Authors: Candace Imison, Emmi Poteliakhoff, James Thompson
These appendices accompany The King’s Fund report Older People and Emergency Bed
Use: Exploring variation. This paper explores variation in the use of acute beds by older people admitted as an emergency, and examines the factors that may be driving this variation. It does this through analysis of routine data sets, primarily Hospital Episode
Statistics (HES). The analysis focuses on four groups of 10 primary care trusts (PCTs):
10 at each extreme of the normal distribution – that is those with the highest and lowest bed use – and two other groups of PCTs:
• urban PCTs with lowest bed use
• PCTs with the greatest reduction in their rate of bed use from 2006/7 to 2009/10.
The appendices describe the data used in the study, the analyses undertaken and the analytical methodology. The appendices are structured as follows:
• appendix A describes how each of the datasets used were constructed and gives sources for the data
• appendix B lists the 40 PCTs of interest
• appendix C gives the data collected on the 40 PCTs as averages across each of the four groups
• appendix D gives the same data at individual PCT level for the 40 PCTs of interest.
It is important to note that at the time of commencing this analysis the most recent HES data available to us related to 2009/10. Relative positions of PCTs may have changed in the intervening period. This does not compromise our overall conclusions which are based on data sets from the same time period and therefore consistent. The importance of this analysis is what it tells us about the relative importance of different factors in driving bed use.

Emergency admissions
We used the Hospital Episode Statistics (HES) version of an ‘emergency’ admission which includes: all emergency admissions (ie, a patient not admitted from a waiting list) via accident and emergency (A&E); admissions via GP; admissions via a bed bureau including the central bureau; admissions via a consultant outpatient clinic; and other admissions, including transfers from another health care provider’s A&E department.
Emergency bed days
At the individual patient level emergency bed days are equivalent to length of stay.
Across a number of patients emergency bed days equal the average length of stay multiplied by the number of patients admitted.
Average length of stay
When a patient is admitted to hospital an admission is created. Each admission that spans more than one calendar day consumes one or more bed days. Average length of stay is the average number of calendar days spent in hospital per admission. PCTspecific average length of stay data were not adjusted for differences in PCT population characteristics, eg, age, sex or need, because this cannot be done using needs-weighted populations and would require specific modelling.
Unadjusted emergency bed days per person over 65, per annum
The bed days used per head of population aged over 65 per annum were calculated from
HES data. Emergency bed days for all emergency admissions in patients over 65 were summed to give total emergency bed days per PCT. These PCT-specific totals were then divided by the over-65 PCT population to give a number of emergency bed days per person, per annum. Please see Data Sources below for a description of the exclusions used.
Rate of emergency admissions per person over 65, per annum
Emergency admissions per person over 65, per annum, were derived from: total numbers of emergency admissions per person over 65 for each PCT divided by the population of that PCT aged over 65.
Bed reduction estimates
Our reduction estimates were made by applying a target number of emergency bed days per person to those populations in PCTs that had a number higher than this target.
These differences were then summed to give a total bed days saved figure.
To work out the number of beds that could be saved, the total bed days figure was then divided by 365 (assumes each bed can be used year-round). This figure was then divided by 90 per cent to take into account an average bed occupancy rate.
Adjusting emergency bed days per person over 65, per annum; for age, sex and need
For each PCT, we used needs-weighted age and sex specific populations to calculate a needs-weighted age- and sex-specific number of emergency bed days per person over
65, per annum, within each of six categories: women 65–74; men 65–74; women 75–
84; men 75–84; women over 85; men over 85. For each PCT, we took a weighted average across these six needs-weighted age/sex-specific number of bed days to calculate a single number for all patients aged over 65. Weights used were the proportions of each age/sex group prevalent in the England population. Calculations

were made as above for both 2009/10 data and 2006/7 data. Both sets of data are standardised to the 2007 England population to remove the impact of changes to population mix over time. The needs weight used was the Hospital and Community
Health Services (HCHS) needs index. The HCHS needs index is used as a component in the resource allocation weighted capitation formula, used each year to distribute annual funding to PCTs by the Department of Health.
See http://www.dh.gov.uk/health/category/policy-areas/nhs/resources-formanagers/allocations/
Rurality classifications
Our rurality classifications were from the Department for Environment, Farming and
Rural Affairs rural and countryside statistics. Each PCT had a score from one to six for rurality: 1 = highly urban, 6 = highly rural. By grouping PCTs by rurality classification we showed the variation in PCT emergency bed use numbers by rurality.
Classification descriptions
6 – Rural 80: PCTs with at least 80 per cent of their population in rural settlements and larger market towns. There were two PCTs in this group.
5 – Rural 50: PCTs with at least 50 per cent but less than 80 per cent of their population in rural settlements and larger market towns. There were 22 PCTs in this group.
4 – Significant rural: PCTs with more than 26 per cent but less than 50 per cent of their population in rural settlements and larger market towns. There were 26 PCTs in this group.
3 – Other urban: PCTs with less than 26 per cent of their population in rural settlements and larger market towns. There were 24 PCTs in this group.
2 – Large urban: PCTs with 50 per cent of their population in 1 of the 17 urban areas with a population between 250,000 and 750,000. There were 19 PCTs in this group.
1 – Major urban: PCTs with 50 percent of their population in urban areas with a population of more than 750,000. There were 59 PCTs in this group.
Outliers
One outlier PCT was removed from our analysis: the Isle of Wight NHS PCT. This PCT records extremely low rates of acute hospital emergency bed use but has a very different geography and NHS provision structure to other PCTs in England.
Readmission rates
A readmission is counted when an emergency readmission to hospital occurs within 28 days of discharge from hospital. We have used the readmissions national indicator which is calculated for patients aged over 75. Readmission rates are indirectly standardised for: age, sex, method of admission of discharge spell, diagnosis (ICD 10 chapter/selected sub-chapters within medical specialties) and procedure (OPCS 4 chapter/selected sub-chapters within surgical specialties). This data for 2009/10 has been standardised to 2005/06 PCT populations.

Secondary care data
We used Hospital Episode Statistics (HES) inpatient data from 2006/07 and 2009/10.
Exclusions were made as below, in line with Department of Health usual practice (from correspondence with Department of Health colleagues) and additional exclusions added by ourselves.
HES Field Description Filter spelend End of spell spelend = "Y"
Reason
Look at spells, not episodes admimeth Method of disyear* admission
Year of discharge admiyear* los*
Year of admission admission year is greater than start year -1 (i.e. where we used 2009–10 data, admiyear was
>2008)
Length of stay los = discharge date - admission date startage admimeth between 21 and
28 discharge year is greater than start year -1 (i.e. where we used 2009–10 data, disyear was >2008) disdate mainspef well_baby_i nd classpat sex rescty trust_1char
*
We looked at non-elective admissions only
Remove discharges that happened before start date of data, i.e.
01/01/1900
Remove admissions that happened before start date of data, i.e.
01/01/1900
Create length of stay field
Age at start of episode
If startage >7,000 then replace startage with 0
Recode all babies ages to 0 (babies ages in HES coded between 7000 and 7007)
Remove if disdate is blank Spells should be completed to be Date of discharge
Main specialty Do not include specialties:
501 obstetrics, 560 midwifery, 700 learning disability, 710 adult mental included in data
Sensitive specialties excluded for privacy illness, 711 child and adolescent psychiatry, 712 forensic psychiatry, 713 psychotherapy, 715 old age psychiatry
Well baby check flag
Well_baby_ind = "N" We want to exclude spells where successful births took place and only include where further treatment was needed
Remove day case attendances Patient classification
Remove where classpat =
2
Sex of patient Keep records with "1" or
"2" only
County of residence
Remove where rescty is: S
Scotland, W Wales, X
Foreign, Y Not Known, Z
1st Character
Trust Code
Northern Ireland
Keep only Trust codes beginning with "R"
Remove not known and not specified gender records
Restrict analysis to England only
This is to remove where PCTs are providers of care, e.g. district general hospitals
* = King's Fund generated field

Primary care data sources
See www.ic.nhs.uk/statistics-and-data-collections/workforce/nhs-staff-numbers/nhsstaff-2000--2010-general-practice and 2009/10 GP Patient Survey www.gppatient.co.uk/ (weighted results).
Community services data
Manual search of PCT websites and other sources for all relevant literature were used to estimate community bed numbers. As we state in the main report, this data therefore needs to be treated with caution.
Acute provider data
NHS indicators (see https://indicators.ic.nhs.uk/webview/ ) emergency readmissions to hospital within 28 days of discharge: indirectly standardised per cent, 75+ years; Care
Quality Commission Inpatient Survey 2009/10.
Exposition book 2009/10 and 2010/11 (2010) from the Department of Health. See http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Managingyourorganisat ion/Financeandplanning/Allocations/DH_091850
Local authority data
Personal social services expenditure and unit costs: England 2009–10 (Information
Centre), number of care homes and places in homes by local authority. Source: Care
Quality Commission database accessed 8 July 2011; NHS Information Centre Community
Care Statistics 2007: Home Help/Care Services for adults, England, Table 1.2 number of households receiving home care; Home care survey 2008/9 Council Annex tables U1
Question 1: ‘Overall, how satisfied are you with the help from [Social Services] that you receive in your own home?’ Answer very or extremely satisfied.
Population data
Office for National Statistics population data from two years were used in the analysis:
• final mid-2007 population estimates by quinary age groups for primary care organisations
• mid-2009 population estimates by quinary age groups for primary care organisations.
See www.ons.gov.uk/ons/index.html
Rurality data
Rural definition and local authority classifications were from the Department for
Environment, Food and Rural Affairs, 2009. See http://archive.defra.gov.uk/evidence/statistics/rural/rural-definition.htm
Readmissions
Information Centre indicator portal: Emergency readmissions to hospital within 28 days of discharge: indirectly standardised percent, 75+ years. See https://indicators.ic.nhs.uk/webview/

Matching locally sourced data to King’s Fund analysis
We have tried to be as detailed as possible in describing the methodology and analysis used in this report. This has been done so that readers may then be able to replicate some of our analyses at a local level. However, we would like to highlight that differences in the numbers obtained at a local level compared to our findings may still occur due to data sources, exclusions and definitions used.

The 40 PCTs analysed in the report fall into the four groups as follows.
PCT group PCT name PCT name
Torbay
Herefordshire
Cornwall and Isles of Scilly
Devon
North Staffordshire
Stoke on Trent
Shropshire County
Great Yarmouth and
Waveney
North East Essex
Norfolk
Redcar and Cleveland
Brighton and Hove City
Wolverhampton City
Bolton
Blackpool
Harrow
Bradford and Airedale Teaching South Birmingham
Dudley South East Essex
North East Lincolnshire
Gloucestershire
Cumbria Teaching
Ashton, Leigh and Wigan
Bromley
Ealing
Bristol
Hammersmith and Fulham
Lambeth
Waltham Forest
Halton and St Helens
Barking and Dagenham
Leicester City
Stoke on Trent
North Staffordshire
Haringey Teaching
Wandsworth
Hounslow
Manchester
Trafford

Average across lowest bed use
Average across lowest bed use urban
Emergency bed days and direct determinants
2009–10 emergency bed days per person over 65, per annum (needs–weighted)
1.46
2006–7 emergency bed days per person over 65, per annum (needs–weighted)
1.45
0.38%
Change 2006–7 to 2009–10
Over 65 average emergency length of stay (days), 2009–
10
Over 65 average emergency length of stay (days), 2006–
7
8
9
-11%
Change 2006–7 to 2009–10
Over 65 average emergency length of stay (days), 2009–
10 not including 0–1 day stay
11
Over 65 average emergency length of stay (days), 2006–
7 not including 0–1 day stay
12
Change 2006–7 to 2009–10 -6%
0.19 Emergency admissions per person over 65 (needs– weighted) 2009–10
Emergency admissions per person over 65 (needs– weighted) 2006–07
0.17
13%
Change 2006–7 to 2009–10
Emergency admissions per person over 65 (needs– weighted) 2009–10 not including 0–1 day stay
Emergency admissions per person over 65 (needs– weighted) 2006–7 not including 0–1 day stay
0.13
0.12
Change 2006–7 to 2009–10
7%
3.6 Over 85 emergency bed days per person, per annum
(needs–weighted), 2009–10
Over 85 average emergency length of stay (days), 2009–
10
Over 85 emergency admissions per person, per annum (needs–weighted)
2009–10
9
0.40
1.97
2.02
-2.77%
8
10
-12%
13
14
-7%
0.24
0.21
11%
0.15
0.15
5%
4.8
10
0.48
Average across most improved
Average across highest bed use
Minimum
(all
PCTs)
Maximum
(all PCTs)
2.10
2.56
11
-23%
12
15
-17%
0.25
0.23
8%
0.16
0.17
-0.5%
5.2
10
0.51
3.30
3.13
-17.69% 5.55%
9 10
11
-7%
15
16
-5%
0.32
0.28
15%
0.22
0.19
12%
8.2
13
0.61
1.06
1.00
6
7
9
10
0.15
0.12
0.11
0.08
2.3
6
0.33
3.81
3.59
13
14
17
18
0.37
0.31
0.24
0.24
10.7
17
0.79

Average across lowest bed use
Primary care
GP single–handed practices as a per cent of all practices
Single–handed GP practitioners as a per cent of all practitioners
2009–10 GP Patient
Survey satisfied with care received at surgery
Community care
Community care beds per
1,000 needs–weighted population over 65
Social care
Care home places with nursing, and intensive home care packages, per
1,000 needs–weighted pop over 65
Patients satisfied with
Social Services care received in own home, from Personal Social
Services: Home care users aged 65 or over,
England survey 2008–9
(per cent)
Local authority personal services spend per needs–weighted population aged over 65
(£ 000s)
7.5%
1.8%
92.3%
2.4
21.5
59.6
£0.80
Average across lowest bed use urban
17.2%
5.4%
88.6%
1.3
23.8
57.2
£1.01
Average across most improved
19.5%
6.2%
89.2%
1.5
22.9
58.2
£0.99
Average across highest bed use
19.4%
Minimum
(all PCTs)
0.0%
Maximum
(all PCTs)
41.2%
6.1%
85.3%
1.7
26.5
51.3
£1.40
0.0%
79.4%
4.9
45.0
£0.60
16.2%
94.0%
42.8
74.0
£2.08

Average across lowest bed use
Configuration of PCT population and of organisations
2009 PCT population
2009 PCT pop aged over
353,070
74,670
65
2009 PCT Pop per cent aged over 65
21%
10,760 2009 PCT pop aged over
85
2009 PCT pop per cent aged over 85
Activity from main acute provider
Urban rural, 1= major urban, 6 = 80 % rural or large market town
Acute care
3%
73%
4.5
Average across lowest bed use urban
286,600
45,630
16%
6,330
2%
79%
1.4
16%
6,910
2%
75%
2.8
Average across most improved
309,390
52,040
11%
4,470
2%
50%
1.1
Average across highest bed use
287,240
31,150
Minimum
(all PCTs)
90,900
15,000
7%
1,600
1%
24%
1
Maximum
(all PCTs)
1,289,400
232,600
25%
33,300
4%
98%
6
Over 75 readmission rate, indirectly standardised for age, sex, method of admission, diagnosis, procedure (per cent)
Home to Social Care
13 16 17 17
4% 4% 3% Patients over 65 where hospital marks transition between home and social care
Over 65 average emergency length of stay
(days) for admitted from home, discharged social care
Patients over 85 where hospital marks transition between home and social care
Over 85 average emergency length of stay
(days) for admitted from home, discharged social care
2%
24
4%
22
26
8%
24
24
6%
22
36
5%
37

Lowest bed use group
Torbay Herefordshire
Cornwall and Isles of Scilly
Devon
Emergency bed days and direct determinants
2009–10 emergency bed days per person over 65, per annum
(needs–weighted)
2006–7 emergency bed days per person over 65, per annum
(needs–weighted)
Change 2006–7 to 2009–10
Over 65 average emergency length of stay (days), 2009–10
Over 65 average emergency length of stay (days), 2006–7
Change 2006–7 to 2009–10
1.06
1.02
3.7%
6
7
-15%
1.17
1.29
-9.3%
8
9
-12%
Over 65 average emergency length of stay (days), 2009–10 not including 0–1 day stay
Over 65 average emergency length of stay (days), 2006–7 not including 0–1 day stay
Change 2006–7 to 2009–10
9
10
10
11
-13% -10%
1.33
1.35
11
-3%
1.41
1.33
-1.1%
7
8
-11%
11
6.0%
7
8
-8%
11
11
-1%
North
Staffordshire
- also top ten improved
Shropshire
County
Great
Yarmouth and
Waveney
North
East
Essex
1.55 1.56 1.61 1.62
Norfolk Redcar and
Cleveland
Average across lowest bed use
1.63 1.66 1.46
1.84
-15.9%
7
10
-27%
12
14
-16%
1.42
9
9
-2%
12
12
-3%
1.53
10.2% 5.2%
8
10
-16%
12
13
-8%
1.65
-1.8% 9.7%
8
9
-9%
11
12
-8%
1.49
8
8
-2%
12
12
0%
1.64
1.7%
7
8
-8%
11
11
-2%
1.45
0.38%
8
9
-11%
11
12
-6%

Torbay Herefordshire
Cornwall and Isles of Scilly
Devon
Emergency admissions per person over 65 (needs– weighted) 2009–10
Emergency admissions per person over 65 (needs– weighted) 2006–07
Change 2006–7 to 2009–10
0.18
0.15
0.15
0.15
21% 3%
Emergency admissions per person over 65 (needs– weighted) 2009–10 not including 0–1 day stay
Emergency admissions per person over 65 (needs– weighted) 2006–7 not including 0–1 day stay
Change 2006–7 to 2009–10
Over 85 emergency bed days per person, per annum
(needs–weighted), 2009–10
Over 85 average emergency length of stay (days), 2009–10
Over 85 emergency admissions per person, per annum
(needs–weighted) 2009–10
0.12
0.10
0.11
0.11
17% 0%
2.3
6
0.36
3.0
9
0.33
0.19
0.17
11%
0.12
0.12
1%
3.3
9
0.38
0.19
0.16
15%
0.13
0.12
6%
3.5
9
0.40
North
Staffordshire
- also top ten improved
0.22
0.19
15%
0.13
0.13
0%
3.6
7
0.51
Shropshire
County
0.18
0.16
12%
0.13
0.12
13%
4.2
11
0.37
Great
Yarmouth and
Waveney
North
East
Essex
0.19 0.20
0.15
24%
0.14
0.12
14%
4.0
10
0.38
0.18
8%
0.14
0.13
7%
3.9
10
0.39
Norfolk Redcar and
Cleveland
Average across lowest bed use
0.20 0.22 0.19
0.18
12%
0.13
0.12
9%
4.5
10
0.44
0.20
10%
0.15
0.14
3%
3.9
9
0.43
0.17
13%
0.13
0.12
7%
3.6
9
0.40

Social care
Care home places with nursing, and intensive home care packages, per 1,000 needs– weighted pop over 65
Patients satisfied with Social
Services care received in own home, from Personal Social
Services: Home care users aged 65 or over, England survey 2008–9 (per cent)
Local authority personal services spend per needs– weighted population aged over
65 (£ 000s)
Torbay Herefordshire
Primary care
GP single–handed practices as a per cent of all practices
Single–handed GP practitioners as a per cent of all practitioners
2009–10 GP Patient Survey satisfied with care received at surgery
4.8%
1.0%
0.0%
0.0%
93.8% 92.3%
Community care
Community care beds per
1,000 needs–weighted population over 65
1.3 3.3
22.6
59.3
23.2
60.9
£0.74 £0.74
Cornwall and Isles of Scilly
Devon
2.8%
0.5%
2.8%
0.5%
North
Staffordshire
- also top ten improved
Shropshire
County
19.4%
5.6%
92.9% 93.6% 90.9%
2.2%
0.5%
92.6%
2.7
22.1
67.7
£0.60
2.7
18.0
67.2
£0.86
3.8
28.1
64.8
£0.72
1.9
26.0
63.8
£0.74
Great
Yarmouth and
Waveney
North
East
Essex
Norfolk Redcar and
Cleveland
Average across lowest bed use
7.4%
1.4%
93.3%
18.2% 1.1%
4.4% 0.2%
16.7%
3.9%
88.5% 91.1% 94.0%
2.2 1.4 1.8 3.1
16.9
56.5
£0.72
13.1 17.1
46.6 51.5
27.7
57.7
£0.96 £0.72 £1.19
7.5%
1.8%
92.3%
2.4
21
60
£0.80

Torbay Herefordshire
Cornwall and Isles of Scilly
Devon North
Staffordshire
- also top ten improved
Shropshire
County
Configuration of PCT population and of organisations
2009 PCT population 134,000 179,100 533,300 747,400 211,500
2009 PCT pop aged over
65
2009 PCT Pop per cent aged over 65
2009 PCT pop aged over
85
31,400
23%
5,300
38,800 113,400 163,800 39,500
22%
5,400
21%
16,500
22%
24,900
19%
5,000
4% 3% 3% 3% 2%
2009 PCT pop per cent aged over 85
Activity from main acute provider
Urban rural, 1= major urban, 6 = 80 % rural or large market town
87%
3
78%
5
67%
6
44%
5
79%
4
Acute care
Over 75 readmission rate, indirectly standardised for age, sex, method of admission, diagnosis, procedure (per cent)
12 10 15 12 18
Great
Yarmouth and
Waveney
North East
Essex
Norfolk Redcar and
Cleveland
Average across lowest bed use
291,800 214,000 325,000 757,100 137,500 353,070
60,500 47,100 66,300 160,000 25,900 74,670
21% 22% 20% 21% 19% 21%
8,100
3%
6,800
3%
10,100
3%
22,300 3,200
3% 2%
10,760
3%
71%
5
75%
4
77%
4
60%
5
90%
4
73%
4.5
12 12 13 13 16 13

Torbay
Home to Social Care
Patients over 65 where hospital marks transition between home and social care
Over 65 average emergency length of stay
(days) for admitted from home, discharged social care
Patients over 85 where hospital marks transition between home and social care
Over 85 average emergency length of stay
(days) for admitted from home, discharged social care
2%
18
2%
17
19
4%
15
Herefordshire
Cornwall and Isles of Scilly
Devon
2% 1% 1%
North
Staffordshire
- also top ten improved
Shropshire
County
2% 3%
32
3%
30
22
2%
18
14
3%
12
28
6%
29
Great
Yarmouth and
Waveney
North East
Essex
Norfolk
3% 2% 2%
Redcar and
Cleveland
Average across lowest bed use
2% 2%
29
6%
26
24
4%
22
30
4%
29
25
4%
24
24
4%
22

Lowest urban bed use group
Stoke on
Trent - also in top ten improved
Wolverhampton
City
Bolton
Emergency bed days and direct determinants
2009–10 emergency bed days per person over 65, per annum
(needs–weighted)
1.69 1.72
2.20 1.68 2006–7 emergency bed days per person over 65, per annum
(needs–weighted)
Change 2006–7 to 2009–10
Over 65 average emergency length of stay (days), 2009–10
Over 65 average emergency length of stay (days), 2006–7
-23.3%
7
10
2.4%
8
9
Change 2006–7 to 2009–10
Over 65 average emergency length of stay (days), 2009–10 not including 0–1 day stay
Over 65 average emergency length of stay (days), 2006–7 not including 0–1 day stay
-31%
12
15
-5%
12
12
Change 2006–7 to 2009–10 -20% -1%
1.89
2.14
Bradford and
Airedale
Teaching
Dudley Brighton and Hove
City
Blackpool
1.95
1.86
-11.9% 4.7%
10 8
11
-9%
13
15
-9%
8
-7%
11
12
-2%
1.98
2.19
-9.8% 12.9%
9 8
-7.6%
10
11
2.01
1.78
8
-26% -2%
12 12
15 12
-16% 4%
2.10
2.27
12
-15%
17
18
-7%
Harrow South
Birmingham
2.10
1.69
7
2.11
2.18
24.2% -3.5%
8 9
12%
12
-7%
14
12
3%
9
14
-5%
South
East
Essex
2.12
2.21
10
-16%
13
-12%
13
14
Average across lowest bed use urban
1.97
2.02
-4.3%
8
-2.77%
8
10
14
-13% -7%

Stoke on
Trent - also in top ten improved
Wolverhampton
City
Bolton
Emergency admissions per person over 65 (needs–weighted)
2009–10
0.24 0.21 0.19
Emergency admissions per person over 65 (needs–weighted)
2006–07
0.22
Change 2006–7 to 2009–10 12%
0.20
7%
0.20
-3%
Emergency admissions per person over 65 (needs–weighted)
2009–10 not including 0–1 day stay
0.14
Emergency admissions per person over 65 (needs–weighted)
2006–7 not including 0–1 day stay
0.15
Change 2006–7 to 2009–10 -5%
Over 85 emergency bed days per person, per annum (needs– weighted), 2009–10
3.5
7 Over 85 average emergency length of stay (days), 2009–10
Over 85 emergency admissions per person, per annum (needs– weighted) 2009–10
0.50
0.14
0.14
3%
4.0
11
0.38
0.14
0.14
-4%
4.4
12
0.36
Bradford and
Airedale
Teaching
Dudley Brighton and Hove
City
Blackpool
0.25
0.23
13%
0.17
0.16
7%
4.5
9
0.50
0.23
0.19
22%
0.15
0.14
7%
5.3
10
0.51
0.26
0.22
17%
0.17
0.15
9%
5.0
10
0.51
0.20
0.19
8%
0.12
0.13
-2%
5.4
13
0.41
Harrow South
Birmingham
South
East
Essex
0.26 0.24
0.24 0.23
11%
0.17
5%
0.15
0.14 0.15
21%
5.2
2%
5.3
9 12
0.55 0.45
0.26
0.23
13%
0.17
0.15
10%
5.8
10
0.60
Average across lowest bed use urban
0.24
0.21
11%
0.15
0.15
5%
4.8
10
0.48

Primary care
GP single–handed practices as a per cent of all practices
Single–handed GP practitioners as a per cent of all practitioners
Stoke on
Trent - also in top ten improved
Wolverhampton
City
22.41% 30.91%
8.13%
2009–10 GP Patient Survey satisfied with care received at surgery
Community care
88.6%
3.1
Community care beds per 1,000 needs–weighted population over 65
Social care
Care home places with nursing, and intensive home care packages, per
1,000 needs–weighted pop over 65
26.9
Patients satisfied with Social Services care received in own home, from
Personal Social Services: Home care users aged 65 or over, England survey
2008–9 (per cent)
64.9
Local authority personal services spend per needs–weighted population aged over 65 (£ 000s)
£0.95
11.49%
86.7%
3.2
27.8
58.8
£1.05
Bolton
8.00% 12.05% 16.36% 20.83% 0.00%
1.90%
89.9%
0.0
20.7
60.1
£0.85
Bradford and
Airedale
Teaching
Dudley
2.46%
87.7%
1.1
38.6
54.8
£1.07
4.59%
91.2%
0.7
17.7
66.8
£0.77
Brighton and Hove
City
Blackpool
6.21%
88.2%
0.9
27.8
58.9
£1.48
0.00%
90.1%
0.0
25.5
62.7
£0.81
Harrow South
Birming
-ham
South
East
Essex
Average across lowest bed use urban
5.41% 14.75
%
41.18% 17.2%
1.32% 3.23% 14.58% 5.39%
84.9%
0.0
19.6
49.8
£0.86
89.5% 89.4%
4.2
20.5
49.3
£1.21
0.3
12.5
45.8
£1.06
88.6%
1.3
23.8
57.2
£1.01

Configuration of PCT population and of organisations
Stoke on
Trent - also in top ten improved
Wolverhampton
City
2009 PCT population 247,000 238,500
Bolton Bradford and
Airedale
Teaching
Dudley Brighton and Hove
City
Blackpool
Harrow South
Birmingham
265,100 506,800 306,600 256,300 140,000 228,100 341,000
41,400
16%
68,400
13%
56,200
18%
35,900
14%
26,900
19%
31,700
14%
50,400
15%
South
East
Essex
Average across lowest bed use urban
336,60
0
286,60
0
64,500 45,630 2009 PCT pop aged over 65
2009 PCT Pop per cent aged over
65
2009 PCT pop aged over 85
40,600
16%
Urban rural, 1= major urban, 6 =
80 % rural or large market town
5,100
2009 PCT pop per cent aged over
85
2%
Activity from main acute provider 89%
2
40,300
17%
5,400
2%
91%
1
Acute care
Over 75 readmission rate, indirectly standardised for age, sex, method of admission, diagnosis, procedure (per cent)
19 14
5,200
2%
9,200
2%
81%
1
13
68%
1
15
6,600
2%
6,500
3%
84%
1
15
91%
2
16
3,600
3%
89%
2
16
4,500
2%
63%
1
16
7,900
2%
53%
1
16
19%
9,300
16%
6,330
3%
83%
2
17
2%
79%
1.4
16

Home to Social Care
Patients over 65 where hospital marks transition between home and social care
2%
Over 65 average emergency length of stay (days) for admitted from home, discharged social care
13
Stoke on
Trent - also in top ten improved
Wolverhampton
City
3%
25
7% Patients over 85 where hospital marks transition between home and social care
3%
Over 85 average emergency length of stay (days) for admitted from home, discharged social care
11 24
Bolton
4%
30
7%
28
Bradford and
Airedale
Teaching
Dudley Brighton and Hove
City
Blackpool
Harrow
6%
16
11%
16
5%
23
10%
20
8%
20
14%
19
3%
53
5%
51
4%
22
8%
20
South
Birmingham
2%
35
5%
34
South
East
Essex
3%
Average across lowest bed use urban
4%
21
5%
18
26
8%
24

Best improved bed use group
North East
Lincolnshire
Gloucestershire
Cumbria
Teaching
Ashton,
Leigh and
Wigan
Bromley Halton and St
Helens
Emergency bed days and direct determinants
1.80 2009–10 emergency bed days per person over 65, per annum (needs– weighted)
2006–7 emergency bed days per person over 65, per annum (needs– weighted)
2.21
Change 2006–7 to 2009–10 -18.4%
Over 65 average emergency length of stay (days), 2009–
10
10
Over 65 average emergency length of stay (days), 2006–
7
13
Change 2006–7 to 2009–10 -25%
Over 65 average emergency length of stay (days), 2009–10 not including 0–1 day stay
Over 65 average emergency length of stay (days), 2006–7 not including 0–1 day stay
Change 2006–7 to 2009–10
11.70
14.50
-19%
1.83
2.50
12
-30%
11.58
15.82
-27%
1.89
2.23
11
-19%
12.50
14.08
-11%
2.20
2.72
10
-20%
12.61
15.38
-18%
2.41
2.79
11
-18%
12.88
14.74
-13%
2.49
2.91
11
-19%
13.59
15.38
-12%
Barking and
Dagenham
Leicester
City
Stoke on
Trent
2.58
3.02
-26.9% -15.5% -18.8% -13.8% -14.3% -14.6%
9 9 8 9 9 10
12
-19%
13.67
16.44
-17%
2.60
3.14
1.69
2.20
-17.1% -23.3%
8 7
11
-25%
12.68
15.41
-18%
10
-31%
11.67
14.56
-20%
North
Staffordshire
1.55
1.84
-15.9%
7
10
-27%
11.66
13.90
-16%
Average across most improved
2.10
2.56
-18%
9
11
-23%
12.45
15.02
-17%

North East
Lincolnshire
Gloucestershire
0.21
Cumbria
Teaching
Ashton,
Leigh and
Wigan
0.21 0.26
Bromley Halton and St
Helens
0.28 0.27 Emergency admissions per person over 65 (needs– weighted) 2009–10
Emergency admissions per person over 65 (needs– weighted) 2006–07
Change 2006–7 to 2009–10
0.19
0.17
9%
Emergency admissions per person over 65 (needs– weighted) 2009–10 not including 0–1 day stay
Emergency admissions per person over 65 (needs– weighted) 2006–7 not including
0–1 day stay
0.15
0.15
Change 2006–7 to 2009–10 1%
0.18
18%
0.16
0.14
12%
0.20
4%
0.15
0.16
-5%
0.26
2%
0.17
0.17
-1%
0.26
4%
0.19
0.19
-3%
0.25
7%
0.18
0.18
-3%
Over 85 emergency bed days per person, per annum
(needs–weighted), 2009–10
3.9
Over 85 average emergency length of stay (days), 2009–
10
11
0.37 Over 85 emergency admissions per person, per annum (needs–weighted)
2009–10
4.4
10
0.43
5.1
12
0.42
5.8
10
0.57
6.9
11
0.62
6.6
12
0.57
Barking and
Dagenham
Leicester
City
Stoke on
Trent
North
Staffordshire
0.28
0.26
6%
0.19
0.18
3%
6.5
12
0.56
0.32
0.28
11%
0.20
0.20
0%
5.7
10
0.59
0.24
0.22
12%
0.14
0.15
-5%
3.5
7
0.50
0.22
0.19
15%
0.13
0.13
0%
3.6
7
0.51
Average across most improved
0.25
0.23
8%
0.16
0.17
-0.5%
5.2
10
0.51

North
East
Lincolnsh ire
Gloucestershire
Cumbria
Teaching
Ashton,
Leigh and
Wigan
Bromley Halton and St
Helens
Primary care
GP single–handed practices as a per cent of all practices
39.4% 0.0%
Single–handed GP practitioners as a per cent of all practitioners
12.7% 0.0%
11.1%
2.3%
2009–10 GP Patient Survey satisfied with care received at surgery
91.3% 92.8% 93.1%
Community care
0.0
Community care beds per 1,000 needs–weighted population over 65
2.4 1.2
Social care
Care home places with nursing, and intensive home care packages, per
1,000 needs–weighted pop over 65
18.0
Patients satisfied with Social
Services care received in own home, from Personal Social Services:
Home care users aged 65 or over,
England survey 2008–9 (per cent)
64.9
Local authority personal services spend per needs–weighted population aged over 65 (£ 000s)
£1.10
31.8
58.6
£1.01
16.6
63.0
£1.13
20.0% 9.8%
6.8%
0.0
20.3
52.2
£1.08
2.3%
14.5%
4.1%
90.7% 87.8% 89.8%
0.9
19.9
47.8
£0.94
0.4
20.6
58.0
£0.70
Barking and
Dagenham
Leicester
City
Stoke on Trent
North
Staffordshire
Average across most improved
28.6%
10.9%
83.1%
1.6
22.5
48.3
£1.22
30.2% 22.4% 19.4% 20%
9.1% 8.13% 5.6%
83.8% 88.61
%
1.1
24.4
59.6
£1.06
3.1
26.9
64.9
6.2%
90.9% 89.2%
3.8
28.1
64.8
1.5
22.9
58.2
£0.95 £0.72 £0.99

North East
Lincolnshire
Gloucestershire
Cumbria
Teaching
Ashton,
Leigh and
Wigan
Bromley Halton and St
Helens
Configuration of PCT population and of organisations
2009 PCT population 158,500
2009 PCT pop aged over 65 27,900
2009 PCT Pop per cent aged over 65
18%
2009 PCT pop aged over 85 3,600
2009 PCT pop per cent aged over 85
2%
Activity from main acute provider
87%
3 Urban rural, 1= major urban, 6 = 80 % rural or large market town
Acute care
Barking and
Dagenham
Leicester
City
Stoke on
Trent
North
Staffordshire
Average across most improved
589,100 495,000 306,500 310,200 295,800 175,600
109,100 99,700
19%
16,100
3%
81%
4
20%
13,000
3%
55%
5
49,600
16%
5,200
2%
73%
3
51,100
17%
7,800
3%
67%
1
47,100
16%
5,000
2%
50%
3
20,100
12%
3,300
2%
76%
1
304,700
35,700
12%
5,000
2%
97%
2
247,000
40,600
16%
5,100
2%
89%
2
211,500 309,390
39,500
19%
5,000
2%
79%
4
52,040
16%
6,910
2%
75%
2.80
13 13 19 17 19 21 17 19 18 17 Over 75 readmission rate, indirectly standardised for age, sex, method of admission, diagnosis, procedure (per cent)
12

Home to Social Care
Patients over 65 where hospital marks transition between home and social care
Patients over 85 where hospital marks transition between home and social care
5%
Over 65 average emergency length of stay (days) for admitted from home, discharged social care
23
8%
Over 85 average emergency length of stay (days) for admitted from home, discharged social care
22
North East
Lincolnshire
Gloucestershire
Cumbria
Teaching
Ashton,
Leigh and
Wigan
2%
29
3%
28
4%
33
7%
31
4%
25
7%
24
Bromley Halton and St
Helens
6%
25
11%
24
3%
28
5%
26
30
7%
29
Barking and
Dagenham
Leicester
City
4% 5%
Stoke on
Trent
2%
North
Staffordshire
Average across most improved
2% 4%
20
9%
19
13
3%
11
14
3%
12
24
6%
22

Highest bed use group
Ealing Bristol Hammersmith and
Fulham
Lambeth Waltham
Forest
Haringey
Teaching
Wandsworth Hounslow Manchester Trafford Average across highest bed use
Emergency bed days and direct determinants
2009–10 emergency bed days per person over 65, per annum
(needs–weighted)
3.09 3.19 3.20
2006–7 emergency bed days per person over 65, per annum
(needs–weighted)
2.91
Change 2006–7 to 2009–10
3.31 3.18
6.1% -3.6% 0.5%
11 10 Over 65 average emergency length of stay (days), 2009–10
9
Over 65 average emergency length of stay (days), 2006–7
10 12 10
Change 2006–7 to 2009–10 -5% -9% 0%
Over 65 average emergency length of stay (days), 2009–10 not including 0–1 day stay
14.21 16.08 16.05
14.02 16.85 16.35 Over 65 average emergency length of stay (days), 2006–7 not including 0–1 day stay
Change 2006–7 to 2009–10 1% -5% -2%
3.21
3.20
0.5%
10
11
-10%
14.53
15.86
-9%
3.22
3.59
-10.1%
10
12
-15%
14.24
15.79
-11%
3.27
3.20
2.1%
10
11
-8%
13.97
15.40
-10%
3.28
3.15
4.0%
10
11
-9%
13.94
15.04
-8%
3.36
2.27
47.9%
9
10
-10%
14.80
15.77
-7%
3.39
3.07
10.4%
12
12
0%
16.28
16.23
0%
3.81
3.40
12.0%
13
14
-7%
16.87
18.27
-8%
3.30
3.13
5.5%
10
11
-7%
15.10
15.96
-5%

Ealing Bristol Hammersmith and
Fulham
Lambeth Waltham
Forest
Haringey
Teaching
Wandsworth Hounslow Manchester Trafford
0.31 0.33 0.32 0.33 0.34 0.37 0.29 0.30
Average across highest bed use
0.32 Emergency admissions per person over 65 (needs– weighted) 2009–10
Emergency admissions per person over 65 (needs– weighted) 2006–07
Change 2006–7 to 2009–10
0.34
0.30
12%
Emergency admissions per person over 65 (needs– weighted) 2009–10 not including 0–1 day stay
0.21
Emergency admissions per person over 65 (needs– weighted) 2006–7 not including
0–1 day stay
0.20
Change 2006–7 to 2009–10 5%
Over 85 emergency bed days per person, per annum (needs– weighted), 2009–10
6.4
Over 85 average emergency length of stay (days), 2009–10
11
Over 85 emergency admissions per person, per annum (needs– weighted) 2009–10
0.59
0.29
0.27
6%
0.20
0.20
1%
8.5
15
0.57
0.31
1%
0.20
0.19
3%
6.8
13
0.52
0.29
12%
0.22
0.20
10%
7.7
12
0.62
0.31
6%
0.22
0.22
0%
9.8
14
0.71
0.30
12%
0.23
0.20
13%
8.4
13
0.66
0.29
15%
0.24
0.21
12%
7.2
13
0.56
0.23
64%
0.22
0.14
56%
9.1
11
0.79
0.27
10%
0.21
0.19
10%
7.2
15
0.49
0.25
21%
0.22
0.18
22%
10.7
17
0.62
0.28
15%
0.22
0.19
12%
8.2
13
0.61

Ealing Bristol Hammersmith and
Fulham
Lambeth Waltham
Forest
Haringey
Teaching
Wandswo rth
Hounslow Manche ster
Trafford Average across highest bed use
Primary care
GP single–handed practices as a per cent of all practices
25.61% 3.57% 12.90% 12.96% 25.53% 23.21% 6.52%
0.6% 3.1% 2.6% 7.6% 7.3% 1.2% Single–handed GP practitioners as a per cent of all practitioners
9.9%
2009–10 GP Patient Survey satisfied with care received at surgery
80.9% 91.7% 84.5% 86.8% 81.3% 81.4% 87.2%
Community care
Community care beds per 1,000 needs–weighted population over 65
2.3 1.9 3.6 2.0 2.7 1.4 2.6
35.8 23.4 32.8 19.2 8.8 35.8
Social care
Care home places with nursing, and intensive home care packages, per
1,000 needs–weighted pop over 65
33.1
Patients satisfied with Social
Services care received in own home, from Personal Social
Services: Home care users aged 65 or over, England survey 2008–9
(per cent)
52.2
Local authority personal services spend per needs–weighted population aged over 65 (£ 000s)
£1.19
58.9
£1.59
55.9
£1.60
49.3
£1.60
44.6
£1.25
44.9
£1.50
53.1
£1.74
38.60% 21.70
%
15.6% 6.5%
23.08% 19%
6.4% 6.1%
82.2% 86.7% 90.0% 85.3%
0.2
27.5
51.5
£1.29
0.4
33.5
50.3
£1.23
0.0
14.9
52.2
£0.98
1.7
26.5
51.3
£1.40

2009 PCT pop aged over 65
2009 PCT Pop per cent aged over 65
2009 PCT pop aged over 85
Ealing
35,100
11%
5,100
2009 PCT pop per cent aged over 85
Activity from main acute provider
2%
39%
Urban rural, 1= major urban, 6
= 80 % rural or large market town
1
Bristol
55,100
13%
8,600
2%
52%
2
Hammersmith and
Fulham
Lambeth Waltham
Forest
Haringey
Teaching
Wandsworth Hounslow Manchester Trafford
Configuration of PCT population and of organisations
2009 PCT population 316,600 433,100 169,700 283,300 224,300 225,500 286,600
17,300
10%
2,600
2%
65%
1
22,900
8%
2,900
1%
43%
1
23,700
11%
3,100
1%
74%
1
21,200
9%
2,500
1%
38%
1
26,500
9%
4,300
2%
51%
1
234,200 483,800
24,400
10%
3,100
1%
44%
1
50,400
10%
7,500
2%
47%
1
Average across highest bed use
215,300 287,240
34,900 31,150
16%
5,000
2%
44%
1
11%
4,470
2%
50%
1.1
Acute care
Over 75 readmission rate, indirectly standardised for age, sex, method of admission, diagnosis, procedure (per cent)
18 15 21 18 18 19 16 18 16 16 17

Ealing Bristol
Home to Social Care
Patients over 65 where hospital marks transition between home and social care
3%
Over 65 average emergency length of stay (days) for admitted from home, discharged social care
24
Patients over 85 where hospital marks transition between home and social care
4%
Over 85 average length of stay
(days) for admitted from home, discharged social care
21
4%
41
8%
40
Hammersmith and
Fulham
Lambeth Waltham
Forest
Haringey
Teaching
Wandsworth Hounslow Manchester Trafford
2% 3% 3% 2% 1% 2% 5% 5%
Average across highest bed use
3%
41
4%
42
35
4%
38
33
5%
35
38
3%
43
35
2%
36
40
5%
45
36
9%
35
36
8%
36
36
5%
37