Chamber and committees

The Scottish Patients at Risk of Readmission and Admission (SPARRA) tool is used to estimate the future risk of unscheduled inpatient admission of someone who has experienced at least one such admission in the preceding three years.

The following table shows the number of people who have experienced at least one unscheduled admission in the three years prior to October 2010, broken down by Scottish Index of Multiple Deprivation decile (SIMD: 2009). For each SIMD decile, the table also shows the number and percentage of these individuals whose risk of admission was estimated to be high, which is defined as a SPARRA risk score of 50% or more.

SPARRA Patients by Deprivation Category

Current SIMD: 2009	October 2010
	SPARRA Cohort	High Risk*
			%
1 (Most Deprived)	96,068	8,339	8.7
2	88,805	6,689	7.5
3	84,924	6,242	7.4
4	79,331	5,541	7.0
5	74,220	4,634	6.2
6	90,408	6,847	7.6
7	67,700	3,359	5.0
8	64,174	2,913	4.5
9	59,231	2,369	4.0
10 (Least Deprived)	51,800	1,982	3.8
Total	756,661	48,915	6.5

Source: ISD Scotland.

Ref: IR2011-00220.

The Scottish Patients at Risk of Readmission and Admission (SPARRA) tool is used to support NHS board and Community Health Partnership healthcare teams in providing proactive, planned and co-ordinated care for patients with frequently changing or complex needs.

The Scottish Government''s Long Term Conditions Collaborative is supporting NHS boards to provide appropriate interventions for people who are at most risk of unscheduled admission or readmission. These may include a period of care management by a member of the extended primary and community care team, and the development and sharing of an anticipatory care plan.

The information requested is not routinely available.

The Scottish Patients at Risk of Readmission and Admission (SPARRA) tool is used to estimate the future risk of unscheduled inpatient admission of someone who has experienced at least one such admission in the preceding three years.

The following table shows the number of people meeting this criterion in each NHS board at the start of both financial years. The table also shows the number and percentage of these individuals whose risk of admission was estimated to be high, which is defined as a SPARRA risk score of 50% or more.

SPARRA Patients by NHS Board

	April 2009			April 2010
NHS Board	SPARRA Cohort	High Risk*		SPARRA Cohort	High Risk*
			%			%
Ayrshire and Arran	62,088	4,683	7.5	63,639	4,308	6.8
Borders	18,116	1,257	6.9	18,345	1,268	6.9
Dumfries and Galloway	20,300	1,373	6.8	21,064	1,606	7.6
Fife	49,843	2,813	5.6	50,792	3,215	6.3
Forth Valley	40,406	2,390	5.9	40,749	2,650	6.5
Grampian	71,119	3,639	5.1	72,739	3,973	5.5
Greater Glasgow and Clyde	183,723	13,697	7.5	186,872	13,525	7.2
Highland	44,537	2,708	6.1	45,465	2,741	6.0
Lanarkshire	85,086	5,165	6.1	87,238	5,674	6.5
Lothian	104,030	6,490	6.2	104,233	6,538	6.3
Orkney Islands	2,525	193	7.6	2,545	166	6.5
Shetland Islands	2,916	98	3.4	2,823	90	3.2
Tayside	57,981	2,475	4.3	60,635	3,270	5.4
Western Isles	3,887	257	6.6	3,908	219	5.6
Total	746,557	47,238	6.3	761,047	49,243	6.5

Source: ISD Scotland.

Ref: IR2011-00218.

The tools used to assess the cohort identified by the Scottish Patients at Risk of Readmission or Admission (SPARRA) tool would be determined by the number and nature of the conditions of each individual, as well as their social, family and carer context.

The Scottish Government''s Long Term Conditions Collaborative (LTCC) has also worked with teams from NHS boards and their local authority and third sector partners to agree and develop practical guidance on the approach to integrated care management and anticipatory care planning.

In partnership with the Releasing Time to Care initiative, further work is being undertaken to build capability in community teams to apply these approaches. The Scottish Government''s Long Term Conditions Unit and the LTCC are also working with ehealth colleagues on developing the Key Information Summary to support electronic sharing of anticipatory care plans across teams and settings.

The overall response rate to the 2009-10 GP patient experience survey was 38%. As expected this was lower than the response rate in 2008-09 because the survey was designed to sample more patients from practices that had lower response rates in 2008-09. This improved the accuracy of results for practices with lower response rates. The number of responses that could be used in the calculation of the Quality and Outcomes Framework (QOF) patient experience of access indicators PE7 and PE8 was less than the number of questionnaires that were returned. This was mainly because people had not tried to access the practice in the way specified.

The results for each of the QOF indicators were derived from combinations of three questions. Therefore, the valid responses for an indicator depended on the sequence of questions being answered, and not just a response rate to a particular question “ which would be higher. For example, those who missed out a question or ticked more than one option in a question were excluded from the analysis for that indicator. The observed valid response rates (as % of the total number sent out) are shown in the following tables.

2009-10	(a) Mean	(b) Median	(c) Standard Deviation
PE7 (48 Hour Access)	25%	25%	5%
PE8 (Advance Access)	20%	21%	5%

The results from 2008-09 are shown below for comparison:

2008-09	(a) Mean	(b) Median	(c) Standard Deviation
PE7 (48 Hour Access)	37%	37%	8%
PE8 (Advance Access)	23%	24%	6%

 

One of the NHS boards signed up to the TrakCare patient management system have the records aggregated at one site. The model being adopted by NHS boards implementing the TrakCare system is one that replaces any disparate electronic patient administrative records with a single integrated design within each board. In parallel, boards have improvement work underway in connection with their paper records. In part this work aims to aggregate paper records in single or fewer sites, whichever is practicable given geography. Longer term work, given the scale of the task, involves digitising (scanning) paper records based on unique Community Health Index number so as to make them available with the patient at whichever point of care.

Health Protection Scotland monitors and publishes ward closures due to norovirus outbreaks via point prevalence Management Information. Norovirus point prevalence reporting commenced on 7 January 2008.

This weekly point prevalence data relates to the number of wards closed at any time on a Monday. This provides an indicator (in as close to real-time as is possible) of the impact norovirus is having on NHSScotland but is not incidence data and can therefore miss some outbreaks, i.e. if an outbreak started on a Tuesday and was over by the Sunday it would not be recorded on the prevalence data.

Ward closures occurring on a Monday that are still ongoing the following Monday will be counted twice even though they relate to a single outbreak.

It is not possible to aggregate the provided data into an annual total of ward closures. Weekly point prevalence data for 2008 to 2011 is available from the Scottish Parliament Information Centre (Bib. number 52416).

Future weekly data for 2011 will be available at:

http://www.hps.scot.nhs.uk/haiic/ic/noroviruspointprev.aspx

There are no mandatory national surveillance systems for hospital-acquired infections outbreaks occurring in hospitals in NHSScotland. Therefore, it is not possible at a national level to identify ward closures due to hospital-acquired infections or other reasons over the time period requested. NHS board level data would need to be requested from boards.

Systems and associated networks are designed to be resilient. In the event that there is systems failure NHS boards have business continuity plans and local service continuity plans in place which will be invoked if necessary. This applies to all IT systems including those which deal with electronic patient records. The NHS Scotland Security Policy states that boards will undertake a survey of their information systems and data and make an assessment of the likely security risks, including an evaluation of the likely impact and occurrence of any threats that may disrupt services. Boards then introduce measures to mitigate these risks. These include, but are not limited to, processes such as virus checking, regular patching of operating systems software and the provision of back-up systems.

The Scottish Government wrote to NHS boards in March 2008 providing guidance on information sharing between NHS Scotland and the police at:

www.sehd.scot.nhs.uk/details.asp?PublicationID=2529.

The guidance sets out how NHS boards and police forces should work together to develop a consistent approach to the sharing of information to promote the prevention and detection of crime, while respecting and safeguarding the interests of patients and the public in the confidentiality of personal health information. The guidance, which remains extant, applies to all NHS settings and to all types of crime.

Additionally, a number of injury surveillance projects are in operation across Scotland. These involve accident and emergency departments sharing anonymised data with the police on injuries caused by assault. The data is used to improve analysis and understanding of patterns of crime to inform decisions on the deployment of local resources aiming to reduce violence. The Scottish Government will consider the evidence emerging from these projects before deciding whether to provide more specific guidance to NHSScotland.