According to the Global Burden of Disease study, in 2017 the top five causes of death and years of life lost in the UK were: ischaemic heart disease, lung cancer, stroke, Alzheimer’s disease and chronic obstructive pulmonary disease (COPD). People with these non-communicable diseases should be cared for according to National Institute for Health and Care Excellence (NICE) clinical guidelines and the standards set out in the NHS Constitution. Following these guidelines will help to ensure that patients receive high-quality care that will enable their conditions to be managed in the best possible way.
We used trend data from national clinical audits to look at changes in the quality of care for patients with heart attack, stroke, diabetes and COPD. We also updated our cancer waiting times indicators using data from NHS England. In the coming months we will turn our attention to the quality of care provided to children as well as older people with serious illnesses, so keep your eyes peeled for future updates. In the meantime, below is a summary of our indicators relating to conditions that cause very high levels of mortality. Click on the links for more detailed content and analysis.
Care for heart attack patients
Patients with ST-elevation myocardial infarction (STEMI) should receive primary percutaneous coronary intervention (PCI) within 90 minutes of arriving at hospital.
- Between 2004/05 and 2013/14, there was a significant increase in the proportion of STEMI patients receiving primary PCI within 90 minutes of arrival at a heart attack centre, from 52% to 92%. Since then, there has been a slight decrease to 89% in 2016/17.
Patients with non-ST elevation myocardial infarction (nSTEMI) should undergo coronary angiography within 72 hours of admission.
- Delays from admission to angiography for nSTEMI patients have not improved over time. In 2010/11, 55% of patients with nSTEMI underwent angiography within 72 hours, and this increased only slightly to 56% in 2016/17. This demonstrates an area for significant quality improvement.
Stroke care
People presenting with acute stroke should have a brain scan within 1 hour and be admitted to a stroke unit within 4 hours of arrival at hospital.
- Between 2013/14 and 2017/18, the percentage of patients who had a brain scan within 1 hour of arrival at hospital increased from 42% to 53%.
- Over the last five years, the percentage of patients admitted to a stroke unit within 4 hours fluctuated between 57% and 58%. It is not clear why no improvement has been made, but there are suggestions that it could be due to increasing problems with bed availability.
Stroke patients should be assessed by a nurse within 24 hours AND at least one therapist within 24 hours AND all relevant therapists within 72 hours AND have rehab goals agreed within 5 days.
- Between 2013/14 and 2017/18, the proportion of patients receiving a timely multidisciplinary review increased from 44% to 63%. The percentage increase may reflect greater weekend working among therapy staff.
Patients having stroke rehabilitation in hospital or in the community should be offered at least 45 minutes of each relevant therapy for a minimum of five days a week.
- In 2017/18, compliance against the speech and language therapy target was 51% compared with 80% for physiotherapy and 86% for occupational therapy.
All applicable patients should receive a joint health and social care plan on discharge.
- The percentage of stroke patients receiving a joint health and social care plan on discharge has increased over time, from 70% in 2013/14 to 93% in 2017/18.
Diabetes care
NICE recommends that all people with diabetes should receive nine annual care processes.
- Fewer people with Type 1 than with Type 2 diabetes receive their annual checks.
- Urine albumin and foot surveillance are most often missed out, while blood pressure and smoking history are most often checked.
NICE recommends treatment targets for HbA1c (glucose control), blood pressure and serum cholesterol.
- Glucose control targets are achieved in Type 1 diabetes less than half as often as in Type 2 diabetes.
- Over the last eight years the proportion of patients achieving all three treatment targets has improved for both Type 1 and Type 2 diabetes, by 2.1 and 5.0 percentage points respectively.
Care for COPD patients
Patients with COPD exacerbations should be reviewed by a member of the respiratory team within 24 hours.
- There was an increase in the proportion of COPD admissions reviewed within 24 hours, from 49% in 2014 to 55% in 2017.
Admitted patients with COPD should have key clinical information recorded.
- There was a marginal improvement in the percentage of admissions being prescribed oxygen: 55% in 2014, rising to 57% in 2017.
- A spirometry result was available for only 40% of admissions in 2017, compared to 46% in 2014.
- In 2017, of the admitted COPD patients who were current smokers, only 25% were prescribed smoking cessation pharmacotherapy during their admission.
Approximately 20% of patients are acidotic on arrival and should receive non-invasive ventilation (NIV).
- Only 11% of patients received NIV treatment in 2017 compared to 12% in 2014. Of those who received it in 2017, only 30% received NIV within three hours of arrival.
Admitted COPD patients should receive a British Thoracic Society, or equivalent, discharge bundle.
- In 2017, only 53% of admitted patients received a discharge bundle, and 19% had ‘no follow-up arrangements apparent’ given as a response.
Cancer waiting times
Following an urgent GP referral for suspected cancer, at least 93% of patients should be seen by a specialist within two weeks of the referral.
- Between 2009 and 2014, the percentage of people with suspected cancer having their first consultant appointment within two weeks fluctuated at 95%. Since then, performance has declined, particularly in the most recent three quarters, where the standard was missed.
The target for all cancer treatment types is for at least 96% of patients to start a first treatment for cancer within 31 days of the decision to treat.
- This operational standard has always been met, but performance has declined over time. In Q3 2018/19, 96.7% of patients waited less than 31 days for a first treatment for cancer following a decision to treat.
At least 85% of patients should start a first treatment for cancer within 62 days of an urgent GP referral.
- The proportion of patients waiting less than two months to start cancer treatment following an urgent GP referral has decreased significantly over time. In Q3 2012/13, 88% of patients started treatment within 62 days compared to 79% in Q3 2018/19.