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All Indicators > Indicator SA4: Quality of social care

Component SA4_1: Suicide

Additional details

The International Classification of Diseases Version 10 (ICD-10) codes used to extract data on deaths from suicide were X60-X84 and Y10-Y34 (excluding Y33.9 where the Coroner's verdict was pending).

For ethnic estimation a Super Output Areas (SOA) level weighting function was created to model incidence for individuals in ethnic groups within Local Authorities.

Component SA4_2: Emergency admissions of over 75s

Additional details

This indicator measures the effectiveness of care in supporting elderly patients in the community. An area with a small percentage of emergency admissions reflects good social care as the majority of visits to hospital will be planned elective admissions.

To control for differences in the age and gender structure across small areas, direct standardisation was used. Direct standardisation involves the application of small area age and gender structures to a standard population, which in this instance is derived from the HES data. This produces an expected number of events (emergency admissions of people over 75 years) in the standard population as if the risk profile of the individual areas was in place. This is contrasted with the actual number of observed events in the standard population to give a ratio. Thus a measure of higher or lower than expected occurrence of emergency admissions of people over 75 years is created.

For indicators derived from the Hospital Episode Statistics (HES) the estimates are based on the relationship between all hospital stays, and those recorded for a specific condition of interest. Detail is added from census data to depict the spatial distribution of individuals in ethnic groups. All estimates are statistically smoothed to reduce noise within the distribution, enabling the underlying trend to be highlighted.

Component SA4_3: Emergency psychiatric readmissions within 90 days of discharge

Additional details

The majority of patients being treated for mental health problems and their carers prefer community-based treatment. This indicator measures the level of social care received by individuals with severe mental illness to help them lead a life within their own community. The Care Programme Approach was introduced in 1991 to provide a framework for effective mental health care. The four main elements are:

• Systematic arrangements for assessing the health and social needs of people accepted into specialist mental health services
• The formation of a care plan which identifies the health and social care required from a variety of providers
• The appointment of a key worker to keep in close touch with the service user and to monitor and co-ordinate care
• Regular review and where necessary, agreed changes to the care plan

The National Service Framework for Mental Health (1999) has a standard for effective services for people with severe mental illness, which again emphasises the importance of regularly reviewed written care plans.

Thus a high proportion of readmissions to hospital within 90 days of discharge (the threshold set for the NHS Performance Indicators 2002) are evidence of ineffective care planning and poor provision of the mental health services required.

The International Classification of Diseases Version 10 (ICD-10) codes used to extract data on emergency admissions for psychiatric conditions were F0 – F9. Cases were used if one or more of these codes were found in any of the seven diagnosis fields in the HES dataset.

For indicators derived from the Hospital Episode Statistics (HES) the estimates are based on the relationship between all hospital stays, and those recorded for a specific condition of interest. Detail is added from census data to depict the spatial distribution of individuals in ethnic groups. All estimates are statistically smoothed to reduce noise within the distribution, enabling the underlying trend to be highlighted.