Performance
National Indicators
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 2023 is used as a proxy for 2023/24 due to the national data for 2023/24 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 2023 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 latest update was received in July 2024 for the results of the 2023/24 survey. Results for indicators 2, 3, 4, 5, 7 and 9 for 2023/24 are not comparable to previous years due to changes in survey wording so previous years have not been reported here.
For those that are comparable, we have improved slightly on our 2021/22 results though performance continues to be lower than the last pre-pandemic survey in 2019/20. The Edinburgh result was higher than the Scotland result in all but one of the indicators. Edinburgh performed slightly worse than the national figure on NI3: Percentage of adults supported at home who agree that they had a say in how their help, care or support was provided at 57.2% compared to 59.6% for Scotland.
| National Indicator (NI) | 2023/24* | 2021/22* | 2019/20* | ||||
| City of Edinburgh | Scotland | City of Edinburgh | Scotland | City of Edinburgh | Scotland | ||
| NI-1 | Percentage of adults able to look after their health very well or quite well | 91.9% | 90.7% | 91.6% | 90.9% | 93.8% | 92.9% |
| NI-2 | Percentage of adults supported at home who agree that they are supported to live as independently as possible | 75.2% | 72.4% | ||||
| NI-3 | Percentage of adults supported at home who agree that they had a say in how their help, care or support was provided | 57.2% | 59.6% | ||||
| NI-4 | Percentage of adults supported at home who agreed that their health and social care services seemed to be well co-ordinated | 63.1% | 61.4% | ||||
| NI-5 | Total percentage of adults receiving any care or support who rated it as excellent or good | 74.1% | 70.0% | ||||
| NI-6 | Percentage of people with a positive experience of the care provided by their GP practice | 75.1% | 68.5% | 73.8% | 66.5% | 82.5% | 78.7% |
| 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 | 72.0% | 69.8% | ||||
| NI-8 | Total combined % carers who feel supported to continue in their caring role | 31.3% | 31.2% | 30.4% | 29.7% | 33.0% | 34.3% |
| NI-9 | Percentage of adults supported at home who agreed they felt safe | 78.6% | 72.7% | ||||
Source: Scottish Government HACE surveys *Please note results for indicators 2, 3, 4, 5, 7 and 9 for 2023/24 are not comparable to previous years due to changes in survey wording.
Indicator 11: Premature mortality rate
While we remain below the Scottish rate, the rate of premature mortality in Edinburgh continues to remain higher than the levels seen before the pandemic. Edinburgh remains in the top 50% of partnerships but moved from being ranked 14th to 16th out of the 32 areas. The increase in the premature mortality rate has slowed this year though, with only a 0.6% increase between 2022 and 2023, representing a small number of additional deaths.
| 2019 | 2020 | 2021 | 2022 | 2023 | |
| City of Edinburgh | 361 | 406 | 410 | 415 | 417 |
| Scotland | 424 | 455 | 463 | 441 | 442 |
Indicator 12: Rate of emergency admissions for adults
Edinburgh has the lowest rate of emergency admissions in Scotland. The rate has increased slightly from 2022/23 into 2023, likely linked to increased flow through the hospital system.
The rate of emergency admissions varies across our localities, but all are below the national rate, as per the table below:
| 2019/20 | 2020/21 | 2021/22 | 2022/23 | 2023* | |
| City of Edinburgh | 9,482 | 8,564 | 8,592 | 7,340 | 8,038 |
| Scotland | 12,529 | 10,964 | 11,643 | 11,276 | 11,707 |
| North East | 10,235 | 9,133 | 8,898 | 7,407 | 8,315 |
| North West | 9,963 | 9,282 | 9,270 | 8,225 | 8,529 |
| South East | 8,001 | 7,070 | 7,379 | 6,189 | 6,998 |
| South West | 9,946 | 8,956 | 8,922 | 7,600 | 8,424 |
Indicator 13: Rate of emergency bed days for adults
Edinburgh has the fifth lowest rate in Scotland and the rate is the lowest it has ever been. The slight increase in emergency admissions shown in indicator 12 is not seen here, suggesting we continue to improve on length of stay in hospital. This is supported by local data collected through our Early Supported Discharges and Discharge without Delay initiatives, described in the Home First section above.
As with emergency hospital admissions, performance varies across our localities depending on demographics, but remains below the national rate in all areas:
| 2019/20 | 2020/21 | 2021/22 | 2022/23 | 2023* | |
| City of Edinburgh | 105,746 | 93,246 | 101,781 | 98,783 | 92,171 |
| Scotland | 119,753 | 102,875 | 115,308 | 119,806 | 112,883 |
| North East | 101,361 | 90,378 | 98,768 | 98,421 | 94,044 |
| North West | 108,557 | 95,676 | 106,652 | 101,228 | 95,629 |
| South East | 105,906 | 96,907 | 99,585 | 97,957 | 86,250 |
| South West | 106,807 | 88,644 | 101,775 | 97,121 | 92,072 |
Indicator 14: Readmissions to hospital within 28 days of discharge
Edinburgh has increased slightly in the rate of emergency re-admissions to hospital within 28 days of discharge, however we are still below the Scottish rate. In 2021, we asked the Local Intelligence Support Team (LIST) at Public Health Scotland to undertake a deep dive analysis into the reasons behind the higher readmissions rate in Edinburgh. This found a change in admissions practice at the Edinburgh Royal Infirmary was contributing to an increase in admissions for people who had a length of stay of less than 1 day. It also found particularly high rates of readmissions in certain cancer specialities due to admission practices and for reasons related to poisoning (which is believed to include certain aspects of alcohol and drug misuse). These were linked to patients with multiple admissions, a key area of focus for our Home First team.
In 2023, in light of the significant reduction in readmissions rates, in Edinburgh LIST reran this analysis. This found that the higher rates of readmissions among cancer and poisoning specialities remained, as did the higher number of people with multiple admissions, but that the changes at the Edinburgh Royal Infirmary which had led to the increasing rate was no longer a factor, suggesting a further practice change in admissions for short periods. When the admissions through this route are removed, the readmissions rate in Edinburgh is steady over the past five years, suggesting that there has not been a wider trend in readmissions or a change in the needs of the population. The slight increase in 2023 is also to be expected in light of Indicator 12 and the increased flow through the system.
Performance of this indicator varies by locality:
| 2019/20 | 2020/21 | 2021/22 | 2022/23 | 2023* | |
| City of Edinburgh | 119 | 132 | 111 | 92 | 98 |
| Scotland | 105 | 120 | 107 | 102 | 104 |
| North East | 124 | 134 | 113 | 94 | 102 |
| North West | 112 | 137 | 110 | 93 | 95 |
| South East | 119 | 119 | 104 | 86 | 99 |
| South West | 124 | 135 | 117 | 95 | 97 |
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 21st but there are minimal differences between rates in different partnerships on this measure. As outlined in the section on our Older People’s Pathway programme, we are currently undertaking a review of our non-acute hospital and care home services in Edinburgh, including Hospital Based Complex Clinical Care (HBCCC) provision, where we currently have one of the highest bed rates in the country, to ensure that people are able to live in the most appropriate setting for their needs and are not unnecessarily treated in this hospital setting when there could be a more appropriate community setting for them. The changes as a result of this review would likely have an impact upon this end of life measure.
The breakdown by locality is as follows:
| 2019/20 | 2020/21 | 2021/22 | 2022/23 | 2023* | |
| City of Edinburgh | 86% | 88% | 88% | 88% | 88% |
| Scotland | 88% | 90% | 90% | 89% | 89% |
| North East | 87% | 88% | 88% | 88% | 89% |
| North West | 85% | 87% | 88% | 87% | 88% |
| South East | 88% | 89% | 89% | 88% | 89% |
| South West | 87% | 89% | 89% | 89% | 88% |
Indicator 16: Falls rate per 1,000 population in over 65s
Edinburgh saw a drop in the rate of emergency admissions for falls in 2022/23 but this has increased again in 2023. Analysis by LIST at Public Health Scotland on behalf of Edinburgh showed that the change in rate in 2022 was linked to a further change in admission practice at Edinburgh Royal Infirmary, as described under indicator 14. Again when we remove the changes that led to this peak and drop between 2019 and 2022, the rate in Edinburgh evens out, suggesting that there has not been an underlying change in the falls rate or severity of falls. We will continue to explore the data to identify the underlying causes of the increase in 2023.
With a rate of 25.7 per 1,000 over 65’s in 2023, we are above the Scottish figure of 23 and rank 25th out of all the partnerships.
The breakdown by locality is as follows:
| 2019/20 | 2020/21 | 2021/22 | 2022/23 | 2023* | |
| City of Edinburgh | 27 | 27 | 26 | 23 | 26 |
| Scotland | 23 | 22 | 23 | 23 | 23 |
| North East | 30 | 28 | 28 | 22 | 29 |
| North West | 27 | 29 | 27 | 24 | 23 |
| South East | 28 | 27 | 26 | 24 | 26 |
| South West | 23 | 24 | 24 | 21 | 26 |
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. 2023/2024 is the highest in the last five years at 83.5%, 6 percentage points above the figure for Scotland as a whole.
| 2019/20 | 2020/21 | 2021/22 | 2022/23 | 2023/24 | |
| City of Edinburgh | 82% | 83% | 81% | 80% | 83% |
| Scotland | 82% | 82% | 76% | 75% | 77% |
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 Hospital Based Complex Clinical Care (HBCCC), has increased again in 2023, so we remain higher than the Scottish average. 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 is 13th out of 32 partnerships, moving us into the second quartile.
This is likely linked to our progress in reducing our unmet need list for care at home combined with difficulties in arranging care home placements in the external market due to current high costs if care. Currently the only beds available for people requiring a nursing or dementia care home bed, are at prices significantly higher than the national care home rate, making them unaffordable, particularly within the current financial climate. Our Older People’s Pathway programme, outlined above, has a range of workstreams to address this issue, primarily an independent analysis to benchmark the cost of care and a proposal for a care bookings service to streamline the process of negotiating and arranging a care home placement.
| 2019 | 2020 | 2021 | 2022 | 2023 | |
| City of Edinburgh | 61.4% | 59.0% | 61.3% | 66.9% | 68.8% |
| Scotland | 63.0% | 63.0% | 64.5% | 64.6% | 64.8% |
Indicator 19: Number of days people aged 75+ spend in hospital when they are ready to be discharged
We continue to see substantial improvement in delay levels and our 2023/24 rate is the lowest level we have seen, excluding the pandemic year of 2021/22. We have seen a 17% reduction over 2023/24 compared to a 2% decrease nationally and our delays bed days rate is now lower than it was before the pandemic. For 2023/24 as a whole, we rank at 23rd in Scotland, compared to 26th out of 32 in 2022/23.
However, we know the pressure that delays can have within our hospital system so we are continuing our focus on improvement in this area. Care home placements for those with complex needs has been a challenging area in Edinburgh for some time. While the external care at home market continues to be responsive to our demands and prioritises support for those in hospital, there continues to be some instability within the external market with a small number of our commissioned care at home providers currently suspended, subject to enhanced monitoring and/or controlled growth, which is affecting our waitlist figures.
These issues are long-standing and intractable, and will take significant shifts within the system to fully resolve, however some of the actions we are taking to support this include:
- Implemented minimum of twice weekly huddles to review the position of each of our services to support discharges (currently daily due to increased number of people delayed).
- Implemented a brokerage team to facilitate flow to packages of care at home.
- Implemented a nursing model at three of our internal care homes to provide for residents with more complex needs.
- Undertaking a strategic review of care home services in Edinburgh.
- Moving our internal service to a reablement model to support more people to live as independently as possible.
- Shifting our external care at home market from competitive, shorter term commissioning models to long term collaboration and partnership commissioning.
- Ongoing work through the Home First project on implementing a Planned Date of Discharge will also support more proactive discharge planning.
| 2019/20 | 2020/21 | 2021/22 | 2022/23 | 2023/24 | |
| City of Edinburgh | 1,175 | 579 | 1,388 | 1,310 | 1,087 |
| Scotland | 774 | 484 | 748 | 919 | 902 |
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.