frontiers of performance in the nhs ii - ipsos

Social Research Institute

Frontiers of performancein the NHS II

2 Ipsos MORI: Frontiers of performance in the NHS II

“ Stop looking up to the Department... and start looking out to your local populations and patients”

David NicholsonNHS Chief Executive

About Ipsos MORI

Ipsos MORI is the sum total of two successful research companies, Ipsos UK and MORI,

which joined together in October 2005 to create the second largest research company in

the UK. We offer a full range of quantitative and qualitative research services, as well as

extensive international research capacity.

The Ipsos MORI Social Research Institute works closely with national government, local

public services and the not-for-profit sector. We help policy makers understand what works

in terms of service delivery, and we provide robust evidence to bridge the gulf between the

public and politicians — we also provide a host of background information for clients on key

policy challenges.

The NHS and Public Health research team is a leading provider of research on attitudes

of public service users, staff and other stakeholders. The team works extensively with the

Department of Health and many Trusts and Strategic Health Authorities on a wide range

of issues, from communications approaches to patient satisfaction, using the full range of

research techniques.

Ipsos MORI: Frontiers of performance in the NHS II 1

ContentsForeword 2Executive Summary 4Introduction 6How is performance measured in the NHS? 6

Structure of the report 9

Part 1 – PCTs 111. What factors are associated with positive patient ratings of PCTs? 12

A. The effect of objective performance measures 12

B. Local population factors 16

C. Can we predict PCT patient ratings? 20

2. What performance levels should we expect? 24

A. Actual versus predicted ratings 24

B. Putting the patient ratings into context – who is performing well given

their local conditions? 25

C. The best performers 26

D. Implications for PCTs 27

Part 2 – acute trusts 293. What factors are associated with inpatient ratings? 30

A. Perceptions of specific service dimensions and overall patient ratings 30

B. Local population factors 37

C. Can we predict inpatient ratings? 40

4. What performance levels should we expect? 44

A. Actual versus predicted ratings 44

B. Putting the patient ratings into context – who is performing well given

their local conditions? 45

C. The best performers 46

D. Implications for acute trusts 48

Conclusions 51What does this mean for you? 51

Appendices 53Appendix A – Performance tables 54

Appendix B – Regression Analysis 90

Appendix C – Notes on the data 92


ForewordWhen we launched the preview draft of this report in January 2008, we were delighted with

the response we received. The reaction from primary care and acute trusts alike has been

that this report has given them important insights into how their patients view them, and,

more importantly, what drives those perceptions.

Perhaps the audience with the greatest interest in the report has been those health bodies

faced with providing high quality services in some of the most challenging areas of the

country. The report highlights the importance of “place” in shaping people’s views of the

healthcare they receive: if you’re in a tough area, people are much less likely to give you the

benefit of the doubt, and your satisfaction scores are likely to be lower than in the leafier,

less deprived parts of the country. This is something many health bodies working in these

tough areas have long suspected, and the report has proved an asset in starting to quantify

this effect.

The flipside is also true. Trusts and PCTs in less deprived, less diverse areas have an

easier ride: their patients tend to be far more positive about the healthcare they receive. So

a good patient score in these areas may simply reflect a more positive target population,

rather than anything about the services per se. The message here for health bodies with

high patient satisfaction scores is: make sure you’re not being complacent.

Perhaps the key message from this is to reframe the question trusts and PCTs should be

asking themselves. The question is not: how well are we doing? It’s: how well are we doing

compared with what’s expected for this type of area? Refocusing the question in this

way is key to helping health bodies consider more closely whether they need to raise their

game. And as the following analyses show, asking the question in this way reveals some

interesting shifts in who count as the better and poorer performers: the Newhams and

Lambeths of this world are doing far better than their raw scores would suggest.

For acute trusts, the analysis goes beyond this, revealing which of the things practitioners

do are most linked to improved patient satisfaction. Privacy, pain control and good

communication are all important – but the real drivers of satisfaction are treating people

with dignity, involving them in the decisions that affect them, and making sure the place

is clean. The question for trusts now is: what does this look like in practice? What

specifically do you need to do to engender a sense of dignity – and how does this vary for

different groups of patients? How involved do patients have to be to really feel involved in

their healthcare decisions? What things really count in patients judging whether the wards

are clean? Understanding these issues will be invaluable for acute trusts looking to build a

stronger reputation amongst their patients.


Perhaps the one gap in this analysis is understanding what PCTs can do to increase patient

satisfaction. It’s a gap because the data we’ve been able to access for this report does

not provide a ready route into this question. Nevertheless, it’s a question that PCTs should

be focusing on. The World Class Commissioning agenda is driving PCTs to far better

understand their local communities – and as part of this, it will be important to understand

what’s driving your reputation and how satisfied people are with you. Comparisons on

measures such as this are likely to become far more visible, so the best trusts would do well

to really delve into this question.

Historically, the NHS has not perhaps focused as much attention on social research as other

sectors. We hope therefore that what follows demonstrates that it is worth paying attention

to the research findings and what they mean. We hope too that you find this a useful

contribution to the debate about how the NHS can best deliver the best patient care.

Jonathan NichollsResearch Director – NHS and Public HealthMay 2008


Executive summaryThe NHS today increasingly talks about being “patient-centred”; its Chief Executive asks it

to “stop looking up to the Department….and start looking out to your local populations and

patients”. How well are those charged with delivery on the ground doing on this, and what

factors affect patient perception?

In 2004, Ipsos MORI published our first Frontiers of Performance in the NHS, exploring what

was driving patient perception, and identifying key local factors that had very significant

effects on patient perception. This report brings this work up to date, and raises a number

of key questions.

We explore those factors underlying the patient experience from a range of patient

surveys – both individual aspects of the treatment and care received and more objective

performance measures. We add to this with an examination of the geo-demographic factors

that are associated with patient ratings – the nature of local population served by the Trusts

in question – and ask what role local conditions play in determining patient ratings, as

opposed to action by managers.

The Primary Care Sector

Our analysis shows again that objective performance measures, such as the standardised

mortality ratios and expenditure per patient (reference costs), have little relationship with

patient ratings of primary care services.

Instead, the nature of local communities has far more impact. Our analysis shows that

PCT services in areas with high ethnic fractionalisation (the extent of different ethnicities in

an area), high deprivation, those with a younger population and those situated in London

nearly always receive lower ratings of satisfaction than those serving wealthier, older, more

homogenous populations. We can predict patient ratings with some accuracy, simply by

knowing the characteristics of the local population served by the PCT.

This means that when looking at patient perception of PCT services, it is important to take

into account local factors: brilliance looks different in different places. Given the strong

associations found, in some cases it will be misleading to consider just the raw scores

of patient ratings in making judgements. Our analysis argues for a more comprehensive

measurement of patient experience, taking all these factors into account.

Lessons can be learned from those PCTs that are able to overcome the challenges posed

by their local conditions and achieve relatively high patient ratings, like Lambeth. In this

report we have analysed patient experience data for all PCTs and using regression analysis

techniques, identified those Trusts which perform best and worst – after taking into account

local conditions.

The Acute Sector

In the acute sector we find that the nature of the place has much less impact, although

as with PCTs, and indeed ratings of the NHS by non-patients, London faces particular

challenges, as do trusts serving younger, more ethnically fractionalised populations.


As in 2004, for acute trusts, a limited number of individual aspects of care are highly

correlated with overall patient experience. It is vital to get these right. The analysis shows

three areas as key drivers of overall inpatient ratings – treating patients with dignity and

respect, involving them in decisions and the cleanliness of the hospital room or ward.

Breaking down the concept of “dignity and respect” highlights a close association with

a number of other individual aspects of care. It confirms the importance of involvement

in treatment decisions and cleanliness and also shows associations with the privacy of

treatment and pain control. Understanding what these mean for specific staff behaviours,

organisation and communications is key.

Key Findings

• Objective performance measures, such as standardised mortality ratio and reference

costs, show a weak relationship with overall ratings of primary care satisfaction.

• The analysis confirms what we found in 2004 - local population factors are associated

with patient ratings, particularly in relation to primary care. PCTs in areas with high ethnic

fractionalisation, high deprivation, those with a young population and those situated in

London or the West Midlands are likely to receive lower ratings of satisfaction.

• This means that it is possible to predict patient ratings with some accuracy, simply by

knowing the characteristics of the local population served by the PCT.

• A strong predictive model was produced, explaining 69% of the variation in patient

ratings, containing ethnic fractionalisation, levels of deprivation and being situated in the

East of England as key negative drivers of patient satisfaction. The number of GPs per

population, the percentage of the population aged over 65, and four region indicators

– North West, North East, Yorkshire and the Humber and East Midlands – all exert a

positive influence.

• The PCT model is broadly similar to that produced in 2004 but with the inclusion of four

region indicators as positive drivers and exclusion of London and the South East as

negative drivers.

• For acute trusts, a weaker predictive model was produced, explaining 40% of the

variation in patient ratings, containing the percentage of the population aged under 16

and being situated in London as negative drivers.

• This model differs from that produced in 2004, where local factors were found to

be more strongly associated with patient ratings. Our 2004 model contained ethnic

fractionalisation, proportion of the population over 65 and two region indicators, South

East and East of England, in addition to the drivers in the current model.

• Individual aspects of care are highly correlated with overall ratings of inpatient care.

Most important are treating patients with dignity and respect, involving patients in

decisions and the cleanliness of the hospital.

• There is a clear contrast between the two types of health bodies – for acute trusts ‘how

patients are treated’ is more important, whereas for PCTs, ‘where patients are treated’ is

more important in predicting patient satisfaction.

Jonathan Nicholls, Anna Quigley, Daniel Tse, Caroline Webb, Ben Page.London, April 2008.


IntroductionHow is performance measured in the NHS?

The current system for rating performance in the NHS was launched in March 2005 by

the Healthcare Commission, the body responsible for assessing and reporting on the

performance of both NHS and independent healthcare organisations. The annual health

check scores NHS trusts on many aspects of their performance, including the quality of the

services they provide to patients and the public as well as their management of finances

and other resources such as property and staff. These scores are based on a range of

information gathered throughout the year through various service reviews and inspections,

as well as data collected by other organisations, such as the Commission for Social Care

Inspection, the Mental Health Act Commission and the Criminal Records Bureau.

However, the recent emphasis on a patient-centred NHS means that the views of patients

are becomingly increasingly important. The ‘Our NHS, our future’ interim report states

that “effective change needs to be animated by the needs and preferences of patients,

empowered to make their decisions count within the NHS”. The Healthcare Commission

itself acknowledges that health services should be shaped by what matters most to patients

and the public – its own survey programme of NHS patients, the results of which feed into

the annual health check, is building up a national picture of people’s experience that will

allow it to compare:

• patient satisfaction with different organisations

• changes in patient ratings over time

• variations in patient experience between different patient groups

This programme of work provides an assessment of patient satisfaction, but does not

provide an explanation of what factors lead to patient satisfaction. A quick examination of

patient ratings and Healthcare Commission ratings of performance shows us that there is

no association between the two. A top-rated trust is not necessarily one that patients rate

highly. Charts 1 and 2 demonstrate this.


Source: PCT patient survey 2005/Healthcare Commission

Healthcare Commission rating and overall PCT rating

0.5

0.6

0.7

0.8

0.9

1.0

0 1 2 3

Healthcare Commission star rating

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PCT

scor

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Chart 1: Healthcare Commission star ratings and overall PCT patient ratings2

Source: Inpatient survey 2006/Healthcare Commission

Healthcare Commission rating and ratings of overall inpatient care

0.5

0.6

0.7

0.8

0.9

1.0

Weak Fair Good Excellent

Healthcare Commission rating

Rat

ings

of o

vera

ll ca

re

Chart 2: Healthcare Commission rating and ratings of inpatient care

2 The chart plots Healthcare Commission star rating against patient ratings derived from the 2005 PCT patient survey. These represent the most recently available patient findings for PCTs.

Therefore, further analysis is needed to understand what it is that actually leads to

patient satisfaction. For example, what aspects of the patient experience are related to

overall ratings of satisfaction? Are there any other issues that are important, for example,

demographic factors relating to the locality of the health body? This report will look at this

data in more detail, exploring the key drivers of patient satisfaction, both those relating to

the patient experience and other situational factors.

MORI’s 2004 Frontiers of Performance in the NHS report3 highlighted the key factors that

determine overall patient perceptions. The report showed that there were some very clear

key drivers of patient perceptions that individual managers and clinicians could affect. For

example, being treated with dignity and respect was key to a positive inpatient experience

and other important factors included cleanliness of the wards and effective communication

between staff and patients. There were others, however, that were effectively beyond the

control of managers and the Department of Health. The report showed that the nature of

the population served by individual trusts was important in relation to ratings of the patient

experience. Trusts serving more ethnically diverse areas with relatively young populations

were rated less positively by patients. The analysis provided an alternative picture of relative

performance that suggested that some apparently under-performing trusts were actually

doing very well given local conditions, whilst some top-rated trusts were benefiting from

operating under relatively ‘easy’ circumstances.

The current report seeks to build on this work using updated data from the national patient

surveys. The primary aim of this report is to consider the situation as it exists at the moment

for health bodies within the NHS and to discuss the implications of the findings for NHS

managers. The previous findings will be discussed where appropriate and any changes in

findings will be discussed. However, some caution must be exercised in comparing results,

as various factors could be affecting the results. Firstly, the constantly evolving NHS creates

new challenges for health bodies on a regular basis. For example, reconfigurations of the

service may mean that health bodies may not exist in the same form as they did at the time

of the last report. Further, the patient surveys used as the dependent variable here employ

a postal methodology. This means that non-response bias may affect results to differing

extents at each point in time. In addition, some data used as independent variables in 2004

are not available to be used in the current analysis.

3 MORI (2004) Frontiers of Performance in the NHS



Structure of the report

This report will examine a range of factors for association with patients’ ratings of their

experiences. It will then look at patient ratings in light of the local context in which individual

health bodies are operating to establish realistic parameters for ratings, based on local

area factors. This allows us to compare the actual ratings of health bodies with what can

realistically be expected, given their situation, to establish relative performance levels of

individual organisations. The report is divided into two parts looking at PCTs and acute

trusts separately:

Part one - PCTs

Chapter one – What factors are associated with patient ratings of PCTs?

This chapter explores the forces that are associated with positive PCT patient experiences,

focusing on:

• ‘objective’ performance indicators (e.g. number of GPs serving the population,

Standardised Mortality Ratio)

• local population characteristics

Chapter two – What performance levels should we expect?

Having looked at the association between local conditions and patient ratings, this chapter

compares actual patient ratings against what is realistic for individual PCTs to achieve and

to identify which PCTs are actually performing well, given their local conditions.


Part two – Acute trusts

Chapter three – What factors are associated with inpatient ratings?

Turning to look at acute trusts, this chapter explores the factors that are associated with

positive inpatient experiences, in this case, specifically:

• patient perceptions of individual aspects of the care they receive

• local population characteristics

Chapter four – What performance levels should we expect?

Again, this analysis will allow us to compare actual patient ratings against what is realistic

for individual trusts to achieve in the context of the local conditions under which they

operate. Again, we will identify which trusts are actually performing well, given their local

conditions.

Conclusions

Having reviewed the data, we finally go on to draw out some key messages about what this

means for PCTs and NHS Trusts. In particular, we draw out the factors that tend to depress

patient ratings, and highlight where NHS managers should focus their attention.

Part 1 - PCTs


4 The PCT patient survey does not contain an overall measure of satisfaction rating. For the purposes of the analysis, an overall score is derived from individual survey items. This means that we cannot look at the relative importance of these items. See Appendix C for the method used to derive overall PCT ratings from individual survey scores.5 These represent the most recent available findings for PCTs. It contains data for pre-reconfigured PCTs.

1. What factors are associated with positive patient ratings of PCTs?

This chapter explores the factors that may be related to how happy patients are with the care they receive from their PCT4, including:

• the role of ‘objective’ performance measures, such as mortality rates and numbers of GPs per head

• the characteristics of the local population served by individual PCTs

A. The effect of objective performance measures

As mentioned earlier, the annual health check combines data from a number of sources

including patient perceptions, financial and managerial measures and clinical outcomes.

In fact, the quality of the patient experience, as perceived by the patients themselves,

does not always reflect these ‘objective’ measures of performance. Measures such as

reference costs, or the numbers of GPs in the population, show a weak association with

patient satisfaction. Using data from the 2005 PCT patient survey5, the results in this section

suggest that how a trust is objectively measured as performing is relatively unimportant in

shaping perceptions.

Reference costs

Reference costs are the average costs to the NHS of providing a defined service in any

given financial year. The Reference Cost Index shows the average cost of an organisation’s

aggregate activity, compared with the same activity delivered at the national average cost,

so that an organisation scoring 125 has costs of 25% more than the national average.


Our 2004 report showed that the average costs of providing health services, either at the

hospital or PCT level, had very little or no bearing on what patients thought of the service

they received6. The current analysis again shows only a small correlation between reference

costs and overall PCT ratings, although this relationship is a statistically significant one

– i.e. it could not have happened by chance. This implies that, as a general rule, those

PCTs where costs are higher than average tend to attract lower patient ratings. However, a

low R-Sq of 0.0534 means that only 5% of the total variation is accounted for by this factor

in isolation from all factors. For example, chart 3 shows that adjusted reference costs are

substantially higher in Halton PCT than in East Lincolnshire PCT but there is only 0.05 points

difference (out of a total of 100 points) in overall ratings. Equally, South and East Dorset

and Tower Hamlets PCTs have similar reference costs but very different overall scores,

suggesting that other factors must be at play here.

While the association is only a weak one, the findings do raise a number of questions. For

example, the fact that those PCTs scoring over 100 on the Reference Cost Index tend to

receive lower patient ratings might suggest that more efficient PCTs operate more effectively

and are better at keeping their patients happy. Or, it may mean that patients in these PCTs

have more challenging needs which are more costly to treat and make it more difficult to

achieve high patient ratings.

Chart 3: PCT reference cost and overall PCT ratings

Source: PCT patient survey 2005/DH

Reference costs and overall PCT ratings

East Lincolnshire

R2= 0.0534

0.65

0.70

0.75

0.80

0.85

0.90

50 75 100 125 150 175 200

Reference Cost Index

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PCT

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Tower Hamlets

S & E Dorset

Halton

6 For example, the R-Sq achieved in relation to PCT ratings was 0.0125. R-Sq values range from zero to one, according to the strength of association between the two variables. It is interpreted as the percentage of variation explained. For example, if the R-Sq is zero, then the independent variable explains none of the variation in patient ratings. If the R-Sq was one, it would explain all of the variation.


GPs per 100,000 population

We know from the findings of the GP Patient Survey 2006/20077 that most patients who

tried to get an appointment quickly report being able to do so – 84% were able to make an

appointment within 48 hours. Yet improved access to a GP within 48 hours was also one of

the areas thought most likely to improve the NHS locally in a survey of the general public.8

However, the current analysis shows that the availability of GPs in a PCT does not appear to

be strongly related to patient ratings of satisfaction. The chart below shows an R-Sq of just

0.0577, representing a slightly weaker association than found in 2004 (R-Sq = 0.0978). The

situation in South Wiltshire and Swale PCTs illustrates the lack of a strong relationship. South

Wiltshire PCT has over double the number of GPs but receives only slightly higher overall

ratings from its patients.

Chart 4: GPs per 100,000 population and overall PCT ratings


GPs per 100,000 population and overall PCT ratings

R2 = 0.0577

0.65

0.70

0.75

0.80

0.85

0.90

40 50 60 70 80 90 100 110 120


Ove

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S. Wiltshire

Swale

Central Derby PCT

Bradford City

Heart of Birmingham

North DorsetHambledon & Richmondshire

7 The GP Patient Survey 2006/2007 National report conducted for the Department of Health by Ipsos MORI8 NHS tracker for the Department of Health, Winter 2006, Ipsos MORI


Standardised Mortality Ratio

Possibly the starkest measure of quality of healthcare provision is the Standardised

Mortality Ratio. The SMR is a measure of mortality rates, taking into account the age and

gender profile of the patient population. The findings do show a clear negative relationship

between this objective measure and overall ratings. However, the strength of the relationship

is tempered by both Kensington & Chelsea PCT and Westminster PCT, which both display

low SMR yet still receive low ratings. The chart shows that although it is important, SMR still

only explains 11% of the variation in patient ratings.

Again, there may be several factors explaining this finding. It may suggest that PCTs with

high SMRs are in fact underperforming and this is reflected in patient ratings. Again though,

it might also result from the more challenging needs of the patients in these PCTs, leading

both to higher SMRs and lower patient ratings.

Chart 5: Standardised Mortality Ratio and overall PCT ratings


SMR and overall PCT ratings

R2 = 0.1073

0.65

0.70

0.75

0.80

0.85

0.90

60 70 80 90 100 110 120 130 140 150


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Kensington &Chelsea

Westminster

North Dorset

Carlisle & District

North Sheffield

Bradford City


B. Local population factors

So, we have seen that objective measures of performance are only marginally associated

with patient ratings. Now we turn to consider whether there are any other factors at play in

determining ratings. Combining the patient survey data with local area statistics from the

Census and the Index of Multiple Deprivation (IMD)9, it becomes evident that where people

live is linked to their attitudes towards the healthcare they receive.

This is consistent with Healthcare Commission findings that people who are older or

from an ethnic minority group report different experiences of the NHS to the rest of the

population.10 Older patients were consistently more likely to report positive experiences

of health services than younger patients. It was also found that patients from black and

minority ethnic groups were more likely than white patients to report negative experiences.

Specifically, this finding relates to the patient’s level of involvement in decisions about their

care, as well as their experience of medical staff talking in front of them as if they were not

there. Finally, Asian patients respond more negatively than white patients in general.

Ethnic Fractionalisation

The ethnic fractionalisation of the area is calculated by taking account of the range and

proportion of local residents from different ethnic groups. Areas with a high proportion of

ethnic minority residents that are predominantly all from the same ethnic group will have a

lower fractionalisation score than an area that has a similar proportion of ethnic minorities

drawn from a wide range of different groups.

The analysis shows that health bodies serving patients from a relatively ethnically diverse

population are somewhat less likely to attract higher ratings from patients. A very strong

association is observed between this factor and overall PCT satisfaction. This is borne out

by the PCTs with EF scores above 0.2, where a very clear downward trend is observed as

ethnic fractionalisation increases (e.g. Newham and Brent Teaching PCTs). Furthermore,

the chart shows that almost 50% of the variation in patient satisfaction can be explained by

ethnic fractionalisation in isolation from all other factors11. This is similar to the findings in

2004 where the R-Sq was 0.4877, confirming the continuing importance of this factor.

9 IMD is a weighted index, calculated according to ‘performance’ in six areas – income (25%), employment (25%), health deprivation and disability (15%), education, skills and training (15%), housing (10%) and geographical access to services (10%), created by the Office of the Deputy Prime Minister (now Communities and Local Government).10 Variations in the experiences of patients using the NHS services in England, Healthcare Commission, November 200611 This regression analysis contains the assumption that all PCTs provide the same quality of service irrespective of the areas in which they are situated, which may not be true.


Chart 6: Ethnic fractionalisation and overall PCT ratings

Age: Percentage of population who are under 16As found in 2004, where the R-Sq was 0.1881, PCTs that serve areas with a relatively large

number of dependent children (measured here by the population who are aged 0-15)

attract lower ratings (chart 7). Cambridge City and Newham PCTs are good examples of

this pattern.

Chart 7: Percentage of population under 16 and overall PCT ratings

Source: PCT patient survey 2005/Ipsos MORI

Ethnic Fractionalisation and overall PCT ratings


Ove

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PCT

scor

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R2 = 0.4948

0.65

0.70

0.75

0.80

0.85

0.90

0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9

Eden Valley

Brent

Newham

BasildonBarking & Dagenham

Cambridge City

Lambeth

Source: PCT patient survey 2005/census mid-year estimates 2005

Percentage of population under 16 years old and overall PCT ratings

R2 = 0.2019

0.65

0.70

0.75

0.80

0.85

0.90

10 15 20 25 30

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% Population aged 0-15 years

Newham

Canbridge City

Westminster

Bradford City

Heart of Birmingham

East Devon North Dorset

Central Derby Blackburn with Darwen


Age: Percentage of population who are 65 and over

A similar picture emerges when looking at the other end of the population. Those PCTs

that serve areas with an older population are more likely to receive higher patient ratings.

As noted in the 2004 report, where the R-Sq was 0.3757, this is a common finding in

public sector research – older people are more likely to express satisfaction with a range

of services for any given level of service quality. For example, Newham PCT serves a

population which contains less than 10% who are over 65 and receives relatively low overall

ratings. Conversely, East Devon PCT serves a population where over one quarter are over

65 and receives much higher overall ratings.

Chart 8: Percentage of population over 65 and overall PCT ratings

Source: PCT patient survey/Census mid-year estimates 2005

Percentage of population over 65 and overall PCT ratings

% Population aged 65 years or older

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R2 = 0.3222

0.65

0.70

0.75

0.80

0.85

0.90

5 10 15 20 25 30

East DevonNewham

Bradford City

Havering

Wednesbury & West Brom

Barking & Dagenham

HuntingdonshireSouth East Oxfordshire


Index of Multiple Deprivation (IMD)

It is also possible to show that the more deprived a local population is, the less satisfied

with PCT services that population is likely to be. This is shown in chart 9 below, and is

particularly demonstrated by South East Oxfordshire PCT at one end of the spectrum and

North Manchester PCT at the other.

This factor is more strongly associated with primary care ratings in the current analysis

compared to the 2004 analysis (R-Sq = 0.113). This difference can be accounted for by

both an increased dispersion in PCT ratings and considerable changes within IMD scores

between the 2000 IMD (used in 2004) and the 2005 data used here – representing real

change in relative deprivations between PCT areas and methodological change in the

measurement of deprivation.

Chart 9: Index of Multiple Deprivation and overall PCT ratings

Source: PCT patient survey 2005/ODPM

IMD and overall PCT ratings

R2 = 0.2443

0.65

0.70

0.75

0.80

0.85

0.90

0 10 20 30 40 50 60

Index of Multiple Deprivation

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South East Oxfordshire

Wokingham

Havering

Barking & Dagenham Bradford City

Heart of Birmingham

North Manchester

Birkenhead & Wallasey

Regional variation

Finally, the following chart shows that there are also regional variations in patient

perceptions, with ratings lowest in London and highest in the South West. We can clearly

see the gap between PCT patient ratings in London and the rest of the country. This may

be a function of those factors we have seen associated with patient ratings above. For

example, the high levels of ethnic fractionalisation and deprivation seen in London may

distinguish these PCTs from those situated in other areas of the country.

Chart 10: Overall PCT ratings - regional variations

C. Can we predict PCT patient ratings?

The current analysis has demonstrated that objective performance measures show a

weak relationship with overall ratings of inpatient and primary care satisfaction. On the

other hand, PCT performance, at least in terms of patient ratings, appears to be affected

by the nature of the population served. PCTs in areas with high ethnic fractionalisation,

high deprivation, those with a young population and those situated in London or the West

Midlands are likely to receive lower ratings of satisfaction.

Now we move on, using multivariate analysis, to examine the relative importance of local

population and area characteristics in explaining the difference in patients’ ratings between

health bodies. Once we have discovered the key drivers of PCT patient ratings, the results

of this analysis can then be used to ‘predict’ patient satisfaction, based only on these

exogenous factors. Therefore, once we know the type of population served by the health

body, we can state with some accuracy what ratings can reasonably be expected.


72 74 76 78 80 82 84

London

West Midlands

East Of England

North West

Yorkshire and the Humber

East Midlands

South Central

South East Coast

North East

South West

Overall PCT Rating


Overall PCT ratings - regional variations


The variables that appeared in the bivariate analysis were considered, alongside a number

of other demographic variables, in a multiple regression (see Appendix B for an explanation

of regression analysis and a list of variables considered). The results found so far tell a

similar story to those found in the first Frontiers report, although with some variation in

actual figures. Therefore, in an attempt to understand any differences in the data between

the two reports, the regression models produced in 2004 were replicated, within a number

of different variable combinations attempted.

The ‘key drivers’ results presented below illustrate the relative importance of the various

factors in driving overall ratings, scaled to 100. The higher the percentage, the stronger

the association. Factors presented in dark blue illustrate a negative relationship; light blue

demonstrates a positive relationship.

Key drivers of patient ratings

As mentioned above, a number of combinations were attempted and the most successful

model is shown in the following chart. The model below displays an R-Sq of 69.3%

suggesting a very good predictive model. Here we can see the model contains many of

the factors we would expect given the results of the bivariate analysis. For example, ethnic

fractionalisation and deprivation are clear negative drivers and the number of GPs per head

and the percentage of the population over 65 are clear positive drivers. The analysis also

shows the importance of the region within which the PCT is situated, despite the absence

of London from the model. This is possibly due to the strength of ethnic fractionalisation

and deprivation – key characteristics of London.

Chart 11: Key drivers of overall PCT ratings – local population factors

PCT Overall Rating


24%

Deprivation (IMD)

23%

East England

3%

GPs per 100,000population

15%

North East

7%

North West

9%

Yorkshire and theHumber

6%

East Midlands

5%

% Aged 65+

9%

R2= 69.3%

This model shows some similarities with that produced in 2004 – the only differences are

found in the inclusion or exclusion of regions – other local population factors have remained

consistent. In 2004, there were just two positive drivers – GPs per head of population,

and the percentage of over 65s, both included here. The difference in the current model

is the addition of the four region indicators. Negative drivers were ethnic fractionalisation,

deprivation, and being situated in the East of England, all included here. In addition, two

region indicators – London and the South East – were found to be negative drivers in 2004.

The fact that the only differences in the overall shape of the two models relate to regional

indicators could suggest that it is the characteristics of the local population in these regions

that have changed since 2004.

This model can be used to predict the patient ratings that can be expected for individual

PCTs, given prevailing local contextual factors. Simply by knowing these factors, it is

possible to predict overall patient ratings quite accurately, as the following chart – which

plots actual and predicted values – illustrates. The chart shows the points reasonably tightly

clustered along the line, illustrating a strong predictive model.

Chart 12: Predicted versus actual overall PCT ratings


Predicted versus actual Overall PCT Ratings

R2 = 0.701

0.65

0.70

0.75

0.80

0.85

0.90

0.70 0.75 0.80 0.85

Predicted Overall PCT Rating

Act

ual O

vera

ll PC

T R

atin

g



Summary

• Objective performance measures show a weak relationship with overall ratings of

inpatient and primary care satisfaction.

• Local population factors are associated with patient ratings, particularly in relation to

primary care. PCTs in areas with high ethnic fractionalisation, high deprivation, those

with a young population and those situated in London or the West Midlands are likely to

receive lower ratings of satisfaction.

• A strong predictive model contained high ethnic fractionalisation, high levels of

deprivation and being situated in the East of England as key negative drivers of patient

satisfaction. The number of GPs per population, the percentage of the population aged

over 65, and four region indicators (North West, North East, Yorkshire and the Humber

and East Midlands) all exert a positive influence.

• Where a PCT is situated is clearly important in relation to the patient ratings they achieve.


2. What performance levels should we expect?

We have discovered that we can quite accurately predict overall patient ratings once we know the nature of the local population (as shown in chart 12). In this chapter, we compare actual performance, as measured by patient ratings, against what can be expected given the contextual factors shown to infl uence patient satisfaction. By comparing actual versus predicted outcomes we can compile a list of PCTs performing better than might be expected, given their situation.

A. Actual versus predicted ratings

In order to do this, a performance index was calculated – a score of 100 means that a

health body is performing to exactly the levels that might be expected given the local

conditions contained in our predictive model. A score of more than 100 shows that a trust

is performing better than might be expected and a score under 100 shows that a trust is

under-performing given its local conditions.

In relation to primary care ratings, which have been shown to be sensitive to local

conditions, we can clearly see from chart 13 that there are a couple of PCTs who are

particularly under-performing (Havering PCT and Bradford City Teaching PCT)12.

Chart 13: Ranked performance of PCTs (London PCTs marked in dark blue)

Source: Ipsos MORI

Ranked Performance of Primary Care Trusts

-6.00

-5.00

-4.00

-3.00

-2.00

-1.00

0.00

1.00

2.00

3.00

1 11 21 31 41 51 61 71 81 91 101

111

121

131

141

151

161

171

181

191

201

211

221

231

241

251

261

271

281

291

301

Bradford CityHavering

Rank

Perf

orm

ance

abo

ve/b

elow

100

12 See Appendix A for a full list of PCTs


B. Putting the patient ratings into context – who is performing well, given their local conditions?

This further analysis provides a richer understanding of the ratings obtained from patient

surveys. For example, we can look at those health bodies that on first glance appear to be

under-performing and ask whether their results have been affected by the local situation

they find themselves in. How does a PCT compare with what can realistically be expected

given its local conditions?

The table below looks at the bottom 20 rated PCTs (as rated by patients) and considers

their position once local population factors are taken into account. We can see that in actual

fact, once we take account of local conditions, there are several trusts which are performing

at a high level. Westminster PCT, Haringey Teaching PCT and Newham PCT all achieve

a performance index of over 100 (highlighted in blue). We can also see what this means

in terms of ranking achieved by the PCTs. For example, Westminster PCT jumps over 100

places to 126th in the table, once local conditions are taken into account.

We can also see that in many cases, a number of PCTs are performing at levels

substantially lower than might be expected (highlighted in grey). This means that these

PCTs are still rated in the bottom 20 even once local conditions are taken into account.

Table 1: Bottom 20 rated PCTs on raw patient scores

Primary Care Trust

Patient rating (raw score from survey)

Change in rank

Performance index (taking local conditions into account)

Score Rank Rank Score

Eastern Leicester PCT 0.748 284 249 98.76

Westminster PCT 0.747 285 126 100.46

Thurrock PCT 0.746 286 295 96.66

Redbridge PCT 0.745 287 218 99.31

Islington PCT 0.745 288 176 99.86

Wednesbury and West Bromwich PCT 0.742 289 294 96.82

Havering PCT 0.741 290 303 94.06

Ealing PCT 0.741 291 238 98.97

Haringey Teaching PCT 0.741 292 121 100.52

Waltham Forest PCT 0.741 293 178 99.84

Newham PCT 0.741 294 62 101.22

Basildon PCT 0.738 295 298 95.51

Hounslow PCT 0.736 296 286 97.62

City and Hackney Teaching PCT 0.734 297 209 99.41

Barking and Dagenham PCT 0.721 298 297 95.83

Tower Hamlets PCT 0.720 299 234 99.02

Brent Teaching PCT 0.719 300 293 96.86

Slough PCT 0.718 301 296 96.02

Heart Of Birmingham Teaching PCT 0.704 302 244 98.89

Bradford City Teaching PCT 0.698 303 302 94.66


C. The best performers

We have seen the importance of local conditions in predicting patient ratings, suggesting

that it is difficult for PCTs to achieve high ratings if they are situated in an area with high

levels of deprivation, ethnic fractionalisation and a young population. Therefore, this chapter

now turns to consider those PCTs that are performing particularly well having taken account

of local conditions and asks what lessons can be learned from them.

Lambeth PCT achieves a score for patient ratings of 0.780 – in the lower half of PCT scores

obtained from the patient survey (ranked 245 out of 303). However, given its high levels of

deprivation and ethnic fractionalisation, it is actually the best performing PCT in the country

according to our performance index.

Table 2: Top 20 performing PCTs once local conditions are taken into account

Primary Care Trust

Patient rating (raw score from survey)

Change in rank



Lambeth PCT 0.780 245 1 102.90

South Cambridgeshire PCT 0.830 36 2 102.84

Cambridge City PCT 0.825 58 3 102.83

Exeter PCT 0.839 12 4 102.82

Norwich PCT 0.826 48 5 102.69

South Western Staffordshire PCT 0.836 17 6 102.66

Middlesbrough PCT 0.823 71 7 102.65

Huddersfield Central PCT 0.806 150 8 102.63

Vale Of Aylesbury PCT 0.832 29 9 102.57

East Leeds PCT 0.813 113 10 102.51

North Manchester PCT 0.780 243 11 102.43

Kensington and Chelsea PCT 0.775 262 12 102.34

Birkenhead and Wallasey PCT 0.835 22 13 102.34

Huntingdonshire PCT 0.833 27 14 102.29

Bedford PCT 0.808 141 15 102.27

Newcastle PCT 0.821 81 16 102.26

Airedale PCT 0.834 24 17 102.16

Durham Dales PCT 0.848 5 18 102.10

North Dorset PCT 0.854 2 19 102.10

Oldham PCT 0.804 160 20 102.07


D. Implications for PCTs

The analysis clearly shows that it is possible for PCTs to overcome negative impacts of

the local conditions in which they operate. We have seen that some PCTs that look as if

they are performing poorly are actually performing reasonably well despite particularly

difficult circumstances. Further, the table above identifies those trusts that are performing

particularly well given local conditions. However, the patient survey data does not tell us

what it is that these PCTs are doing to overcome the local conditions. Further analysis

exploring these issues would provide valuable lessons for all PCTs, but particularly those

that are suffering from operating in the most difficult circumstances.

Of course the patient does not rate the PCT as a whole, instead they are asked to rate

the service they received from their GP, dentist or other health professional at the surgery

or health centre.13 PCT scores reported in this analysis are therefore an aggregate of the

individual scores received. Although scores relating to individual GP surgeries are not

available, we know from the GP Patient Survey that there can be considerable variation

from one surgery to another. For example, within Lambeth PCT, satisfaction with telephone

access ranges from 57% to 94% with an average of 86%14. Therefore, for PCTs to take

effective action, it is necessary for them to consider the ratings for individual surgeries

rather than for the PCT as a whole. This data can then be considered in light of the local

conditions.

13 These are the topics covered in the 2005 primary care patient survey14 The GP Patient Survey 2006/2007 National report conducted for the Department of Health by Ipsos MORI


Summary

• A number of PCTs which look like they are underperforming are actually doing well given

their local conditions, e.g. Newham PCT, Haringey Teaching PCT and Westminster PCT.

• Lambeth PCT is the best performing PCT once the local conditions in our model are

taken into account.


Part 2 - Acute trusts


3. What factors are associated with inpatient ratings?

We turn now to consider the situation for acute trusts. This chapter will explore those factors that may be related to how happy patients are with the care they receive whilst they are an inpatient, specifi cally looking at:

• Patient perceptions of specifi c aspects of care

• Local population characteristics

A. Perceptions of specific service dimensions and overall patient ratings

Using data from the 2006 inpatient survey, the relationship between specific aspects of

the patient experience can be shown to be very closely associated with patients’ overall

assessment of the care received. The charts presented in this section illustrate these

relationships, by plotting overall inpatient ratings of the quality of care received against

individual aspects of inpatient care, for example, privacy, communication, cleanliness and

pain control.

The importance of dignity, respect and privacy

The importance of treating patients with dignity and respect has recently been highlighted

by the Healthcare Commission, particularly in regard to older patients. A number of

standards are used by the Healthcare Commission to assess whether NHS trusts are

treating people with dignity and respect and to ensure that nutritional needs and the need

for privacy are being met. Findings from the most recent NHS Inpatient Survey indicate that

a high proportion of older inpatients are being treated with dignity and respect while in

hospital, and many NHS trusts have declared compliance with standards relating to dignity

in the Healthcare Commission’s annual health check. However, the Healthcare Commission

decided to focus on ‘dignity’ as a key theme in the annual health check for 2006/2007 and

to undertake a targeted inspection programme to assess the extent to which NHS trusts are

meeting the standards relating to dignity in care for hospital inpatients. They found no major

breaches of national standards, but reported that there was still a considerable need for

improvement in many areas and made a number of recommendations.


The chart below clearly shows how important being treated with dignity and respect is

for patients. The higher the ratings a trust receives from its patients for treating them with

dignity and respect, the higher ratings of overall patient satisfaction it receives. The chart

shows an R-Sq of 0.877, which represents a very strong association between these two

variables, illustrated by the proximity of the points to the line. This is similar to the situation

in 2004 where this factor was found to be the most closely associated with overall patient

ratings, with an R-Sq of 0.9009.

This relationship is particularly demonstrated by the trusts identified on chart 14. For

example, the Newcastle upon Tyne Hospitals NHS Foundation Trust and Norfolk and

Norwich University Hospital NHS Trust are both rated highly by patients in relation to dignity

and respect and overall. We can also see that trusts that receive poor ratings for this one

aspect of care are also more likely to receive poor overall ratings (e.g. Mayday Healthcare

NHS Trust, Newham University Hospital NHS Trust and North Middlesex University Hospital

NHS Trust).

Chart 14: Treating patients with dignity and respect and overall ratings of inpatient care

Similarly, being given privacy during treatment discussions and examinations is also

strongly related to overall satisfaction, though less so than being treated with dignity and

respect. The chart below shows an R-Sq of 0.5689 for examination privacy, slightly lower

to that found in 2004 where the R-Sq was 0.6726. Again, we can see the Newcastle Upon

Tyne Hospitals NHS Foundation Trust and Newham University Hospital NHS Trust illustrating

this pattern. There is a similar level of association between privacy during treatment

discussions (R-Sq = 0.5901, chart not shown).

Source: NHS inpatient survey 2006

Treated with dignity and respect and ratings of overall inpatient care

R2 = 0.877

0.60

0.65

0.70

0.75

0.80

0.85

0.75 0.80 0.85 0.90 0.95

Treated with dignity and respect

Rat

ings

of o

vera

ll ca

re

Newcastleupon Tyne

Norfolk &Norwich

Mayday

N. Middlesex

Newham

UCLH

Barnet & Chase Farm

South Manchester

Peterborough & Stamford


Chart 15: Satisfaction with examination privacy and overall ratings of inpatient care

Patients want to be involved in their treatment

Communication between patients and staff and involvement in treatment decisions are

consistently found to be strongly and positively related to overall satisfaction.

Again, the Newcastle Upon Tyne Hospitals NHS Foundation Trust is a good illustration of

the positive link between communication and overall ratings (chart 16).

Chart 16: Effectiveness of communication with doctors and overall ratings of inpatient care


Satisfaction with examination privacy and ratings of overall inpatient care

Newham

= 0.5689

0.97

Satisfaction with examination privacy

R2

0.60

0.65

0.70

0.75

0.80

0.85

0.87 0.89 0.91 0.93 0.95

Rat

ings

of o

vera

ll ca

re

NewcastleUpon Tyne

Royal WestSussexLancashire

Ealing

Royal Liverpool & Broadgreen

Queen Mary’s Sidcup


Effectiveness of communication with doctors and ratings of overall inpatient care

Mayday

NewcastleUpon Tyne

R2 = 0.5742

0.60

0.65

0.70

0.75

0.80

0.85

0.70 0.75 0.80 0.85 0.90

Rat

ings

of o

vera

ll ca

re

Doctors answered questions in an understandable way

Lewisham

Dartford & Gravesham

Queen Mary’s Sidcup

Royal Cornwall


The findings suggest that involvement in decision-making is particularly important

to patients, explaining 75% of the total variation in overall ratings (see chart 17). The

relationship between satisfaction with involvement in decision-making and overall ratings is

demonstrated by North Middlesex University Hospital NHS Trust and Ealing Hospital NHS

Trust at one end and Norfolk and Norwich University Hospital NHS Trust at the other. The

strength of this association has increased since 2004 where the R-Sq was 0.5393. This

suggests that there is increasing appetite for patient involvement, reflecting the policy move

towards this in the wider health service.

Chart 17: Satisfaction with involvement in decision-making and overall ratings of inpatient care


Satisfaction with involvement in decision-making and ratings of overall inpatient care

0.80

R2 = 0.7466

0.60

0.65

0.70

0.75

0.80

0.85

0.55 0.60 0.65 0.70 0.75

Satisfaction with involvement in decision-making

Rat

ings

of o

vera

ll ca

re

Norfolk &Norwich

N.Middlesex

Ealing

Aintree

East Kent

Coventry & Warks

Tameside & Glossop

Northampton


Pain control is also important

The analysis also shows that physical comfort whilst in hospital is important to patients,

although to a lesser extent than the personal treatment they receive from staff. Chart 18

shows a strong positive correlation, with an R-Sq of 0.6575, similar to that found in 2004

(R-Sq = 0.6932). Hinchingbrooke Healthcare NHS Trust is a clear example of this positive

relationship.

Chart 18: Satisfaction with pain control and overall ratings of inpatient care

Cleanliness matters too

The cleanliness of hospital premises has received substantial public attention in recent

years and the current findings confirm the importance of this aspect of healthcare to

patients. They clearly show that patients’ perception of their surroundings, particularly their

cleanliness, is almost as important as the treatment they receive. For example, the chart

below shows a strong positive correlation between ratings of how clean the room or ward

is and overall satisfaction. Poole Hospital NHS Trust and Homerton University Hospital NHS

Foundation Trust illustrate this relationship.


Satisfaction with pain control and ratings of overall inpatient care

R2 = 0.6575

0.60

0.65

0.70

0.75

0.80

0.85

0.70 0.75 0.80 0.85 0.90

Satisfaction with pain control

Rat

ings

of o

vera

ll ca

re

Hinchingbrooke

Newham

Ealing

Walsall

Central Manchester

Salisbury


Chart 19: Cleanliness of hospital room or ward and overall ratings of inpatient care

Thus we can see that perceptions of cleanliness are associated with ratings of overall care

but an examination of MRSA rates shows that these perceptions are not always accurate.

As chart 20 shows, there is only a weak correlation between MRSA rates and ratings of

cleanliness of hospital bathrooms/toilets. Perceptions at Homerton University Hospital Trust

are particularly inaccurate – it has the lowest rating for toilet and bathroom cleanliness by

some distance but actually has the lowest incidence of MRSA.

However, the correlation is statistically significant. Rotherham General Hospitals NHS Trust

and University Hospital Birmingham NHS Foundation Trust are good examples of the

relationship.

Chart 20: MRSA rate (per 1000 bed days) and ratings of cleanliness of toilet/bathroom


Cleanliness of hospital room or ward and ratings of overall inpatient care

R2= 0.5352

0.60

0.65

0.70

0.75

0.80

0.85

0.70 0.75 0.80 0.85 0.90

Cleanliness of hospital room or ward

Rat

ings

of o

vera

ll ca

re

Homerton

Newham

Poole

Plymouth

West Middlesex

UCLH

Newcastle upon Tyne

Source: Healthcare Commission/Inpatient survey 2006

MRSA rate and rating of toilet/bathroom cleanliness

0.55

0.60

0.65

0.70

0.75

0.80

0.85

0.90

0.00 0.05 0.10 0.15 0.20 0.25 0.30 0.35 0.40 0.45

MRSA rate (per 1000 bed days)

Rat

ing

of to

ilet/b

athr

oom

cle

anlin

ess

R = - 0.219

Homerton

Rotherham

Birmingham


But what service aspects are most important to patients?

So, we know that trusts where patients feel that they have been treated with dignity and

respect, felt their privacy was respected, felt they were involved in their treatment, had their

pain managed well and thought the hospital looked clean were more likely to receive higher

overall ratings. The analysis above shows that people who are generally satisfied with their

experience as an inpatient are also likely to have positive views about most aspects of their

care. However, these bivariate relationships do not tell us which aspects of care are most

important to patients. Using multivariate analysis techniques, it is possible to identify the

relative importance of these various factors15. This will lead to a better understanding of

which particular aspects of care providers should focus on to improve the overall patient

experience16.

As previously, the results presented in the chart below show the relative importance of

specific service aspects, scaled to 100, all positive in this case. The higher the percentage,

the stronger the association. The model demonstrates a very high R-Sq of 90.9%. This

figure means that 91% of the variation in overall ratings of quality of care can be explained

by just these three factors. The results corroborate those illustrated in the two-way

scatterplots above – i.e. being treated with dignity and respect is the strongest predictor

of overall satisfaction. Involvement in decisions and cleanliness of the hospital are also

confirmed as important factors underlying a positive patient experience.

Chart 21: Key drivers of inpatient ratings

Ratings of overall inpatient care

Dignity & respect

59%

Involved in decisions

28%

Cleanliness of room & ward

13%

R2 = 90.9%

15 This analysis only allows for discussion of the relative importance of those factors included in the NHS inpatient survey. There may be other factors affecting patient experience that are not adequately measured by this survey16 See Appendix B for an explanation of regression analysis


As mentioned earlier, caution should be exercised when comparing results with the

previous Frontiers report. However, it is worth noting that although this model differs from

that produced in 2004, dignity and respect has remained the key driver of positive patient

ratings. In 2004, it featured as the most important driver (37%) in a model explaining

94% of the variation in patient ratings. While the other individual aspects differed slightly,

cleanliness also featured (cleanliness of toilets, 15%), as did measures of involvement in

treatment (purpose of medicines explained, 13%; and communicated side-effects, 8%)17.

B. Local population factors

So, we know that individual aspects of care, particularly dignity and respect, involvement in

treatment decisions and cleanliness are important in relation to overall patient satisfaction.

We have also seen consistent ratings of individual aspects of care e.g. the Newcastle Upon

Tyne Hospitals NHS Foundation Trust received high ratings across all individual aspects

and Newham received low ratings across all individual aspects of inpatient care. In Part 1

one of this report we saw that PCT patient ratings are affected by local population factors,

so now we turn to consider whether the same is true for acute trusts. Again, combining

the patient survey data with local area statistics from the Census and the Index of Multiple

Deprivation (IMD) will allow us to look at these associations.18

Chart 22 below also shows a relationship between inpatient satisfaction ratings and ethnic

fractionalisation (R-Sq = 0.2747), but this relationship is weaker than that found for PCTs or

in 2004 (R-Sq = 0.5237).

Chart 22: Ethnic fractionalisation and overall ratings of inpatient care

Source: NHS Inpatient survey 2006/Ipsos MORI

Ethnic fractionalisation and ratings of overall inpatient care

R2= 0.2747

0.60

0.65

0.70

0.75

0.80

0.85

0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80

Rat

ings

of o

vera

ll ca

re

NorthCumbria

Hinchingbrooke

Homerton

Barking, Havering & Redbridge

Ealing

Newham


17 Other factors were pain control (13%), A&E organisation (7%) and privacy to discuss treatment (6%)18 See Appendix C for an explanation of the calculation of acute trust boundaries


This is typical of the results in this section which all show a weaker relationship with overall

patient ratings than found for PCTs, suggesting that the difference may be due to the

differences in the nature of health provision between primary and secondary care. For

example, acute trusts can be said to be less rooted in the community in which they are

situated than PCT services. Therefore, acute trust ratings may be less sensitive to factors

linked to the community.

Age: Percentage of population who are under 16

Chart 23 shows that trusts that serve areas with a relatively large number of dependent

children attract lower ratings. Again, this association is weaker than that found for PCT ratings.

Chart 23: Percentage of population under 16 and overall ratings of inpatient care

Age: Percentage of the population who are over 65

Considering those areas with an older population, we can again see a weak association

with overall ratings of care. For example, Poole is situated in an area with a relatively older

population and attracts higher ratings than somewhere like Homerton University Hospital

NHS Foundation Trust (see chart 24).

Source: NHS inpatient survey 2006/Census mid-year estimates 2005

Percentage of population under 16 years old and ratings of overall inpatient care

Rat

ings

of o

vera

ll ca

re

% Population aged 0-15

R2= 0.1301

0.60

0.65

0.70

0.75

0.80

0.85

14 16 18 20 22 24

Chelsea &Westminster

Good Hope

Newham

NewcastleUpon Tyne

UCLH

St Mary’s

Royal Free

Airedale

Ealing


Chart 24: Percentage of population over 65 years and overall ratings of inpatient care

Index of Multiple Deprivation (IMD)

We saw a strong association between deprivation and PCT patient ratings. However a similar

relationship was not found for inpatients. Therefore, an acute trust in an area of deprivation

cannot be expected to receive lower patient ratings than the equivalent trust in a more

affluent area simply because of this fact.

Chart 25: Index of Multiple Deprivation and overall ratings of inpatient care

Source: NHS Inpatient survey 2006/Census mid-year estimates 2005

Percentage of population over 65 years old and ratings of overall inpatient care

% Population aged 65 years or older

Rat

ings

of o

vera

ll ca

re

R2 = 0.2155

0.60

0.65

0.70

0.75

0.80

0.85

8 10 12 14 16 18 20 22 24

EalingNewham

Guy’s and St. Thomas’

UH South Manchester

Norfolk & Norwich

Poole

Royal Bournemouth & Christchurch

Queen Mary’s, Sidcup

Bart’s and The London

Source: NHS Inpatient survey 2006/ODPM

Index of Multiple Deprivation and ratings ofoverall inpatient care

R2 = 0.0005

0.60

0.65

0.70

0.75

0.80

0.85

5 10 15 20 25 30 35 40 45 50


Rat

ings

of o

vera

ll ca

re

Frimley Park

Royal Surrey

Ashford & St. Peter’s

Newcastle upon Tyne

AintreeRoyal Liverpool & Broadgreen

Homerton

Newham

North Middlesex


Regional variation

When looking at regional variation, we can see that ratings differ by region, particularly as

regards those trusts situated in London. The overall pattern is similar to that seen in relation

to PCT ratings, with the notable exception of South East Coast, which drops significantly in

the overall ratings.

Chart 26: Ratings of overall inpatient care – regional variations

C. Can we predict inpatient ratings?

This chapter has demonstrated that some local population factors – age, region and

ethnic fractionalisation – show some association with inpatient ratings. Part 1 of this report

demonstrated that using multiple regression, it is possible to produce a strong predictive

model for PCT patient ratings, using just local population factors. Again, multivariate

analysis was conducted to examine the relative importance of the local population and

area characteristics in explaining differences in patient ratings. In relation to acute trusts,

the analysis produced a model containing just two negative drivers – London and the

proportion of the population under 16.19 This is perhaps not surprising given the findings

of the bivariate analysis, where these two factors were found to be the most strongly

associated with patient ratings. As the proportion of the population over 65 is likely to be

strongly correlated with the proportion of the population under 16, this accounts for the

absence of this factor here.

19 See Appendix B for a list of factors included in the analysis

Source: NHS Inpatient survey 2006/Ipsos MORI

Ratings of overall patient care - regional variations

68 70 72 74 76 78 80

London

South East Coast

East Midlands

West Midlands

North West

South Central

East of England


North East

South West

Ratings of overall care

The R-Sq is substantially lower than that obtained for the PCT model, and that produced

in 2004, where the model contained a larger number of factors, including ethnic

fractionalisation, proportion of the population over 65 and two region indicators – South

East and East of England – in addition to the drivers in the current model. This is perhaps

due to changes in the population and patient profile of particular areas or it could be a

reflection of changes in healthcare since 2004 and the impact of choice. This is a point to

consider for the future and is an encouraging finding for trust managers, bearing in mind

the importance of individual aspects of care, seen in the previous chapter. It appears

that for acute trusts, the local situation is less important than perceptions of the individual

treatment received by patients.

However, despite this, it is still important to note the potential role that local population

factors can play in determining patient ratings, as the model accounts for 40% of the

variance in scores.

Chart 27: Key drivers of overall ratings of inpatient care – local population factors

Overall rating of inpatient care

London

58%

R2= 40.3%% Aged under 16

42%



Again, we can use this model to predict the ratings that can be expected for acute trusts,

given their local conditions. Chart 28 plots predicted versus actual ratings using this model

and demonstrates a weaker predictive model than that obtained for PCTs. This reinforces

the importance of individual aspects of care in relation to inpatient ratings. Whereas for

primary care ratings, the analysis shows that where patients are treated is important, for

acute trusts, how patients feel they have been treated is more important.

Chart 28: Predicted versus actual overall ratings of inpatient care

Source: NHS Inpatient survey 2006

Predicted versus actual ratings of overall inpatient care

R2 = 0.4114

0.60

0.65

0.70

0.75

0.80

0.85

0.65 0.70 0.75 0.80

Predicted ratings of overall care

Act

ual r

atin

gs o

f ove

rall

care

Summary

• Individual aspects of care are highly correlated with overall ratings of inpatient care.

Most important are treating patients with respect and dignity, involving patients in

decisions and the cleanliness of the hospital.

• Local population factors are less important, but are still associated with patient ratings.

• The percentage of the population aged under 16 and being situated in London are

negative drivers in predicting inpatient ratings.

• There is a clear contrast between the two types of health bodies – for acute trusts how

patients feel they are treated is more important whereas for PCTs, where patients are

treated is more important in predicting patient satisfaction.



4. What performance levels should we expect?

Although local population factors are less important in relation to inpatient ratings than PCT patient ratings, it is still possible to predict overall inpatient ratings with relative accuracy once we know the nature of the local population (as shown in chart 28). In this chapter, we can again compare actual performance, as measured by patient ratings, against what can be expected, given the contextual factors shown to infl uence patient satisfaction. By comparing actual versus predicted outcomes, we can compile a list of trusts performing better than might be expected, given their situation.

A. Actual versus predicted ratings

Again, a performance index was created, based on the factors contained in our predictive

model – a score of 100 means that a health body is performing to exactly the levels that might

be expected given the local conditions contained in our predictive model. A score of more

than 100 shows that a trust is performing better than might be expected and a score under

100 shows that a trust is under-performing given its local conditions.

The following chart quickly shows the pattern of results for acute trusts.20 We can see that

relative performance is evenly spread above and below 100 with one trust achieving more

than 8 points above what can be expected (Bromley Hospitals NHS Trust) and three achieving

more than 8 points less than can be expected (Trafford Healthcare NHS Trust, Ealing Hospital

NHS Trust and Surrey and Sussex Healthcare NHS Trust).

Chart 29: Ranked performance of acute trusts (London trusts marked in dark blue)

Source: Ipsos MORI

Ranked Performance of Acute Trusts

Rank

Perf

orm

ance

abo

ve/b

elow

100

-10

-8

-6

-4

-2

0

2

4

6

8

10

1 11 21 31 41 51 61 71 81 91 101 111 121 131 141 151

Bromley

TraffordEalingSurrey & Sussex

20 See Appendix A for a full list of health bodies


B. Putting the patient ratings into context – who is performing well given their local conditions?

Again, we can use this analysis to provide a deeper understanding of the raw scores

obtained from the patient survey ratings. We have considered the bottom 20 rated acute

trusts, but it is important to remember that local population factors are less important

here, so these trusts are less likely to be suffering from the impact of local conditions.

Nevertheless, we can see that there are three trusts (indicated in blue) that look as if they

are under-performing but are actually performing well, given their local conditions. Again,

we can see that there are several trusts who are performing at levels substantially lower

than might be expected (highlighted in grey). These trusts find themselves in the bottom 20

even once local conditions are taken into account.

Table 3: Bottom 20 rated acute trusts on raw patient scores

Acute trust

Patient rating (raw score from patient survey)

Change in rank



The Hillingdon Hospital NHS Trust 0.713 132 40 101.7

Maidstone And Tunbridge Wells NHS Trust 0.709 133 141 95.3

Kingston Hospital NHS Trust 0.708 134 101 98.9

Queen Elizabeth Hospital NHS Trust 0.707 135 48 101.4

Homerton University Hospital NHS Foundation Trust 0.706 136 45 101.6

George Eliot Hospital NHS Trust 0.705 137 146 94.0

West Middlesex University Hospital NHS Trust 0.705 138 98 99.1

Tameside And Glossop Acute Services NHS Trust 0.701 139 140 95.5

Luton And Dunstable Hospital NHS Foundation Trust 0.700 140 144 95.0

Trafford Healthcare NHS Trust 0.689 141 149 91.4

Walsall Hospitals NHS Trust 0.686 142 147 93.7

North West London Hospitals NHS Trust 0.682 143 113 97.9

Barking, Havering And Redbridge Hospitals NHS Trust 0.677 144 93 99.3

Surrey And Sussex Healthcare NHS Trust 0.675 145 151 91.2

The Lewisham Hospital NHS Trust 0.673 146 137 96.0

Queen Mary’s Sidcup NHS Trust 0.669 147 130 96.7

Newham University Hospital NHS Trust 0.664 148 107 98.6

Mayday Healthcare NHS Trust 0.652 149 145 94.8

North Middlesex University Hospital NHS Trust 0.630 150 148 93.6

Ealing Hospital NHS Trust 0.622 151 150 91.3


C. The best performers

As we have seen, local conditions play less of a role in relation to inpatient scores so

Bromley Hospitals NHS Trust, at the top of our table, already achieved a relatively high

patient rating score of 0.786, and was ranked at 35 based on this rating. Further, the

Newcastle Upon Tyne Hospitals NHS Foundation Trust was the highest scoring trust and still

is performing well given its local conditions.

Table 4: Top 20 performing acute trusts once local conditions are taken into account

Acute trust

Patient rating (raw score from patient survey)

Change in rank



Bromley Hospitals NHS Trust 0.786 35 1 108.5

The Newcastle Upon Tyne Hospitals NHS Foundation Trust 0.845 1 2 106.4

Airedale NHS Trust 0.805 13 3 106.2

Guy’s And St Thomas’ NHS Foundation Trust 0.784 41 4 106.0

Hinchingbrooke Health Care NHS Trust 0.824 4 5 105.5

University Hospital of South Manchester NHS Foundation Trust 0.826 3 6 105.0

Norfolk And Norwich University Hospital NHS Trust 0.838 2 7 105.0

King’s College Hospital NHS Foundation Trust 0.773 60 8 104.9

Whipps Cross University Hospital NHS Trust 0.730 119 9 104.8

Aintree University Hospitals NHS Foundation Trust 0.813 8 10 104.6

Bolton Hospitals NHS Trust 0.802 17 11 104.5

Peterborough And Stamford Hospitals NHS Foundation Trust 0.805 14 12 104.4

Basingstoke and North Hampshire NHS Foundation Trust 0.800 18 13 104.2

Plymouth Hospitals NHS Trust 0.823 5 14 104.0

Sheffield Teaching Hospitals NHS Foundation Trust 0.811 9 15 103.6

Royal Cornwall Hospitals NHS Trust 0.820 6 16 103.6

County Durham And Darlington NHS Foundation Trust 0.796 24 17 103.3

Wirral Hospital NHS Trust 0.807 12 18 103.2

University Hospital Birmingham NHS Foundation Trust 0.766 72 19 103.2

Dartford And Gravesham NHS Trust 0.782 46 20 103.1


So what is it that these top performing acute trusts are doing? We have already seen that

how patients feel they are treated is more important for acute trusts than where they are

situated. In the table below we can see the top five performers tend to achieve high scores

for those factors we have seen are associated with positive patient ratings - dignity and

respect, cleanliness and involving their patients in decision-making. These scores tend to

be lower among the bottom five performers.

Table 5: Top 5 performers – individual aspects of care

Table 6: Bottom 5 performers – individual aspects of care

Rank Trust Name Performance Index

Dignity & respect

Involved in decisions Cleanliness

1 Bromley Hospitals NHS Trust 108.5 0.904 0.686 0.824

2The Newcastle Upon Tyne Hospitals NHS Foundation Trust

106.4 0.925 0.791 0.853

3 Airedale NHS Trust 106.2 0.899 0.730 0.867

4 Guy’s And St Thomas’ NHS Foundation Trust 106.0 0.782 0.732 0.902

5 Hinchingbrooke Health Care NHS Trust 105.5 0.835 0.779 0.919

Rank Trust Name Performance Index

Dignity & respect

Involved in decisions Cleanliness

147 Walsall Hospitals NHS Trust 93.7 0.822 0.599 0.746

148 North Middlesex University Hospital NHS Trust 93.6 0.713 0.583 0.713

149 Trafford Healthcare NHS Trust 91.4 0.820 0.630 0.778

150 Ealing Hospital NHS Trust 91.3 0.788 0.593 0.709

151 Surrey and Sussex Healthcare NHS Trust 91.2 0.819 0.619 0.776


D. Implications for acute trusts

The information in these tables confirms that dignity and respect, involving patients in

treatment decisions and the perceived cleanliness of the hospital are the three areas

that are important in relation to patient ratings. Key driver analysis showed the relative

importance of these areas and now these tables confirm that trusts that are rated highly on

these issues are also rated highly overall. While our analysis does not necessarily imply a

causal relationship, it does suggest that trust managers would be wise to concentrate on

these issues, given their importance to their patients.

The analysis shows that treating patients with dignity and respect is particularly important,

but what does this mean? While the cleanliness of a hospital and involving patients in

their treatment are relatively straightforward concepts and suggest clear actions to be

undertaken, it is less clear what trusts can do to make patients feel as if they have been

treated with dignity and respect. However, the Healthcare Commission has focused on this

issue recently and has provided recommendations for action to improve the care and overall

experience, particularly of older people, in this regard.21

Although it acknowledges that the concept is difficult to define, it suggests that many

patients find it easier to explain where their dignity has been compromised. For example,

this includes being talked about as if they were not there, being left in soiled clothes, not

being given adequate assistance at meal times and being treated in mixed sex wards.

Its list of common complaints of where patients’ dignity has been compromised covers

many of the individual aspects of care that we have already looked at e.g. cleanliness

of the environment, privacy of treatment, involvement in treatment decisions and pain

management. While the concept may mean different things to different people, our analysis

shows that these last two issues are particularly closely associated with dignity and respect,

as shown in the following charts. We have already seen that these aspects of care are

closely associated with overall patient ratings, and this further analysis suggests that the

ratings of dignity and respect may be measuring a combination of these factors.

21 Healthcare Commission, Caring for Dignity, 2007

Chart 30: Satisfaction with involvement in treatment decisions and treating patients with dignity and respect

Chart 31: Satisfaction with pain control and treating patients with dignity and respect


Satisfaction with involvement in treatment decisions and dignity and respect

0.70

0.75

0.80

0.85

0.90

0.95

0.55 0.60 0.65 0.70 0.75 0.80

Patient felt involved in decisions about treatment

Dig

nity

and

Res

pect


Satisfaction with pain control and dignity and respect

0.70

0.75

0.80

0.85

0.90

0.95

0.70 0.75 0.80 0.85 0.90 0.95

Satisfaction with pain control

Dig

nity

and

Res

pect



Summary

• A number of acute trusts which look like they are underperforming are actually doing

well, given their local conditions, e.g. the Hillingdon Hospital NHS Trust and Homerton

University Hospital NHS Foundation Trust.

• Bromley Hospitals NHS Trust is the best performing trust once the local conditions in our

models are taken into account.

• Top performing trusts all score highly on treating patients with dignity and respect,

involving them in treatment decisions and the cleanliness of the hospital room or ward.


ConclusionsWhat does this mean for you?

The analysis provides food for thought for all interested spectators of the NHS, but what

does it mean for those managers who are tasked with improving the patient experience? It’s

clear that the implications depend on your sector. For acute trusts, it’s about how you treat

your patients, whereas for PCTs, it’s more to do with where you’re situated.

As in 2004, we found that the nature of the local community will often limit the potential

of PCTs to achieve high ratings of patient satisfaction. This confirms the validity of these

factors as real issues. If you serve an area with high levels of deprivation, high ethnic

fractionalisation and large numbers of younger residents, you are likely to find it more

difficult to achieve high patient ratings. For example, Newham PCT is amongst the lowest

rated PCTs in the country and is operating in just such an area, with high levels for each of

these factors.

So what are the reasons behind this? There are any number of possibilities to consider.

Is it about more complex health needs in these communities? Is it about getting the right

staff and resources into these areas? Is it about the challenges of delivering a service

when faced with multiple languages and cultural expectations? Is it that these groups

are more demanding of the service they receive? Or is it even an artefact of the survey

measures themselves?

Of course, it’s likely to be a combination of many of these things. And what we do know

from our work in places like Newham, Tower Hamlets and Birmingham is that different

cultural groups do indeed expect different things from the health service – which will

inevitably challenge healthcare providers in those areas, and potentially hit their overall

patient satisfaction scores.

But what we also know is that some PCTs are able to overcome the particular challenges

posed by their local situation. For example, Newham PCT is actually performing well once

local factors are taken into account. Lambeth PCT is another good example: even though

its raw patient scores are poor, it actually achieved the highest performance index of any

PCT in the country. For PCTs whose Frontiers scores suggest they are underperforming,

these are the PCTs to look towards to see what they’re doing to meet the needs of their

populations: there are almost certainly useful lessons to learn.

If you work in an acute trust, the situation is not quite as difficult. As we found in 2004, there

are factors you can concentrate on that are linked to patient satisfaction. Involving patients

in their treatment, the cleanliness of the hospital and, most importantly, treating patients

with dignity and respect, are all issues that are key to a positive inpatient experience. This is

not to say that local population factors do not play a role: they will still influence the patient

ratings achievable by trusts. But by identifying key things you need to deliver, the analysis

gives acute trusts an agenda for where they might most usefully focus their efforts.

Whether you work in a PCT or an acute trust, the first step is to look at your scores in the

tables at the end of this report, to understand what you are faced with and how you are

dealing with it. The next step is to ask yourselves how this analysis can be taken forward to


your benefit and the benefit of your patients.

For example, patient satisfaction is lower amongst younger patients, those from ethnic

minority groups and those in more deprived areas. Therefore, if you serve these

communities you may want to forge greater links with these groups. The analysis suggests

there may be value in investigating the beliefs, attitudes and experiences of these patients

to gain a better understanding of their needs. We know that many trusts are already doing

this, not least from our own work with them. The challenge is for health bodies to learn from

each other on these issues and build links with these groups so that they are better able to

understand and meet their needs.

For acute trusts, further investigation is also needed to fully understand the nature of the

relationship between factors like cleanliness, involving patients and respect and dignity

and the levels of satisfaction patients express. The relationships highlighted in this report

are essentially correlational. The questions that therefore arise are: to what extent do these

factors cause patient satisfaction; and what specifically are the critical elements within

these factors that matter?

These pose some challenging research questions, but the current ‘deep clean’ of NHS

hospitals provides a good opportunity to test its impact on perceptions of cleanliness and

overall ratings. And to understand the importance of dignity and respect in relation to

overall patient ratings, the Healthcare Commission’s work in this area appears timely and

appropriate. Acute trusts would be wise to look carefully at these issues, dissecting what

they mean for their own patients, how this varies across different patient groups, and how

they can turn this into a strategy for improving patient experience.

APPENDICES


APPENDIX A – Performance tables PCTs in alphabetical order

Raw Score Rank

PIRank Primary Care Trust Region Performance

Index EF IMDGPs per 100K Population

Age 65+

169 283 Adur, Arun and Worthing PCT

South East Coast

98.01 0.098 16.065 66.688 23.881

24 17 Airedale PCT Yorkshire and the Humber

102.16 0.200 20.138 69.282 17.477

18 36 Amber Valley PCT East Midlands

101.70 0.042 18.994 64.059 16.717

254 275 Ashfield PCT East Midlands

98.15 0.037 28.502 48.804 16.001

148 190 Ashford PCT South East Coast

99.66 0.097 13.487 61.713 16.150

218 242 Ashton, Leigh and Wigan PCT

North West 98.93 0.048 29.307 54.128 14.411

298 297 Barking and Dagenham PCT

London 95.83 0.342 31.315 49.842 14.710

274 250 Barnet PCT London 98.69 0.617 17.529 70.978 14.463

201 168 Barnsley PCT Yorkshire and the Humber

99.93 0.037 33.001 55.826 16.192

295 298 Basildon PCT East Of England

95.51 0.109 27.963 59.264 14.078

99 58 Bassetlaw PCT East Midlands

101.29 0.054 25.655 55.096 16.243

100 219 Bath and North East Somerset PCT

South West 99.31 0.116 12.223 75.414 17.841

38 104 Bebington and West Wirral PCT

North West 100.73 0.064 15.834 54.957 20.379

139 15 Bedford PCT East Of England

102.27 0.342 17.543 65.350 14.859

103 79 Bedfordshire Heartlands PCT

East Of England

101.00 0.116 9.968 64.162 13.530

46 128 Bexhill and Rother PCT

South East Coast

100.40 0.089 16.084 59.145 28.338

215 180 Bexley Care Trust London 99.83 0.225 15.006 53.107 15.808

237 285 Billericay, Brentwood and Wickford PCT

East Of England

97.79 0.119 9.055 60.013 17.140

22 13 Birkenhead and Wallasey PCT

North West 102.34 0.072 39.137 80.559 16.672

222 56 Blackburn With Darwen PCT

North West 101.31 0.401 32.343 58.476 13.319

197 207 Blackpool PCT North West 99.42 0.068 33.882 55.977 19.579

134 144 Blackwater Valley and Hart PCT

South Central 100.19 0.125 7.406 60.425 12.139

121 41 Bolton PCT North West 101.53 0.235 29.381 64.438 14.917

102 177 Bournemouth Teaching PCT

South West 99.85 0.135 23.383 80.656 20.120

152 49 Bracknell Forest PCT South Central 101.47 0.178 8.606 47.644 10.823

303 302 Bradford City Teaching PCT


94.66 0.649 51.504 84.977 10.503


Raw Score Rank



Age 65+

168 142 Bradford South and West PCT


100.23 0.244 31.785 79.012 14.318

300 293 Brent Teaching PCT London 96.86 0.845 25.715 74.053 11.477

186 112 Brighton and Hove City PCT

South East Coast

100.61 0.222 25.672 67.445 16.323

189 140 Bristol North PCT South West 100.25 0.267 27.449 79.185 15.529

162 169 Bristol South and West PCT

South West 99.92 0.169 27.800 84.576 14.125

67 115 Broadland PCT East Of England

100.56 0.051 9.646 64.408 19.274

217 263 Bromley PCT London 98.45 0.250 13.157 67.235 16.854

77 95 Broxtowe and Hucknall PCT

East Midlands

100.84 0.112 18.139 63.268 16.034

181 99 Burnley, Pendle and Rossendale PCT

North West 100.79 0.206 28.224 54.306 15.023

161 146 Burntwood, Lichfield and Tamworth PCT

West Midlands

100.13 0.069 15.850 58.716 13.390

151 105 Bury PCT North West 100.71 0.175 23.510 54.500 14.758

117 50 Calderdale PCT Yorkshire and the Humber

101.45 0.172 25.632 59.399 15.593

58 3 Cambridge City PCT East Of England

102.83 0.373 14.308 81.464 13.192

276 47 Camden PCT London 101.48 0.685 34.611 68.995 10.715

220 197 Cannock Chase PCT West Midlands

99.49 0.049 18.911 49.747 13.671

52 43 Canterbury and Coastal PCT

South East Coast

101.51 0.128 16.479 65.058 18.680

11 39 Carlisle and District PCT

North West 101.59 0.040 22.197 67.413 18.000

277 301 Castle Point and Rochford PCT

East Of England

95.34 0.065 10.809 56.463 17.249

111 212 Central Cheshire PCT North West 99.36 0.062 16.213 60.996 15.380

10 34 Central Cornwall PCT South West 101.75 0.064 21.583 78.245 20.363

223 205 Central Derby PCT East Midlands

99.43 0.547 37.932 107.248 13.299

213 54 Central Liverpool PCT North West 101.32 0.208 51.547 70.548 14.253

281 148 Central Manchester PCT

North West 100.11 0.616 48.699 79.223 10.756

34 76 Central Suffolk PCT East Of England

101.03 0.054 10.136 69.800 18.208

157 235 Charnwood and North West Leicestershire PCT

East Midlands

99.01 0.146 13.695 61.505 15.353

112 97 Chelmsford PCT East Of England

100.83 0.119 9.035 58.812 15.539

114 245 Cheltenham and Tewkesbury PCT

South West 98.89 0.106 12.843 77.476 17.654

62 51 Cherwell Vale PCT (North Oxfordshire PCT partnership)

South Central 101.40 0.117 10.782 64.061 14.548

74 256 Cheshire West PCT North West 98.56 0.084 15.515 79.607 17.634


Raw Score Rank



Age 65+

44 106 Chesterfield PCT East Midlands

100.71 0.065 27.072 78.017 17.676

59 73 Chiltern and South Bucks PCT

South Central 101.14 0.204 6.690 65.365 16.718

123 203 Chorley and South Ribble PCT

North West 99.44 0.070 15.527 58.235 14.884

297 209 City and Hackney Teaching PCT

London 99.41 0.755 43.859 81.594 9.473

170 139 Colchester PCT East Of England

100.25 0.135 14.522 61.645 14.755

16 143 Cotswold and Vale PCT

South West 100.22 0.074 9.630 81.343 18.623

263 160 Coventry Teaching PCT

West Midlands

100.01 0.378 28.226 61.465 15.275

7 65 Craven, Harrogate and Rural District PCT


101.17 0.090 11.292 73.420 18.151

280 300 Crawley PCT South East Coast

95.35 0.282 14.728 74.085 14.696

268 145 Croydon PCT London 100.18 0.578 19.793 65.364 12.886

202 248 Dacorum PCT East Of England

98.82 0.159 9.471 67.164 15.103

130 254 Darlington PCT North East 98.62 0.066 24.611 71.589 17.024

235 194 Dartford, Gravesham and Swanley PCT

South East Coast

99.57 0.177 16.585 50.206 15.063

40 64 Daventry and South Northamptonshire PCT

East Midlands

101.19 0.079 9.043 57.279 13.287

101 85 Derbyshire Dales and South Derbyshire PCT

East Midlands

100.95 0.073 14.095 46.244 15.248

163 260 Derwentside PCT North East 98.53 0.027 28.268 64.878 17.335

209 267 Doncaster Central PCT


98.36 0.141 35.680 80.414 17.726

153 77 Doncaster East PCT Yorkshire and the Humber

101.02 0.049 25.444 45.041 15.709

206 150 Doncaster West PCT Yorkshire and the Humber

100.10 0.041 35.219 54.034 16.165

207 69 Dudley Beacon and Castle PCT

West Midlands

101.16 0.190 28.193 53.192 16.857

145 133 Dudley South PCT West Midlands

100.34 0.116 18.520 61.715 16.548

83 199 Durham and Chester-Le-Street PCT

North East 99.47 0.068 19.641 71.563 14.823

5 18 Durham Dales PCT North East 102.10 0.030 27.953 74.720 18.116

291 238 Ealing PCT London 98.97 0.753 23.484 63.622 11.523

195 200 Easington PCT North East 99.46 0.024 41.762 64.319 17.044

174 202 East Cambridgeshire and Fenland PCT

East Of England

99.46 0.093 15.936 63.085 17.904

3 55 East Devon PCT South West 101.31 0.049 12.723 73.687 27.241

95 171 East Elmbridge and Mid Surrey PCT

South East Coast

99.91 0.214 6.636 69.088 17.558

54 113 East Hampshire PCT South Central 100.59 0.066 16.102 71.613 18.355


Raw Score Rank



Age 65+

122 107 East Kent Coastal PCT South East Coast

100.69 0.087 22.501 58.915 20.418

113 10 East Leeds PCT Yorkshire and the Humber

102.51 0.190 35.024 60.927 15.611

136 222 East Lincolnshire PCT East Midlands

99.26 0.051 21.325 55.309 21.475

75 28 East Staffordshire PCT West Midlands

101.88 0.138 17.479 63.468 15.734

147 220 East Surrey PCT South East Coast

99.30 0.159 9.048 66.199 16.000

76 132 East Yorkshire PCT Yorkshire and the Humber

100.34 0.054 12.365 53.982 17.629

56 122 Eastbourne Downs PCT

South East Coast

100.51 0.114 17.213 62.547 26.244

269 94 Eastern Birmingham PCT

West Midlands

100.84 0.420 41.966 67.939 16.132

39 216 Eastern Cheshire PCT North West 99.33 0.082 10.952 72.265 17.821

259 213 Eastern Hull PCT Yorkshire and the Humber

99.36 0.036 40.423 49.328 14.789

284 249 Eastern Leicester PCT East Midlands

98.76 0.643 28.720 59.493 13.167

104 53 Eastern Wakefield PCT Yorkshire and the Humber

101.35 0.037 34.228 64.747 15.694

109 158 Eastleigh and Test Valley South PCT

South Central 100.02 0.090 8.247 61.564 14.954

1 108 Eden Valley PCT North West 100.67 0.035 15.261 86.693 19.162

105 227 Ellesmere Port and Neston PCT

North West 99.13 0.060 19.821 69.453 16.282

278 166 Enfield PCT London 99.95 0.601 23.054 56.320 13.783

204 179 Epping Forest PCT East Of England

99.83 0.166 13.408 56.572 16.867

176 277 Erewash PCT East Midlands

98.12 0.068 19.257 68.279 15.828

12 4 Exeter PCT South West 102.82 0.095 20.179 71.842 16.633

185 253 Fareham and Gosport PCT

South Central 98.65 0.066 11.309 58.680 16.904

65 157 Fylde PCT North West 100.04 0.070 13.045 48.426 22.779

87 103 Gateshead PCT North East 100.73 0.061 33.190 66.848 17.339

179 232 Gedling PCT East Midlands

99.07 0.117 16.538 53.959 16.915

154 71 Great Yarmouth PCT East Of England

101.15 0.058 27.639 57.286 19.645

92 25 Greater Derby PCT East Midlands

101.91 0.162 21.784 49.816 17.270

271 116 Greenwich Teaching PCT

London 100.56 0.491 31.462 61.803 12.954

50 134 Guildford and Waverley PCT

South East Coast

100.30 0.164 7.155 74.686 16.820

246 270 Halton PCT North West 98.30 0.047 34.278 58.946 13.539

8 35 Hambleton and Richmondshire PCT


101.72 0.050 11.408 61.350 16.585


Raw Score Rank



Age 65+

279 87 Hammersmith and Fulham PCT

London 100.90 0.632 27.485 57.823 10.495

292 121 Haringey Teaching PCT

London 100.52 0.747 38.022 66.822 9.780

264 278 Harlow PCT East Of England

98.09 0.158 21.359 65.640 14.701

270 175 Harrow PCT London 99.87 0.694 13.504 65.900 14.471

232 273 Hartlepool PCT North East 98.22 0.039 37.695 64.436 16.227

133 26 Hastings and St Leonards PCT

South East Coast

101.90 0.114 31.701 60.285 18.010

290 303 Havering PCT London 94.06 0.152 14.779 53.932 17.692

302 244 Heart Of Birmingham Teaching PCT

West Midlands

98.89 0.816 52.052 65.267 9.957

30 98 Herefordshire PCT West Midlands

100.80 0.048 15.661 73.281 19.204

239 228 Hertsmere PCT East Of England

99.13 0.254 12.022 57.509 16.283

192 137 Heywood and Middleton PCT

North West 100.27 0.096 35.219 59.134 15.415

9 93 High Peak and Dales PCT

East Midlands

100.85 0.052 13.407 72.586 18.064

216 33 Hillingdon PCT London 101.75 0.461 17.644 54.674 13.897

135 210 Hinckley and Bosworth PCT

East Midlands

99.40 0.066 10.345 51.600 15.149

63 100 Horsham and Chanctonbury PCT

South East Coast

100.79 0.103 6.572 61.017 16.460

296 286 Hounslow PCT London 97.62 0.650 23.075 66.350 11.476

150 8 Huddersfield Central PCT


102.63 0.361 29.817 56.587 15.772

27 14 Huntingdonshire PCT East Of England

102.29 0.131 10.166 72.751 12.988

178 187 Hyndburn and Ribble Valley PCT

North West 99.72 0.147 22.258 53.395 15.995

137 83 Ipswich PCT East Of England

100.98 0.160 20.554 67.921 16.760

125 173 Isle Of Wight PCT South Central 99.89 0.063 21.097 60.708 22.378

288 176 Islington PCT London 99.86 0.650 42.365 77.750 10.232

80 118 Kennet and North Wiltshire PCT

South West 100.54 0.077 9.051 63.802 15.061

262 12 Kensington and Chelsea PCT

London 102.34 0.679 22.029 54.527 12.217

255 280 Kingston PCT London 98.05 0.416 11.613 74.497 13.366

240 198 Knowsley PCT North West 99.47 0.053 46.265 62.252 14.819

245 1 Lambeth PCT London 102.90 0.714 34.233 79.516 9.248

119 233 Langbaurgh PCT North East 99.03 0.036 26.388 68.979 16.990

183 290 Leeds North East PCT Yorkshire and the Humber

97.14 0.332 19.422 98.870 17.613

98 59 Leeds North West PCT Yorkshire and the Humber

101.26 0.234 20.967 67.600 14.449

252 257 Leeds West PCT Yorkshire and the Humber

98.56 0.133 28.627 54.616 15.123


Raw Score Rank



Age 65+

248 224 Leicester City West PCT

East Midlands

99.18 0.304 37.822 76.852 14.060

267 38 Lewisham PCT London 101.59 0.646 28.562 70.718 10.992

127 274 Lincolnshire South West Teaching PCT

East Midlands

98.18 0.063 12.483 69.778 16.676

265 22 Luton Teaching PCT East Of England

102.00 0.561 23.286 56.248 12.002

66 42 Maidstone Weald PCT South East Coast

101.51 0.091 11.131 59.675 14.928

225 259 Maldon and South Chelmsford PCT

East Of England

98.53 0.070 9.305 55.357 14.029

166 72 Mansfield District PCT East Midlands

101.15 0.060 32.538 49.481 16.361

266 258 Medway PCT South East Coast

98.53 0.146 17.605 50.712 12.734

70 164 Melton, Rutland and Harborough PCT

East Midlands

100.00 0.093 8.528 59.386 16.679

47 129 Mendip PCT South West 100.40 0.070 14.353 76.176 17.189

6 57 Mid Devon PCT South West 101.31 0.048 17.260 89.753 18.969

71 7 Middlesbrough PCT North East 102.65 0.124 40.631 66.446 15.196

142 243 Mid-Hampshire PCT South Central 98.92 0.093 8.192 65.260 16.316

116 231 Mid-Sussex PCT South East Coast

99.08 0.122 6.453 68.972 16.593

250 229 Milton Keynes PCT South Central 99.11 0.242 15.454 59.252 10.389

61 189 Morecambe Bay PCT North West 99.70 0.064 21.378 72.639 18.619

72 230 New Forest PCT South Central 99.10 0.062 10.375 70.458 22.611

172 266 Newark and Sherwood PCT

East Midlands

98.37 0.060 19.706 64.057 17.324

49 84 Newbury and Community PCT

South Central 100.97 0.101 8.556 68.746 13.911

81 16 Newcastle PCT North East 102.26 0.177 34.553 63.681 15.940

171 161 Newcastle-Under-Lyme PCT

West Midlands

100.00 0.077 20.025 56.254 17.395

294 62 Newham PCT London 101.22 0.830 40.521 69.447 8.947

97 152 North and East Cornwall PCT

South West 100.07 0.047 20.636 68.228 19.892

149 63 North Birmingham PCT

West Midlands

101.21 0.243 22.885 64.109 17.583

32 78 North Bradford PCT Yorkshire and the Humber

101.01 0.199 25.700 90.383 16.243

26 89 North Devon PCT South West 100.89 0.047 20.916 79.251 20.264

2 19 North Dorset PCT South West 102.10 0.073 11.534 77.894 21.139

224 271 North East Lincolnshire PCT


98.28 0.049 29.364 62.340 16.509

51 70 North East Oxfordshire PCT (North Oxfordshire PCT Partnership)

South Central 101.15 0.145 8.005 69.631 13.288

118 138 North Eastern Derbyshire PCT

East Midlands

100.26 0.038 23.730 56.901 17.647


Raw Score Rank



Age 65+

53 30 North Hampshire PCT South Central 101.84 0.115 8.783 59.671 12.983

258 284 North Hertfordshire and Stevenage PCT

East Of England

97.95 0.192 12.839 60.485 15.191

231 66 North Kirklees PCT Yorkshire and the Humber

101.17 0.329 28.756 51.040 13.778

126 167 North Lincolnshire PCT


99.95 0.078 21.182 59.998 16.861

273 264 North Liverpool PCT North West 98.44 0.067 55.272 66.573 14.605

243 11 North Manchester PCT North West 102.43 0.342 58.437 62.400 14.817

96 214 North Norfolk PCT East Of England

99.35 0.044 16.919 67.879 25.426

228 46 North Peterborough PCT

East Of England

101.48 0.318 26.370 60.544 14.256

124 31 North Sheffield PCT Yorkshire and the Humber

101.79 0.239 38.259 76.478 15.519

106 281 North Somerset PCT South West 98.04 0.064 14.113 85.595 19.295

234 127 North Stoke PCT West Midlands

100.42 0.104 37.256 58.375 17.424

182 225 North Surrey PCT South East Coast

99.16 0.221 9.167 62.616 16.695

138 186 North Tees PCT North East 99.73 0.074 26.387 62.138 14.850

35 101 North Tyneside PCT North East 100.75 0.060 25.985 70.196 17.888

241 241 North Warwickshire PCT

West Midlands

98.93 0.101 19.362 49.175 14.899

233 262 Northampton PCT East Midlands

98.46 0.220 19.366 63.492 13.892

156 172 Northamptonshire Heartlands PCT

East Midlands

99.91 0.136 17.545 55.745 14.863

94 272 Northumberland Care Trust

North East 98.22 0.038 21.892 78.052 17.591

48 5 Norwich PCT East Of England

102.69 0.126 28.754 77.601 16.812

221 40 Nottingham City PCT East Midlands

101.58 0.339 41.364 64.946 14.416

283 255 Oldbury and Smethwick PCT

West Midlands

98.60 0.535 35.814 70.157 16.038

160 20 Oldham PCT North West 102.07 0.282 30.726 54.294 14.282

167 81 Oxford City PCT South Central 101.00 0.376 17.947 73.592 13.857

120 90 Plymouth Teaching PCT

South West 100.88 0.068 26.165 68.663 15.983

90 149 Poole PCT South West 100.11 0.087 14.678 64.449 20.658

236 184 Portsmouth City Teaching PCT

South Central 99.79 0.155 24.874 56.435 15.358

212 183 Preston PCT North West 99.80 0.282 26.996 61.806 14.663

214 170 Reading PCT South Central 99.92 0.295 15.574 64.990 12.434

287 218 Redbridge PCT London 99.31 0.701 17.767 49.304 13.434

180 208 Redditch and Bromsgrove PCT

West Midlands

99.41 0.111 14.919 62.416 14.727

198 155 Richmond and Twickenham PCT

London 100.06 0.370 9.684 66.035 13.738

177 27 Rochdale PCT North West 101.90 0.330 32.964 59.856 13.693


Raw Score Rank



Age 65+

219 239 Rotherham PCT Yorkshire and the Humber

98.97 0.079 28.241 56.869 15.577

282 289 Rowley Regis and Tipton PCT

West Midlands

97.38 0.223 35.122 62.800 15.596

173 196 Royston, Buntingford and Bishop’s Stortford PCT

East Of England

99.50 0.131 5.407 61.004 12.744

84 60 Rugby PCT West Midlands

101.25 0.168 13.582 65.504 16.066

14 74 Rushcliffe PCT East Midlands

101.08 0.130 8.969 68.639 16.212

229 237 Salford PCT North West 98.98 0.140 38.299 68.383 16.252

37 182 Scarborough, Whitby and Ryedale PCT


99.80 0.045 20.534 75.502 21.091

132 226 Sedgefield PCT North East 99.14 0.026 29.064 68.305 16.369

33 141 Selby and York PCT Yorkshire and the Humber

100.24 0.075 13.818 73.012 16.292

129 282 Sheffield South West PCT


98.03 0.236 13.930 86.348 17.522

158 217 Sheffield West PCT Yorkshire and the Humber

99.32 0.167 21.798 71.299 14.808

159 159 Shepway PCT South East Coast

100.01 0.105 20.743 57.367 20.109

146 247 Shropshire County PCT

West Midlands

98.83 0.053 15.403 68.507 18.079

301 296 Slough PCT South Central 96.02 0.622 20.885 57.007 11.672

187 223 Solihull PCT West Midlands

99.24 0.166 16.527 66.207 16.832

45 111 Somerset Coast PCT South West 100.62 0.048 18.635 70.822 20.941

43 251 South and East Dorset PCT

South West 98.68 0.063 10.799 75.394 26.929

184 21 South Birmingham PCT

West Midlands

102.01 0.373 31.281 71.519 15.430

36 2 South Cambridgeshire PCT

East Of England

102.84 0.127 6.336 53.069 14.896

230 265 South East Hertfordshire PCT

East Of England

98.42 0.154 11.081 64.047 14.546

4 24 South East Oxfordshire PCT

South Central 101.94 0.120 7.239 84.116 16.314

257 287 South East Sheffield PCT


97.55 0.175 35.285 74.071 17.130

194 276 South Gloucestershire PCT

South West 98.13 0.081 9.813 66.911 14.381

64 147 South Hams and West Devon PCT

South West 100.12 0.057 14.446 68.930 20.565

15 151 South Huddersfield PCT


100.09 0.070 14.664 86.792 14.546

191 114 South Leeds PCT Yorkshire and the Humber

100.57 0.132 33.025 61.542 14.488

93 131 South Leicestershire PCT

East Midlands

100.35 0.204 8.873 58.228 15.780


Raw Score Rank



Age 65+

226 185 South Liverpool PCT North West 99.76 0.123 40.018 55.471 18.349

208 45 South Manchester PCT

North West 101.49 0.303 40.904 62.906 14.416

115 37 South Peterborough PCT

East Of England

101.64 0.131 15.587 60.664 14.229

140 110 South Sefton PCT North West 100.62 0.057 31.955 56.264 16.962

23 75 South Somerset PCT South West 101.08 0.052 13.743 69.876 19.710

244 215 South Stoke PCT West Midlands

99.34 0.137 31.824 62.790 15.386

68 52 South Tyneside PCT North East 101.39 0.068 33.082 64.104 17.833

82 88 South Warwickshire PCT

West Midlands

100.89 0.155 10.759 63.628 17.206

28 162 South West Dorset PCT

South West 100.00 0.061 17.332 82.144 22.001

41 91 South West Kent PCT South East Coast

100.86 0.116 9.013 67.835 17.439

86 123 South West Oxfordshire PCT

South Central 100.51 0.102 7.128 62.571 14.423

17 6 South Western Staffordshire PCT

West Midlands

102.66 0.080 11.966 56.971 16.888

42 268 South Wiltshire PCT South West 98.35 0.070 11.695 98.975 18.063

91 165 South Worcestershire PCT

West Midlands

99.99 0.080 13.892 68.814 17.325

196 174 Southampton City PCT South Central 99.87 0.211 23.761 73.884 14.546

249 269 Southend On Sea PCT East Of England

98.35 0.136 21.661 58.999 19.183

73 86 Southern Norfolk PCT East Of England

100.91 0.072 12.281 64.321 18.676

25 135 Southport and Formby PCT

North West 100.30 0.077 17.677 66.580 21.770

272 29 Southwark PCT London 101.88 0.687 35.401 71.408 10.355

78 23 St Albans and Harpenden PCT

East Of England

101.97 0.243 7.725 64.400 14.907

210 252 St Helens PCT North West 98.65 0.045 32.122 62.402 15.596

107 82 Staffordshire Moorlands PCT

West Midlands

100.99 0.033 17.629 54.999 16.597

227 291 Stockport PCT North West 97.02 0.137 18.062 64.624 16.522

55 125 Suffolk Coastal PCT East Of England

100.48 0.080 11.968 69.374 21.002

110 130 Suffolk West PCT East Of England

100.38 0.176 11.327 71.334 16.455

175 188 Sunderland Teaching PCT

North East 99.71 0.057 34.223 60.277 15.589

164 191 Surrey Heath and Woking PCT

South East Coast

99.65 0.218 6.513 62.270 14.016

19 124 Sussex Downs and Weald PCT

South East Coast

100.50 0.100 10.142 79.529 18.604

211 109 Sutton and Merton PCT

London 100.63 0.450 13.942 64.709 13.715

261 236 Swale PCT South East Coast

99.01 0.078 22.190 43.741 14.572

251 288 Swindon PCT South West 97.38 0.164 16.856 70.500 13.722


Raw Score Rank



Age 65+

203 136 Tameside and Glossop PCT

North West 100.29 0.131 28.084 50.099 14.711

13 48 Taunton Deane PCT South West 101.48 0.066 16.277 74.918 19.185

60 154 Teignbridge PCT South West 100.06 0.054 17.610 71.122 22.196

238 206 Telford and Wrekin PCT

West Midlands

99.43 0.134 21.799 58.787 12.396

205 240 Tendring PCT East Of England

98.96 0.063 23.255 55.114 26.171

286 295 Thurrock PCT East Of England

96.66 0.138 21.213 49.105 13.051

21 44 Torbay PCT South West 101.50 0.062 23.705 73.793 22.636

299 234 Tower Hamlets PCT London 99.02 0.697 45.862 66.611 9.362

253 221 Trafford North PCT North West 99.29 0.328 27.737 53.914 15.560

20 32 Trafford South PCT North West 101.77 0.172 14.411 62.137 16.737

31 68 Uttlesford PCT East Of England

101.16 0.094 6.771 73.391 15.236

29 9 Vale Of Aylesbury PCT

South Central 102.57 0.176 7.987 61.936 13.346

128 201 Wakefield West PCT Yorkshire and the Humber

99.46 0.098 23.076 73.920 15.120

275 246 Walsall Teaching PCT West Midlands

98.84 0.270 29.276 51.290 16.178

293 178 Waltham Forest PCT London 99.84 0.751 30.255 64.713 9.814

260 102 Wandsworth PCT London 100.75 0.563 20.959 67.876 10.430

190 261 Warrington PCT North West 98.48 0.076 19.337 61.116 14.151

141 61 Watford and Three Rivers PCT

East Of England

101.24 0.304 11.885 67.128 14.907

144 192 Waveney PCT East Of England

99.62 0.052 21.132 66.068 21.593

289 294 Wednesbury and West Bromwich PCT

West Midlands

96.82 0.364 35.291 65.291 17.581

193 153 Welwyn Hatfield PCT East Of England

100.07 0.210 12.612 58.715 17.157

89 193 West Cumbria PCT North West 99.61 0.032 25.762 72.893 16.903

143 163 West Gloucestershire PCT

South West 100.00 0.120 17.313 66.617 16.070

199 156 West Hull PCT Yorkshire and the Humber

100.04 0.103 41.860 73.365 15.821

155 211 West Lancashire PCT North West 99.36 0.057 21.104 55.718 15.616

79 92 West Lincolnshire PCT East Midlands

100.86 0.065 19.622 57.932 17.188

88 117 West Norfolk PCT East Of England

100.55 0.080 18.668 68.380 21.678

69 119 West Of Cornwall PCT South West 100.53 0.059 26.618 81.327 19.981

247 299 West Wiltshire PCT South West 95.46 0.077 11.959 75.750 17.214

57 96 Western Sussex PCT South East Coast

100.83 0.084 12.820 55.265 23.403

285 126 Westminster PCT London 100.46 0.712 31.171 58.519 12.362

188 195 Windsor, Ascot and Maidenhead PCT

South Central 99.56 0.284 8.074 63.427 15.080


Raw Score Rank



Age 65+

242 279 Witham, Braintree and Halstead Care Trust

East Of England

98.08 0.081 13.522 56.675 14.753

131 120 Wokingham PCT South Central 100.53 0.192 5.107 59.246 11.926

256 67 Wolverhampton City PCT

West Midlands

101.17 0.414 31.788 55.090 16.901

165 80 Wycombe PCT South Central 101.00 0.327 10.647 60.124 13.507

108 204 Wyre Forest PCT West Midlands

99.44 0.072 17.193 76.750 16.754

200 292 Wyre PCT North West 97.00 0.047 17.795 57.324 22.175

85 181 Yorkshire Wolds and Coast PCT


99.80 0.040 18.798 62.746 19.343


PCTs in rank order

Raw Score Rank



Age 65+

245 1 Lambeth PCT London 102.90 0.714 34.233 79.516 9.248

36 2 South Cambridgeshire PCT

East Of England 102.84 0.127 6.336 53.069 14.896

58 3 Cambridge City PCT East Of England 102.83 0.373 14.308 81.464 13.192

12 4 Exeter PCT South West 102.82 0.095 20.179 71.842 16.633

48 5 Norwich PCT East Of England 102.69 0.126 28.754 77.601 16.812

17 6 South Western Staffordshire PCT

West Midlands 102.66 0.080 11.966 56.971 16.888

71 7 Middlesbrough PCT North East 102.65 0.124 40.631 66.446 15.196

150 8 Huddersfield Central PCT

Yorkshire and the Humber 102.63 0.361 29.817 56.587 15.772

29 9 Vale Of Aylesbury PCT South Central 102.57 0.176 7.987 61.936 13.346

113 10 East Leeds PCT Yorkshire and the Humber 102.51 0.190 35.024 60.927 15.611

243 11 North Manchester PCT North West 102.43 0.342 58.437 62.400 14.817

262 12 Kensington and Chelsea PCT London 102.34 0.679 22.029 54.527 12.217

22 13 Birkenhead and Wallasey PCT North West 102.34 0.072 39.137 80.559 16.672

27 14 Huntingdonshire PCT East Of England 102.29 0.131 10.166 72.751 12.988

139 15 Bedford PCT East Of England 102.27 0.342 17.543 65.350 14.859

81 16 Newcastle PCT North East 102.26 0.177 34.553 63.681 15.940

24 17 Airedale PCT Yorkshire and the Humber 102.16 0.200 20.138 69.282 17.477

5 18 Durham Dales PCT North East 102.10 0.030 27.953 74.720 18.116

2 19 North Dorset PCT South West 102.10 0.073 11.534 77.894 21.139

160 20 Oldham PCT North West 102.07 0.282 30.726 54.294 14.282

184 21 South Birmingham PCT

West Midlands 102.01 0.373 31.281 71.519 15.430

265 22 Luton Teaching PCT East Of England 102.00 0.561 23.286 56.248 12.002

78 23 St Albans and Harpenden PCT

East Of England 101.97 0.243 7.725 64.400 14.907

4 24 South East Oxfordshire PCT South Central 101.94 0.120 7.239 84.116 16.314

92 25 Greater Derby PCT East Midlands 101.91 0.162 21.784 49.816 17.270

133 26 Hastings and St Leonards PCT

South East Coast 101.90 0.114 31.701 60.285 18.010

177 27 Rochdale PCT North West 101.90 0.330 32.964 59.856 13.693


Raw Score Rank



Age 65+

75 28 East Staffordshire PCT West Midlands 101.88 0.138 17.479 63.468 15.734

272 29 Southwark PCT London 101.88 0.687 35.401 71.408 10.355

53 30 North Hampshire PCT South Central 101.84 0.115 8.783 59.671 12.983

124 31 North Sheffield PCT Yorkshire and the Humber 101.79 0.239 38.259 76.478 15.519

20 32 Trafford South PCT North West 101.77 0.172 14.411 62.137 16.737

216 33 Hillingdon PCT London 101.75 0.461 17.644 54.674 13.897

10 34 Central Cornwall PCT South West 101.75 0.064 21.583 78.245 20.363

8 35 Hambleton and Richmondshire PCT


18 36 Amber Valley PCT East Midlands 101.70 0.042 18.994 64.059 16.717

115 37 South Peterborough PCT

East Of England 101.64 0.131 15.587 60.664 14.229

267 38 Lewisham PCT London 101.59 0.646 28.562 70.718 10.992

11 39 Carlisle and District PCT North West 101.59 0.040 22.197 67.413 18.000

221 40 Nottingham City PCT East Midlands 101.58 0.339 41.364 64.946 14.416

121 41 Bolton PCT North West 101.53 0.235 29.381 64.438 14.917

66 42 Maidstone Weald PCT South East Coast 101.51 0.091 11.131 59.675 14.928

52 43 Canterbury and Coastal PCT

South East Coast 101.51 0.128 16.479 65.058 18.680

21 44 Torbay PCT South West 101.50 0.062 23.705 73.793 22.636

208 45 South Manchester PCT North West 101.49 0.303 40.904 62.906 14.416

228 46 North Peterborough PCT

East Of England 101.48 0.318 26.370 60.544 14.256

276 47 Camden PCT London 101.48 0.685 34.611 68.995 10.715

13 48 Taunton Deane PCT South West 101.48 0.066 16.277 74.918 19.185

152 49 Bracknell Forest PCT South Central 101.47 0.178 8.606 47.644 10.823

117 50 Calderdale PCT Yorkshire and the Humber 101.45 0.172 25.632 59.399 15.593

62 51Cherwell Vale PCT (North Oxfordshire PCT partnership)

South Central 101.40 0.117 10.782 64.061 14.548

68 52 South Tyneside PCT North East 101.39 0.068 33.082 64.104 17.833

104 53 Eastern Wakefield PCT


213 54 Central Liverpool PCT North West 101.32 0.208 51.547 70.548 14.253

3 55 East Devon PCT South West 101.31 0.049 12.723 73.687 27.241

222 56 Blackburn With Darwen PCT North West 101.31 0.401 32.343 58.476 13.319

6 57 Mid Devon PCT South West 101.31 0.048 17.260 89.753 18.969

99 58 Bassetlaw PCT East Midlands 101.29 0.054 25.655 55.096 16.243


Raw Score Rank



Age 65+

98 59 Leeds North West PCT


84 60 Rugby PCT West Midlands 101.25 0.168 13.582 65.504 16.066

141 61 Watford and Three Rivers PCT

East Of England 101.24 0.304 11.885 67.128 14.907

294 62 Newham PCT London 101.22 0.830 40.521 69.447 8.947

149 63 North Birmingham PCT

West Midlands 101.21 0.243 22.885 64.109 17.583

40 64Daventry and South Northamptonshire PCT

East Midlands 101.19 0.079 9.043 57.279 13.287

7 65 Craven, Harrogate and Rural District PCT


231 66 North Kirklees PCT Yorkshire and the Humber 101.17 0.329 28.756 51.040 13.778

256 67 Wolverhampton City PCT

West Midlands 101.17 0.414 31.788 55.090 16.901

31 68 Uttlesford PCT East Of England 101.16 0.094 6.771 73.391 15.236

207 69 Dudley Beacon and Castle PCT

West Midlands 101.16 0.190 28.193 53.192 16.857

51 70

North East Oxfordshire PCT (North Oxfordshire PCT Partnership)

South Central 101.15 0.145 8.005 69.631 13.288

154 71 Great Yarmouth PCT East Of England 101.15 0.058 27.639 57.286 19.645

166 72 Mansfield District PCT East Midlands 101.15 0.060 32.538 49.481 16.361

59 73 Chiltern and South Bucks PCT South Central 101.14 0.204 6.690 65.365 16.718

14 74 Rushcliffe PCT East Midlands 101.08 0.130 8.969 68.639 16.212

23 75 South Somerset PCT South West 101.08 0.052 13.743 69.876 19.710

34 76 Central Suffolk PCT East Of England 101.03 0.054 10.136 69.800 18.208

153 77 Doncaster East PCT Yorkshire and the Humber 101.02 0.049 25.444 45.041 15.709

32 78 North Bradford PCT Yorkshire and the Humber 101.01 0.199 25.700 90.383 16.243

103 79 Bedfordshire Heartlands PCT

East Of England 101.00 0.116 9.968 64.162 13.530

165 80 Wycombe PCT South Central 101.00 0.327 10.647 60.124 13.507

167 81 Oxford City PCT South Central 101.00 0.376 17.947 73.592 13.857

107 82 Staffordshire Moorlands PCT

West Midlands 100.99 0.033 17.629 54.999 16.597

137 83 Ipswich PCT East Of England 100.98 0.160 20.554 67.921 16.760

49 84 Newbury and Community PCT South Central 100.97 0.101 8.556 68.746 13.911


Raw Score Rank



Age 65+

101 85 Derbyshire Dales and South Derbyshire PCT

East Midlands 100.95 0.073 14.095 46.244 15.248

73 86 Southern Norfolk PCT East Of England 100.91 0.072 12.281 64.321 18.676

279 87 Hammersmith and Fulham PCT London 100.90 0.632 27.485 57.823 10.495

82 88 South Warwickshire PCT

West Midlands 100.89 0.155 10.759 63.628 17.206

26 89 North Devon PCT South West 100.89 0.047 20.916 79.251 20.264

120 90 Plymouth Teaching PCT South West 100.88 0.068 26.165 68.663 15.983

41 91 South West Kent PCT South East Coast 100.86 0.116 9.013 67.835 17.439

79 92 West Lincolnshire PCT East Midlands 100.86 0.065 19.622 57.932 17.188

9 93 High Peak and Dales PCT

East Midlands 100.85 0.052 13.407 72.586 18.064

269 94 Eastern Birmingham PCT

West Midlands 100.84 0.420 41.966 67.939 16.132

77 95 Broxtowe and Hucknall PCT

East Midlands 100.84 0.112 18.139 63.268 16.034

57 96 Western Sussex PCT South East Coast 100.83 0.084 12.820 55.265 23.403

112 97 Chelmsford PCT East Of England 100.83 0.119 9.035 58.812 15.539

30 98 Herefordshire PCT West Midlands 100.80 0.048 15.661 73.281 19.204

181 99 Burnley, Pendle and Rossendale PCT North West 100.79 0.206 28.224 54.306 15.023

63 100 Horsham and Chanctonbury PCT

South East Coast 100.79 0.103 6.572 61.017 16.460

35 101 North Tyneside PCT North East 100.75 0.060 25.985 70.196 17.888

260 102 Wandsworth PCT London 100.75 0.563 20.959 67.876 10.430

87 103 Gateshead PCT North East 100.73 0.061 33.190 66.848 17.339

38 104 Bebington and West Wirral PCT North West 100.73 0.064 15.834 54.957 20.379

151 105 Bury PCT North West 100.71 0.175 23.510 54.500 14.758

44 106 Chesterfield PCT East Midlands 100.71 0.065 27.072 78.017 17.676

122 107 East Kent Coastal PCT South East Coast 100.69 0.087 22.501 58.915 20.418

1 108 Eden Valley PCT North West 100.67 0.035 15.261 86.693 19.162

211 109 Sutton and Merton PCT London 100.63 0.450 13.942 64.709 13.715

140 110 South Sefton PCT North West 100.62 0.057 31.955 56.264 16.962

45 111 Somerset Coast PCT South West 100.62 0.048 18.635 70.822 20.941

186 112 Brighton and Hove City PCT

South East Coast 100.61 0.222 25.672 67.445 16.323

54 113 East Hampshire PCT South Central 100.59 0.066 16.102 71.613 18.355

191 114 South Leeds PCT Yorkshire and the Humber 100.57 0.132 33.025 61.542 14.488


Raw Score Rank



Age 65+

67 115 Broadland PCT East Of England 100.56 0.051 9.646 64.408 19.274

271 116 Greenwich Teaching PCT London 100.56 0.491 31.462 61.803 12.954

88 117 West Norfolk PCT East Of England 100.55 0.080 18.668 68.380 21.678

80 118 Kennet and North Wiltshire PCT South West 100.54 0.077 9.051 63.802 15.061

69 119 West Of Cornwall PCT South West 100.53 0.059 26.618 81.327 19.981

131 120 Wokingham PCT South Central 100.53 0.192 5.107 59.246 11.926

292 121 Haringey Teaching PCT London 100.52 0.747 38.022 66.822 9.780

56 122 Eastbourne Downs PCT

South East Coast 100.51 0.114 17.213 62.547 26.244

86 123 South West Oxfordshire PCT South Central 100.51 0.102 7.128 62.571 14.423

19 124 Sussex Downs and Weald PCT

South East Coast 100.50 0.100 10.142 79.529 18.604

55 125 Suffolk Coastal PCT East Of England 100.48 0.080 11.968 69.374 21.002

285 126 Westminster PCT London 100.46 0.712 31.171 58.519 12.362

234 127 North Stoke PCT West Midlands 100.42 0.104 37.256 58.375 17.424

46 128 Bexhill and Rother PCT

South East Coast 100.40 0.089 16.084 59.145 28.338

47 129 Mendip PCT South West 100.40 0.070 14.353 76.176 17.189

110 130 Suffolk West PCT East Of England 100.38 0.176 11.327 71.334 16.455

93 131 South Leicestershire PCT

East Midlands 100.35 0.204 8.873 58.228 15.780

76 132 East Yorkshire PCT Yorkshire and the Humber 100.34 0.054 12.365 53.982 17.629

145 133 Dudley South PCT West Midlands 100.34 0.116 18.520 61.715 16.548

50 134 Guildford and Waverley PCT

South East Coast 100.30 0.164 7.155 74.686 16.820

25 135 Southport and Formby PCT North West 100.30 0.077 17.677 66.580 21.770

203 136 Tameside and Glossop PCT North West 100.29 0.131 28.084 50.099 14.711

192 137 Heywood and Middleton PCT North West 100.27 0.096 35.219 59.134 15.415

118 138 North Eastern Derbyshire PCT

East Midlands 100.26 0.038 23.730 56.901 17.647

170 139 Colchester PCT East Of England 100.25 0.135 14.522 61.645 14.755

189 140 Bristol North PCT South West 100.25 0.267 27.449 79.185 15.529

33 141 Selby and York PCT Yorkshire and the Humber 100.24 0.075 13.818 73.012 16.292

168 142 Bradford South and West PCT



Raw Score Rank



Age 65+

16 143 Cotswold and Vale PCT South West 100.22 0.074 9.630 81.343 18.623

134 144 Blackwater Valley and Hart PCT South Central 100.19 0.125 7.406 60.425 12.139

268 145 Croydon PCT London 100.18 0.578 19.793 65.364 12.886

161 146 Burntwood, Lichfield and Tamworth PCT

West Midlands 100.13 0.069 15.850 58.716 13.390

64 147 South Hams and West Devon PCT South West 100.12 0.057 14.446 68.930 20.565

281 148 Central Manchester PCT North West 100.11 0.616 48.699 79.223 10.756

90 149 Poole PCT South West 100.11 0.087 14.678 64.449 20.658

206 150 Doncaster West PCT Yorkshire and the Humber 100.10 0.041 35.219 54.034 16.165

15 151 South Huddersfield PCT


97 152 North and East Cornwall PCT South West 100.07 0.047 20.636 68.228 19.892

193 153 Welwyn Hatfield PCT East Of England 100.07 0.210 12.612 58.715 17.157

60 154 Teignbridge PCT South West 100.06 0.054 17.610 71.122 22.196

198 155 Richmond and Twickenham PCT London 100.06 0.370 9.684 66.035 13.738

199 156 West Hull PCT Yorkshire and the Humber 100.04 0.103 41.860 73.365 15.821

65 157 Fylde PCT North West 100.04 0.070 13.045 48.426 22.779

109 158 Eastleigh and Test Valley South PCT South Central 100.02 0.090 8.247 61.564 14.954

263 159 Shepway PCT South East Coast 100.01 0.105 20.743 57.367 20.109

159 160 Coventry Teaching PCT

West Midlands 100.01 0.378 28.226 61.465 15.275

171 161 Newcastle-Under-Lyme PCT

West Midlands 100.00 0.077 20.025 56.254 17.395

28 162 South West Dorset PCT South West 100.00 0.061 17.332 82.144 22.001

143 163 West Gloucestershire PCT South West 100.00 0.120 17.313 66.617 16.070

70 164 Melton, Rutland and Harborough PCT

East Midlands 100.00 0.093 8.528 59.386 16.679

91 165 South Worcestershire PCT

West Midlands 99.99 0.080 13.892 68.814 17.325

278 166 Enfield PCT London 99.95 0.601 23.054 56.320 13.783

126 167 North Lincolnshire PCT


201 168 Barnsley PCT Yorkshire and the Humber 99.93 0.037 33.001 55.826 16.192

162 169 Bristol South and West PCT South West 99.92 0.169 27.800 84.576 14.125

214 170 Reading PCT South Central 99.92 0.295 15.574 64.990 12.434


Raw Score Rank



Age 65+

95 171 East Elmbridge and Mid Surrey PCT

South East Coast 99.91 0.214 6.636 69.088 17.558

156 172 Northamptonshire Heartlands PCT

East Midlands 99.91 0.136 17.545 55.745 14.863

125 173 Isle Of Wight PCT South Central 99.89 0.063 21.097 60.708 22.378

196 174 Southampton City PCT South Central 99.87 0.211 23.761 73.884 14.546

270 175 Harrow PCT London 99.87 0.694 13.504 65.900 14.471

288 176 Islington PCT London 99.86 0.650 42.365 77.750 10.232

102 177 Bournemouth Teaching PCT South West 99.85 0.135 23.383 80.656 20.120

293 178 Waltham Forest PCT London 99.84 0.751 30.255 64.713 9.814

204 179 Epping Forest PCT East Of England 99.83 0.166 13.408 56.572 16.867

215 180 Bexley Care Trust London 99.83 0.225 15.006 53.107 15.808

85 181 Yorkshire Wolds and Coast PCT


37 182 Scarborough, Whitby and Ryedale PCT


212 183 Preston PCT North West 99.80 0.282 26.996 61.806 14.663

236 184 Portsmouth City Teaching PCT South Central 99.79 0.155 24.874 56.435 15.358

226 185 South Liverpool PCT North West 99.76 0.123 40.018 55.471 18.349

138 186 North Tees PCT North East 99.73 0.074 26.387 62.138 14.850

178 187 Hyndburn and Ribble Valley PCT North West 99.72 0.147 22.258 53.395 15.995

175 188 Sunderland Teaching PCT North East 99.71 0.057 34.223 60.277 15.589

61 189 Morecambe Bay PCT North West 99.70 0.064 21.378 72.639 18.619

148 190 Ashford PCT South East Coast 99.66 0.097 13.487 61.713 16.150

164 191 Surrey Heath and Woking PCT

South East Coast 99.65 0.218 6.513 62.270 14.016

144 192 Waveney PCT East Of England 99.62 0.052 21.132 66.068 21.593

89 193 West Cumbria PCT North West 99.61 0.032 25.762 72.893 16.903

235 194 Dartford, Gravesham and Swanley PCT

South East Coast 99.57 0.177 16.585 50.206 15.063

188 195 Windsor, Ascot and Maidenhead PCT South Central 99.56 0.284 8.074 63.427 15.080

173 196Royston, Buntingford and Bishop’s Stortford PCT

East Of England 99.50 0.131 5.407 61.004 12.744

220 197 Cannock Chase PCT West Midlands 99.49 0.049 18.911 49.747 13.671

240 198 Knowsley PCT North West 99.47 0.053 46.265 62.252 14.819

83 199 Durham and Chester-Le-Street PCT North East 99.47 0.068 19.641 71.563 14.823

195 200 Easington PCT North East 99.46 0.024 41.762 64.319 17.044

128 201 Wakefield West PCT Yorkshire and the Humber 99.46 0.098 23.076 73.920 15.120


Raw Score Rank



Age 65+

174 202 East Cambridgeshire and Fenland PCT

East Of England 99.46 0.093 15.936 63.085 17.904

123 203 Chorley and South Ribble PCT North West 99.44 0.070 15.527 58.235 14.884

108 204 Wyre Forest PCT West Midlands 99.44 0.072 17.193 76.750 16.754

223 205 Central Derby PCT East Midlands 99.43 0.547 37.932 107.248 13.299

238 206 Telford and Wrekin PCT

West Midlands 99.43 0.134 21.799 58.787 12.396

197 207 Blackpool PCT North West 99.42 0.068 33.882 55.977 19.579

180 208 Redditch and Bromsgrove PCT

West Midlands 99.41 0.111 14.919 62.416 14.727

297 209 City and Hackney Teaching PCT London 99.41 0.755 43.859 81.594 9.473

135 210 Hinckley and Bosworth PCT

East Midlands 99.40 0.066 10.345 51.600 15.149

111 211 West Lancashire PCT North West 99.36 0.057 21.104 55.718 15.616

155 212 Central Cheshire PCT North West 99.36 0.062 16.213 60.996 15.380

259 213 Eastern Hull PCT Yorkshire and the Humber 99.36 0.036 40.423 49.328 14.789

96 214 North Norfolk PCT East Of England 99.35 0.044 16.919 67.879 25.426

244 215 South Stoke PCT West Midlands 99.34 0.137 31.824 62.790 15.386

39 216 Eastern Cheshire PCT North West 99.33 0.082 10.952 72.265 17.821

158 217 Sheffield West PCT Yorkshire and the Humber 99.32 0.167 21.798 71.299 14.808

100 218 Redbridge PCT London 99.31 0.701 17.767 49.304 13.434

287 219 Bath and North East Somerset PCT South West 99.31 0.116 12.223 75.414 17.841

147 220 East Surrey PCT South East Coast 99.30 0.159 9.048 66.199 16.000

253 221 Trafford North PCT North West 99.29 0.328 27.737 53.914 15.560

136 222 East Lincolnshire PCT East Midlands 99.26 0.051 21.325 55.309 21.475

187 223 Solihull PCT West Midlands 99.24 0.166 16.527 66.207 16.832

248 224 Leicester City West PCT

East Midlands 99.18 0.304 37.822 76.852 14.060

182 225 North Surrey PCT South East Coast 99.16 0.221 9.167 62.616 16.695

132 226 Sedgefield PCT North East 99.14 0.026 29.064 68.305 16.369

105 227 Ellesmere Port and Neston PCT North West 99.13 0.060 19.821 69.453 16.282

239 228 Hertsmere PCT East Of England 99.13 0.254 12.022 57.509 16.283

250 229 Milton Keynes PCT South Central 99.11 0.242 15.454 59.252 10.389

72 230 New Forest PCT South Central 99.10 0.062 10.375 70.458 22.611

116 231 Mid-Sussex PCT South East Coast 99.08 0.122 6.453 68.972 16.593


Raw Score Rank



Age 65+

179 232 Gedling PCT East Midlands 99.07 0.117 16.538 53.959 16.915

119 233 Langbaurgh PCT North East 99.03 0.036 26.388 68.979 16.990

299 234 Tower Hamlets PCT London 99.02 0.697 45.862 66.611 9.362

157 235Charnwood and North West Leicestershire PCT

East Midlands 99.01 0.146 13.695 61.505 15.353

261 236 Swale PCT South East Coast 99.01 0.078 22.190 43.741 14.572

229 237 Salford PCT North West 98.98 0.140 38.299 68.383 16.252

291 238 Ealing PCT London 98.97 0.753 23.484 63.622 11.523

219 239 Rotherham PCT Yorkshire and the Humber 98.97 0.079 28.241 56.869 15.577

205 240 Tendring PCT East Of England 98.96 0.063 23.255 55.114 26.171

218 241 North Warwickshire PCT

West Midlands 98.93 0.101 19.362 49.175 14.899

241 242 Ashton, Leigh and Wigan PCT North West 98.93 0.048 29.307 54.128 14.411

142 243 Mid-Hampshire PCT South Central 98.92 0.093 8.192 65.260 16.316

302 244 Heart Of Birmingham Teaching PCT

West Midlands 98.89 0.816 52.052 65.267 9.957

114 245 Cheltenham and Tewkesbury PCT South West 98.89 0.106 12.843 77.476 17.654

275 246 Walsall Teaching PCT West Midlands 98.84 0.270 29.276 51.290 16.178

146 247 Shropshire County PCT

West Midlands 98.83 0.053 15.403 68.507 18.079

202 248 Dacorum PCT East Of England 98.82 0.159 9.471 67.164 15.103

284 249 Eastern Leicester PCT East Midlands 98.76 0.643 28.720 59.493 13.167

274 250 Barnet PCT London 98.69 0.617 17.529 70.978 14.463

43 251 South and East Dorset PCT South West 98.68 0.063 10.799 75.394 26.929

210 252 St Helens PCT North West 98.65 0.045 32.122 62.402 15.596

185 253 Fareham and Gosport PCT South Central 98.65 0.066 11.309 58.680 16.904

130 254 Darlington PCT North East 98.62 0.066 24.611 71.589 17.024

283 255 Oldbury and Smethwick PCT

West Midlands 98.60 0.535 35.814 70.157 16.038

74 256 Cheshire West PCT North West 98.56 0.084 15.515 79.607 17.634

252 257 Leeds West PCT Yorkshire and the Humber 98.56 0.133 28.627 54.616 15.123

266 258 Medway PCT South East Coast 98.53 0.146 17.605 50.712 12.734

225 259 Maldon and South Chelmsford PCT

East Of England 98.53 0.070 9.305 55.357 14.029

163 260 Derwentside PCT North East 98.53 0.027 28.268 64.878 17.335

190 261 Warrington PCT North West 98.48 0.076 19.337 61.116 14.151


Raw Score Rank



Age 65+

233 262 Northampton PCT East Midlands 98.46 0.220 19.366 63.492 13.892

217 263 Bromley PCT London 98.45 0.250 13.157 67.235 16.854

273 264 North Liverpool PCT North West 98.44 0.067 55.272 66.573 14.605

230 265 South East Hertfordshire PCT

East Of England 98.42 0.154 11.081 64.047 14.546

172 266 Newark and Sherwood PCT

East Midlands 98.37 0.060 19.706 64.057 17.324

209 267 Doncaster Central PCT


42 268 South Wiltshire PCT South West 98.35 0.070 11.695 98.975 18.063

249 269 Southend On Sea PCT East Of England 98.35 0.136 21.661 58.999 19.183

246 270 Halton PCT North West 98.30 0.047 34.278 58.946 13.539

224 271 North East Lincolnshire PCT


94 272 Northumberland Care Trust North East 98.22 0.038 21.892 78.052 17.591

232 273 Hartlepool PCT North East 98.22 0.039 37.695 64.436 16.227

127 274 Lincolnshire South West Teaching PCT

East Midlands 98.18 0.063 12.483 69.778 16.676

254 275 Ashfield PCT East Midlands 98.15 0.037 28.502 48.804 16.001

194 276 South Gloucestershire PCT South West 98.13 0.081 9.813 66.911 14.381

176 277 Erewash PCT East Midlands 98.12 0.068 19.257 68.279 15.828

264 278 Harlow PCT East Of England 98.09 0.158 21.359 65.640 14.701

242 279 Witham, Braintree and Halstead Care Trust

East Of England 98.08 0.081 13.522 56.675 14.753

255 280 Kingston PCT London 98.05 0.416 11.613 74.497 13.366

106 281 North Somerset PCT South West 98.04 0.064 14.113 85.595 19.295

129 282 Sheffield South West PCT


169 283 Adur, Arun and Worthing PCT

South East Coast 98.01 0.098 16.065 66.688 23.881

258 284 North Hertfordshire and Stevenage PCT

East Of England 97.95 0.192 12.839 60.485 15.191

237 285 Billericay, Brentwood and Wickford PCT

East Of England 97.79 0.119 9.055 60.013 17.140

296 286 Hounslow PCT London 97.62 0.650 23.075 66.350 11.476

257 287 South East Sheffield PCT


251 288 Swindon PCT South West 97.38 0.164 16.856 70.500 13.722

282 289 Rowley Regis and Tipton PCT

West Midlands 97.38 0.223 35.122 62.800 15.596

183 290 Leeds North East PCT Yorkshire and the Humber 97.14 0.332 19.422 98.870 17.613


Raw Score Rank



Age 65+

227 291 Stockport PCT North West 97.02 0.137 18.062 64.624 16.522

200 292 Wyre PCT North West 97.00 0.047 17.795 57.324 22.175

300 293 Brent Teaching PCT London 96.86 0.845 25.715 74.053 11.477

289 294 Wednesbury and West Bromwich PCT

West Midlands 96.82 0.364 35.291 65.291 17.581

286 295 Thurrock PCT East Of England 96.66 0.138 21.213 49.105 13.051

301 296 Slough PCT South Central 96.02 0.622 20.885 57.007 11.672

298 297 Barking and Dagenham PCT London 95.83 0.342 31.315 49.842 14.710

295 298 Basildon PCT East Of England 95.51 0.109 27.963 59.264 14.078

247 299 West Wiltshire PCT South West 95.46 0.077 11.959 75.750 17.214

280 300 Crawley PCT South East Coast 95.35 0.282 14.728 74.085 14.696

277 301 Castle Point and Rochford PCT

East Of England 95.34 0.065 10.809 56.463 17.249

303 302 Bradford City Teaching PCT


290 303 Havering PCT London 94.06 0.152 14.779 53.932 17.692


Acute trusts in alphabetical order

RawScore Rank

PIRank Trust Name Region Performance

Index EF Under 16 Over 65 IMD

8 10Aintree University Hospitals NHS Foundation Trust

North West 104.6 0.1133 19.21 15.37 46.53

14 3 Airedale NHS Trust Yorkshire and the Humber 106.2 0.3271 21.55 14.68 28.31

128 135 Ashford And St Peter’s Hospitals NHS Trust

South East Coast 96.3 0.2783 19.64 14.97 10.02

144 93Barking, Havering And Redbridge Hospitals NHS Trust

London 99.3 0.4509 21.85 13.94 22.29

131 67Barnet And Chase Farm Hospitals NHS Trust

London 100.7 0.5993 19.55 14.34 16.09

92 100 Barnsley Hospital NHS Foundation Trust


113 35 Barts And The London NHS Trust London 102.4 0.7353 19.23 8.79 42.12

98 94

Basildon And Thurrock University Hospitals NHS Foundation Trust

East of England 99.3 0.1241 19.87 16.31 16.02

18 13Basingstoke and North Hampshire NHS Foundation Trust

South Central 104.2 0.1790 20.02 13.21 9.29

73 56 Bedford Hospital NHS Trust

East of England 101.1 0.2257 20.39 13.66 13.82

57 90Blackpool, Fylde And Wyre Hospitals NHS Trust

North West 99.4 0.1202 17.87 19.43 22.53

17 11 Bolton Hospitals NHS Trust North West 104.5 0.1617 20.15 15.18 29.20

125 105Bradford Teaching Hospitals NHS Foundation Trust


28 61Brighton And Sussex University Hospitals NHS Trust

South Central 100.9 0.1540 17.45 18.40 18.12

36 1 Bromley Hospitals NHS Trust London 108.5 0.3169 20.15 15.77 16.58

124 120 Buckinghamshire Hospitals NHS Trust South Central 97.4 0.2936 20.39 15.75 10.39

70 68 Burton Hospitals NHS Trust

West Midlands 100.7 0.1583 19.72 15.73 20.25

53 29Calderdale And Huddersfield NHS Foundation Trust


21 28Cambridge University Hospitals NHS Foundation Trust

East of England 102.8 0.1751 18.77 14.53 9.81


RawScore Rank



42 57

Central Manchester And Manchester Children’s University Hospitals NHS Trust

North West 101.1 0.3757 18.57 12.96 41.00

79 76Chelsea And Westminster Hospital NHS Foundation Trust

London 100.2 0.6354 14.48 10.47 23.76

91 115Chesterfield Royal Hospital NHS Foundation Trust

East Midlands 97.8 0.0887 18.17 17.71 26.12

99 118City Hospitals Sunderland NHS Foundation Trust

North East 97.7 0.0562 18.39 17.26 34.86

111 138Countess Of Chester Hospital NHS Foundation Trust

North West 96.0 0.1027 18.30 16.95 28.50

25 17County Durham And Darlington NHS Foundation Trust

North East 103.3 0.0761 19.54 16.17 27.76

48 20 Dartford And Gravesham NHS Trust

South East Coast 103.1 0.1991 20.72 15.20 18.29

78 80 Derby Hospitals NHS Foundation Trust

East Midlands 99.9 0.1600 19.51 15.81 21.34

51 43Doncaster And Bassetlaw Hospitals NHS Foundation Trust


117 127 Dudley Group Of Hospitals NHS Trust

West Midlands 97.1 0.2650 19.73 17.29 27.91

151 150 Ealing Hospital NHS Trust London 91.3 0.7176 19.38 11.28 21.53

97 77East And North Hertfordshire NHS Trust

East of England 100.2 0.2939 20.71 14.43 13.83

45 54 East Cheshire NHS Trust North West 101.2 0.1221 18.83 17.45 18.36

55 63 East Kent Hospitals NHS Trust

South East Coast 100.9 0.1036 19.17 18.27 19.20

95 65 East Lancashire Hospitals NHS Trust North West 100.8 0.2257 21.24 14.77 25.20

37 46 East Sussex Hospitals NHS Trust South Central 101.5 0.1009 18.82 20.96 16.60

110 36Epsom And St Helier University Hospitals NHS Trust

London 102.4 0.5339 19.12 12.59 16.10

75 97 Essex Rivers Healthcare NHS Trust

East of England 99.2 0.1047 18.58 18.07 17.27

38 31 Frimley Park Hospital NHS Foundation Trust

South East Coast 102.7 0.1808 20.05 13.74 7.15

67 99 Gateshead Health NHS Foundation Trust North East 99.0 0.1057 18.07 15.75 34.39

138 146 George Eliot Hospital NHS Trust

West Midlands 94.0 0.2347 19.37 15.00 22.08

24 37Gloucestershire Hospitals NHS Foundation Trust

South West 102.3 0.1010 18.62 18.29 13.08


RawScore Rank



116 92 Good Hope Hospital NHS Trust

West Midlands 99.4 0.4674 21.94 14.93 33.30

43 4 Guy’s And St Thomas’ NHS Foundation Trust London 106.0 0.7341 17.91 9.18 38.77

100 62 Hammersmith Hospitals NHS Trust London 100.9 0.7333 16.31 10.47 28.95

20 49 Harrogate And District NHS Foundation Trust


88 24 Heart Of England NHS Foundation Trust

West Midlands 102.9 0.5839 23.09 13.48 39.64

120 122Heatherwood And Wexham Park Hospitals NHS Trust

South Central 97.4 0.4332 20.26 14.01 15.02

112 132 Hereford Hospitals NHS Trust

West Midlands 96.5 0.0857 18.81 18.21 16.11

132 40 Hillingdon Hospital NHS Trust London 101.7 0.6360 20.68 12.54 20.35

4 5 Hinchingbrooke Health Care NHS Trust

East of England 105.5 0.2099 18.99 14.15 13.58

136 45Homerton University Hospital NHS Foundation Trust

London 101.6 0.7649 21.23 8.86 43.06

56 73Hull And East Yorkshire Hospitals NHS Trust


19 33 Ipswich Hospital NHS Trust

East of England 102.5 0.1060 18.44 19.14 16.56

60 104James Paget University Hospitals NHS Foundation Trust

East of England 98.6 0.0689 17.30 19.80 19.30

74 69 Kettering General Hospital NHS Trust

East Midlands 100.7 0.1533 19.97 14.91 15.68

61 8King’s College Hospital NHS Foundation Trust

London 104.9 0.6992 17.92 9.11 33.80

134 101 Kingston Hospital NHS Trust London 98.9 0.4104 18.47 12.79 11.33

114 121Lancashire Teaching Hospitals NHS Foundation Trust

North West 97.4 0.1991 19.88 15.90 21.31

58 89 Leeds Teaching Hospitals NHS Trust


146 137 Lewisham Hospital NHS Trust London 96.0 0.5934 19.04 10.87 29.12

140 144Luton And Dunstable Hospital NHS Foundation Trust

East of England 95.0 0.2921 20.85 14.29 13.30

133 141Maidstone And Tunbridge Wells NHS Trust

South East Coast 95.3 0.1177 20.30 15.04 13.79

149 145 Mayday Healthcare NHS Trust London 94.8 0.5939 19.90 11.75 21.56

129 133 Medway NHS Trust South East Coast 96.5 0.1330 20.63 14.63 16.79


RawScore Rank



126 142 Mid Cheshire Hospitals NHS Trust North West 95.2 0.0807 18.64 16.96 19.80

31 21 Mid Essex Hospital Services NHS Trust

South East Coast 103.1 0.1013 19.75 15.70 12.06

80 96Mid Staffordshire General Hospitals NHS Trust

West Midlands 99.2 0.0889 18.94 16.59 20.31

121 125 Mid Yorkshire Hospitals NHS Trust


62 34 Milton Keynes General Hospital NHS Trust South Central 102.5 0.2442 21.08 12.67 14.00

1 2Newcastle Upon Tyne Hospitals NHS Foundation Trust

North East 106.4 0.1112 17.81 16.33 33.12

148 107 Newham University Hospital NHS Trust London 98.6 0.7625 22.37 8.96 37.22

2 7Norfolk And Norwich University Hospital NHS Trust

East of England 105.0 0.0686 17.15 19.78 16.26

29 53 North Bristol NHS Trust South West 101.3 0.1687 17.91 14.46 20.68

65 66 North Cheshire Hospitals NHS Trust North West 100.8 0.0578 19.77 15.14 27.73

49 82 North Cumbria Acute Hospitals NHS Trust North West 99.9 0.0469 17.70 18.84 21.91

150 148North Middlesex University Hospital NHS Trust

London 93.6 0.6849 20.90 11.03 30.95

64 60 North Tees And Hartlepool NHS Trust North East 100.9 0.0689 19.78 16.45 35.26

143 113 North West London Hospitals NHS Trust London 97.9 0.7468 19.95 13.06 19.21

123 126 Northampton General Hospital NHS Trust

East Midlands 97.1 0.1760 20.11 13.71 15.35

44 85 Northern Devon Healthcare NHS Trust South West 99.7 0.0616 17.37 19.77 18.74

68 83Northern Lincolnshire And Goole Hospitals NHS Trust


63 103Northumbria Healthcare NHS Foundation Trust

North East 98.7 0.0851 17.60 16.88 29.53

47 81 Nottingham University Hospitals NHS Trust

East Midlands 99.9 0.2213 17.67 14.81 27.87

39 41 Oxford Radcliffe Hospitals NHS Trust South Central 101.7 0.1969 19.08 14.30 10.55

59 42 Pennine Acute Hospitals NHS Trust North West 101.7 0.3442 20.14 13.65 42.99

15 12Peterborough And Stamford Hospitals NHS Foundation Trust

East of England 104.4 0.1356 19.78 16.25 16.30

5 14 Plymouth Hospitals NHS Trust South West 104.0 0.0593 17.66 18.90 20.90


RawScore Rank



13 55 Poole Hospital NHS Trust South West 101.2 0.0889 16.65 23.09 14.85

40 70 Portsmouth Hospitals NHS Trust South Central 100.7 0.0916 18.12 17.44 16.89

122 124 Princess Alexandra Hospital NHS Trust

South East Coast 97.2 0.2508 20.17 15.13 15.61

86 116Queen Elizabeth Hospital King’s Lynn NHS Trust

East of England 97.7 0.1014 17.93 20.44 17.65

135 48 Queen Elizabeth Hospital NHS Trust London 101.4 0.5671 20.94 11.22 29.90

147 130 Queen Mary’s Sidcup NHS Trust London 96.7 0.2884 20.09 15.90 17.77

83 91 Rotherham NHS Foundation Trust


77 74 Royal Berkshire NHS Foundation Trust South Central 100.4 0.2191 19.90 13.27 9.23

30 87

Royal Bournemouth And Christchurch Hospitals NHS Foundation Trust

South West 99.6 0.0887 16.39 23.45 14.88

6 16 Royal Cornwall Hospitals NHS Trust South West 103.6 0.0617 17.55 19.30 25.02

7 26Royal Devon And Exeter NHS Foundation Trust

South West 102.9 0.0635 16.86 21.29 18.45

118 106 Royal Free Hampstead NHS Trust London 98.6 0.6999 15.80 10.14 33.10

41 52Royal Liverpool And Broadgreen University Hospitals NHS Trust

North West 101.3 0.1309 18.80 15.27 47.07

82 84 Royal Surrey County Hospital NHS Trust

South East Coast 99.8 0.1823 19.58 15.35 7.05

106 134 Royal United Hospital Bath NHS Trust South West 96.4 0.1474 18.19 15.79 19.35

9 32 Royal West Sussex NHS Trust South Central 102.6 0.0996 17.45 20.10 17.73

46 25 Royal Wolverhampton Hospitals NHS Trust

West Midlands 102.9 0.3082 20.57 16.63 30.91

50 72 Salford Royal NHS Foundation Trust North West 100.6 0.3098 18.70 13.96 36.77

87 117 Salisbury NHS Foundation Trust South West 97.7 0.1171 17.92 17.73 12.97

76 22Sandwell And West Birmingham Hospitals NHS Trust

West Midlands 103.0 0.6704 22.37 12.84 40.49

81 114Scarborough And North East Yorkshire Health Care NHS Trust


10 15Sheffield Teaching Hospitals NHS Foundation Trust


101 112Sherwood Forest Hospitals NHS Foundation Trust

East Midlands 97.9 0.0668 18.90 16.42 28.72


RawScore Rank



71 86Shrewsbury And Telford Hospital NHS Trust

West Midlands 99.6 0.0990 18.73 17.86 16.36

22 71South Devon Healthcare NHS Foundation Trust

South West 100.7 0.0641 16.86 20.56 18.02

34 30 South Tees Hospitals NHS Trust North East 102.8 0.0747 19.82 16.10 31.52

52 78 South Tyneside NHS Foundation Trust North East 100.1 0.0734 18.25 17.08 33.85

35 50South Warwickshire General Hospitals NHS Trust

West Midlands 101.4 0.2702 18.66 16.22 18.78

115 139Southampton University Hospitals NHS Trust

South Central 95.6 0.1288 18.20 15.86 13.78

54 44Southend University Hospital NHS Foundation Trust

East of England 101.6 0.0942 19.77 16.72 17.36

96 111Southport And Ormskirk Hospital NHS Trust

North West 98.0 0.0627 18.48 18.72 25.42

94 38 St George’s Healthcare NHS Trust London 102.3 0.6055 17.24 10.40 21.17

27 23St Helens And Knowsley Hospitals NHS Trust

North West 103.0 0.0797 19.34 15.77 39.16

102 102 St Mary’s NHS Trust London 98.7 0.7103 14.51 10.65 29.88

104 123 Stockport NHS Foundation Trust North West 97.2 0.2319 18.74 15.03 27.80

145 151 Surrey And Sussex Healthcare NHS Trust

South East Coast 91.2 0.2310 19.57 16.04 9.90

84 75Swindon And Marlborough NHS Trust

South West 100.3 0.1086 20.25 15.42 11.01

139 140Tameside And Glossop Acute Services NHS Trust

North West 95.5 0.2259 21.23 14.47 35.43

11 27 Taunton And Somerset NHS Trust South West 102.9 0.0547 18.01 21.55 16.52

141 149 Trafford Healthcare NHS Trust North West 91.4 0.2556 18.38 14.40 31.97

16 39 United Bristol Healthcare NHS Trust South West 102.2 0.1693 17.78 14.73 20.83

107 131 United Lincolnshire Hospitals NHS Trust

East Midlands 96.6 0.0596 18.45 18.18 18.97

90 88University College London Hospitals NHS Foundation Trust

London 99.5 0.6891 14.41 10.20 33.73

72 19University Hospital Birmingham NHS Foundation Trust

West Midlands 103.2 0.6348 22.40 12.90 39.28

32 51University Hospital Of North Staffordshire NHS Trust

West Midlands 101.3 0.0845 18.13 17.20 23.30


RawScore Rank



3 6University Hospital of South Manchester NHS Foundation Trust

North West 105.0 0.3203 18.33 14.40 28.12

108 129

University Hospitals Coventry And Warwickshire NHS Trust

West Midlands 97.0 0.2580 19.18 15.65 21.40

130 143University Hospitals Of Leicester NHS Trust

East Midlands 95.1 0.3766 19.42 14.54 19.83

23 58University Hospitals of Morecambe Bay NHS Trust

North West 101.1 0.0562 17.31 20.01 18.88

142 147 Walsall Hospitals NHS Trust

West Midlands 93.7 0.3440 20.94 16.31 32.39

33 59 West Dorset General Hospitals NHS Trust South West 100.9 0.0700 17.77 21.29 14.81

109 108 West Hertfordshire Hospitals NHS Trust

East of England 98.3 0.2928 20.57 15.02 11.73

137 98West Middlesex University Hospital NHS Trust

London 99.1 0.6408 18.97 11.51 19.42

69 79 West Suffolk Hospitals NHS Trust

East of England 100.0 0.1400 19.03 16.96 13.06

105 136 Weston Area Health NHS Trust South West 96.1 0.1170 17.68 16.88 19.81

119 9Whipps Cross University Hospital NHS Trust

London 104.8 0.7534 22.03 10.15 33.48

127 95 Whittington Hospital NHS Trust London 99.3 0.6779 17.15 9.76 34.89

89 110Winchester And Eastleigh Healthcare NHS Trust

South Central 98.0 0.1305 18.36 15.39 13.66

12 18 Wirral Hospital NHS Trust North West 103.2 0.1244 18.44 16.46 39.95

103 119 Worcestershire Acute Hospitals NHS Trust

West Midlands 97.5 0.0875 18.87 17.22 15.25

85 128Worthing And Southlands Hospitals NHS Trust

South East Coast 97.1 0.1479 17.22 19.11 18.92

66 64 Wrightington, Wigan And Leigh NHS Trust North West 100.8 0.0968 19.81 15.31 28.07

93 109 Yeovil District Hospital NHS Foundation Trust South West 98.3 0.0595 18.67 20.38 14.79

26 47 York Hospitals NHS Trust



Acute trusts in rank order

Raw Score Rank


Index

Ethnic Fraction-alisation

Under 16 Over 65 IMD

36 1 Bromley Hospitals NHS Trust London 108.5 0.3169 20.15 15.77 16.58

1 2The Newcastle Upon Tyne Hospitals NHS Foundation Trust

North East 106.4 0.1112 17.81 16.33 33.12

14 3 Airedale NHS Trust Yorkshire and the Humber 106.2 0.3271 21.55 14.68 28.31

43 4 Guy’s And St Thomas’ NHS Foundation Trust London 106.0 0.7341 17.91 9.18 38.77

4 5 Hinchingbrooke Health Care NHS Trust

East of England 105.5 0.2099 18.99 14.15 13.58

3 6University Hospital of South Manchester NHS Foundation Trust

North West 105.0 0.3203 18.33 14.40 28.12

2 7Norfolk And Norwich University Hospital NHS Trust

East of England 105.0 0.0686 17.15 19.78 16.26

61 8King’s College Hospital NHS Foundation Trust

London 104.9 0.6992 17.92 9.11 33.80

119 9Whipps Cross University Hospital NHS Trust

London 104.8 0.7534 22.03 10.15 33.48

8 10Aintree University Hospitals NHS Foundation Trust

North West 104.6 0.1133 19.21 15.37 46.53

17 11 Bolton Hospitals NHS Trust North West 104.5 0.1617 20.15 15.18 29.20

15 12Peterborough And Stamford Hospitals NHS Foundation Trust

East of England 104.4 0.1356 19.78 16.25 16.30

18 13Basingstoke and North Hampshire NHS Foundation Trust

South Central 104.2 0.1790 20.02 13.21 9.29

5 14 Plymouth Hospitals NHS Trust South West 104.0 0.0593 17.66 18.90 20.90

10 15Sheffield Teaching Hospitals NHS Foundation Trust


6 16 Royal Cornwall Hospitals NHS Trust South West 103.6 0.0617 17.55 19.30 25.02

25 17County Durham And Darlington NHS Foundation Trust

North East 103.3 0.0761 19.54 16.17 27.76

12 18 Wirral Hospital NHS Trust North West 103.2 0.1244 18.44 16.46 39.95

72 19University Hospital Birmingham NHS Foundation Trust

West Midlands 103.2 0.6348 22.40 12.90 39.28

48 20 Dartford And Gravesham NHS Trust

South East Coast 103.1 0.1991 20.72 15.20 18.29


Raw Score Rank


Index



31 21 Mid Essex Hospital Services NHS Trust

South East Coast 103.1 0.1013 19.75 15.70 12.06

76 22Sandwell And West Birmingham Hospitals NHS Trust

West Midlands 103.0 0.6704 22.37 12.84 40.49

27 23St Helens And Knowsley Hospitals NHS Trust

North West 103.0 0.0797 19.34 15.77 39.16

88 24 Heart Of England NHS Foundation Trust

West Midlands 102.9 0.5839 23.09 13.48 39.64

46 25The Royal Wolverhampton Hospitals NHS Trust

West Midlands 102.9 0.3082 20.57 16.63 30.91

7 26Royal Devon And Exeter NHS Foundation Trust

South West 102.9 0.0635 16.86 21.29 18.45

11 27 Taunton And Somerset NHS Trust South West 102.9 0.0547 18.01 21.55 16.52

21 28Cambridge University Hospitals NHS Foundation Trust

East of England 102.8 0.1751 18.77 14.53 9.81

53 29Calderdale And Huddersfield NHS Foundation Trust


34 30 South Tees Hospitals NHS Trust North East 102.8 0.0747 19.82 16.10 31.52

38 31 Frimley Park Hospital NHS Foundation Trust

South East Coast 102.7 0.1808 20.05 13.74 7.15

9 32 Royal West Sussex NHS Trust South Central 102.6 0.0996 17.45 20.10 17.73

19 33 Ipswich Hospital NHS Trust

East of England 102.5 0.1060 18.44 19.14 16.56

62 34 Milton Keynes General Hospital NHS Trust South Central 102.5 0.2442 21.08 12.67 14.00

113 35 Barts And The London NHS Trust London 102.4 0.7353 19.23 8.79 42.12

110 36Epsom And St Helier University Hospitals NHS Trust

London 102.4 0.5339 19.12 12.59 16.10

24 37Gloucestershire Hospitals NHS Foundation Trust

South West 102.3 0.1010 18.62 18.29 13.08

94 38 St George’s Healthcare NHS Trust London 102.3 0.6055 17.24 10.40 21.17

16 39 United Bristol Healthcare NHS Trust South West 102.2 0.1693 17.78 14.73 20.83

132 40 The Hillingdon Hospital NHS Trust London 101.7 0.6360 20.68 12.54 20.35

39 41 Oxford Radcliffe Hospitals NHS Trust South Central 101.7 0.1969 19.08 14.30 10.55

59 42 Pennine Acute Hospitals NHS Trust North West 101.7 0.3442 20.14 13.65 42.99

51 43Doncaster And Bassetlaw Hospitals NHS Foundation Trust



Raw Score Rank


Index



54 44Southend University Hospital NHS Foundation Trust

East of England 101.6 0.0942 19.77 16.72 17.36

136 45Homerton University Hospital NHS Foundation Trust

London 101.6 0.7649 21.23 8.86 43.06

37 46 East Sussex Hospitals NHS Trust South Central 101.5 0.1009 18.82 20.96 16.60

26 47 York Hospitals NHS Trust


135 48 Queen Elizabeth Hospital NHS Trust London 101.4 0.5671 20.94 11.22 29.90

20 49 Harrogate And District NHS Foundation Trust


35 50South Warwickshire General Hospitals NHS Trust

West Midlands 101.4 0.2702 18.66 16.22 18.78

32 51University Hospital Of North Staffordshire NHS Trust

West Midlands 101.3 0.0845 18.13 17.20 23.30

41 52Royal Liverpool And Broadgreen University Hospitals NHS Trust

North West 101.3 0.1309 18.80 15.27 47.07

29 53 North Bristol NHS Trust South West 101.3 0.1687 17.91 14.46 20.68

45 54 East Cheshire NHS Trust North West 101.2 0.1221 18.83 17.45 18.36

13 55 Poole Hospital NHS Trust South West 101.2 0.0889 16.65 23.09 14.85

73 56 Bedford Hospital NHS Trust

East of England 101.1 0.2257 20.39 13.66 13.82

42 57

Central Manchester And Manchester Children’s University Hospitals NHS Trust

North West 101.1 0.3757 18.57 12.96 41.00

23 58University Hospitals of Morecambe Bay NHS Trust

North West 101.1 0.0562 17.31 20.01 18.88

33 59 West Dorset General Hospitals NHS Trust South West 100.9 0.0700 17.77 21.29 14.81

64 60 North Tees And Hartlepool NHS Trust North East 100.9 0.0689 19.78 16.45 35.26

28 61Brighton And Sussex University Hospitals NHS Trust

South Central 100.9 0.1540 17.45 18.40 18.12

100 62 Hammersmith Hospitals NHS Trust London 100.9 0.7333 16.31 10.47 28.95

55 63 East Kent Hospitals NHS Trust

South East Coast 100.9 0.1036 19.17 18.27 19.20

66 64 Wrightington, Wigan And Leigh NHS Trust North West 100.8 0.0968 19.81 15.31 28.07

95 65 East Lancashire Hospitals NHS Trust North West 100.8 0.2257 21.24 14.77 25.20

65 66 North Cheshire Hospitals NHS Trust North West 100.8 0.0578 19.77 15.14 27.73


Raw Score Rank


Index



131 67Barnet And Chase Farm Hospitals NHS Trust

London 100.7 0.5993 19.55 14.34 16.09

70 68 Burton Hospitals NHS Trust

West Midlands 100.7 0.1583 19.72 15.73 20.25

74 69 Kettering General Hospital NHS Trust

East Midlands 100.7 0.1533 19.97 14.91 15.68

40 70 Portsmouth Hospitals NHS Trust South Central 100.7 0.0916 18.12 17.44 16.89

22 71South Devon Healthcare NHS Foundation Trust

South West 100.7 0.0641 16.86 20.56 18.02

50 72 Salford Royal NHS Foundation Trust North West 100.6 0.3098 18.70 13.96 36.77

56 73Hull And East Yorkshire Hospitals NHS Trust


77 74 Royal Berkshire NHS Foundation Trust South Central 100.4 0.2191 19.90 13.27 9.23

84 75Swindon And Marlborough NHS Trust

South West 100.3 0.1086 20.25 15.42 11.01

79 76Chelsea And Westminster Hospital NHS Foundation Trust

London 100.2 0.6354 14.48 10.47 23.76

97 77East And North Hertfordshire NHS Trust

East of England 100.2 0.2939 20.71 14.43 13.83

52 78 South Tyneside NHS Foundation Trust North East 100.1 0.0734 18.25 17.08 33.85

69 79 West Suffolk Hospitals NHS Trust

East of England 100.0 0.1400 19.03 16.96 13.06

78 80 Derby Hospitals NHS Foundation Trust

East Midlands 99.9 0.1600 19.51 15.81 21.34

47 81 Nottingham University Hospitals NHS Trust

East Midlands 99.9 0.2213 17.67 14.81 27.87

49 82 North Cumbria Acute Hospitals NHS Trust North West 99.9 0.0469 17.70 18.84 21.91

68 83Northern Lincolnshire And Goole Hospitals NHS Trust


82 84 Royal Surrey County Hospital NHS Trust

South East Coast 99.8 0.1823 19.58 15.35 7.05

44 85 Northern Devon Healthcare NHS Trust South West 99.7 0.0616 17.37 19.77 18.74

71 86Shrewsbury And Telford Hospital NHS Trust

West Midlands 99.6 0.0990 18.73 17.86 16.36

30 87

Royal Bournemouth And Christchurch Hospitals NHS Foundation Trust

South West 99.6 0.0887 16.39 23.45 14.88

90 88University College London Hospitals NHS Foundation Trust

London 99.5 0.6891 14.41 10.20 33.73


Raw Score Rank


Index



58 89 Leeds Teaching Hospitals NHS Trust


57 90Blackpool, Fylde And Wyre Hospitals NHS Trust

North West 99.4 0.1202 17.87 19.43 22.53

83 91 The Rotherham NHS Foundation Trust


116 92 Good Hope Hospital NHS Trust

West Midlands 99.4 0.4674 21.94 14.93 33.30

144 93Barking, Havering And Redbridge Hospitals NHS Trust

London 99.3 0.4509 21.85 13.94 22.29

98 94

Basildon And Thurrock University Hospitals NHS Foundation Trust

East of England 99.3 0.1241 19.87 16.31 16.02

127 95 The Whittington Hospital NHS Trust London 99.3 0.6779 17.15 9.76 34.89

80 96Mid Staffordshire General Hospitals NHS Trust

West Midlands 99.2 0.0889 18.94 16.59 20.31

75 97 Essex Rivers Healthcare NHS Trust

East of England 99.2 0.1047 18.58 18.07 17.27

137 98West Middlesex University Hospital NHS Trust

London 99.1 0.6408 18.97 11.51 19.42

67 99 Gateshead Health NHS Foundation Trust North East 99.0 0.1057 18.07 15.75 34.39

92 100 Barnsley Hospital NHS Foundation Trust


134 101 Kingston Hospital NHS Trust London 98.9 0.4104 18.47 12.79 11.33

102 102 St Mary’s NHS Trust London 98.7 0.7103 14.51 10.65 29.88

63 103Northumbria Healthcare NHS Foundation Trust

North East 98.7 0.0851 17.60 16.88 29.53

60 104James Paget University Hospitals NHS Foundation Trust

East of England 98.6 0.0689 17.30 19.80 19.30

125 105Bradford Teaching Hospitals NHS Foundation Trust


118 106 Royal Free Hampstead NHS Trust London 98.6 0.6999 15.80 10.14 33.10

148 107 Newham University Hospital NHS Trust London 98.6 0.7625 22.37 8.96 37.22

109 108 West Hertfordshire Hospitals NHS Trust

East of England 98.3 0.2928 20.57 15.02 11.73

93 109 Yeovil District Hospital NHS Foundation Trust South West 98.3 0.0595 18.67 20.38 14.79

89 110Winchester And Eastleigh Healthcare NHS Trust

South Central 98.0 0.1305 18.36 15.39 13.66


Raw Score Rank


Index



96 111Southport And Ormskirk Hospital NHS Trust

North West 98.0 0.0627 18.48 18.72 25.42

101 112Sherwood Forest Hospitals NHS Foundation Trust

East Midlands 97.9 0.0668 18.90 16.42 28.72

143 113 North West London Hospitals NHS Trust London 97.9 0.7468 19.95 13.06 19.21

81 114Scarborough And North East Yorkshire Health Care NHS Trust


91 115Chesterfield Royal Hospital NHS Foundation Trust

East Midlands 97.8 0.0887 18.17 17.71 26.12

86 116The Queen Elizabeth Hospital King’s Lynn NHS Trust

East of England 97.7 0.1014 17.93 20.44 17.65

87 117 Salisbury NHS Foundation Trust South West 97.7 0.1171 17.92 17.73 12.97

99 118City Hospitals Sunderland NHS Foundation Trust

North East 97.7 0.0562 18.39 17.26 34.86

103 119 Worcestershire Acute Hospitals NHS Trust

West Midlands 97.5 0.0875 18.87 17.22 15.25

124 120 Buckinghamshire Hospitals NHS Trust South Central 97.4 0.2936 20.39 15.75 10.39

114 121Lancashire Teaching Hospitals NHS Foundation Trust

North West 97.4 0.1991 19.88 15.90 21.31

120 122Heatherwood And Wexham Park Hospitals NHS Trust

South Central 97.4 0.4332 20.26 14.01 15.02

104 123 Stockport NHS Foundation Trust North West 97.2 0.2319 18.74 15.03 27.80

122 124The Princess Alexandra Hospital NHS Trust

South East Coast 97.2 0.2508 20.17 15.13 15.61

121 125 Mid Yorkshire Hospitals NHS Trust


123 126 Northampton General Hospital NHS Trust

East Midlands 97.1 0.1760 20.11 13.71 15.35

117 127 Dudley Group Of Hospitals NHS Trust

West Midlands 97.1 0.2650 19.73 17.29 27.91

85 128Worthing And Southlands Hospitals NHS Trust

South East Coast 97.1 0.1479 17.22 19.11 18.92

108 129

University Hospitals Coventry And Warwickshire NHS Trust

West Midlands 97.0 0.2580 19.18 15.65 21.40

147 130 Queen Mary’s Sidcup NHS Trust London 96.7 0.2884 20.09 15.90 17.77


Raw Score Rank


Index



107 131 United Lincolnshire Hospitals NHS Trust

East Midlands 96.6 0.0596 18.45 18.18 18.97

112 132 Hereford Hospitals NHS Trust

West Midlands 96.5 0.0857 18.81 18.21 16.11

129 133 Medway NHS Trust South East Coast 96.5 0.1330 20.63 14.63 16.79

106 134 Royal United Hospital Bath NHS Trust South West 96.4 0.1474 18.19 15.79 19.35

128 135 Ashford And St Peter’s Hospitals NHS Trust

South East Coast 96.3 0.2783 19.64 14.97 10.02

105 136 Weston Area Health NHS Trust South West 96.1 0.1170 17.68 16.88 19.81

146 137 The Lewisham Hospital NHS Trust London 96.0 0.5934 19.04 10.87 29.12

111 138Countess Of Chester Hospital NHS Foundation Trust

North West 96.0 0.1027 18.30 16.95 28.50

115 139Southampton University Hospitals NHS Trust

South Central 95.6 0.1288 18.20 15.86 13.78

139 140Tameside And Glossop Acute Services NHS Trust

North West 95.5 0.2259 21.23 14.47 35.43

133 141Maidstone And Tunbridge Wells NHS Trust

South East Coast 95.3 0.1177 20.30 15.04 13.79

126 142 The Mid Cheshire Hospitals NHS Trust North West 95.2 0.0807 18.64 16.96 19.80

130 143University Hospitals Of Leicester NHS Trust

East Midlands 95.1 0.3766 19.42 14.54 19.83

140 144Luton And Dunstable Hospital NHS Foundation Trust

East of England 95.0 0.2921 20.85 14.29 13.30

149 145 Mayday Healthcare NHS Trust London 94.8 0.5939 19.90 11.75 21.56

138 146 George Eliot Hospital NHS Trust

West Midlands 94.0 0.2347 19.37 15.00 22.08

142 147 Walsall Hospitals NHS Trust

West Midlands 93.7 0.3440 20.94 16.31 32.39

150 148North Middlesex University Hospital NHS Trust

London 93.6 0.6849 20.90 11.03 30.95

141 149 Trafford Healthcare NHS Trust North West 91.4 0.2556 18.38 14.40 31.97

151 150 Ealing Hospital NHS Trust London 91.3 0.7176 19.38 11.28 21.53

145 151 Surrey And Sussex Healthcare NHS Trust

South East Coast 91.2 0.2310 19.57 16.04 9.90


Appendix B – Regression analysisRegression analysis was carried out on the key dependent variables – patients’ ratings

of the acute trust or PCT. Multiple regression techniques allow us to assess which of a

selection of relevant independent variables are statistically related to a given dependent

variable when all other significant variables under consideration have been taken into

account. In this case, it allows us to analyse which factors listed below are significantly and

independently associated with the ratings received by health bodies. Multiple regression

allows us to explore the association between variables; however, evidence of an association

does not necessarily imply a causal relationship. The results presented here therefore

identify factors associated with high patient ratings.

The independent variables shown in the tables overleaf were considered as possible

drivers, and entered into the model using a stepwise approach.

Table 7: Key drivers of PCT patient ratings

Key drivers of PCT patient ratings

Independent variables used in regression analysis

Reference Costs



Percentage of population who are Under16

Percentage of population who are Over 65

Percentage of households that are owned outright by the occupier(s)



East of England

London

North East


North West

South Central

South East Coast

South West

East Midlands

West Midlands

Dependent variablePatient rating derived from individual survey questions (see Appendix C)


Table 8 Key drivers of inpatient ratings (individual aspects of care)

Table 9: Key drivers of inpatient ratings

Key drivers of inpatient ratings (individual aspects of care)


Q22. In your opinion, how clean was the hospital room or ward that you were in? (All)

Q23. How clean were the toilets and bathrooms that you used in hospital? (All)

Q26. When you had important questions to ask a doctor, did you get answers that you could understand? (All)

Q36. Were you involved as much as you wanted to be in decisions about your care and treatment? (All)

Q40. Were you given enough privacy when discussing your condition or treatment? (All)

Q41. Were you given enough privacy when being examined or treated? (All)

Q45. Do you think the hospital staff did everything they could to help control your pain? (Those who were ever in pain, i.e. Selected option 1 to Q44)

Q64. Overall, did you feel you were treated with respect and dignity while you were in the hospital? (All)

Dependent variableQ66. Overall, how would you rate the care you received? (All)

Key drivers of inpatient ratings


Reference Costs

Percentage of population who are Under 16

Percentage of population who are Over 65

Percentage of households that are owned outright by the occupier(s)



East of England

London

North East


North West

South Central

South East Coast

South West

East Midlands

West Midlands

Dependent variableQ66. Overall, how would you rate the care you received? (All)


Appendix C – Notes on the data

Limitations of the data

Both the PCT and the acute inpatient survey have been limited by the level and quality of

information on patient satisfaction collected in the two surveys. The PCT patient surveys do

not ask about overall satisfaction/ratings of care, hence the need to derive such a measure

from individual questions (see below). And, whilst the 2006 acute inpatient survey did ask

respondents to provide an overall assessment of the care they have received, this question

has a biased scale, with three positive and only one wholly negative response possible, as

follows:

Q. Overall, how would you rate the care you received?Excellent

Very good

Good

Fair

Poor

Moreover, the inpatient survey data that is in the public domain does not supply information

on the percentage of patients responding according to this pre-coded list. Instead it uses

a scoring system to arrive at a summary measure of overall ratings – where ‘excellent’ is

allocated 100 points, ‘very good’ is allocated 75 points, ‘good’ is allocated 50 points, ‘fair’

25 points and ‘poor’ zero points.

These measurement issues should be borne in mind when interpreting the findings

presented in this report.

Deriving PCT overall patient scores

The overall patient rating for Primary Care Trusts was calculated from 28 questionnaire items

from the 2005 PCT patient survey. The selection of the particular questions was based on

individual survey questions used in the old star rating system to score patient experience in

five ‘domains’:

• Access and waiting (5 questions)

• Safe, high quality co-ordinated care (5)

• Better information, more choice (10)

• Building relationships (3)

• Clean, comfortable, friendly place to be (5)


While this system is no longer in use, the range of items and methodology used was

considered the best overall measurement of the patient experience. It was also the closest

approximation to previous analysis conducted.

In calculating the PCT overall patient rating, each question was recoded onto a scale of

0-100. The most desirable option within the question was assigned the value 100, and the

least valuable assigned zero. Linear interpolation was used to calculate the intermediate

values. Where there is no clear direction of desirability, the largest or most affirmative

response was assigned the value of 100.

Each domain score was calculated by taking an unweighted average of each group of

responses per domain. No information is available regarding the relative importance of

each domain in contributing to positive patient experiences. Consequently, equal weight has

been given to each of the five domains in calculating this overall measure.

Due to changes in the questions posed on the respective PCT patient surveys in 2003 and

2005, the lists of questions from which the overall rating is composed are not identical. The

mean overall PCT score has increased from 0.770 for the 2003 survey to 0.801 for 2005

survey, though the extent to which this is attributable to the changes in constituent questions

is unknown. Although the interpretative text contained in the body of the report examines

differences between the two reports, it must be emphasised that caution is to be exercised

when making direct comparisons between the reports.

Calculating Acute trust boundaries

Acute trusts do not operate within defined boundaries in the same way as PCTs but much of

our own research has shown that patients tend to be referred to hospitals in their local area.

Therefore, it was considered reasonable to explore the effect of local population factors

for inpatient ratings of acute trusts. This required a method of calculating artificial trust

boundaries, to estimate the likely population from which patients would be drawn. Several

attempts were made to run different boundary schemes, assigning varying numbers of

Output Areas (as defined by the Census) to each trust to obtain the optimum figure, so that

every OA was allocated to a trust, while limiting any overlaps. It was found that a figure of

2100 resulted in the best overall scheme, so the nearest 2100 OAs were allocated to each

trust to calculate the boundary to be used in the analysis of the effects of local population

characteristics.

Notes



Further information

For more information on NHS research please contact:

Jonathan [email protected]

Anna [email protected]

Caroline [email protected]

Ben [email protected]

Alternatively you can call us on +44(0)20 7347 3000

Or visit our website at: http://www.ipsos-mori.com/nhs for information about our latest events, papers and thought leadership work.

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