Performance

There are nine national health and wellbeing outcomes which have been set by the Scottish Government. Each Integration Joint Board (IJB) uses these outcomes to set their local priorities.

Underpinning the nine wellbeing outcomes sits a core suite of integration indicators, which all HSCPs report their performance against. These national indicators have been developed from national data sources to ensure consistency in measurement. The table below shows how the strategic priorities from our Strategic Plan contribute to these national outcomes and the national indicators associated with each priority.

Strategic priority National outcomes this priority contributes to National indicators
Prevention and early intervention Outcome 1: People are able to look after and improve their own health and wellbeing and live in good health for longer

Outcome 4: Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services

Indicator 1

Indicator 7

Indicator 12

Indicator 16

Tackling inequalities Outcome 5: Health and social care services contribute to reducing health inequalities Indicator 11
Person-centred care Outcome 3: People who use health and social care services have positive experiences of those services, and have their dignity respected

Outcome 7: People who use health and social care services are safe from harm

Indicator 3

Indicator 4

Indicator 5

Indicator 9

Indicator 17

Managing our resources effectively Outcome 9: Resources are used effectively and efficiently in the provision of health and social care services Indicator 14

Indicator 20

Making best use of capacity across the system Outcome 8: People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide Indicator 6
Right care, right place, right time Outcome 2: People are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community

Outcome 6: People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing

Indicator 2

Indicator 8

Indicator 13

Indicator 15

Indicator 18

Indicator 19

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 11th to 14th 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.

premature mortality rate
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.

Rate of emergency admissions for adults

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.

Rate for emergency bed days for adults

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.

Emergency readmissions to hospital within 28 days of discharge

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 23rd but there are minimal differences between rates in different partnerships on this measure.

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

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 21st 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.

Falls rate per 1,000 population aged 65+

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 20th to 12th 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.

Percentage of adults with intensive care needs receiving care at home
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 2nd for this indicator; in March 2023 we ranked 8th, with 1st 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.

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

We also report on the performance indicators set by the Ministerial Strategic Group for Health and Community Care (MSG). These performance indicators give a view of how HSCPs are progressing against a range of whole system level measures. The performance indicators are largely based on hospital sector data due to routine availability of national data. While similar to some of the core indicators, these figures are calculated in slightly different ways so are not comparable.

Since the 2017/18 baseline was set, we are moving in the desired direction for all but one of these indicators: Mental Health Bed Days.

Indicator 2017/18 Baseline total Desired direction of travel Latest available figures Achieved Direction of travel Latest Period
A&E Attendances 103,986 99,264 2022/23
Unplanned Admissions 35,597 30,741 2022/23
Emergency Occupied Bed Days:
Acute 330,759 282,529 2022/23
Geriatric Long Stay^ 22,324  18,063^ 2022/23
Mental Health 122,841 126,649p 2022/23
Delayed Discharges 76,933 70,208 2022/23
Last 6 months of life spent in a community setting 85.7% 88.4% 2021/22
Balance of Care: at home# 95.6%# 96.0% 2021/22

^ Geriatric long stay unscheduled occupied bed days data is affected by SMR completeness issue.

p This data is provisional.

# This indicator is still under development and may change in future releases. The Balance of Care 2017/18 baseline figure has been updated since it was last published; it is now 95.5%