Suicides - notifications in England
Suicides - notifications in England by Anthony Deery - Epsonet.eu
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<strong>Suicides</strong> - <strong>notifications</strong> <strong>in</strong> <strong>England</strong>EPSO meet<strong>in</strong>gJune 2 & 3 2008Healthcare CommissionAnthony DeeryHead of Mental Health, Learn<strong>in</strong>g Disabilities and Older People
Agenda• National policy• Report<strong>in</strong>g requirements• Confidential <strong>in</strong>quiry – suicides• Our role2
Background• Established the Confidential Inquiry <strong>in</strong>to Homicides and <strong>Suicides</strong> bymentally ill people (1996)• Sav<strong>in</strong>g Lives; Our Healthier Nation – 1997> Department of Health set a target of a 20% reduction <strong>in</strong> suicide by2010• Recognised that people with mental illness represent one of the mosthigh risk groups for suicide• National Service Framework for Mental Health (1999) conta<strong>in</strong>ed aspecific standard on suicide prevention• Safety First Report 2001 - Introduced a National Suicide PreventionStrategy for <strong>England</strong> (2002) – people under the care of mental healthservices seen as a priority.• Suicide prevention toolkit 20033
Report<strong>in</strong>g requirementsNHS provider trustsRegional Strategic HealthAuthorityIndependent SectorRegistration Authority(Healthcare Commission)Coroner’s OfficeMental Health ActCommission where patienthas been deta<strong>in</strong>ed under theMental Health ActNational Patient SafetyAgency (voluntary)Mental Health ActCommission where patienthas been deta<strong>in</strong>ed under theMental Health ActNational Patient SafetyAgency (voluntary)4
Confidential homicide and suicide <strong>in</strong>quiryPurpose of the <strong>in</strong>quiry• To elicit avoidable causes of death• Determ<strong>in</strong>e best practice by detailed exam<strong>in</strong>ation ofthe circumstances surround<strong>in</strong>g such events• First complete national data collection began <strong>in</strong> 1997• Managed by the University of Manchester5
Methodology3 stages to the data collection1. General population suicides and deaths from undeterm<strong>in</strong>ed cause iscollected from the Office for National Statistics2. Details on each case submitted to mental health services <strong>in</strong> each<strong>in</strong>dividual’s district of residence, district of death and adjacent districtsto identify those with a history of mental health service contact <strong>in</strong> the12 months before death.3. Information on Inquiry cases is obta<strong>in</strong>ed from cl<strong>in</strong>ical teams via aquestionnaire sent to the consultant psychiatrist• Inquiry data <strong>in</strong>cludes <strong>in</strong>formation on people who die by suicide or whoreceive an open verdict follow<strong>in</strong>g a coroner’s <strong>in</strong>quest6
Data• data completeness for <strong>in</strong>quiry cases is high, overall97% (range 91%-99%)s<strong>in</strong>ce data collection began.• the figures reported <strong>in</strong> the confidential <strong>in</strong>quiry relateto suicides <strong>in</strong> <strong>England</strong> and Wales from age 10 andover.7
General population suicides; age and sex profile450040003500300025002000150010005000
Trends• Overall general population number of suicides has decreased s<strong>in</strong>ce1997.• Highest <strong>in</strong> 1998 and lowest <strong>in</strong> 2004• from 1997 to 2004 there was a fall of 30% (n67) <strong>in</strong> the number of <strong>in</strong>patientsuicides.Most recent figures 2006• 23,477 cases <strong>in</strong> the general population notified to the <strong>in</strong>quirybetween 2000-2004• Included 16,324 cases of suicide and 7,153 open verdicts or deathsfrom undeterm<strong>in</strong>ed cause• 74% were male giv<strong>in</strong>g a male to female ration of 3:1• Highest <strong>in</strong> the 25-34 group (80% male), lowest <strong>in</strong> the over 75 group(61% male)9
Known factsHigh rates are particularly associated with• Acute episodes of illness• Recent hospital discharge• Social factors such as liv<strong>in</strong>g alone• Cl<strong>in</strong>ical features such as substance misuse and nonfatalself-harm10
Methods of suicide90008000Hang<strong>in</strong>g/strangulation7000Self poison<strong>in</strong>g600050004000300020001000carbon monoxidepoison<strong>in</strong>gjump<strong>in</strong>g/multiple<strong>in</strong>juriesdrown<strong>in</strong>g0MaleFemaleother11
Ethic orig<strong>in</strong> (not <strong>in</strong>clud<strong>in</strong>g white)36%13%15%Black Caribbean13%Black African 15%Other non-white 15%Mixed Race 19%Ch<strong>in</strong>ese 2%2%19%15%Indian/Pakistani/Bangladeshi 35%12
Contact with mental health services• 27% (6,367) of the total sample for the period 2000-2004 were known tobe <strong>in</strong> contact with mental health services <strong>in</strong> the year before death whichmarked a slight <strong>in</strong>crease from 24% <strong>in</strong> the previous periodPreventability• 19% (1017) of cases it was felt that the suicide could have beenprevented• These cases were more likely to:-> be suffer<strong>in</strong>g from an affective disorder> have been an <strong>in</strong>-patient at the time of death> have detectable symptoms at f<strong>in</strong>al contact13
contd• cases under the age of 25 seen to be morepreventable, as were cases of people with a severemental illnessLeast preventable• people with drug dependenceOverall estimate of possible preventable deaths• <strong>in</strong>patients 41%• community 12%14
Key service recommendationsDescription1 The removal of ligature po<strong>in</strong>ts on <strong>in</strong>-patient wards <strong>in</strong>clud<strong>in</strong>g noncollapsiblecurta<strong>in</strong> railsFull95%2 Community Services <strong>in</strong>clude an assertive outreach team 97%3 Community Services <strong>in</strong>clude a s<strong>in</strong>gle po<strong>in</strong>t of access for people <strong>in</strong> crisisavailable 24hrs a day (as part of the mental health service)4 There are written policies/strategies regard<strong>in</strong>g follow-up with<strong>in</strong> 7 days ofdischarge from psychiatric <strong>in</strong>-patient care5 There are written policies/strategies regard<strong>in</strong>g response to patients whoare non-compliant with treatment6 There are written policies/strategies regard<strong>in</strong>g the management of patientswith a dual diagnosis7 There are written policies/strategies regard<strong>in</strong>g <strong>in</strong>formation shar<strong>in</strong>g withcrim<strong>in</strong>al justice agencies on risk8 There are written policies/strategies regard<strong>in</strong>g multi-discipl<strong>in</strong>ary reviewand the shar<strong>in</strong>g of <strong>in</strong>formation with families after suicide9 Tra<strong>in</strong><strong>in</strong>g and record keep<strong>in</strong>g: front l<strong>in</strong>e cl<strong>in</strong>ical staff receive tra<strong>in</strong><strong>in</strong>g <strong>in</strong> themanagement of suicide risk at least every three years70%95%73%55%85%86%86%15
Our role• To assess if trusts and <strong>in</strong>dependent sectorproviders have the systems <strong>in</strong> place• Assess performance aga<strong>in</strong>st the national suicidetarget• Undertake service reviews and national audits• Investigate where we have cause for concern16
Safety First’, the 2001 five year report of the National Confidential Inquiry <strong>in</strong>to suicide and homicideby people with mental illness, put forward a series of recommendations for mental health services.These were formulated <strong>in</strong>to eight measurable standards <strong>in</strong> the guidance document 'Prevent<strong>in</strong>gSuicide: A toolkit for Mental Health services' published <strong>in</strong> October 2003.Data sourceSpecial data collectionConstructionIndicator:‘Prevent<strong>in</strong>g Suicide: A toolkit for Mental Health Services’ sets out eight measurable standards for suicide prevention, namely:Standard one: appropriate level of careStandard two: <strong>in</strong>-patient suicide preventionStandard three: post discharge prevention of suicideStandard four: family/carer contactStandard five: appropriate medicationStandard six: co-morbidity/dual diagnosisStandard seven: post-<strong>in</strong>cident reviewStandard eight: tra<strong>in</strong><strong>in</strong>g of staffThe toolkit also describes a process by which audits aga<strong>in</strong>st these standards may be carried out, and which trusts maychoose to follow <strong>in</strong> conduct<strong>in</strong>g their own suicide prevention audits. More broadly, a robust audit will <strong>in</strong>clude the follow<strong>in</strong>gma<strong>in</strong> stages:1) The selection of a sample of cases that are either at risk of suicide or have committed suicide2) The obta<strong>in</strong><strong>in</strong>g of <strong>in</strong>formation from cl<strong>in</strong>ical records to answer the questions set out <strong>in</strong> the audit tool (and/or, as locallyappropriate, other relevant questions l<strong>in</strong>ked to the eight standards)3) Interviews with relevant cl<strong>in</strong>ical service managers4) The f<strong>in</strong>d<strong>in</strong>gs of the audit presented as both a written report and as an oral presentation to managers and cl<strong>in</strong>icians5) Timetable agreed with cl<strong>in</strong>ical teams to address any standards not yet fully met6) Re-audit to ensure remedial action has been effective or, if no remedial action was required, there is an agreed date for are-audit to ensure cont<strong>in</strong>ued compliance with the eight standards.Trusts are assessed on how far their audits have progressed along these stages with<strong>in</strong> a 12 month period.17
The National results of staff tra<strong>in</strong>ed <strong>in</strong> the evidence baseC5: are staff tra<strong>in</strong>ed to update skills and techniques relevant to theircl<strong>in</strong>ical workEvidence based *NICE cl<strong>in</strong>ical care pathwaysNationalAverage %How to give <strong>in</strong>formation to patients on diagnosis, medication andside effectsHow to undertake Care programme Approach 18How to assess SUs at risk of suicide 18How to assess carers 15How to ask patients about the use of drugs and alcohol 12How to handle patients under <strong>in</strong>fluence of drugs & alcohol 10How to treat dual diagnosis 10Psychological tra<strong>in</strong><strong>in</strong>g therapies 15* National Institute for Health and Cl<strong>in</strong>ical ExcellenceSource HC Staff survey 20071418
Futurecont<strong>in</strong>ue to focus on• Local accountability – <strong>in</strong>telligent board <strong>in</strong>formation• Quality of the environment• Staff tra<strong>in</strong><strong>in</strong>g – particularly around evidence basedtreatments and risk assessments• Reduce abscond<strong>in</strong>g from <strong>in</strong>patient units• Effective implementation of the care programme approachespecially around transition from ward to community sett<strong>in</strong>gs19
Thank youanthony.deery@healthcarecommission.org.uk20
The pr<strong>in</strong>ciples and practice of<strong>in</strong>formation-led regulationEPSO meet<strong>in</strong>gJune 3 2008Richard Hambl<strong>in</strong>Head of Information PolicyHealthcare Commission
AgendaWhat we contribute as a regulatorHow <strong>in</strong>formation is critical to our contributionExpla<strong>in</strong> what we do and what we don’tDispel myths
What we seek to do as a regulatorStimulate improvement <strong>in</strong> health servicesProvide assurance that services are of anacceptable standardIdentify problems before they become crisesRespond quickly to concernsProvide comparative <strong>in</strong>formation on performancelevel with the aim of stimulat<strong>in</strong>g improvementBe proportionate, risk-based, and avoid duplication
It’s not about mak<strong>in</strong>g all the decisions<strong>in</strong> the officeNo super computer on which we press abutton and the result comes outInformation targets <strong>in</strong>spectionInspection provides <strong>in</strong>formationWe visit as often as is necessaryInformation is more than just numbers
The NHS is a very data rich environmentExtensive use of exist<strong>in</strong>g data streams215 <strong>in</strong>dividual data streams (ma<strong>in</strong>ly nationallycollected data sets)40 different organisations (government, NHS, otherregulators, academic departments, royal colleges)
Assess<strong>in</strong>g core standards24 core standards – 44 part standardsIntroduced 2004 – first time the NHS had standardsCover 7 doma<strong>in</strong>sIn theory represented consistent practice <strong>in</strong> 2004We assess annually but how•Can’t <strong>in</strong>spect everywhere•Too broad for straightforward measurement
1 issue – 1 measureAssessment frameworks –many related measures1 issue – many (unrelated) measuresIdentify and respond to outliersStandardised mortality ratio54.543.532.521.510.500 2 4 6 8 10 12 14Expected deaths
C01aC01bC02C03C04aC04bC04cC04dC04eC05aC05bC05cC05dC06C07acC07bC07eC08aC08bC09C10aC10bC11aC11bC11cC12C13aC13bC13cC14aC14bC14cC15aC15bC16C17C18C20aC20bC21C22acC22bC23C24Buck<strong>in</strong>ghamshire Hospitals NHS TrustEast Somerset NHS TrustGloucestershire Hospitals NHS Foundation TrustHeatherwood and Wexham Park Hospitals NHS TrustMilton Keynes General Hospital NHS TrustNorth Bristol NHS TrustNorth Hampshire Hospitals NHS TrustNorthern Devon Healthcare NHS TrustNuffield Orthopaedic Centre NHS TrustOxford Radcliffe Hospitals NHS TrustPlymouth Hospitals NHS TrustPoole Hospital NHS TrustPortsmouth Hospitals NHS TrustRoyal Berkshire and Battle Hospitals NHS TrustRoyal Bournemouth and Christchurch Hospitals NHS FoundationTrustRoyal Cornwall Hospitals NHS TrustRoyal Devon and Exeter NHS Foundation TrustRoyal National Hospital For Rheumatic Diseases NHS FoundationTrustRoyal United Hospital Bath NHS TrustSalisbury Health Care NHS TrustSouth Devon Health Care NHS TrustSouthampton University Hospitals NHS TrustSw<strong>in</strong>don and Marlborough NHS TrustTaunton and Somerset NHS TrustUnited Bristol Healthcare NHS TrustWest Dorset General Hospitals NHS TrustWeston Area Health NHS TrustW<strong>in</strong>chester and Eastleigh Healthcare NHS TrustSouth west region acutes, 44 standards...Declaration April 2006C C C C C C C C C C C C C C C C C C C C C C C IA C C C C C C C C C C C C C C C C C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C IA C C C C C C C C C C C C C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C NM C C C CC C C C C C C C NM C C C C C C C NM C C C C C C C C C C C C C IA C C C C C C IA C C C IA IA NMNM IA NM NM C C C C C NM C NM C C NM C NM NM NM NM C C 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C C CC C C C C C C C C C C C C C C C C C C C C C C NM C C C C C C C C C C C C C C C NM C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C IA C C C C C IA C C C C C C C C C C C C C C C C C C C C C C C C C C IA C C C C C C CC C NM C C IA NM C C C C C C C C C C C C C C C C NM C C C NM C C C C C C C C C C C C C C C NMRisk-based <strong>in</strong>spections!Q Q Q Q Q Q C Q Q CC C Q Q CQ Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q QQ Q Q Q QRandomly selected <strong>in</strong>spectionsC C C C CC C C C CC C C C CC C C C CDignity <strong>in</strong> care auditsCCYCCCYCYCompla<strong>in</strong>ts auditsCRCCCCYCCRCCNew declaration April 2007NM C NM C C C C NM C C C C C NM NM C NM C NM NM C C NM NM NM C NM C NM C C NM C NM NM NM NM NM NM NM C NM NM CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C C C C C IA C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C NM C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C NM C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C NM C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C IA C C C C C CNM C C NM C C C C C C C NM C C NM NM NM C NM NM NM C NM C NM NM NM C C NM NM NM C C C C NM C C C NM NM NM CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C NM C C C C C C C NM C NM C C C C C C C C C C C C IA C C C C C C C C C C NM C C C C CC C C C C C C C C IA C C C C C C IA C C NM C C C C C C C C C C C C C NM C C C C C C C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C IA C C C C C C C C C C C C C C C C C C C C C C C C C IA C C C C C C C C C C C C CC C C C C C IA C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CNM C NM NM NM NM NM NM NM NM NM NM NM NM NM C NM C NM NM NM C NM NM NM C NM NM C C C C C NM C C NM NM NM NM NM C NM NMC C C C C C C IA C C C C C C C C NM C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C C C C IA C IA C C C C C C C C C IA C C C C C C C C C C C C C C C C C C C C C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C IA C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C IA C IA NM C C C C C C C C C C C C C NM C C C C C C C C C C C C C C C IA C C C C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C C C C C C C C C C C C C C C C C C C C NM C C C C C C C C C C C C C C C NM C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C IA C C C C CC C C IA C C C C C IA C C C C C C C C NM NM C C C C C C C C C C C C C C C C C C C C C C C CC C NM C NM C NM NM C C C C C C C C C C C C C C C NM C C C NM C C C C C C C C C C C C C C C CNew risk estimatesNM C NM C C C C NM C C C C C NM NM C NM C NM NM C C NM NM NM C NM C NM C C NM C NM NM NM NM NM NM NM C NM NM CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C C C C C IA C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C NM C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C NM C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C NM C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C IA C C C C C CNM C C NM C C C C C C C NM C C NM NM NM C NM NM NM C NM C NM NM NM C C NM NM NM C C C C NM C C C NM NM NM CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C NM C C C C C C C NM C NM C C C C C C C C C C C C IA C C C C C C C C C C NM C C C C CC C C C C C C C C IA C C C C C C IA C C NM C C C C C C C C C C C C C NM C C C C C C C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C IA C C C C C C C C C C C C C C C C C C C C C C C C C IA C C C C C C C C C C C C CC C C C C C IA C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CNM C NM NM NM NM NM NM NM NM NM NM NM NM NM C NM C NM NM NM C NM NM NM C NM NM C C C C C NM C C NM NM NM NM NM C NM NMC C C C C C C IA C C C C C C C C NM C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C C C C IA C IA C C C C C C C C C IA C C C C C C C C C C C C C C C C C C C C C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C IA C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C IA C IA NM C C C C C C C C C C C C C NM C C C C C C C C C C C C C C C IA C C C C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C CC C C C C C C C C C C C C C C C C C C C C C C NM C C C C C C C C C C C C C C C NM C C C CC C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C IA C C C C CC C C IA C C C C C IA C C C C C C C C NM NM C C C C C C C C C C C C C C C C C C C C C C C CC C NM C NM C NM NM C C C C C C C C C C C C C C C NM C C C NM C C C C C C C C C C C C C C C CRisk-based <strong>in</strong>spections!C C C C CC C C C CQ C Q C CQ C Q Q CRandomly selected <strong>in</strong>spectionsC C C C QC C C C CC C C C C
Does it work?Three times more likely to pick up undeclared noncomplianceConsistent judgements made (improv<strong>in</strong>g over time)85% of decisions to <strong>in</strong>spect draw on qualitative dataCapacity to identify “deeper dives” (Dignity)
It’s not a once-a-year all or noth<strong>in</strong>gexercise• Quarterly updates to field staff• Ongo<strong>in</strong>g monitor<strong>in</strong>g>outliers>time-series
Screen<strong>in</strong>g PlusDetail
What is an outlier?Standardised mortality ratio54.543.532.521.510.50Outcomes for patients admitted withheart valve disordersObserved mortalitysignificantly differentthan expected0 2 4 6 8 10 12 14Expected deaths
Poor outcomes over time – CUSUMAlert signalledPlot goes upwhen there isa deathDown whena patientsurvivesPlot can neverfall below zero
Response to outliersSelf-generatedoutliersCl<strong>in</strong>ical adviceAlertsreceivedInformaticsInternalanalysisDecision panelOps.Local<strong>in</strong>telligencePursue as anInitialConsiderationNot pursu<strong>in</strong>g atpresentWrite to TrustWrite to Trust
Us<strong>in</strong>g outcomes data for cont<strong>in</strong>uous monitor<strong>in</strong>g of heart transplant successFigure 2: Cumulative O-E chart for Papworth from January 2002 to September 2007, unadjustedfor patient risk4Signal –for <strong>in</strong>vestigation3Cumulative observed m<strong>in</strong>us expected2100 50 100 150 200 250-1-2January 2007-3Case numberSource: UK Transplant
But what do you dowhen the numbersaren’t there?
An important question• Independent sector has relatively little comparativedata• Social care has even less• But both have a lot of qualitative <strong>in</strong>formation
Us<strong>in</strong>g unstructured data to help adjust riskWhat is unstructured data?• Qualitative <strong>in</strong>formation• A mixture of non – numeric and numeric data• Data from ‘non-standard’ sources
What we do with it• Review material received• Decide on what can be used• Code and weight the unstructured data (local<strong>in</strong>telligence)>Data quality>Patient experience>Association with assessment criterion
Some examples received from Patientand the Public Involvement ForaStaff were consulted about the plans and <strong>in</strong>volved <strong>in</strong> the design andplann<strong>in</strong>g of the unit. (Low)The forum cont<strong>in</strong>ues to experience good work<strong>in</strong>g relationships with X.(Low)Follow<strong>in</strong>g reconfiguration, C has failed to adequately seek the views ofpatients and the public. The C did no consultation when tak<strong>in</strong>g thedecision to close X and Y <strong>in</strong> Z, despite confirm<strong>in</strong>g afterwards that theystarted to discuss it as early as A. The forum learned of closures of Xand Y through a C press release that announced that the closures hadtaken place. The forum raised this with the Trust, OSC and SHA.Moreover, the forum feels strongly that C failed <strong>in</strong> its statutory duty toconsult with patients and the public. The forum cont<strong>in</strong>ues to receiveconcerns from local people regard<strong>in</strong>g X and Y closures. (High)
The trust has also held focus groups and consultation eventswith patients for example a session on Self Directed Care whichga<strong>in</strong>ed ideas and op<strong>in</strong>ions of patients with long term conditions<strong>in</strong> order to <strong>in</strong>fluence services. Forum members also took part <strong>in</strong>this event.(Medium)PALS officers attend as many PPI Forum meet<strong>in</strong>gs as possible.Recently a draft PALS report format for X has been shared withmembers for comments. A 2 way referral process exists betweenthe forum and PALS. S<strong>in</strong>ce reconfiguration there has been a lackof direction <strong>in</strong> Y as the Z trust have taken on the role. The forumis aware that the new PCT needs to fill this gap <strong>in</strong> the future.(Medium)
Does it work?Information (<strong>in</strong> all its senses) is the only way to understand allof what is really happen<strong>in</strong>g“Soft” <strong>in</strong>telligence often allows us to spot problems early119 requests for <strong>in</strong>vestigation – 85 considered - many led to<strong>in</strong>tervention21% of all data items used <strong>in</strong> AHC are qualitative10% of decisions to <strong>in</strong>spect purely on basis of qualitative<strong>in</strong>formation
AllPeople
The importance ofpublish<strong>in</strong>gcomparative<strong>in</strong>formation
How might it workPressure on providersPatients as consumers – choos<strong>in</strong>g the bestprovidersInformed and empowered patients – gett<strong>in</strong>gthe best from their providers• Which of these two is most likely towork?
Proportion of respondents cit<strong>in</strong>g different uses for data(forced choice of one use)100%would not use80%60%understand better40%20%0%TotalMyGHNMyGHDiabetesNo CCchoose doctor (newplan)change doctor(exist<strong>in</strong>g plan)boost confidenceFor all groups “understand better” is a significantly greater proportion than anyotherUse versus self-reported <strong>in</strong>terest does not vary (except for the would not usegroup)
How does satisfaction affect <strong>in</strong>terest?Are satisfied patients less <strong>in</strong>terested <strong>in</strong> hav<strong>in</strong>g<strong>in</strong>formation about quality?Test 1: Correlation of <strong>in</strong>terest scale with CAHPSsatisfaction scaleCorrelation between <strong>in</strong>terestand satisfaction rat<strong>in</strong>gsTotalMyGHNMyGHDiabetesNo CCr 20.0000.0020.0110.0010.001
How does satisfaction affect <strong>in</strong>terest?Test 2: Comparison of <strong>in</strong>terest scale with specificCAHPS attributes of patient-focused careMean <strong>in</strong>terest scores by regularity ofCAHPS attributesExpla<strong>in</strong>sListensRespectsTimeAlways7.77.67.77.5Not always7.77.77.57.9
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