Introduction
Learning objectives:You will learn about how it is possible to measure health service provision and use.
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Resource text
Access
Average time for an ambulance to arrive from call time: Indicates whether ambulance provision reflects needs of the population, given its distribution.
General Practice provision
Either (whole time equivalent) doctors per 1000 population or (equivalently) average list size per whole time equivalent doctor. Mapped over a region, this can be useful in identifying under-provided areas. In England there are 65.7 GPs per 100,000 population. The average ratio of whole time equivalent GPs to practice nurses is 2.4:1.
Time to first GP appointment: Has been used as a measure of provision, but is really more of an indicator of management effectiveness.
UK patients have an average of 4.5 GP consultations each year. GPs have a median consultation length of 13.3 minutes.
Hospitals provision
Hospital doctors per 1000 catchment population, and beds/1000 catchment population: Both depend on the notion of a catchment population, which has rather vanished with the advent of commissioning. Catchment could be replaced by "commissioned-for".
Time to first routine elective admission, i.e. routine waiting list admission: This is a good indicator if the system is left to operate as a pure queuing process, but waiting times are a major political football, and various targets have been achieved with them without providing additional capacity, which may be an indication of management effectiveness rather than a measure of provision.
Time from fit for discharge to actual discharge of an elderly person: This is a good indicator of provision of support care in the community.
General and community provision: Any service many be measured in terms of the whole time equivalent (wte) staff or other resources available to it, using the appropriate population as denominator (e.g. district nurse wte/100 under 5 year olds).
Hospital usage
Outpatient Did Not Attend (DNA) rates: Indicate proportion of booked appointments not attended, so measure of utilisation of clinics. However, most hospitals intentionally overbook outpatient appointments to minimise this effect.
Bed occupancy: The ratio of occupied bed days to the days the bed is available for use. To enable adequate cleaning between patients, and to avoid placing patients in unsuitable beds (eg wrong specialty), this should generally not go above 85%. However, occupancy in excess of 90% is not unusual and contracts specifying 95% are not unknown. Such high occupancy can place strain on the ability of the hospital to cope. Closely related measures are: turnaround time, which is the average time between one patient being discharged from a bed and another patient being admitted to it, and hospital acquired infection rates.
Theatre utilisation: The proportion of scheduled operating theatre time that is actually used for surgery.
Public health and community services
Immunisation coverage is one measure used by the World Health Organisation to profile the public health provision of a country. In 2007, the coverage of measles-containing vaccine (first dose) in the UK was 86%. This is the highest it has been since 2000. The coverage in the UK fell following the publication of the notorious Wakefield paper in the Lancet in 1998, and the ensuing flood of media misinformation about the MMR vaccine.
WHO/UNICEF figures on national immunisation coverage are given in the World Health Organisation's Immunization surveillance, assessment and monitoring.