NHS England publishes monthly data on the number of patients (aged over 18 years) delayed at midnight on the last Thursday of each month. The data are published at National Health Service trust and local authority level and provide information on the reason for delay.

The latest data is for February 2017 and is available at the following link:

https://www.england.nhs.uk/statistics/statistical-work-areas/delayed-transfers-of-care/

Data are collected on the total delayed days during each month for all patients delayed throughout the month. The total number of delayed days in each year between 2011/12 (the first full year for which data are available) and 2015/16, for Barnsley, South Yorkshire and England are shown in the table below. As health is a devolved issue, the number of delayed days in Scotland, Wales and Northern Ireland are not collected by NHS England.

Total number of delayed days in Barnsley, South Yorkshire and England

Source: NHS England, Delayed Transfers of Care Data

Notes:

¹South Yorkshire includes Barnsley, Sheffield, Rotherham and Doncaster Local Authorities.

This is the responsibility of each local clinical commissioning group (CCG) and we do not collect this information.

However, the Public Health Outcomes Framework includes an indicator on preventable sight loss which tracks three of the commonest causes of preventable sight loss, age-related macular degeneration, glaucoma and diabetic retinopathy. The open availability of this data provides a resource for commissioners and local health and wellbeing boards to identify what is needed in their areas and for comparisons to be made with other areas.

The CCG Outcomes Indicator Set also provides clear, comparative information for CCGs, health and wellbeing boards, local authorities, patients and the public about the quality of health services commissioned by CCGs and the associated health outcomes. The indicators are useful for CCGs and health and wellbeing boards in identifying local priorities for quality improvement and to demonstrate progress that local health systems are making on outcomes.

The Government’s Mandate to NHS England sets out the requirements for NHS England to improve outcomes in a range of areas, including preventing premature deaths from the biggest killers (including lung disease) and supporting people with long term physical and mental health conditions. It also requires NHS England to demonstrate progress on reducing mortality rates among patients with lung disease.

The NHS Outcomes Framework 2014/15 sets out the Department’s highest priority areas for the National Health Service and includes reducing deaths from lung disease as a key indicator.

Early diagnosis of chronic obstructive pulmonary disease plays an important role in maximising the ability to manage the condition. NHS England is currently working with several pilot sites exploring different approaches to diagnosis for people with symptoms of breathlessness.

Disposal of waste medicines is an essential service within the community pharmacy contractual framework, to be provided by all community pharmacies in England. NHS England is responsible for commissioning National Health Service pharmaceutical services.

Patients are normally advised to return unused medicines to their local community pharmacy for safe disposal. This is the case also for patients and families of deceased patients who no longer require prescribed medicines.

Appliances are normally collected by community nurses. Occasionally there is a local amnesty with appeals to patients to return equipment, for example crutches and wheelchairs to accident and emergency departments.

The information is not available in the format requested. NHS England publishes data on the number of patients occupying National Health Service hospital beds on the last Thursday of each month who were ready to return home or transfer to another form of care. This data is shown by the agency responsible. The latest data is for December 2016 and is available at the following link:

https://www.england.nhs.uk/statistics/statistical-work-areas/delayed-transfers-of-care/

There has been an increase in delayed transfers of care over the past two years. This has resulted in pressure on the availability of hospital beds. The proportion of occupied bed capacity attributable to social care delays is estimated at 1.8% between April 2016 and November 2016, which is an increase of 0.8 percentage points over the same period in 2014-15. However, there is also a 20-fold difference in social care delays between the 10% best performing and 10% worst performing local authorities but not a 20-fold difference in funding.

The Department, NHS England, NHS Improvement and local government are working together to provide a wide-ranging package of support to help local areas improve transfers out of hospital and reduce delays. This includes the implementation of best practice interventions such as:

- home first or discharge to assess models of care - so patients are discharged quickly and safely to home or to step down care so they no longer need wait unnecessarily for assessments in hospital; and

- trusted assessor models - using trusted assessors to carry out a holistic assessment of need avoids duplication and speeds up response times so that people can be discharged in a safe and timely way.

Commissioning through Evaluation is an innovative programme, established by NHS England, to gather new evidence on treatments that are currently not routinely funded by the National Health Service but nonetheless show significant potential promise for the future.

Selective Internal Radiation Therapy (SIRT) has not been routinely funded by the NHS in England due to the currently limited evidence base on the clinical and cost effectiveness of the procedure. If new evidence becomes available and NHS England determines that SIRT should be made routinely available in the NHS in the future, it would formally assess any implementation requirements (including training, mandatory standards for commissioned centres etc.) at that point as part of the associated Commissioning Plan.

SIRT is available via Individual Funding Requests.

Clinical commissioning groups (CCGs) are responsible for commissioning hospital eye services and for holding providers to account in terms of contract performance.

The Department expects patients who require further planned stages of treatment in line with their agreed care plan to receive this treatment without undue delay when clinically appropriate.

NHS Improvement advises that Southend University Hospital NHS Foundation Trust has implemented a comprehensive quality improvement plan for its ophthalmology service. Southend CCG is also developing an Essex-wide Ophthalmology strategy to improve services and reduce waiting times.

It is expected that around 530 patients will have accessed Selective Internal Radiation Therapy via the Commissioning through Evaluation programme by the end of March 2017.

The National Audit Office published an estimate of the total amount spent on cancer care in the National Health Service to show the relative scale of the cost of cancer services to the NHS. The NHS does not routinely publish estimates of the total amount spent on cancer patients as the large scale and highly complex range of services that cancer patients interact with makes this very difficult. Many of the services used by people with cancer, in particular diagnostic and rehabilitation services, but also some treatment services, are not specific to cancer patients.

There were 196,692 finished hospital admission episodes with a primary diagnosis for urinary tract infections in England in 2015/16.

Replies to the hon. Member of Hornsey and Wood Green’s recent letters on urinary tract infections should be sent on or before Friday 27 January 2017.

The Department does not have a specific policy on the retention of general practitioner (GP) practices in areas with an elderly demographic.

NHS England is responsible for the provision of primary medical services in England. As such, it is for NHS England to ensure that patients in all areas have access to GP services. To assess GP service provision in an area, NHS England works with the Care Quality Commission and local clinical commissioning groups (CCGs), using data from information sources such as the GP Patient survey and the primary care web tool.

In terms of overall strategy, the provision of primary care will be part of the Joint Strategic Needs Assessment (JSNA) which is published in each local authority area and reported through the local Health and Well-being Board. The JSNA will identify any gaps and risks in the provision of primary care to the local population which, in turn, will then inform commissioning strategies for that area.

GP Practices as independent contractors are responsible for ensuring that the practice clinical workforce is fit for purpose and able to meet the reasonable needs of population. Where practices are struggling to maintain a clinical workforce with the necessary skillmix, they can seek support from NHS England and their local CCGs. The Department is investing £40 million over four years targeted at supporting practice resilience.

The attached document shows the following information:

- Total count of Unplanned A&E Attendances in each year

- A count of attendances where the patient GP Practice has been recorded as V81997 - No registered GP Practice, broken down by the Commissioning Region of residence of the patient for each year.

This data does not represent the number of patients, as an individual may have more than one attendance at accident and emergency in any given period.

Please be aware of the following when interpreting the data:

The Commissioning Region of residence is derived from the patient’s postcode of home address. A default value can be used to identify records where the patient is not normally resident in the United Kingdom. Where the postcode recorded is invalid or left blank the Commissioning Region will be recorded as Unknown.

There are 44 Sustainability and Transformation Plans (STPs) covering the whole of England. STPs are being developed within their local area, with support from NHS England. The Department expects individual STPs to take account of challenges specific to their area including a rural population.

Proposals are at a draft stage but we expect all local leaders to be talking to the public and stakeholders regularly – it is vital that people are able to shape the future of their local services.

Directly comparable figures are not available, but it is clear that in the past two years there has been a substantial increase in delayed discharge figures attributable to social care at the trust, which this year were among the worst currently being recorded across the NHS.

How many patient-days of delayed discharge attributable to the levels of suitable social care available at the Royal Wolverhampton NHS Trust there were in (a) 2010 and (b) 2016.

Sadly, those figures are no surprise, despite the well-managed New Cross hospital, because central Government have cut Wolverhampton City

Council’s total income by almost 50% in the past six years. The primary care vertical integration pilot in Wolverhampton is a redesign of services so that a single organisation—the hospital trust—deals with patients from initial contact to ongoing management and end-of-life care. What steps is the Department of Health taking to support vertical integration as one potential way to improve care and lessen hospital admissions and delayed discharges?

NHS England involves patients, patient groups and the public at numerous stages of the process for developing clinical commissioning policies and service specifications that may be subject to a process of relative prioritisation.

Clinical policies and service specifications are developed by Clinical Reference Groups (CRGs), which are advisory groups and which include patients and patient representatives in their membership. Draft clinical policies and service specifications undergo a process of testing with registered stakeholders before they are submitted for a full public consultation. The CRG will consider the outcome of stakeholder testing and public consultation before submitting the final proposed document to NHS England for the purpose of relative prioritisation.

Recommendations on the relative prioritisation of new investments in specialised services are made by the Clinical Priorities Advisory Group, which is independently chaired and which includes patient and public voice representatives in its membership.

NHS England held a public consultation on ‘Developing a Method to Assist Investment Decisions in Specialised Commissioning’ between April and May 2016. The response to consultation can be found here:

https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2016/06/prioritisation-method-cons-response.pdf

Increased data sharing can help improve both health and work outcomes for individuals and this is a matter referenced in ‘Improving Lives: The Work, Health and Disability Green Paper’. We welcome comments on this over the consultation period which runs until 17 February 2017.