being ranked 11^th to 14^th out of the 32 areas. This represents a small number of additional deaths, but more work will be undertaken to understand why the trend in Edinburgh is not consistent with the wider country.

	2018	2019	2020	2021	2022
City of Edinburgh	386	360	405	407	411
Scotland	432	426	457	466	442

Indicator 12: Rate of emergency admissions for adults

Edinburgh has the lowest rate of emergency admissions in Scotland, and it is now the lowest it has been in at least six years, including during the pandemic. While admissions are affected by flow through the hospital system, 2022/23 also saw the lowest rate of A&E attendances by Edinburgh residents for many years.

The rate of emergency admissions varies across our localities, as per the table below:

	2018/19	2019/20	2020/21	2021/22	2022*
City of Edinburgh	8,566	9,482	8,554	8,571	7,472
Scotland	12,284	12,529	10,957	11,632	11,155
North East	9,134	10,235	9,128	8,887	7,596
North West	8,962	9,963	9,272	9,230	8,369
South East	7,303	8,001	7,058	7,374	6,244
South West	9,065	9,946	8,940	8,897	7,751

Indicator 13: Rate of emergency bed days for adults

Edinburgh has the seventh lowest rate in Scotland and the rate is the lowest it has ever been, other than during the pandemic. The decrease in emergency bed days in the last year has been sharper for Edinburgh than Lothian or Scotland as a whole.

As with emergency hospital admissions, performance varies across our localities depending on demographics:

	2018/19	2019/20	2020/21	2021/22	2022*
City of Edinburgh	112,193	105,746	91,722	99,005	93,387
Scotland	121,174	119,753	101,967	112,939	113,134
North East	108,143	101,361	88,545	96,170	92,825
North West	115,417	108,557	95,104	104,369	96,759
South East	114,311	105,906	94,207	94,641	88,599
South West	109,839	106,807	87,777	100,933	95,818

Indicator 14: Readmissions to hospital within 28 days of discharge

Edinburgh has seen a sharp drop in the rate of emergency re-admissions to hospital within 28 days of discharge and is now below the Scottish rate. The re-admissions rate improved across the whole of Lothian so further analysis will be undertaken alongside other Lothian HSCPs to understand the factors supporting this improvement and how it can be maintained.

Performance of this indicator varies by locality:

	2018/19	2019/20	2020/21	2021/22	2022*
City of Edinburgh	112	120	132	111	94
Scotland	103	105	120	107	102
North East	119	124	134	113	96
North West	104	112	137	110	94
South East	110	119	119	104	86
South West	119	124	135	118	98

Indicator 15: Proportion of last 6 months of life spent at home or in community setting

The Edinburgh rate is now the highest it has ever been and is almost in line with the Scottish rate. Edinburgh is ranked 23^rd but there are minimal differences between rates in different partnerships on this measure.

The breakdown by locality is as follows:

	2018/19	2019/20	2020/21	2021/22	2022*
City of Edinburgh	85%	86%	88%	88%	88%
Scotland	88%	88%	90%	90%	89%
North East	85%	87%	88%	88%	88%
North West	83%	85%	87%	88%	88%
South East	87%	88%	89%	89%	89%
South West	86%	87%	89%	89%	89%

Indicator 16: Falls rate per 1,000 population in over 65s

Edinburgh has seen a drop in the rate of emergency admissions for falls in 2022 and the rate is the lowest it has been since changes were made to admission practices in Lothian (at the Edinburgh Royal Infirmary) in 2019. However, with a rate of 23.4, we are slightly above the Scottish figure of 22.1 and rank 21^st out of all of the partnerships. The falls rate also improved across the whole of Lothian so further analysis will be undertaken alongside other Lothian partnerships to understand the factors supporting this improvement and how it can be maintained.

The breakdown by locality is as follows:

	2018/19	2019/20	2020/21	2021/22	2022*
City of Edinburgh	22	27	27	26	23
Scotland	23	23	22	23	22
North East	23	30	28	28	22
North West	22	27	29	27	26
South East	22	28	26	25	24
South West	21	23	24	24	21

Indicator 17: Proportion of care services graded ‘good’ (4) or better in Care Inspectorate inspections

Following a reduction in inspection frequency due to the Covid-19 pandemic, 2022/23 saw the resumption of inspections across all sectors in the Partnership. The data for NI-17 comes from the Care Inspectorate and covers all registered services in Edinburgh, not just those that we run. The figure covers the latest inspection result for each registered service, even if the inspection took place before the referenced financial year. While the figure of 80% for 2022/23 represents the lowest figure for the partnership in five years, it is 5% above the figure for Scotland as a whole.

	2018/19	2019/20	2020/21	2021/22	2022/23
City of Edinburgh	84.2%	82.1%	82.9%	80.6%	80.0%
Scotland	82.2%	81.8%	82.5%	75.8%	75.2%

Indicator 18: Percentage of adults with intensive needs receiving care at home

The percentage of adults receiving personal care at home (rather than in residential care or HBCCC) has increased slightly in 2022, taking us above the Scottish average. This is likely linked to our progress in reducing our unmet need list for care at home.

Our performance in this indicator has improved compared to the previous year and is now at the highest level in the last six years. Our ranking compared to other partnerships improved from 20^th to 12^th out of 32 partnerships, moving us into the second quartile. We continue to work to shift the balance of care from hospital settings to the community, through our bed-based review and Home First approach.

	2018	2019	2020	2021	2022
City of Edinburgh	61.8%	61.4%	59.0%	61.6%	65.7%
Scotland	62.1%	63.0%	63.0%	64.6%	63.5%

Indicator 19: Number of days people aged 75+ spend in hospital when they are ready to be discharged

Edinburgh is one of only four partnerships that saw improved performance in delays in 2022/23. Our performance improved in each quarter so the results do not reflect the progress made throughout the year. In March 2022 we ranked 2^nd for this indicator; in March 2023 we ranked 8^th, with 1^st being the worst performing.

The improvement in delay levels has been supported by our interim placement programme, which supported 174 people out of hospital saving 12,988 bed days in 2022/23, and work under way through our ‘One Edinburgh’ approach to home-based care is supporting increased efficiency and capacity gains in this sector. Our bed-based strategy will implement changes that support increased capacity in intermediate care and a move to a nursing model within our internal care homes. Ongoing work through the Home First project on implementing a Planned Date of Discharge will also support more proactive discharge planning.

	2018/19	2019/20	2020/21	2021/22	2022/23
City of Edinburgh	1,621	1,175	579	1,388	1,310
Scotland	793	774	484	748	919

Indicator 20: Percentage of total health and care spend on hospital stays where the patient was admitted in an emergency

NHS Boards have not been able to provide detailed cost information since 2019/20 due to changes in service delivery during the COVID-19 pandemic. As a result, PHS have not provided information for indicator 20 beyond 2019/20. PHS previously published information to calendar year 2020 using costs from 2019/20 as a proxy, but given the impact of the COVID-19 pandemic on activity and expenditure, PHS no longer consider this appropriate.