This month’s update covers a range of areas including NHS resources, premature mortality, early intervention and substance misuse.
Resources
NHS staff turnover
The NHS in England employs around 1.2 million people. This includes 150,000 doctors, 41,000 GPs and 315,000 nurses and health visitors (2014 figures). The number of employees has been increasing at about 1.3% per year for the past decade . Staff turnover can be a key determinant of organisational success and service delivery. Appropriate levels allow for the influx of fresh ideas and the displacement of poor performers. On the other hand too much or too little turnover can be detrimental.
This month we have updated staff turnover data for health visitors, doctors and nurses. In October 2010, the Government made a commitment to increase health visitor numbers by 4,200 by 2015, acknowledging the vital role they play in supporting and educating families. Unfortunately this target was missed. Despite this, between September 2009 and October 2016 their numbers did increase, from 8,100 to 9,410.
Physician density (the number of physicians per 1,000 people) has been increasing in many OECD countries over the past two decades. In 1993 the UK had a relatively low physician density of 1.7 per 1,000 people. However by 2015 this had risen to 2.8 per 1000. Conversely, the nurse density in the UK has declined, falling from 9 nurses per 1,000 people in 2000 to 7.9 per 1,000 in 2015.
Cancelled operations
Cancelled operations lead to increased costs and workloads, and decreased efficiency. There is also a huge impact upon patients and their families.
Data regarding cancelled operations can offer important insight into hospital capacity as cancellations are often due to insufficient facilities, equipment or personnel. The latest data shows that the number of cancelled elective operations peaks each year around October, November and December. This is likely due to hospitals dealing with winter pressures.
Between 1994/95 and 2016/17 there was a 79% increase in the number of cancelled elective operations. Despite this increase, the proportion of elective admissions cancelled has declined slightly.
Premature mortality
Ischaemic stroke mortality
Stroke is the third leading cause of death in England each year and the leading cause of disability.
Mortality rates can help us understand more about the quality of acute care provided by the health service. This month’s update offers further insight into outcomes for patients that have suffered a stroke. Encouragingly, the ischaemic stroke 30-day mortality rate has been declining in the UK, falling from 17 per 100 patients in 2008 to 11 per 100 patients in 2013. Despite this fall, the rate in the UK remains above similar nations.
Prevention and early intervention
The NHS has an important role to play in the prevention and earlier diagnosis of conditions. This month we have new data regarding two key services - cervical screening and the management of chronic kidney disease (CKD).
Cervical screening
It is estimated that cervical screening saves up to 5,000 lives a year in the UK. The NHS screening programme is available to women aged 25 to 64 in England. Screening offers an excellent opportunity to identify women that seem healthy but may be at increased risk of disease.
Since 2013, the proportion of eligible women aged 25-49 invited for screening has stayed at a similar level. And as of 2016, just 33% of eligible women had been invited for screening. Cervical screening coverage (proportion of women eligible for screening who were screened) for women aged 25-64 has been declining since 2011 and in 2016 coverage was 73%.
Chronic kidney disease
In the UK in 2015, the prevalence of stage 3-5 CKD was over 8%. In England 45,000 adults are on renal replacement therapy (RRT) and around 2% of the total UK NHS budget is spent on these patients. The successful management of CKD relies largely upon effective primary care through early detection and timely referral to prevent progression and reduce mortality.
Identifying high blood pressure and whether there is proteinuria (presence of excess proteins in the urine) or haematuria (presence of red blood cells in the urine) are key aspects of managing CKD in a primary care setting. Since 2008/09, the percentage of CKD patients whose blood pressure is below the recommended threshold (140/85) has risen from 73% in 2008/09 to 81% in 2014/15. The percentage of patients with hypertension and proteinuria receiving appropriate treatment (with an angiotensin converting enzyme inhibitor or angiotensin receptor blocker) has remained steady (91.5% in 2014/15).
Substance misuse
Substance misuse and treatment
Estimates indicate the annual cost of drug addiction is £15.4bn in terms of its impact on health, crime and other aspects of life. Individuals who complete drug treatment demonstrate a significant improvement in health and wellbeing. Drug treatment services in England have helped thousands of drug users to recover from their drug problems.
In 2013, local authorities became responsible for commissioning drug treatment services. The National Drug Treatment Monitoring System (NDTMS) collects data relating to substance misuse treatment showing how these services performed. From 2005-06 to 2015-16, adult waiting times for treatment improved substantially. The greatest improvements can be seen in alcohol treatment users, improving from 73% of people waiting three weeks or less for treatment in 2005-06 to 96% in 2015-16.
Of those adults in treatment, the proportion who exited treatment in each year free of dependence has remained above 50% since 2011-12. However opiate users show much lower levels of service users completing treatment free of dependence (28% in 2015-16).
Summary
The update for this month presents a mixed picture. The proportion of operations cancelled is falling, as is premature mortality due to stroke and waiting times for substance misuse treatment. Less positive stories can be found in the low physician density in the UK relative to similar nations as well as falling nurse density in the UK. The coverage offered by cervical screening also appears to be in decline.