JSNA high quality coordinated care

Holistic care and support aims to boost choice and control. It also aims to make positive changes in people’s lives, in terms of wellbeing, resilience and connections to others. These factors are vital to people as physical health needs. They can also improve their ability to self-care. Holistic care has been shown to lead to better use of resources.

There's proof that hospital is not the best place for people to recover from injury or illness. They can be cared for at home or in the community. It also shows giving care outside of hospital supports independence and self-care.

Members of staff who are familiar with the community they work with are better able to adopt strengths-based approaches. They can utilise assets within those communities.

Healthwatch Barnsley asked people to complete a survey to find out how to make local NHS services better. Read the full NHS long term plan: Barnsley engagement report to learn more.

The Whole System Partnership (WSP) report was brought about by Barnsley Care Commissioning Group (CCG). This sets the scene for the CCG’s out of hospital workforce strategy. The project used WSP modelling tools explore workforce futures and workforce modelling. Find out more about Barnsley's out of hospital workforce report.

The Modelling Population Health Needs in the Barnsley Health and Social Care System report explores the impact that a stock and flow modelling approach can make. It will help us to understand future population health needs. 

Services rated as high quality

This section includes:

  • adult social care
  • hospitals
  • primary care

Adult social care

Why this is important

This metric provides an overall score indicative of the quality of care in a CCG area as determined by Care Quality Commission (CQC) inspection ratings. The summary score by sector (hospitals, general practices and adult social care) for each area allows CCGs to assess the quality of care in their area against an England average and provides a baseline to monitor improvements.

The indicator is based on the ratings for each of CQC’s five key questions:

  • Is it safe?
  • Is it effective?
  • Is it caring?
  • Is it responsive?
  • Is it well-led?

The ratings are scored as follows:

  • outstanding = 3
  • good = 2
  • requires improvement = 1
  • inadequate = 0

The Barnsley picture and how we compare

Barnsley’s rating for provision of high quality adult social care services has declined slightly recently.

Out of 10 comparator CCGs, Barnsley has the lowest rating.

View the trend and comparator data charts for services rated as high quality - adult social care.

Resources and supporting documents

Hospitals

Why this is important

This metric provides an overall score indicative of the quality of care in a CCG area as determined by Care Quality Commission (CQC) inspection ratings. The summary score by sector (hospitals, general practices and adult social care) for each area allows CCGs to assess the quality of care in their area against an England average and provides a baseline to monitor improvements.

The indicator is based on the ratings for each of CQC’s five key questions:

  • Is it safe?
  • Is it effective?
  • Is it caring?
  • Is it responsive?
  • Is it well-led?

The ratings are scored as follows:

  • outstanding = 3
  • good = 2
  • requires improvement = 1
  • inadequate = 0

The Barnsley picture and how we compare

Barnsley’s rating for provision of high quality hospital care has improved over recent years.

Out of 10 comparator CCGs, Barnsley has the 5th highest rate.

View the trend and comparator data charts for services rated as high quality - hospitals.

Resources and supporting documents

Primary care

Why this is important

This metric provides an overall score indicative of the quality of care in a CCG area as determined by Care Quality Commission (CQC) inspection ratings. The summary score by sector (hospitals, general practices and adult social care) for each area allows CCGs to assess the quality of care in their area against an England average and provides a baseline to monitor improvements.

The indicator is based on the ratings for each of CQC’s five key questions:

  • Is it safe?
  • Is it effective?
  • Is it caring?
  • Is it responsive?
  • Is it well-led?

The ratings are scored as follows:

  • outstanding = 3
  • good = 2
  • requires improvement = 1
  • inadequate = 0

The Barnsley picture and how we compare

Published data for quarter 3 2018/19 shows that Barnsley’s rating for provision of high quality primary care services has declined slightly recently.

Out of 10 comparator CCGs, Barnsley has the lowest rating.

View the trend and comparator data charts for services rated as high quality - primary care.

Resources and supporting documents



Unplanned hospital admissions

This section includes:

  • ambulatory care and urgent care sensitive conditions
  • delayed transfers of care
  • falls (65+)
  • total hospital bed days

Ambulatory care and urgent care sensitive conditions

Why this is important

There are large inequalities in the rate of unplanned hospitalisation for chronic ambulatory care sensitive and urgent care sensitive conditions when comparing the most and least deprived areas nationally.

Providing information on the level of inequalities within CCGs will shine a spotlight on variations in practice and will provide data to enable CCGs to explore levels of inequalities in order to address and reduce these. This indicator reflects variations in the quality of management of long-term conditions in primary, community and outpatient care as well as urgent care. It will help identify areas of good practice and those where improvements should be made for the benefit of patients and the local health economy.

It is seen as being sensitive to in-year change as a direct result of local action.

The Barnsley picture and how we compare

Barnsley has consistently higher rates than the England average for unplanned hospitalisation for chronic ambulatory care sensitive conditions.

When compared to other clinical commissioning groups (CCGs) within the Yorkshire and Humber region, Barnsley is ranked 7th highest out of 19.

When compared to similar CCGs, Barnsley is ranked 4th lowest out of 10.

View the trend and comparator data charts for ambulatory care and urgent care sensitive conditions.

Delayed transfers of care

Why this is important

This measures the impact of hospital services (acute, mental health and non-acute) and community-based care in facilitating timely and appropriate transfer from all hospitals for all adults.

This indicates the ability of the whole system to ensure appropriate transfer from hospital for the entire adult population and is an indicator of the effectiveness of the interface within the NHS, and between health and social care services.

Minimising delayed transfers of care and enabling people to live independently at home is one of the desired outcomes of social care.

The Barnsley picture and how we compare

Barnsley’s rates per 100,000 for delayed transfers of care have been consistently lower than regional and national rates since 2010/11.

When compared to other local authorities within the Yorkshire and Humber region in 2018/19, Barnsley has the lowest rate.

When compared to similar CCGs, Barnsley has the lowest rate.

View the trend and comparator data charts for delayed transfers of care.

Resources and supporting documents

Falls (65+)

Why this is important

In 2020/21, Barnsley’s rate for emergency hospital admissions due to falls in people aged 65 and over (2,377 per 100,000) was significantly higher than the England rate of 2,023 per 100,000. Out of 16 similar local authorities, Barnsley’s rate was the fourth highest. In terms of numbers, the rate of 2,377 represents just over 1,110 people aged 65 and over in Barnsley who were admitted to hospital as a result of a fall in 2020/21. Rates have increased in recent years. Similarly, the rates for those aged 65-79 and 80+ are significantly higher than the England average.

Falls are the largest cause of emergency hospital admissions for older people, and significantly impact on long term outcomes, eg being a major cause of people needing to move from their own home to long-term nursing or residential care.

The highest risk of falls is in those aged 65 and above and it is estimated that about 30% people (2.5 million) aged 65 and above living at home and about 50% of people aged 80 and above living at home or in residential care will experience a fall at least once a year.

You can read the National Institute for Health and Clinical Excellence (2017) guidance, Falls in older people: assessing risk and prevention.

Falls that results in injury can be very serious. Approximately one in 20 older people living in the community experience a fracture or need hospitalisation after a fall. Falls and fractures in those aged 65 and above account for over four million bed days per year in England alone, at an estimated cost of £2 billion.

The rate of hip fractures in Barnsley for people aged 65 and over (2020/21) is 554 per 100,000, similar to the England rate of 529 per 100,000.  This is the equivalent of 255 Barnsley residents in the aged 65 and over population, and is the second lowest rate since 2010/11.

Hip fracture is a debilitating condition. Only one in three sufferers return to their former levels of independence and one in three ends up leaving their own home and moving to long-term care. Hip fractures are almost as common and costly as strokes and the incidence is rising. In the UK, about 75,000 hip fractures occur annually at an estimated health and social cost of about £2 billion a year. The incidence is projected to increase by 34% in 2020, with an associated increase in annual expenditure.

You can read the National Institute for Health and Clinical Excellence (2017) report, The management of hip fracture in adults.

As well as physical injury, people who experience falls are likely to experience loss of confidence, independence, social isolation and loneliness all of which has been exacerbated by the COVID-19 pandemic measures. In July 2021 Public Health England published a report on the wider impacts of COVID-19 on physical activity, deconditioning and falls in older adults. Modelling in the report predicts a 3.9% increase in the number of older people having at least one fall per year and the total number of falls increasing for males by 6.3% and females by 4.4% if mitigations are not put in place.

You can read the full report on the wider impacts of COVID-19 on physical activity, deconditioning and
falls in older adults.

We aim to raise awareness of the risks involved with falls for this age group and give advice on how to prevent falls. We're committed to #LiveIt by helping people to live independently at home for longer.

There are a number of reasons why people fall:

  • cold weather has a direct effect on falls
  • high blood pressure
  • visual or hearing impairment
  • bone health and muscle mass
  • reduced strength and balance
  • environment, for example, hazards at home
  • medication
  • alcohol
  • hydration and nutrition
  • urinary incontinence
  • ill fitting shoes or feet problems
  • cognitive impairment

Find out more about older people's health.

The National Institute for Health and Clinical Excellence (NICE) has produced Quality Standard 86: falls in older people that covers assessment after a fall and preventing further falls (secondary prevention) in older people living in the community and during a hospital stay. The standard is designed to drive measurable improvements in the three dimensions of quality which are patient safety, patient experience and clinical effectiveness through the delivery of quality statements.

Local actions are expected to contribute to improvements in the following outcomes:

  • prevention of falls in the 65 and over age range
  • reduction in hip fractures
  • rates of osteoporosis
  • excess winter deaths
  • morbidity
  • rates of hospital admissions and re-admissions
  • demand on social care

The Barnsley picture and how we compare

  • In 2020/21, Barnsley’s rate for emergency hospital admissions due to falls in people aged 65 and over (2,377 per 100,000) was significantly higher than the England rate of 2,023 per 100,000.

  • Out of 16 similar local authorities, Barnsley’s rate was the fourth highest.

  • In terms of numbers, the rate of 2,377 represents just over 1,110 people aged 65 and over in Barnsley who were admitted to hospital as a result of a fall in 2020/21.

  • Rates have increased in recent years.

  • Similarly, the rates for those aged 65-79 and 80+ are significantly higher than the England average.

What we're doing and the assets or services we have

We are reviewing our prevention messages across the life course, and a number of key strategic work programmes:

Frailty

  • Multi-agency working to use Rockwood scoring to identify frail people and those at risk of falling
  • Develop effective frailty pathways (falls, osteoporosis and anticipatory/proactive care)
  • Identification of those residents who are most frail and complete Comprehensive Geriatric Assessments
  • Commission Fracture Liaison Service

Falls prevention

  • Integrated Community Falls Service is being delivered by South West Yorkshire Partnership Foundation Trust (SWYPFT) which offers secondary prevention advice
  • The Barnsley Older People Physical Activity Alliance led by Age UK Barnsley has been established this is a one-year pilot project aiming to increase the provision of strength and balance exercise activities across Barnsley.
  • Barnsley is a member of the UK Age Friendly Communities Network
  • Berneslai Homes scheme managers are trained to deliver gentle exercise and healthy bones classes to residents of independent living schemes
  • #FallProofBarnsley is the falls prevention campaign launched in 2020
  • Distribution of Fall-Proof booklets and falls prevention leaflets is ongoing
  • Barnsley is part of the Yorkshire and Humber falls and deconditioning network

Excess winter deaths

  • Identification of people at risk of excess winter morbidity and mortality is taking place
  • A borough wide assessment of people at risk of excess winter morbidity and mortality is to be implemented
  • Implementation or signposting to interventions to address winter morbidity and mortality is taking place
  • Monitoring and evaluation of the impact of actions to address winter morbidity and mortality is underway
  • A system wide communication plan for the public and stakeholders exists
  • Awareness is being raised of the impact of adverse weather through alerts, emergency preparedness and building community resilience

Flu vaccination uptake (2019/2020)

  • In the 65+ age group, Barnsley’s uptake rate (73.1%) was slightly higher than the England rate (72.4%)

Dementia

  • The Barnsley Dementia Strategy Action Plan identifies the increased falls risk for people living with dementia compared to cognitively healthy older adults, and links strategically to the Falls Prevention Plan.

Vision

  • Those with vision impairment/sight loss are at risk of falling. The Barnsley Vision Strategy Action Plan identifies work to prevent falls.

Alcohol Plan and Food Plan

  • Work is ongoing to identify correlations between food, nutrition, hydration, alcohol and falls.
  • Barnsley have developed an Older People Alcohol Toolkit

Oral health improvement

  • Poor oral health can impact on the types of food a person can eat. Poor nutrition and hydration can be a risk factor for falls. Work is ongoing to link the two work programmes.

Opportunities for improvement or future development

  • Primary prevention messages are to be targeted across the life course

  • Work with partners of the Barnsley Older People Physical Activity Alliance to increase provision of physical activity for older people

  • Work with the Active in Barnsley partnership to promote physical activity for older people with ‘What’s your move?’ campaign

  • Identification of those at risk of a fall earlier in the life course

  • Those at risk of osteoporosis and hip fracture to be identified sooner and given prevention advice and sign posting.

  • Strength and balance exercise to be available for those who are identified as at risk of falling

  • Clear communication of prevention messages (primary, secondary and tertiary) are to be provided, especially when someone may be more at risk of a fall, to the workforce and the public.

  • Collaborative working, for example, the Integrated Care System

  • Integrated Workforce Development.

Resources and supporting documents

Total hospital bed days

Why this is important

To ensure unnecessary hospital admissions are avoided and so that people are able to spend less time in hospital.

The Barnsley picture and how we compare

Although Barnsley’s rates have been consistently higher than regional and national rates over recent years, the current rate (April 2019) of 54.66 per 1,000 registered population is similar to the Yorkshire and the Humber and England rate.

When compared to similar CCGs, Barnsley is ranked 5th highest out of 11.

View the trend and comparator data charts for bed days.

Resources and supporting documents



End of life care

This section includes:

  • emergency hospital admission during the last 90 days of life

End of life care

Why this is important

The purpose of the indicator is to encourage improvement in the quality of end of life care.  This is done in the following ways:

  • proactive planning and end of life care being addressed in a coordinated and timely way.
  • key details about the person’s condition, needs and preferences being shared across the local health and care system.
  • where unplanned needs arise. The speed and quality of urgent care response taking place. Which should reduce the need for repeat emergency admissions during the last 90 days of life.

The Barnsley picture and how we compare

People in Barnsley had three or more emergency hospital admissions in the last 90 days of life, in 2016 and 2017. This is the highest segment of people when compared to other CCGs within the Yorkshire and Humber region. Barnsley also had the highest rates when compared to similar CCGs.

View the trend and comparator data charts for unplanned admissions at the end of life.

Resources and supporting documents