Since November we have been updating indicators relating to a range of areas in health and social care. These include indicators on patient experience of community mental health services, reablement services for the elderly, support for people with learning disabilities, quality of life for carers, the effectiveness of care for people with mental ill health and cancer, and the prevention of obesity and sexually transmitted infections (STIs). This month’s indicator updates show continued difficulties in delivering patient-centred care. Latest figures also point to the presence of substantial inequalities in premature mortality and cancer survival.
How effective is care?
The Health and Social Care Act 2012 established the first specific legal duties on NHS England to reduce access and outcome inequalities. Despite this, inequalities persist.
The mortality rate for people with serious mental ill-health (under 75) are over three times higher than the rest of the population. There appears to have been little progress to reduce this gap over the time period measured. In 2013/14 the mortality rate for a female with a serious mental health condition (under 75) was over 3.5 times that of the general population. This figure was even larger for males, at 3.6 times.
Cancer survival varies noticeably by gender. There are generally higher levels of cancer survival amongst women compared to men. Five-year survival estimates are significantly higher for women for eight cancers (kidney, lung, and mesothelioma, melanoma of the skin, non-Hodgkin lymphoma, oesophagus, stomach and thyroid).
Breast cancer mortality in the UK has been declining and fell from 37.7 deaths per 100,000 women in 2001 to 29.1 deaths per 100,000 women in 2013. However, the UK is consistently amongst the top four countries with the highest mortality rate.
How effective is prevention?
Recently there has been a shift in NHS investment towards targeted and proven prevention programmes . To a large degree, the sustainability of the NHS will come to depend upon improved prevention and public health. Prevention of obesity and sexually transmitted infections are two key areas of focus.
Overall, the percentage of reception-aged children who are overweight, obese or underweight has remained broadly stable between 2006/07 and 2015/16. Achieving significant reductions in levels of overweight and obese reception children is proving difficult.
Sexually Transmitted Infections (STIs)
In 2015, there were approximately 430,000 diagnoses of STIs in England, the most common being chlamydia (368.7 per 100,000) and genital warts (125.8 per 100,000). Rising trends in STIs may be attributed both to more routine testing and case finding in genitourinary medicine and sexual and reproductive health services, but also to continued unsafe sexual behaviour. From 2006 to 2015, the proportion of new HIV diagnoses diagnosed late in the UK decreased from 56% to 39%, with the absolute number decreasing from 7,316 to 6,028. The decline is mostly attributable to reductions in late diagnoses among men who have sex with men (MSM) (from 42% in 2006 to 30% in 2015) with a smaller decline among heterosexual men (67% to 55%) and women (64% to 49%).
Is patient-centred care being delivered?
The Government’s Five Year Forward View, published in 2014, highlighted the need for patient-centred approaches throughout primary, community and acute care. Being person-centred is about focusing care on the needs of the person rather than the needs of the service. Patients have the right to contribute to their care. The health and social care system must remember that patients have their own views on what’s best for them.
Recognition of the vital role carers play in the health system, and the need to provide them with adequate support, is growing. Despite this, recent research from Carers UK suggests that a lack of adequate support for carers is resulting in increased pressure on NHS emergency departments.
People’s perceptions of their mental health care remained similar in 2016 compared to the previous year. In 2016 almost three quarters (73%) of people gave their mental health care a score of at least 6 out of 10, a slight increase on 2015 (71%). The proportion of people rating their overall experience as five or below fell in 2016. In terms of acquiring support in their daily life, users of community mental health services appear to experience particular difficulty in acquiring support to find and keep work.
Reablement services show consistent success in helping older people maintain a level of independence. The proportion of older people at home after 91 days has varied little over time. It has been generally high, ranging from 81.2% in 2009/10 to 82.7% in 2015/16. The proportion of women who received a reablement service who were still living at home 91 days after discharge was higher in each year compared to all males. In 2015/16, 82.0% of females 85 and over and 77.3% of males 85 and over were living at home 91 days after discharge.
The proportion of adults with learning disabilities in their own home or with family is on the rise and stood at over 75% in 2015-16. In 2015-16, there was large variation between different regions in England in terms of the proportion of people with learning disabilities living in their own home or with their family. This was highest in the North West (89%) and lowest the in the West Midlands (68%) - a 21 percentage point difference.
Attempts via the Care Programme framework to improve coordination of mental health care for people show signs of success. People on a Care Programme Approach (CPA) are more likely to have at least one formal meeting to discuss their care in a year. In 2016, 82% of people on a CPA had a meeting to review their care, compared with 69% of people not on a CPA.
The quality of life of carers appears to be falling and there is substantial variation by region, sex and age group. The average carer-reported quality of life score has decreased slightly across the country from 8.1 in 2012-13 to 7.9 in 2015-16. There is regional variation in the reported quality of life score. In 2015-16, the North East reported the highest quality of life scores (8.5) and London the worst (7.6). Male carers had an average score of 8.1 in England, which is 0.3 points higher than females who scored 7.8.