Birmingham Health and Wellbeing Strategy Performance ...
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1 Birmingham Health and Wellbeing Strategy Performance Summary – June ʹͲͳ4
Transcript of Birmingham Health and Wellbeing Strategy Performance ...
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Birmingham Health and Wellbeing Strategy Performance Summary – June 4
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Introduction
This report enables the Birmingham Health and Wellbeing Board to monitor progress against its Health and Wellbeing Strategy and the achievement of its vision to be a
City that sets the health and wellbeing of its most vulnerable citizens as its most important priority and that has an integrated health and social care system that is both
resilient and sustainable .
The overarching aims of the Strategy are to:
Improve the health and wellbeing of our most vulnerable adults and children in need
Improve the resilience of our health and care system
Improve the health and wellbeing of our children
The Birmingham Health and Wellbeing Strategy spans the health and wellbeing system for children, young people and adults and involves partners from the NHS, local
authority, social care, public health, police, community safety partnership, third sector and Healthwatch. In addition to more traditional health and wellbeing measures, the
Strategy includes measures on some of the wider determinants of health such as housing and employment.
The Board has set ten strategic outcomes for Birmingham which lead to 17 Actions. Progress has been measured against 22 indicators and targets; it is the intention of the
Board to monitor the effectiveness of these measures and develop them as necessary on an on-going basis.
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Contents
1. Overview of indicators
Bir i gha s urre t positio o ea h of its i di ators
2. Executive Summary and recommendations
Vulnerable People
Child Health
System Resilience
3. Focus on each of the Strategic outcomes
Indicators and targets that need to be reviewed
Indicators where performance is on target
Indicators where performance is not on target
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BHWB – Overview of indicators : June 4
Out
come
Priority Indicator Birmingham D
O
T
G
O
O
D
ENG CORE
CITY
BEST
CORE CITY
LATEST
DATA
FREQ NEXT
UPDATE
TARGET
Vu
lne
rab
le P
eo
ple
Make children
in need safer
1.Proportion of children who started to
be looked after and were taken into
care
HI Ann April
2015 Increase to 1500
Improve the
wellbeing of
vulnerable
children
2.Work with children in need April
2015 Increase to 5000
3.Children in need rates per 10,000
children 413 HI 332 414 2012/13 Ann
April
2015 Increase to 343
4.First time entrants to youth justice
system per 100,000 10-17 year olds 573 LO 537 674
370
Sheffield 2012 Ann
Late
2014 Reduce to 517
5.Emotional & behavioural health of
looked after children 13.6
HI 14.0 13.5
11.8
Newcastle 2012/13 Ann
April
2015 Increase
Increase the
independence
of people with
a learning
disability or
severe mental
health problem
6.Adults with a learning disability who
live in stable & appropriate
accommodation (%)
51.2 HI 73.5 74.0
89.4
Manchest
er
2012/13 Ann Late
2014
Increase to 70% in 5
years
7.Adults with a learning disability who
are in employment (%) 4.7 HI 7.1 5.4
7.8
Liverpool 2012/13 Ann
Late
2014
Increase to 7.1% in 2
years
8.Adults who are in contact with
secondary mental health services who
live in stable & appropriate
accommodation (%)
57.1 HI 59.3 50.4 60.8
Liverpool 2012/13 Ann
Late
2014
Increase to 55% in 5
years
9.Adults who are in contact with
secondary mental health services in
employment (%)
3.4 HI 7.7 5.3 11.2
Leeds 2012/13 Ann
Late
2014
Increase to 8.9% in 2
years
Reduce the
number of
people and
families who
are statutory
homeless
10.Homeless acceptance per 1,000
households 9.4 LO 2.4 4.3
0.9
Liverpool 2012/13 Ann
Late
2014 Reduce to 4.4 in 2 years
11.Households in temporary
accommodation per 1,000 households 2.2 LO 2.4 1.0
0.2
Leeds
/Liverpool
2012/13 Ann Late
2014 Reduce to 1 in 2 years
Support older
people to
remain
independent
12.Fuel poverty 15.5 LO 10.9 13.0
11.02
Leeds 2011 NK TBC
Reduce to 20.3 in 3
years
13.Permanent admissions to resident &
nursing care homes age 65 and over 742.4 LO 697.2 793.9
683.7
Leeds 2012/13 Ann
April
2015
Reduce to 695.0 in 3
year
14.Emergency hospital admissions for
injuries due to falls in person age 65+ 2195.7 LO
2011.
0 2343.2
1987.0
Sheffield 2011/12 Ann
April
2014
Reduce to 1642 in 3
years
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Out
come
Priority Indicator Birmingham D
O
T
G
O
O
D
ENG CORE
CITY
BEST
CORE
CITY
LATEST
DATA
FREQ NEXT
UPDATE
TARGET C
hil
d H
ea
lth
an
d R
esi
lie
nce
Reduce
Childhood
obesity
15.Proportion of children with excess
weight in Reception 23.3 LO 22.3 25.8
19.6
Sheffield 2012/13 Ann
Nov
2014
Reduce to 22.6% in 5
years
16.Proportion of children with excess
weight in Year 6 35.5 LO 33.3 29.6
33.8
Leeds 2012/13 Ann
Nov
2014
Reduce to 33.9% in 5
years
Reduce Infant
Mortality 17.Early neonatal mortality, rate per
1,000 live births 4.4 LO 2.3 3.0
1.4
Bristol 2010/12 Ann
Nov
2014 Reduce to 3.1 in 3 years
Health and care
system in
financial
balance
18.Clearly defined Birmingham budget
across agencies Achieved NA NA NA NA NA NA NA Achieved
Support older
people to
remain
independent
19.Opportunities for common
approaches identified Established NA NA NA NA NA NA NA
Established and
maintained
20.Common approaches established Established NA NA NA NA NA NA NA Established and
maintained
Improve
Primary care
Management
of common and
chronic
conditions
21.Unplanned hospitalisation for
chronic ambulatory care sensitive
conditions
310 LO 210 261 144.9
Newcastle 2011/12 Ann
Nov
2014
Reduce to 210 in 3
years
22.Emergency readmissions within 30
days of discharge from hospital 12.6 LO 11.8 13.4
11.5
Bristol 2011/12 Ann
Nov
2014
Reduce to 11.8% in 3
years
Key:
DOT – Direction of Travel. Arrows show whether direction of travel is going up, down or remaining constant; a star indicates the target has been achieved; Red, Amber and
Green rating shows whether performance is poor, average or good; GOOD – shows whether it is better to have a higher number (HI) or a lower number (LO); ENG – Shows
the England average figure; CORE CITY – gives the average figure across the Core Cities: Birmingham, Bristol, Leeds, Manchester, Newcastle, Nottingham and Sheffield;
BEST CORE CITY – gives the Core City that has the best performance against this indicator and their score; LATEST DATA – indicates the date range for the most up-to date
data available; FREQ – shows whether the data is published on an annual basis (Ann) or not known (NK); NEXT UPDATE – gives the date that the updated data for the
indicator will be published; TARGET – gi es the Health a d Well ei g Board s target for ea h of the i di ators; NA – Not applicable
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Metadata of Indicators
Indicator Source
1.Proportion of children who started to be looked after and were taken into
care ASCOF
2.Work with children in need ASCOF
3.Children in need rates per 10,000 children ASCOF
4.First time entrants to youth justice system per 100,000 10-17 year olds Police national computer - PHOF
5.Emotional & behavioural health of looked after children Dirgov.uk
6.Adults with a learning disability who live in stable & appropriate
accommodation PHOF
7.Adults with a learning disability who are in employment PHOF
8.Adults who are in contact with secondary mental health services who live
in stable & appropriate accommodation PHOF
10.Adults who are in contact with secondary mental health services in
employment PHOF
11.Number of homelessness preventions Dept. for communities / local govt.
12.Number of households in B&B Dept. for communities / local govt.
13.Fuel poverty PHOF
14.Permanent admissions to resident & nursing care homes age 65 and
over PHOF
15.Emergency hospital admissions for injuries due to falls in person age 65+ PHOF
16.Proportion of children with excess weight in Reception NCMP
17.Proportion of children with excess weight in Year 6 NCMP
18.Early neonatal mortality, rate per 1,000 live births PHOF
19.Clearly defined Birmingham budget across agencies
20.Opportunities for common approaches identified
21.Common approaches established
22.Unplanned hospitalisation for chronic ambulatory care sensitive
conditions HSCIC (PHOF)
23.Emergency readmissions within 30 days of discharge from hospital HSCIC (PHOF)
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Executive Summary and Recommendations
The Birmingham Health and Wellbeing Board agreed its Health and Wellbeing Strategy in June 2013. This report represents the first annual update on progress towards the
strategic outcomes set, looki g at Bir i gha s perfor a e agai st the England average and that of the Core Cities.
In what has been a very challenging year, given the dramatic changes to the health system and significant pressures to the collective health and care budgets, the Board and
its respective organisations should be applauded on their progress – particularly in terms of their work towards Childhood Obesity, homelessness preventions, the
resilience of the health and care system, Older Adults Integration work and work in preparation for the Better Care Fund.
Now that the Strategy has been in place for a year, in addition to looking at performance, it would be opportune also assess the effectiveness of the Strategy itself –
whether it is accessible and whether the measures and targets are appropriate moving forward. At the Health and Wellbeing Away Day, feedback was received from
members of the Board about the accessibility of the Vision and Aims of the Strategy – particularly regarding the wording used. It was suggested that the Vision and Aims be
revisited so that they can be made more meaningful to members of the public.
Recommendation
It is recommended that:
The ordi g of the Bir i gha Health a d Well ei g Board’s Visio a d Ai s for its Health a d Well ei g Strategy e revisited to make them more accessible
and meaningful to members of the public.
N.B. This update has been produced using the latest available data, however in some cases this may be over a year old, where there is a considerable lag in available data,
or where there are other limitations in the data available this will be discussed in the focus on outcomes section
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Vulnerable People Strategic Theme
There is a variable picture in performance in this area, work around fuel poverty and homelessness prevention has exceeded the targets set, whereas we have been unable
to increase employment opportunities for adults with mental health conditions or learning disabilities. As with many of the indicators, performance is not the sole
responsibility of one organisation and can be impacted upon by external factors such as the economy or availability of suitable housing.
Some of the indicators under this theme o e u der the u rella of the Better Care Board s ork, it is suggested that this arra ge e t e for alised ith the Health and
Wellbeing Board delegating accountability for delivery of these outcomes to the Better Care Board.
Delivery of the outcomes relating to the independence of people with a learning disability or severe mental health problem have been delegated to the Birmingham
Integrated Commissioning Board.
A u er of re ie s of the City s Childre s ser i es ha e ee u dertake re e tly, i light of these it is proposed that alternative outcomes, measures and targets
relating to vulnerable children be adopted.
Recommendations
It is recommended that:
The method of measuring the health and wellbeing reported by Looked After Children be revised and the target be amended accordingly
Measures and targets relating to vulnerable children be revisited in light of recommendations by Professor Le Grand, Ofsted and Lord Warner
Respo si ility for deli ery of the Support Older People to re ai i depe de t out o e e delegated to the Better Care Board
The Board considers whether or not to maintain Fuel Poverty and Homelessness preventions as strategic priorities in light of the targets being met and
exceeded
The target for the Adults i o ta t ith se o dary e tal health ser i es i e ploy e t measure be revised
Child Health Strategic Theme
Work to target childhood obesity is going well in the City, we are seeing reductions in obesity rates at both the Year 6 and reception levels. Infant mortality remains an
issue in Birmingham, however, the latest figures available covered the time period before the Strategy was agreed. We are not yet able to see the impact of the Strategy or
its associated workstreams implemented in this area.
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System Resilience Theme
The work towards the Better Care Fund is going a considerable way to achieving the system resilience outcomes; as above, it is suggested that this arrangement be
formalised with the Better care Board being delegated accountability for the delivery of the relevant outcomes.
The emergency readmissions within 30 days of discharge from hospital remains on target, however we are still waiting for the latest figures to be made available to see if
performance has been maintained.
Recommendations
It is recommended that:
Respo si ility for deli ery of the Health a d are syste i fi a ial ala e a d Co o NHS a d Lo al Authority approa hes out o es e delegated to the Better Care Board
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3. Focus on each of the strategic outcomes Indicators and targets that need to be reviewed
Le Grand, Ofsted and Lord Warner
A number of recommendations have arisen from the reviews by Professor Le Grand, Ofsted and currently by Lord Warner. It has been suggested that the outcomes,
measures and targets set in the Health and Wellbeing Strategy are no longer the most appropriate measures to enable the City of Birmingham to move forward.
The measures in question are detailed on the following pages; it is suggested that an in-depth exercise be undertaken to develop and agree the most appropriate indicator
set for improving the health and wellbeing of vulnerable children.
Homelessness Preventions
The latest figures sho that Bir i gha s performance towards homelessness preventions has considerably exceeded the target set by the Health and Wellbeing Board
last year. Perfor a e has i pro ed y % upo the pre ious year s figures. The Board ill eed to o sider hether Ho elessness Preventions remains one of its
strategic priorities and if so, agree a suitable target, or whether it be removed as one of the strategic priorities and ask the Operations Group to monitor performance to
ensure that the current level of homelessness preventions is maintained or improved.
Fuel poverty
When the Strategy was approved, the latest fuel poverty data available was from 2010. Due to the time lag in data being published, Bir i gha s perfor a e had actually exceeded the target at the time the strategy was approved, however this was not known until the 2011 figures were published. Although showing a significant
redu tio i fuel po erty rates, si e 9, Bir i gha s perfor a e is still orse tha the E gla d a d Core Cities a erage. In light of this, the Board must consider
whether to retain Fuel Poverty as one of its strategic outcomes, and if so, agree an appropriate target.
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3.Children in need rate per 10,000 children:
Source:ASCOF – Education Dept.
Since the baseline and targets were set for this indicator, the
rate per 10,000 children in need has risen significantly in
Birmingham, exceeding the target set and bringing the City
in line with the average rates in the Core Cities. It has been
suggested that alternative measures may be more
appropriate in light of the recent reviews.
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5. Emotional and behavioural health of looked after children: * a higher score indicates more emotional difficulties
Source: Dirgov.uk
The target set for this indicator was to increase the
emotional and behavioural health of looked after children;
the data for this indicator comes from the annual SDQ
(Strengths and Difficulties Questionnaire) completed by
carers about each of the children in care. In the SDQ scale, a
higher score indicates more emotional difficulties. As the
measure and target currently stand it may cause confusion
that the target is to increase, when in actual fact we want to
see the trajectory go down.
The average SDQ score, per se, is a limited measure as trend
analysis has shown that there has been negligible change to
the emotional and behavioural wellbeing scores of Looked
After Children over the last ten years.
Of more value would be to look at the average SDQ score by
the length of time children and young people have been in
care using appropriate age bands. This would test whether
being in care is having a positive effect in reducing
emotional and behavioural difficulties and allow a year on
year comparison of the extent to which this was the case. It
could also potentially identify areas to target where there
may be a deterioration in emotional wellbeing e.g. where
young people in care are reaching adolescence and
emotional and behavioural difficulties may increase.
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8. Adults in contact with secondary mental health services who live in stable and appropriate accommodation:
Baseline value dateTarget set date
Target achieved dateReporting date
0%
10%
20%
30%
40%
50%
60%
70%
80%
2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18
Pe
rce
nta
ge
Year
Birmingham England Core cities Target Trajectory
Source: PHOF
The target of i rease u er of adults i o ta t ith secondary mental health services who live in stable and
appropriate a o odatio to % as agreed y the Health and Wellbeing Board in June 2013. However, at this
point in time Birmingham was performing better than this
figure. It is proposed that 55% is an insufficient target and
that work should be done to identify a more suitable target
moving forward.
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11. Homelessness preventions
The total number of homeless preventions at the end of
2013/14 was 10,712 – resulting in a homeless prevention
rate of 25.15 preventions per thousand households,
compared to the previous financial year of 17.45.
There has been a 46% increase in homeless prevention
outcomes achieved in 2013/14 when compared to the
previous financial year.
The target set was for homeless preventions to be increased
to 8,000 within two years, the graph shows that
performance to date has not only met the target but has
exceeded it considerably.
The Board will need to consider whether it is still
appropriate to retain homelessness preventions as one of its
strategic outcomes, and if so amend the target accordingly,
or may wish to monitor progress to ensure that this level of
performance is maintained.
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13. Fuel Poverty
Source: Public Health Outworks Framework February 2014
Please ote the target of redu e to . % i years as of figures has ee a hie ed.
The original target for this measure was set based on the 2010
figure; the latest information shows that we have already
achieved and exceeded the target set within the Health and
Wellbeing Strategy.
Although showing a significant reduction in fuel poverty rates
since 2009, performance in Birmingham is worse than both the
Core Cities and England averages.
Figures for 2012 are not yet available.
The Board will have to consider if it still wishes to have Fuel
Poverty as one of its strategic outcomes, and if so, agree a new
target.
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Indicators where performance is on target Birmingham is well on track to achieve its strategic outcomes within the childhood obesity and system resilience areas; these represent two areas of established cross-
sector working in the City. Given the scale of the problems faced in each of these areas, the Board should be proud of the work that has been and continues to be done to
meet these significant challenges.
Childhood obesity
Despite achieving considerable successes in addressing childhood obesity such as a 5% reduction in the rates of Year 6 children with excess weight in only one year; over 1
in 3 of Year 6 children in Birmingham are still classified as having excess weight. This highlights the magnitude of the problem we face here in Birmingham; whilst it is very
reassuring to see such a large reduction in a short space of time, we should not become complacent and should ensure that addressing childhood obesity rates in our city
still remains one of the key priorities of the Health and Wellbeing Board.
Better care fund
The programme of work towards the Better Care Fund has significantly contributed to a number of the system resilience measures, i.e. a clearly defined budget across
agencies; opportunities for common approaches identified; and common approaches established. In addition, the i di ators fro the support older people to re ai i depe de t outcome i.e. fewer admissions to care homes aged 65+ and fewer injuries due to falls aged 65+ also fall within the Better Care Fund umbrella of work and so
the Board may wish to delegate accountability for delivery of these targets to the Better Care Board. In addition, the Board may wish to formalise links with the Better Care
Board making it a formal sub-group of the Health and Wellbeing Board.
Other indicators that appear on track to meet the targets set relate to first time entrants to the youth justice board and adults in contact with secondary mental health
services who live in stable and appropriate accommodation and emergency readmissions within 30 days of discharge from hospital.
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4. First time entrants to youth justice system per 100,000 10-17 year olds (Jan 2012 to Dec 2012)
Source: PHOF
As can be seen from the graph opposite, the rate of first
time entrants to the youth justice system has decreased
dramatically in recent years. Performance in Birmingham is
marginally higher than the England average but is better
than the Core Cities average. The reporting date for
reducing the rate of first time justice system to 517 (the
current England average) is 2016; we appear well on track to
achieve this target.
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7.Adults with a learning disability who are in employment:
Source: PHOF
The graph opposite shows a slight increase in the
percentage of adults with a learning disability who are in
employment. We have not yet received any national data
for this indicator to cover the period after the Strategy was
set, so it is difficult to gauge whether or not we are on track
for achieving the target of 7.1% by 2015/16.
Birmingham is performing marginally worse than the Core
Cites, both of which are performing approximately 2% worse
than the England average.
There are many external factors affecting this indicator, such
as the economic climate and lack of employment
opportunities across the board.
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16. Proportion of children with excess weight in Reception:
Source: NCMP
Childhood obesity rates have started to decline in
Birmingham, meaning that we are well on target to reduce
the proportion of children with excess weight in Reception
to 22.6% within 5 years. Birmingham is performing
favourably against the Core Cities, who have shown an
average increase in obesity rates since 2010.
Since the approval of the childhood obesity strategy,
working groups have been established to support the
implementation of the strategy and report progress to the
childhood obesity strategy steering group. The aim of the
working groups have been to support the development of
joint working arrangements between key partners both
formally via group and informally through networking.
The Health and Social Care Overview and Scrutiny inquiry
report on childhood obesity has since been launched with a
set of 10 recommendations. The Childhood Obesity Strategic
Steering Group has agreed the recommendations as a
positive step forward in tackling this agenda. The group will
be responsible for ensuring that we move forward with
these recommendations; including supporting the HWB
board as a body show a united front to lobby on this
agenda.
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17. Proportion of children with excess weight in Year 6:
Source: NCMP
Childhood obesity rates in Year 6 have also started to
decline in Birmingham, meaning that we are well on target
to reduce the proportion of children with excess weight in
Year 6 to 33.9% within 5 years. In fact, Birmingham can
boast a 5% reduction in the proportion of children with
excess weight from 2011/12-2012/13.
Other successes of the Childhood Obesity workstream
include:
Birmingham has been recognised nationally via the
media on the progress made towards limiting fast
food outlets
A series of events and workshops have taken place
to engage potential partners e.g. Planning and
Health workshop, district workshops and citywide
clinicians workshop
8/10 districts have chosen childhood obesity as one
of their top 3 priorities
Sparked interest from the shadow Public Health
Secretary and currently setting up a visit to
Birmingham
The procuring of childhood obesity services is in
process with four commissioning priorities
identified to support a reduction in childhood
obesity
We have been successful in submitting an abstract
for the UK Congress on Obesity
Despite the successes the childhood obesity steering group
have recognised there is a risk that the level of investment
to support the reduction in childhood obesity is not
commensurate with the scale of change required.
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18.Clearly defined Birmingham budget across agencies;
19.Opportunities for common approaches identified; and
20.Common approaches established:
The Better Care Fund has been designed to enable the development of pooled commissioning budgets around integrated care (primarily for older people), to deflect
activity from reactive acute and long term care to more person centred proactive and preventative activity.
Much of the work being done across the City to meet the system resilience strategic outcomes (clearly defined Birmingham budget across agencies; opportunities for
common approaches identified; and common approached established) falls under the umbrella of the Better Care Board (BCB) work.
The BCB builds upon the work of:
• Joint commissioning for learning disability and mental health – established the UK s largest pooled udget, o i its th year, £300m per annum.
• Childre s Strategi Part ership Board orki g to ards joi t commissioning arrangements circa £45m per annum.
• Older Adults Integration Programme currently evaluating potential for joint arrangements beyond £82m.
• 75% data matching on NHS number and Central Care Record work.
8 BCB intersectoral workstreams have been initiated and project managers appointed. The workstreams are as follows: Developing and agreeing the case for change;
Creating the impetus for change; Accountable community professional; Defining new primary care service delivery models and associated roles and infrastructure;
Discharge from acute settings and step up/step down care; Instigate 7 day health and care services across the economy; Establish combined point of access; and Improve
data sharing across health and social care.
It is proposed that the Board delegate assign accountability for achieving the above outcomes (in addition to the reduction in falls and fuel poverty) to the Better Care
Board.
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22.Emergency readmissions within 30 days of discharge from hospital:
Source: Heath and Social Care Information Centre
As can be seen from the graph opposite, performance in
Birmingham in relation to emergency readmissions within
30 days of discharge from hospital has been improving since
2010, and although still higher than the England average,
has improved upon the average performance in the Core
Cities. Achievement of the target (11.8%) looks possible by
the 2015/16 deadline. However, it should be noted that NO
new performance data has been made available since the
target was set, so it is not yet possible to gauge whether or
not we have sustained the improvements of 2011/12 in
recent years.
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Indicators where performance is not on target There are a number of areas, where performan e o the strategi out o e s i di ators is ot o tra k to a hie e the target y the date set.
In some cases the reasons for this are out of the control of the Health and Wellbeing Board, for example the two indicators relating to the employment of adults with
Learning Disabilities and those who are in contact with secondary mental health services is in part down to the lack of employment opportunities across the country rather
than being unique to Birmingham.
In other cases, we are not yet able to see whether performance in Birmingham has improved since being selected as a strategic priority of the Board due to the
considerable delay in national data being made available. In some cases no new data has been made available since the targets were set a year ago and in others, the
latest data that is available is for the time period before the targets were set. Where this is the case, it will be highlighted in the commentary accompanying the graph.
For these reasons the data presented below should be viewed with caution.
That is not to say that we cannot improve upon our performance, in some cases despite facing similar problems and pressures, Bir i gha s perfor a e lags ehi d that of the Core Cities a d E gla d a erages. Ma y ork pla s a d proje ts are in place across the City to address these issues, in future annual reports, the Board will be in a
position to see whether these have resulted in the achieving the desired benefits.
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6.Adults with a learning disability who live in stable and appropriate accommodation:
Source: PHOF
The graph opposite shows the required trajectory to meet
the target of 70% adults with a learning disability who live in
stable and appropriate accommodation by 2017/18. As the
Birmingham rate remained constant between 2011/12 and
2012/13, it is not possible to say whether or not we are on
target, until the 2013/14 figures are published later this
year. However, it can clearly be seen that performance in
Birmingham is significantly worse than that of the Core
Cities and England average, where performance has steadily
improved since 2010.
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9. Adults in contact with secondary mental health services who are in employment:
Source: ASCOF
The graph opposite shows a decline in the percentage of
adults in contact with secondary mental health services who
are in employment meaning that Birmingham is not on
trajectory for achieving its target of 8.9% by 2015/16.
As above, there are many external factors affecting this
indicator, such as the economic climate and lack of
employment opportunities across the board.
However, even though employment for adults in contact
with secondary MH services appears to have fallen across
England and the Core Cities, the scale of the reduction is
much greater in Birmingham.
In order to show the finer detail, the scale on the y axis only
covers from 0-10%, therefore the gradient of the change
should be viewed with caution, the difference between the
latest Birmingham figures and the target is approximately
5.5%.
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11. Number of households in B&B
Where young people are concerned the Board s ai is to eliminate B&B use expect in exceptional emergencies such
as weekend use only. Achieving reductions in B&B is
dependent upon a number of factors, some are within
control of the Council:
Homeless assessments and decision making
Availability of non-B&B temporary accommodation
to move into se ured ia Bir i gha s so ial letting agency
turnaround of council void property so that they
are ready for letting or as non-B&B temporary
accommodation
nominations made to housing associations and
council lettings
additional procurement of non-B&B temp
accommodation
Matters less within the Council s o trol relate to the costs
and competition for housing in the city:
Other local authorities using private rental housing
in Birmingham to discharge homelessness duties
following the enactment of the Localism Act
UKBA procurement for asylum dispersal and
support
wider impacts of welfare reform, such as the
continued displacement of households resulting
from the benefit cap
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13.Permanent admissions to residential and nursing care homes age 65 and over
Source: ASCOF
The graph opposite shows the rate per 100,000 of
permanent admissions to residential and nursing care
homes aged 65 and over. As can be seen from the graph
performance since the baseline was set has gotten worse,
however, this represents the time period before this
outcome was selected by the Board. We are currently
awaiting data for 2013/14 which would show the impact
since the strategy was introduced.
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14.Emergency hospital admissions for injuries due to fall in over 65 (all persons)
Source: PHOF
As can be seen from the graph, performance since the
baseline was set has gotten worse, however, this represents
the time period before this outcome was selected by the
Board. We are currently awaiting data for 2013/14 which
would show the impact since the strategy was introduced.
It should be noted, however, that during the same time
period, performance in the Core Cities improved, however,
the rate per 100,000 population in the Core Cities is still, on
average, higher than in Birmingham.
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17.Early neonatal mortality, rate per 1,000 births
Source: ONS
As can be seen from the graph opposite, the rate of early
neonatal mortality in Birmingham exceeds that of the Core
Cities a d E gla d a erages, al eit that the figures e are looking at are very small: 4.4 per 1000 in Birmingham,
compared to 2.3 per 1000 on average across England.
The latest data available covers the time period before the
Strategy was approved and so it is not yet possible to gauge
if the introduction of the strategy has had any impact upon
the early neonatal mortality rates in the City.
The Child Death Overview Panel 2012-13 Annual Report
went to the Childre s Part ership Board i No e er. The annual report clarified understanding and identified further
lines of action to reduce our very high rates of infant
mortality in Birmingham.
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21.Unplanned hospitalisation for chronic ambulatory care sensitive conditions :
Source: HES
As can be seen from the graph opposite, performance in
Birmingham relating to the unplanned hospitalisation for
chronic ambulatory care sensitive conditions (i.e. admissions
to hospital that are deemed to be avoidable) has remained
constant when allowing for seasonal variations between
quarterly reports. Performance in Birmingham is worse
than both the England and Core Cites average. It should be
noted that no new reporting data has been made available
since the target was set so it is not yet possible to gauge
whether or not performance has improved in light of being
selected as a strategic priority of the Board.
A number of projects are in place to improve these figures
such as:
Acute Medical Clinics (UHB) and Ambulatory
Emergency Clinics (HEFT) aim to reduce unplanned
admissions
Initiatives led by the Ambulance service including:
single point of access, allowing crews to explore
alternative pathways; developing a Directory of
services which offers alternatives to hospital
admission; Plans to increase the number of paramedics
The OPAT service (HEFT)
The DVT pathway at Good Hope Hospital
The OPAL service at UHB assessing older people in
the Emergency Department.
