Health and Wellbeing Outcomes and National Indicators
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.
The table below shows how the strategic priorities form our Strategic Plan contribute to these national outcomes.
| Strategic priority | National outcomes this priority contributes to | Associated 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 & social care services are centred on helping to maintain or improve the quality of life of people who use those services |
|
| Tackling inequalities | Outcome 5: Health & social care services contribute to reducing health inequalities | |
| Person-centred care | Outcome 3: People who use health & 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 |
|
| Managing our resources effectively | Outcome 9: Resources are used effectively and efficiently in the provision of health and social care services | |
| Making best use of capacity across the system | Outcome 8: People who work in health & social care services feel engaged with the work they do and are supported to continuously improve information, support, care and treatment they provide | |
| 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 |
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. There are 23 indicators but four of them (indicators 10, 21, 22 and 23) have not yet been finalised for reporting.
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 national indicators 11 to 20 are Scottish Morbidity Records (SMRs) which are nationally collected discharge-based hospital records.
Calendar year 2020 is used for some of the indicators as a proxy for 2020/21 due to the national data for 2020/21 being incomplete. We have done this following guidance from Public Health Scotland and to improve consistency between our report and those for other Health and Social Care Partnerships. Please note that figures presented will not take into account the full impact of covid-19 during 2020/21.
Performance against national indicators
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. This survey is sent randomly to around 5% of the Scottish population every two years.
The most recent survey results for inclusion in this report are from the 2019/20 survey. In 2019/20 the survey was sent to 46,099 people in Edinburgh with 11,415 responses which shows a response rate of 25%. The response rate across Scotland was also 26%. The methodology was changed in 2019/20 therefore, following advice from PHS, we have provided the results from previous surveys but have not made direct comparisons.
Edinburgh is above the Scottish average for 2019/20 in six of the nine HACE survey indicators, as shown in the table below.
| National Indicator (NI) | 2019/20* Edinburgh | 2019/20* Scotland | 2015/16* Edinburgh | 2015/16* Scotland | 2017/18* Edinburgh | 2017/18* Scotland |
|---|---|---|---|---|---|---|
| NI-1:Percentage of adults able to look after their health very well or quite well | 93.8% | 92.9% | 96.1% | 95.0% | 93.6% | 93.0% |
| NI-2:Percentage of adults supported at home who agree that they are supported to live as independently as possible | 77.6% | 80.8% | 80.8% | 83.0% | 78.6% | 81.0% |
| NI-3:Percentage of adults supported at home who agree that they had a say in how their help, care or support was provided | 76.7% | 75.4% | 77.4% | 79.0% | 73.8% | 76.0% |
| NI-4:Percentage of adults supported at home who agree that their health and social care services seemed to be well co-ordinated | 72.6% | 73.5% | 71.4% | 75.0% | 66.7% | 74.0% |
| NI-5:Percentage of adults receiving any care or support who rated it as excellent or good | 82.2% | 80.2% | 78.1% | 81.0% | 80.4% | 80.0% |
| NI-6:Percentage of people with a positive experience of the care provided by their GP practice | 82.5% | 78.7% | 86.9% | 85.0% | 84.2% | 83.0% |
| 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 | 83.2% | 80.0% | 82.6% | 83.0% | 78.9% | 80.0% |
| NI-8:Percentage of carers who feel supported to continue in their caring role | 33.0% | 34.3% | 36.6% | 40.0% | 34.8% | 37.0% |
| NI-9:Percentage of adults supported at home who agreed they felt safe | 86.5% | 82.8% | 81.8% | 83.0% | 77.5% | 83.0% |
*Figures for 2019/20 are not directly comparable to previous years due to changes in methodology. Source: Scottish Government HACE surveys.
The areas where we are just below the Scottish average are:
- Adults supported at home agree that they are supported to live as independently as possible
- Adults supported at home agree that their health and social care services seemed to be well co-ordinated
- Carers feel supported to continue in their caring role
We continue to focus on improvement in each of these areas. Our Home First project, described here, seeks to increase the provision of care and support in the community so people can continue to live as independently as possible. The project is also looking at pathways through the health and social care services to ensure that these are provided in ways that are well coordinated between services and makes sense for the individuals experiencing those services.
The Three Conversations approach, currently being rolled out as shown here, focuses on working differently to achieve improved outcomes for people and families. This includes collaborating with the people who are referred to our services to focus on what matters to them and help them make connections or build relationships in order to go on with their life independently. Our Three Conversations approach also seeks to improve coordination between services by ensuring a holistic approach is taken to the needs of individuals to connect them with the different services, both internally and in the community, that will best support their needs.
We have also put in place new contracts to support the implementation of the Joint Carers’ Strategy, as described here. These will focus on increasing support for the health and wellbeing of carers as well as the provision of robust advice and information. As with many areas across Scotland, we still have work to do to identify all those in caring roles in Edinburgh and ensure they receive the support they need.
The impact of the pandemic can sadly be seen in this indicator. After declining for years, the premature mortality rate rose sharply in Edinburgh in 2020. This increase was also seen across Scotland. Edinburgh continues to have a lower premature mortality rate than the Scottish average, and in 2020 Edinburgh is ranked 15 out of the 31 health and social care partnerships in Scotland.
Our Edinburgh Wellbeing Pact and community mobilisation approach will support continued improvement in this indicator, as described earlier. The Pact is underpinned by a shared common purpose: to achieve and maximise the wellbeing of all our citizens. It sets out a reciprocal agreement with the people of Edinburgh to create healthy communities, empowered by local services and organisations that support people to prevent crisis and manage their health and personal independence at home, working together to put wellbeing first.
| 2016 | 2017 | 2018 | 2019 | 2020 | |
|---|---|---|---|---|---|
| Edinburgh | 399 | 380 | 386 | 360 | 405 |
| Scotland | 440 | 425 | 432 | 426 | 457 |
Source: Public Health Scotland
We continue to have a much lower rate for emergency admissions than the Scottish average. The Edinburgh rate is the second lowest in Scotland, following Aberdeenshire.
The rate increased in 2019/20 due to a service change at A&E at the Royal Infirmary Edinburgh that artificially increased the number of emergency admissions. This change will continue to affect the emergency admission rate in 2020, however this has also been influenced by changes in behaviour due to the pandemic, with fewer people attending hospital A&E departments. The drop in emergency admissions in 2020 was much lower in Edinburgh than in Scotland, likely reflecting the lower number of emergency admissions to begin with. Due to the disruption over the last year, we can’t accurately assess the ongoing trend in this indicator.
While we cannot yet know whether this behaviour change will be sustained, our Home First project, described here, continues to look for ways to treat patients at home or in the community where appropriate, including through a redesign of unscheduled care pathways.
The differences in the rate between our localities reflects the different demographics of these localities, shown here.
| 2016/17 | 2017/18 | 2018/19 | 2019/20 | 2020* | |
|---|---|---|---|---|---|
| Edinburgh | 8,512 | 8,670 | 8,564 | 9,481 | 8,711 |
| Scotland | 12,229 | 12,210 | 12,279 | 12,522 | 11,100 |
| Our localities | |||||
| North East | 8,852 | 9,042 | 9,128 | 10,210 | 9,391 |
| North West | 9,360 | 9,471 | 8,961 | 9,974 | 9,267 |
| South East | 7,480 | 7,502 | 7,306 | 7,998 | 7,303 |
| South West | 8,402 | 8,750 | 9,059 | 9,959 | 9,071 |
*2020 calendar year data has been used instead of 2020/21 financial year data due to data availability.
Source: Public Health Scotland
Like the rate of emergency admissions, the rate of emergency bed days has been consistently below the Scottish average over the last five years. We are the eighth best performing partnership on this indicator.
This indicator has also been affected by the impact of the pandemic and fewer people attending our hospital for emergency treatment. We are therefore unable to accurately compare to previous years, as we are unable to identify how much of the continuing drop in emergency bed days is due to the pandemic.
As with the rate of emergency admissions, the rate of emergency bed days varies across our localities depending on demographics outlined here.
| 2016/17 | 2017/18 | 2018/19 | 2019/20 | 2020* | |
|---|---|---|---|---|---|
| Edinburgh | 120,090 | 114,035 | 112,425 | 104,646 | 91,920 |
| Scotland | 125,948 | 122,388 | 120,155 | 118,288 | 101,852 |
| Our localities | |||||
| North East | 113,830 | 103,505 | 106,451 | 98,567 | 87,934 |
| North West | 129,659 | 120,854 | 114,742 | 105,552 | 90,960 |
| South East | 133,043 | 127,709 | 120,753 | 110,399 | 101,998 |
| South West | 98,478 | 99,542 | 105,390 | 102,810 | 84,613 |
*2020 calendar year data has been used instead of 2020/21 financial year data due to data availability.
Source: Public Health Scotland
Edinburgh has been consistently above the Scottish average on this indicator and ranks in the lowest 20% of partnerships. Work is ongoing to better understand the reasons behind this high rate of readmissions and look at how we can target improvements in this area.
This indicator was also affected by the pandemic, with a sharp increase in both Edinburgh and Scotland between 2019/20 and 2020. The increase in rate in Edinburgh is roughly the same as the increase in Scotland. This is likely partially due to the lower number of people in hospital over 2020, meaning that those in hospital have more complex issues and are therefore more likely to have recurring issues that result in the need to be readmitted. Again, we can’t accurately compare this indicator to previous years due to the impact of the pandemic on these figures.
| 2016/17 | 2017/18 | 2018/19 | 2019/20 | 2020* | |
|---|---|---|---|---|---|
| Edinburgh | 110 | 112 | 112 | 119 | 130 |
| Scotland | 101 | 103 | 103 | 105 | 114 |
| Our localities | |||||
| North East | 113 | 110 | 119 | 124 | 131 |
| North West | 104 | 106 | 104 | 112 | 130 |
| South East | 116 | 116 | 109 | 119 | 122 |
| South West | 107 | 117 | 119 | 124 | 135 |
* 2020 calendar year data has been used instead of 2020/21 financial year data due to data availability.
Source: Public Health Scotland
Edinburgh has a lower rate than the Scottish average on this indicator but while we have one of the lowest rates in Scotland, the difference with the national average is small. Over the last five years, we have made progress to close this gap and improve our performance in this space. As this measure is based on how much time people spent in hospital during the last six months of their life, the lower numbers in hospital in 2020 will have affected the trend.
Our Home First project is continuing to focus on supporting people at home or in a community setting where appropriate, including through our Hospital at Home service. Our bed based strategy is also looking to ensure we have the right mix of beds across hospital and community settings to support a shift in the balance of care to the community.
| 2016/17 | 2017/18 | 2018/19 | 2019/20 | 2020* | |
|---|---|---|---|---|---|
| Edinburgh | 85% | 86% | 85% | 87% | 88% |
| Scotland | 87% | 88% | 88% | 88% | 90% |
| Our localities | |||||
| North East | 85% | 85% | 85% | 87% | 88% |
| North West | 82% | 84% | 83% | 85% | 86% |
| South East | 86% | 87% | 87% | 88% | 90% |
| South West | 87% | 86% | 86% | 87% | 89% |
* 2020 calendar year data has been used instead of 2020/21 financial year data due to data availability.
Source: Public Health Scotland
The falls rate in Edinburgh is higher than the national average and in 2020 we have the third highest rate out of all the health and social care partnerships. However, in 2018/19 we had the 12th lowest rate out of the 31 partnerships. This rate is based on the number admitted to hospital following a fall, rather than all falls in the community.
The rate increased sharply from 2019/20 and was accompanied by a drop in the average length of stay following admission. It is likely this is linked to the service change at A&E at the Royal Infirmary Edinburgh that artificially inflated emergency admission numbers.
The restriction in activities associated with the pandemic may also have influenced this figure in 2020. Many people could have lost fitness or muscle tone following the inability for them to continue their normal activities, particularly those who were shielding. This increases the risk of falls and may have offset the reducing numbers attending hospital last year.
The staying active activities described here, run through our long term conditions programme and funded through our grants programme, continue to support our vulnerable population and those with long term conditions to stay active and reduce the likelihood of falls.
| 2016/17 | 2017/18 | 2018/19 | 2019/20 | 2020* | |
|---|---|---|---|---|---|
| Edinburgh | 21.7 | 23.4 | 21.9 | 26.8 | 26.7 |
| Scotland | 21.4 | 22.2 | 22.5 | 22.8 | 21.7 |
| Our localities | |||||
| North East | 22.0 | 25.0 | 23.0 | 30.0 | 29.2 |
| North West | 22.0 | 24.0 | 22.0 | 27.0 | 27.8 |
| South East | 24.0 | 23.0 | 22.0 | 28.0 | 26.4 |
| South West | 19.0 | 21.0 | 21.0 | 23.0 | 23.1 |
* 2020 calendar year data has been used instead of 2020/21 financial year data due to data availability.
Source: Public Health Scotland
Indicator 17 has also been affected by the pandemic, as the Care Inspectorate altered the way they ran inspections and their areas of focus during the inspections.
Advice from directors of Public Health in Scotland was that inspection visits would present a real risk of introducing and spreading covid-19 in Scotland’s care homes. With agreement from Scottish Government, the Care Inspectorate therefore restricted their presence in services unless necessary. This approach resulted in most services not being graded as normal and instead retaining the grades they had last received.
Instead the Care Inspectorate intensified oversight using a range of remote and virtual approaches to ensure services were supported and operating well throughout the pandemic. The Care Inspectorate also developed a new question to allow them to focus inspections on how services were responding to pandemic, particularly in relation to increased infection prevention and control requirements.
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.
In 2020/21, 84% of care services in Edinburgh had a grade of ‘good’ (4) or better, compared to 83% in Scotland, meaning we are above the Scottish average. We rank 20th out of 31 partnerships on this indicator. A summary of the Care Inspectorate reviews of our services during financial year 2020/21 and the work we have done to improve services in our care homes is shown here.
| 2016/17 | 2017/18 | 2018/19 | 2019/20 | 2020/21 | |
|---|---|---|---|---|---|
| Edinburgh | 84% | 88% | 84% | 82% | 84% |
| Scotland | 84% | 85% | 82% | 82% | 83% |
Source: Care Inspectorate
There has been a slight drop in the percentage of adults with intensive needs receiving care at home (those receiving personal care or direct payments for personal care) in 2020 from 61.4% to 59%. We remain below the national average and are ranked 24th out of 31 partnerships. In 2020 this indicator has likely been affected by the need to prioritise our support to the most vulnerable during the pandemic.
We continue to work to shift the balance of care from hospital settings to the community, including through our bed-based review and Home First approach.
| 2016 | 2017 | 2018 | 2019 | 2020 | |
|---|---|---|---|---|---|
| Edinburgh | 62.4% | 61.6% | 61.8% | 61.4% | 59.0% |
| Scotland | 61.6% | 60.7% | 62.1% | 63.1% | 62.9% |
Source: Public Health Scotland
The rate of bed days lost due to delayed discharge for those over 75 has decreased sharply in 2020/21 for both Edinburgh and Scotland. The figure for Edinburgh was 579 compared to 488 in Scotland. This is a decrease in Edinburgh from 1,175 in 2019/20.
The 2020/21 figures will be affected by the pandemic both due to the lower number of people being admitted to hospital and the focus on this area to free up beds to increase hospital capacity. However, between 2019/20 and 2020/21, this figure decreased by 51% in Edinburgh compared to a 37% decrease in the figure for Scotland. We remain higher than the national level, but the gap has closed over the last few years. In 2020/21 we were ranked 22nd out of 31 partnerships, an improvement from our ranking of 27th in 2019/20.
We continue to work to reduce the levels of delayed discharges in Edinburgh, however these are likely to increase again as our services remobilise and pressures on capacity increases following the removal of restrictions. Our bed-based strategy will implement changes that support increased capacity in intermediate care and nursing homes and a smoother pathway for referrals to additional bed-based care. Ongoing work through the Home First project on implementing a Planned Date of Discharge will also support more proactive discharge planning.
| 2016/17 | 2017/18 | 2018/19 | 2019/20 | 2020/21 | |
|---|---|---|---|---|---|
| Edinburgh | 1,395 | 1,502 | 1,621 | 1,175 | 579 |
| Scotland | 841 | 762 | 793 | 774 | 488 |
Source: Public Health Scotland
The percentage of total health and care spend on hospital stays resulting from emergency admissions has decreased in 2020. This figure includes spend that is not part of our budget so does not match our financial information. The figure in 2020 likely decreased due to the combination of increased spending, primarily community based, due to the pandemic, and the lower numbers of emergency admissions. As with other indicators, this means that we are unable to accurately compare trends across years.
This indicator is linked to our desire to shift the balance of care from hospital settings to the community where appropriate. This is supported by our Home First, bed-based strategy and community mobilisation projects within our Transformation programme. We have described our own financial situation in more detail here.
| 2016/17 | 2017/18 | 2018/19 | 2019/20 | 2020* | |
|---|---|---|---|---|---|
| Edinburgh | 23.5% | 24.3% | 23.8% | 23.2% | 21.1% |
| Scotland | 23.4% | 24.1% | 24.1% | 24.1% | 21.0% |
* 2020 calendar year data has been used instead of 2020/21 financial year data due to data availability.
Source: Public Health Scotland
We also report performance indicators to the Scottish Government through 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.
As with the core indicators, these figures have been impacted by the pandemic. The restrictions on both people’s movement and hospital activity resulted in lower numbers of A&E attendances, unplanned admissions, emergency bed days and delayed discharges. The percentage of the last 6 months spent in community setting and the population over 65 living at home (balance of care) were also likely affected by the reduction in hospital activity.
A summary of the MSG measures and performance for Edinburgh in 2020/21 is shown in the table below. No targets were set for 2020/21 due to the pandemic.
| Indicator | 2017/18 Baseline total | Desired direction of travel | Latest available figures | Latest period available |
|---|---|---|---|---|
| A&E Attendances | 103,986 | ↓ | 83,458 | 2020/21 |
| Unplanned Admissions | 35,597 | ↓ | 36,642+ | 2020 |
Emergency Occupied Bed Days:
|
30,759 22,234 122,841 |
↓ ↓ ↓ |
268,972 19,472^ 131,002p |
2020 2020/21 2019/20 |
| Delayed Discharges | 79,933 | ↓ | 32,798 | 2020/21 |
| Last 6 months of life spent in a community setting | 85.7% | ↑ | 86.7%p | 2019/20 |
| Balance of Care# | 95.5% | ↑ | 95.7%p | 2019/20 |
+More detail on the change in emergency admissions since 2017/18 is provided under national indicator 12.
^ 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 was previously 95.6%.