community services benchmarking deep dive report for
TRANSCRIPT
NHS Benchmarking NetworkJune 2020
Raising standards through sharing excellence
Community Services benchmarking Deep dive report for Physiotherapy (Child)
Raising standards through sharing excellence
© NHS Benchmarking Network (NHSBN)
Citation for this document: NHS Benchmarking NetworkDeep dive report for Physiotherapy (Child). June 2020
Community Services benchmarking - Deep dive report for Physiotherapy (Child)
ContentsSection 1: Introduction Content of this report Executive summary Physiotherapy (Child)
Section 2: National policy context Community Services Physiotherapy (Child)
Section 3: Key Findings - Physiotherapy (Child) Service model Access Activity Workforce Finance Quality and outcomes
Section 4: References
Appendix 1: The Community Services benchmarking project
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Community Services benchmarking - Deep dive report for Physiotherapy (Child)
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Community Services benchmarking - Deep dive report for Physiotherapy (Child)
Section 1: Introduction
Section 1: IntroductionWhen reviewing this document, please note:
the 2019 Community Services project collected and analysed data for the NHS financial year 2018/19. The “2018 project” refers to 2017/18 data
any reference to the “national average” within this document refers to the mean average of 2019 project participants
all charts and data in this report refer to the overall UK position. Peer group profiling is available in the online toolkit
on bar charts, each blue bar represents an individual service. The orange horizontal line represents the mean average value of all services
this report is an overview national report and therefore the charts in this report do not show the position of any one organisation in particular. Member organisations who participated in the Community Services project can check their individual positions in the online toolkit, which is issued to members once the dataset has been finalised. This allows individual comparison of every metric collected against the sample position.
Content of this report
NHSBN Community Services 2019 - Physiotherapy (Child)
Face to face contacts per 100,000 population
Face to face contacts per clinical WTE in post Patient facing time
Average length of a contact
Clinical WTE per 100,000 population Average waiting time
Referrals received per 100,000 population
Unique service users per clinical WTE in post
Face to face contacts per service user
1,420 656 50%
48 mins
3.0 49 days
235
154
5.1
5
Community Services benchmarking - Deep dive report for Physiotherapy (Child)
Section 1: Introduction
Executive summary Physiotherapy (Child)Children’s physiotherapy services remain crucial in providing long term condition management, therapeutic exercise and rehabilitation to children (predominantly described as those under the age of 18, although this differs between services). However, access to children’s physiotherapy services is a challenge, with average waiting times increasing. Since the first iteration of the community services project in 2013, the average waiting time for children’s physiotherapy has risen from 35 days in 2013 to 49 days in 2019, with no services reportedly operating at weekends. The waiting times for children’s physiotherapy services are notably higher than the 33 days reported by adult physiotherapy services.
On average, there were 235 referrals received per 100,000 registered population, and the referral acceptance rate was 87%, indicating that the majority of referrals were appropriate, however, only 39% of referrals were accepted, assessed and seen within 28 days of the referral (adult physiotherapy 53%).
When compared to adult physiotherapy services, children’s services reported a higher number of face to face contacts per service user with 5.1 contacts per service user compared to 3.6. The average length of a contact was similar across both services, at 48 minutes for children’s services and 46 minutes for adults.
Clinical staffing levels have shown variation since the 2013 iteration of the community services project. The highest reported level of clinical staffing was 3.2 WTE per 100,000 registered population in 2013. The 2019 findings showed clinical WTE per 100,000 registered population at 2.8.
The 2019 community services project is the first iteration of the project where participants were asked for their yearly budget and spend, in order to allow comparisons between the two. When 2018/19 financial data was compared, all areas, with the exception of non-clinical staff pay spend, reported, on average, an underspend. Non-clinical staff pay costs have, on average, an increased budget in 2019/20 when compared with 2018/19. Clinical staff pay costs have also seen an increase in their planned budget for 2019/20, which could reflect the extra physiotherapists promised as part of the NHS Long Term Plan.
The 2019 Community Services project showed that in general, service users were happy with the services they received, with the average Friends and Family Test score at 96%. 97% of patients reported having an improvement in their condition between admission and discharge, and patient centred goals being fully met in 91% of cases.
Average waiting time (days)
0
10
50
20
40
30
60
2013
2015
2016
2014
2017
2018
2019
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Community Services benchmarking - Deep dive report for Physiotherapy (Child)
Section 2: National Policy Context
National policy contextCommunity ServicesEngland
The NHS Long Term Plan, published in January 2019, highlights the importance of community services in supporting service users in the community and reducing unnecessary hospital admissions. The Long Term Plan sets out to:
boost ‘out-of-hospital’ care, and dissolve the historic divide between primary and community health services
increase investment in primary medical and community health services, which will equate to an extra £4.5 billion a year by 2023/24. Extra money will start to flow to community via Sustainability and Transformation Partnership (STP)/ Integrated Care Systems (ICS) and Primary Care Networks (PCN) via Directed Enhanced Service (DES) contracts in 2020/21. The Long Term Plan Implementation Framework outlines funding allocations, with funding for Primary Care flowing more quickly than funding for Community Services
increase the capacity and responsiveness of community and intermediate care services via a new offer of urgent community response and recovery support. These services will aim to prevent unnecessary admissions to hospitals and residential care, as well as ensure a timely transfer from hospital to community
expand community multidisciplinary teams aligned with new Primary Care Networks based on neighbouring GP practices. Expanded neighbourhood teams will comprise a range of staff such as GPs, Pharmacists, District Nurses, Community Geriatricians, Dementia workers and AHPs.
Yes
No
Does your organisation operate with any Primary Care Networks (PCNs)?
0% 60%
40%
20%
100%80%
69% 31%
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Community Services benchmarking - Deep dive report for Physiotherapy (Child)
Section 2: National Policy Context
Although the focus of community services within the NHS Long Term Plan is on adult services, wider children’s services and providing a strong start in life for children and young people is also highlighted in the plan. The Long Term Plan sets out to:
bring together the NHS, Local Authorities and other local partners through local maternity systems, with the aim of ensuring women and their families receive seamless care, including when moving between maternity or neonatal services or to other services such as primary care or health visiting
expand and invest in mental health services for children and young people
design and implement models of care that are age appropriate, closer to home and bring together physical and mental health services. These models will support health development by providing holistic care across Local Authority and NHS services, including primary care, community services, speech and language therapy, school nursing, oral health, acute and specialised services
roll out clinical networks to ensure improvement in the quality of care for children with long-term conditions such as asthma, epilepsy and diabetes.
Wales
Community services strategy in Wales is contained within the document A Healthier Wales: Our Plan for Health and Social Care and sets a clear ambition to bring health and social care services together for the benefit of service users. This is not a new vision, but is supported by clear expectations, milestones and design principles to establish new models of care in every part of Wales.
The overall aim is to provide services that are designed and delivered around the needs and preferences of individuals, with greater emphasis on sustaining a healthy population and preventing ill health. To achieve this ambition, Wales must continue to break down the barriers that prevent health and social care services and their wider partners from operating across the whole system, delivering seamless care to the people of Wales.
Good planning arrangements are critical to bring together multiple providers and allow the system to be pre-emptive and anticipatory, ensuring that the right level of care is provided at the right time, from the right source and in the right setting.
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Section 2: National Policy Context
A Healthier Wales outlines the following strategies, all of which relate to the provision of community services:
services which support people to stay well, not just treat them when they become ill when people need help, health and social care services will work with them and their loved ones
to find out what is best for them and agree how to make those things happen. This is the basis of the ‘person-centred approach’
more services will be provided outside of hospitals, closer to home, or at home, and people will only go into hospital for treatment that cannot be provided safely anywhere else. This ‘community-based approach’ will help take pressure off the Welsh hospitals, reduce the time people have to wait to be treated, and the time they spend in hospital when they have to go there
health and social care services will use the latest technology and medicines to help people get better, or to live the best life possible if they aren’t able to get better.
Northern Ireland
Northern Ireland have a strategy which, in tandem with the modernisation of acute hospitals, seeks to expand the range of services that can be delivered in the community and is described in A Healthier Future. This encompasses the following:
the key aim is to support an increasing number of people to live independent lives, preferably in their own homes
to do this, the Health and Social Care Board and the Public Health Agency in Northern Ireland need to develop effective alternatives to hospital care, which are designed to reduce inappropriate admissions and unnecessary lengths of stay
there also needs to be a strong focus on rehabilitation in tandem with assessment of long term care needs to avoid unnecessary reliance on residential and nursing home care.
To deliver on this vision, the following strategies are being pursued in relation to community services provision in Northern Ireland:
secure an appropriate balance between hospital and community based services within local health economies
continue the expansion and evaluation of intermediate care as a way of working that is designed to prevent unnecessary hospital admission, promote faster recovery from illness, support timely discharge, maximise independent living and improve the quality of assessment of long-term health and social care needs
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Community Services benchmarking - Deep dive report for Physiotherapy (Child)
Section 2: National Policy Context
Scotland
The newly created Public Health Scotland’s strategy around community services is embodied in A Fairer Healthier Scotland 2017-22. There are five strategic priorities that have been developed in partnership with stakeholders, including providers of community services. These are as follows:
Fairer and healthier policy - ensure that knowledge and evidence is used by policy and decision makers. This is so that strategies focus on fairness and influence the social determinants of health and wellbeing.Children, young people and families - ensure the knowledge and evidence provided is used to implement strategies focused on improving the health and wellbeing of children, young people and families.A fair and inclusive economy - providing knowledge and evidence on socio-economic factors and their impact on health inequalities. This is to contribute to more informed and evidence-based social and economic policy reform.Healthy and sustainable places - ensure the knowledge and evidence provided is used to improve the quality and sustainability of places. This will increase their positive effect on health and wellbeing.Transforming public services - working in partnership with and support public sector organisations to design and deliver services that have fairer health improvement and the protection of human rights at their core.
in co-operation with the independent sector, expand the use of supported living, domiciliary care, day care and assistive technologies as alternatives to residential accommodation, focusing on rehabilitation and independent living
develop a range of housing and care options for different levels of support, offering a continuum of care as people’s needs change
contribute to the development of a region-wide single assessment process, focused upon the person and designed to streamline and improve decision making about long-term health and social care needs and simplify access to services
expand the range of flexible and responsive respite and support services for carers increase the take up of Direct Payments engage actively with users and the voluntary and community sector in the design and delivery
of services.
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Community Services benchmarking - Deep dive report for Physiotherapy (Child)
Section 2: National Policy Context
Physiotherapy (Child)
Physiotherapists can treat a wide range of health conditions. The aim is to improve the service user’s physical activity and to help prevent any further injuries. Physiotherapy can be provided to people of all ages, however this report focuses on those providing physiotherapy to children. An adult physiotherapy services report is also available. Physiotherapists can provide education and advice, movement, tailored exercise and physical activity advice as well as manual therapy.
Physiotherapy provided in the community provides a key role in improving care and rehabilitation for children living with long term conditions and for those needing rehabilitation.
The Chartered Society of Physiotherapy (CSP) say that the NHS Long Term Plan (LTP) is a major breakthrough for physiotherapy in England. The LTP has committed to ‘increase investment in primary medical and community health services’ between 2019/20 and 2023/24, resulting in spending being at least £4.5 billion higher in 5 years’ time.
For physiotherapy in particular, the LTP commits to increasing the number of physiotherapists in primary care and rolling out First Contact Physiotherapists with the aim of enabling people to see the
17% 17%
66%
Adults - aged 18+
Children - aged 0-18
Children - aged 5-19
Children - aged 0-19
All ages - no restriction
Other
0%
0%
0%
What is the age group served by this service?
right professional without the need of a GP referral, and reducing the demand on GP appointments.
Whilst the LTP covers England, ‘A Healthier Wales’, ‘A Health and Social Care Delivery Plan in Scotland’ and the ‘Transformation Programme in Northern Ireland’ have similar commitments for the other UK countries.
This report also explores vacancy rates within children’s physiotherapy services, with clinical staff vacancy rate being reported at 8% for 2019. The King’s Fund recommended in their ‘Closing the Gap’ report, that the NHS should look to maximise opportunities offered to physiotherapists due to the large size of their current workforce, and strong future supplies. In 2018, the CSP reported a 17 percent
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Section 2: National Policy Context
increase in the number of physiotherapy student places in 2017, which combined with expanding job roles and greater responsibilities could aid with recruitment and retention for physiotherapists. The Interim NHS People Plan projects the need for an additional 5,000 physiotherapists working within primary care networks by 2023.
With the increased funding being made available to community health services, expanded job prospects and the increase in student places available, the future of children’s physiotherapy services is strong. The LTP states the 98% of Sustainability and Transformation Partnerships (STPs) have pilots for first contact programmes, and in 55% of those, the pilots are already underway. However, the Royal College of General Practitioners reported in 2018 that less than 20% of GPs currently rate their access to physiotherapists as ‘good’. It is hopeful the continued investment and First Contact Physiotherapists will go some way to improving this over the coming years.
Another key message of the LTP is for a redesign of health services for children and young people with the creation of the Children and Young People’s Transformation Programme. The Children and Young People’s Transformation Programme will, in conjunction with the Maternity Transformation Programme, oversee the delivery of the children and young people’s commitments in the LTP as covered in chapter 3 of the LTP on “A strong start in life for children and young people”.
The CSP are looking to develop a set of community physiotherapy standards to follow a format similar to NICE which will become available in December 2021.
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Section 3: Key Findings - Physiotherapy (Child)
Physiotherapy (Child) - service model Children’s physiotherapy services are defined as physiotherapy
services offered for children (up to 18 years) delivered in the community, as opposed to non-acute settings
in the 2019 Community Services project, 100% of respondents reported their children’s physiotherapy services offers support for long-term condition management. Almost all services also offered; therapeutic exercise, rehabilitation, supporting recovery from ill
Key findings
health, restoring, maintaining and improving movement and activity, as well as provision of specialist equipment, mobility aids, splints and supports, offered by over 90% of respondents. Less frequently offered was injection of botulinum toxin to help with the management of spasticity and intraarticular injection therapy for pain management, offered at 15% and 8% of responding services respectively
Are the following services provided?
0% 60%
40%
20%
100%80%
Therapeutic exercise
Rehabilitation
Manual therapy
Supporting recovery from ill health
Support for long-term condition management
Restore, maintain and improve movement
Provision of specialist equipment
Intra-articular injection therapy
Prescription of mechanical positive pressure devices
Injection of botulinium toxin
Other
100%
98%
95%
95%
93%
93%
78%
30%
15%
15%
8%
Yes No
2%
5%
5%
7%
7%
22%
70%
85%
85%
92%
13
Community Services benchmarking - Deep dive report for Physiotherapy (Child)
Section 3: Key Findings - Physiotherapy (Child)
Does your Child Physiotherapy Service have links with acute services?
Does this service provide in-reach into the acute services?
Is this service managerially and
functionally integrated with acute services?
0% 60%
40%
20%
100%80%
46% 54%
24% 76%
100% of children’s physiotherapy services were offered in the service user’s own home. The service was also frequently provided in clinics and health centres, special schools, and education facilities (98%). 36% of respondents offered services in leisure facilities and 39% in community facilities
46% of participants reported their service provides in-reach into the acute services and 24% reported the service was managerially and functionally integrated with acute services
the majority of respondents (66%) reported their service was available for children aged 0-19; 17% reported their service was available for children aged 0-18, and the remaining participants responded as ‘other’. Where ‘other’ was chosen, participants were asked to describe. In the majority of responses, ‘other’ was described as offering the service to older service users if they had special needs e.g. children aged 0-19 in special school provision but 0-16 in mainstream schools.
Yes No
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Community Services benchmarking - Deep dive report for Physiotherapy (Child)
Section 3: Key Findings - Physiotherapy (Child)
Physiotherapy (Child) - AccessAverage waiting time (days)
0
60
40
20
100
80
120
Throughout this report, the mean average position for the participating organisations is shown by the orange line.
The average waiting time in days for children’s physiotherapy services was 49 days, which was notably longer than for adult services (33 days). The average waiting time has shown a general increase since the 2013 iteration of the project, where the average waiting time reported was 35 days.
DNA rates were also notably higher in children’s physiotherapy services than in adults at 7.1% compared to 3.4%.
Staff available (weekdays)
Hours available (weekdays)
The average number of staff available on weekdays was reported at 15 and on average, these staff were available for 8 hours per day. No participants reported having weekend availability. The total closure of children’s physiotherapy services at weekends may be impacting the longer waiting times to access the service when compared to adult physiotherapy. Four adult physiotherapy services reported having availability at weekends. Where adult physiotherapy services were available, reported weekend hours of availability as a percentage of weekday availability, was at least half.
0
30
20
10
50
40
0
6
4
2
10
8
12
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Community Services benchmarking - Deep dive report for Physiotherapy (Child)
Section 3: Key Findings - Physiotherapy (Child)
Physiotherapy (Child) - ActivityTotal referrals received per
100,000 registered population
0
300200
100
500
400
600
The chart to the left shows the total number of referrals received, benchmarked per 100,000 registered population.
There is evident variation in the demand for the service with a range from 18 to 870, with a mean average of 235 referrals per 100,000 population.
Of these referrals, the average acceptance rate was 87%, which represents a 6 percentage point fall from the 2018 project
700
findings, however the percentage of referrals accepted, assessed and seen within 28 days has remained relatively consistent at around 38%.
900
800
1,000
Average time on caseloads (days)
0
300
200
100
500
400
600
The average caseload per clinical WTE in establishment for children’s physiotherapy services was 73. Each service user spent an average of 303 days on the caseload. This ranged from 30 days to 868 days. This was notably longer than the 82 days reported by adult physiotherapy services.
This could indicate that children are using physiotherapy services
700
for managing long term conditions, where as many adults are using the service for relatively short term rehabilitation requirements.
900
800
1,000
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Community Services benchmarking - Deep dive report for Physiotherapy (Child)
Section 3: Key Findings - Physiotherapy (Child)
Physiotherapy (Child) - ActivityUnique service users per
100,000 registered population
0
200
400
600
The adjacent chart shows the number of unique service users per 100,000 registered population, which was, on average, 298.
The online toolkit in the members’ area also enables an examination of the number of unique service users per clinical WTE in establishment, which was, on average, 125.
1,200
800
1,000
Face to face contacts per 100,000 registered population
0
500
1,000
1,500
The total number of contacts can be split by face to face contacts and non-face to face contacts. The average total number of contacts per 100,000 registered population for children’s physiotherapy services was 1,622.
The majority of contacts are face to face contacts. Children’s physiotherapy services reported an average of 1,420 face to face contacts per 100,000 registered population and 212 non-face to face contacts per 100,000 population.
3,000
2,000
2,500
The average length of a face to face contact was 48 minutes, with each service user receiving an average of 5 contacts.
3,500
4,000
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Section 3: Key Findings - Physiotherapy (Child)
Patient facing time
50% of clinical time is spent patient facing, with a further 21% being spent on indirect patient specific activity.
100% of respondents in the community services project reported offering children’s physiotherapy services in the service user’s own home. Travel time accounts for 6% of clinical staff time.
8% of clinical time was spent on non-patient specific activity.
21%
14%
50%
6%
8%
Patient facing time Patient non-facing time
Indirect patient specific activity
Non-patient specific activity Travel time
Physiotherapy (Child) - Activity
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Section 3: Key Findings - Physiotherapy (Child)
Clinical WTE in establishment per 100,000 registered population
0
1
2
3
On average there were 2.8 clinical WTE in establishment per 100,000 registered population. These were supported by a further 0.4 non-clinical WTE per the same benchmark. Non-clinical staff, on average comprise 13% of the workforce.
Participants reported, on average 92% of the workforce had completed mandatory training requirements and 94% of the workforce had an annual appraisal.
6
4
5
7
8
Physiotherapy (Child) - Workforce
Clinical staff vacancy rate (%)
Staff turnover rate (%)
Vacancies and staff turnover rates can have impacts on activity, patient experience and staff morale. The clinical staff vacancy rate for children’s physiotherapy services in 2019 was 8% and 5% for non-clinical staff. The sickness rate is low when compared to other community services at 3% and the staff turnover rate was 12%. On average 4% of staff were reported as on maternity leave.
0
30
20
10
50
40
0
15
10
5
25
20
30
60 35
19
Community Services benchmarking - Deep dive report for Physiotherapy (Child)
Section 3: Key Findings - Physiotherapy (Child)
Physiotherapy (Child) - Workforce
Clinical staff skill mix
56% of the clinical workforce were reported as either band 6 or band 7 staff, with band 6 accounting for 31% of clinical staff and band 7 accounting for 25%.
14% of the clinical workforce were represented by band 5, 18% were band 3 and 10% were band 4. Less than 1% of the clinical workforce was band 8b or above.
Non-clinical staff were predominantly comprised of band 3 staff (53%).
14%
10%
18%
25%
31%
2%
Band 2 Band 3 Band 4 Band 5Band 6 Band 7 Band 8a Band 8b / 8c / 8d / 9
20
Community Services benchmarking - Deep dive report for Physiotherapy (Child)
Section 3: Key Findings - Physiotherapy (Child)
Physiotherapy (Child) - Finance
Budget per 100,000 registered population
The chart to the left shows the 2018/19 budget (blue) when compared with the 2019/20 planned budget (orange) per 100,000 registered population.
Both clinical and non-clinical staff pay costs have been allocated an increase in budget for 2019/20 when compared with 2018/19.
£20,000
£0
£60,000
£40,000
£120,000
£100,000
£80,000
£140,000
Clinical staff pay cost
Non-clinical staff pay cost
Non-pay cost
Indirect costs & overheads
Budget 2018/19 Budget 2019/20
Year/Cost
Budget 2018/19
Budget 2019/20
121,555
128,626
Clinical staff pay cost (£)
10,655
11,881
Non-clinical staff pay cost (£)
10,145
9,990
Non-pay cost (£)
41,773
41,800
Indirect costs and overheads (£)
Non-pay costs and indirect costs and overheads have remained relatively consistent with the previous years budget.
The largest percentage change is seen in clinical staff pay costs where it was reported that the budget increased by 6% (from £121,555 to £128,626) between years.
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Community Services benchmarking - Deep dive report for Physiotherapy (Child)
Section 3: Key Findings - Physiotherapy (Child)
Physiotherapy (Child) - Finance
Budget vs Spend per 100,000 registered population
The chart to the left shows the average 2018/19 budget (blue) when compared with the average 2018/19 spend (orange) per 100,000 registered population. All areas except non-clinical pay spend reported an underspend when compared to the budget.
On average, total pay spend for children’s physiotherapy services accounted for 79% of the total costs.
£20,000
£0
£60,000
£40,000
£120,000
£100,000
£80,000
£140,000
Clinical staff pay cost
Non-clinical staff pay cost
Non-pay cost
Indirect costs & overheads
Budget 2018/19 Spend 2018/19
Year/Cost
Budget 2018/19
Spend 2018/19
121,555
116,163
Clinical staff pay cost (£)
10,655
11,603
Non-clinical staff pay cost (£)
10,145
9,764
Non-pay cost (£)
41,773
41,020
Indirect costs and overheads (£)
63% of respondents reported achieving the CIP/CRES target with 29% of respondents saying that procurement initiatives contributed towards this.
22
Community Services benchmarking - Deep dive report for Physiotherapy (Child)
Section 3: Key Findings - Physiotherapy (Child)
The above charts show the bank and agency spend as a percentage of the total pay budget. On average, organisations reported spending 1.1% of pay budget on bank staff. Spend on agency staff was slightly higher, accounting for 3.1% of the total pay budget. Bank and agency spend in adult physiotherapy services were at similar levels, with bank spend at 0.5% of total pay budget and agency spent accounting for 3.7%. On average, less than 0.1% of the total pay budget was spent on overtime pay.
0%
3%
2%
1%
5%
4%
0%
6%
4%
2%
10%
8%
12%
6%14%
Physiotherapy (Child) - Finance
Bank spend as % of total budget
Agency spend as % of total budget
7%16%
18%
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Community Services benchmarking - Deep dive report for Physiotherapy (Child)
Section 3: Key Findings - Physiotherapy (Child)
Physiotherapy (Child) - Quality and outcomesFriends & Family Test results -
average score
0%
20%
40%
60%
Like adult physiotherapy services, children’s physiotherapy services also performed well with an average of 96% on the Friends and Family Test. The Friends and Family Test score indicates the percentage of service users who were ‘likely’ or ‘extremely likely’ to recommend the service.
Complaints about the service were also low, with
80%
100%
an average of 5 complaints per annum per 100 WTE staff members. Typically, 93% of complaints were responded to within the target time frame.
Children’s physiotherapy services received an average of 118 compliments per annum per 100 WTE members of staff, which is lower than adult physiotherapy services which received, on average, 223.
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Community Services benchmarking - Deep dive report for Physiotherapy (Child)
Section 3: Key Findings - Physiotherapy (Child)
Unlike in adult services, children’s physiotherapy services did report having SUIs, although the numbers reported were low. On average, there were 0.4 SUIs per 100 WTE staff, with a median of 0. Overall, 72% of participants reported using a Patient Reported Experience Measure (PREM) and 74% of respondents reported using a Patient Centred Outcome Measure (PCOM).
On average, 97% of patients had an improvement in their condition between admission and discharge for cases where a validated assessment tool has been used (82% for adult physiotherapy services) and 96% of patients had a care plan documented and agreed.
Yes No
28%
72%
Patient experience
Physiotherapy (Child) - Quality and outcomes
On average, 99% of patients on the caseload had patient centred goals set. Where these goals were set, 91% were met fully, with only 9% partially met. Less than 1% said the patient centred goals were not met, indicating the positive impact of the children’s physiotherapy service on the condition of service users.
39% of of patients on the caseload had a validated assessment tool used on admission, which is notably lower than the 65% reported by adult physiotherapy services.
Fully met Partially met Not met
<1%
91%
9%
Were the patient goals met?
Do you use a PREM?
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Community Services benchmarking - Deep dive report for Physiotherapy (Child)
Section 4: References
ReferencesCSP. NHS plan for England – details for the physiotherapy profession. January 2019Department of Health (Northern Ireland). A Healthier Future: a Twenty Year Vision for Health and Wellbeing in Northern Ireland 2005-2025. 2004NHS England. Next Steps on the NHS Five Year Forward View. March 2017NHS England. The NHS Long Term Plan. January 2019 NHS England. NHS Long Term Plan Implementation Framework. June 2019NHS England. First Contact Physiotherapists https://www.england.nhs.uk/gp/our-practice-teams/first-contact-physiotherapists/. April 2020NHS England. Interim NHS People Plan. June 2019NHS Health Scotland. A Fairer Healthier Scotland. A strategic framework for action 2017 – 2022. 2017Royal College of General Practitioners. GP Forward View. August 2018The King’s Fund. Closing the Gap. March 2019The Health Foundation/Nuffield Trust. Community Services. What do we know about quality? November 2017Welsh Government. A Healthier Wales: Our Plan for Health and Social Care. June 2018
Community Services benchmarking - Deep dive report for Physiotherapy (Child)
Appendix 126
Community Services benchmarking projectThe Community Services project is one of the NHS Benchmarking Network’s longest standing projects, being a key area for members to want to benchmark, given the lack of national data available in this area. Community services represent over £10 billion of NHS expenditure and they play a key role in supporting service users at home and reducing unnecessary hospital admissions. The Next Steps on the NHS Five Year Forward View highlights the importance of close working with community services, with an aim to free up capacity in 2,000-3,000 hospital beds over the next two years. Despite this policy intention, The Nuffield Trust reports that funding given to NHS Trusts for community services fell by 4% last year. An NHS priority over the next 10 years is to help older people stay healthy and live independently in their communities, with a move towards more integrated care for this cohort. Community services provision is expected to play an important part in the NHS Long Term Plan.
National data on community services is currently limited and the Network’s Community Services project aims to fill this information gap, taking a view across all aspects of service provision including access, activity, workforce, finance and quality metrics. The project provides a detailed view of 25
different community services, and there is a series of case study reports for every single service benchmarked.
Appendix 1
Cardiac Community Team
Wheelchairs
Speech & Language Therapy (Child)
Speech & Language Therapy (Adult)
School Nursing
Respiratory Community Team
Podiatry
Physiotherapy (Child)
Physiotherapy (Adult)
Occupational Therapy (Child)
Occupational Therapy (Adult)
MSK
Integrated Sexual Health Service
Health Visiting
End of Life Community Team
Continence Community Team
Dietetics (Child)
Dietetics (Adult)
Diabetes Community Team (Adult)
Community Paediatrics
Community Matrons
Community Integrated Care Teams
Community Dental
Community / District Nursing
Children’s Community Nursing Team
Community Services benchmarking - Deep dive report for Physiotherapy (Child)
Appendix 1 27
The Community Services benchmarking project runs on an annual cycle; project scoping taking place with the Community Reference Group from January through to April; data collection from May through to June; data analysis and validation in September and October, with the national event and other outputs being made available in November and December. There may be some changes to the community services where data is collected between the years the project has been operating.
The Community Services benchmarking project collects provider level data on access, activity, workforce, finance and quality and outcomes at aggregated organisational level for the whole year. Some organisations may chose to make multiple submissions, often where service models differ between different geographic areas or their service covers multiple CCG areas. The metrics are agreed with the Network’s Community Reference Group and definitions are provided for every metric to ensure consistency of interpretation of metrics. The Network provides a Helpline to help with interpretation and give advice on data collection. Metrics are reviewed at the end of each cycle, with a view to refining data collection, and ensure that metrics and definitions utilised are relevant and up-to-date. Metrics with a poor response rate tend to be discarded for the next year’s benchmarking. Within the membership, participants take part in the Community Services benchmarking project from all four UK countries. The project provides the most comprehensive dataset available in the NHS on Community Services.
Data is collected via an online data collection tool, input via the online data collection pages in the Network website members’ area. The project collects data for subsequent NHS financial years, running from 1st April to 31st March, so the 2019 iteration of the Community Services project collected data from 1st April 2018 to 31st March 2019. As the project has run for many iterations, time series analysis is available, through toggling between the years on the online toolkit.
During the data validation phase, all submissions are reviewed and participants are given the opportunity to amend or update their data where any outlier positions are identified. These are checked following the production of a draft online benchmarking toolkit, which shows the draft benchmarked findings for the whole sample against every metric collected. All outputs are anonymised, and provider organisations can see their own position(s) only.
Jan DecNovOctSepAugJulJunMayAprMarFeb
Project scoping Data collection ValidationValidation
& Draft toolkit
EventOther
outputs published
Community Services benchmarking - Deep dive report for Physiotherapy (Child)
Appendix 128
Next cycle
Project outputs
Networking and sharing good practice
The Community Services project will feature in the Network’s 2020/21 work programme, collecting2019/20 outturn data. In response to member requests, the data specifications have been cut down and the number of community services being benchmarked in this year’s cycle has been reduced, to enable members to have the capacity to complete the benchmarking, following the coronavirus pandemic.
NEW Community Services Covid-19 trackerThe Network is also offering a NEW Community Services Covid-19 tracker dashboard project which reports on a monthly basis on a limited set of metrics to track the impact of the pandemic upon community services provision.
Every participant in the Community Services benchmarking project receives a suite of outputs. All of the outputs from the Community Services project are available via the members’ area of the NHS Benchmarking Network’s website. Log-in details are required to access the member’s area. To request new, or to be sent a reminder of existing log-in details, please email [email protected].
Once logged-in to the members’ area, each of the Network’s projects is listed on the home page. The following outputs can be accessed: Online toolkit Project reports Good Practice Compendium Presentations from the Network’s 2019 Community Services national conference
In addition to the project outputs, organisations who participated in the project are still able to view their data submission via the online data collection pages in a read-only format. Please contact Lucy Atherton if you need any assistance accessing the project outputs.
The Network is keen to facilitate networking and sharing good practice examples between project participants. If your organisation is interested in contacting other project participations, please email Lucy Atherton and, providing consent is granted, the relevant project lead contact details can be passed on. Please note, although some organisations choose to share their organisation’s identifier codes between each other, the Network keeps all data supplied to the benchmarking projects anonymous. The Network will never pass on identifier codes to colleagues outside your organisation.