Appendix 1 - IJB Key Strategic Performance Report - Quarter One
Perth and Kinross Council · 29 October 2025
Back to Perth and Kinross Council — 29 October 2025 and its agenda
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1 PKC - GENERAL Perth & Kinross Integration Joint Board Audit & Performance Committee 27 October 2025 Key Strategic Performance Report – Quarter One Report by Chief Officer (Appendix 1) Purpose of Report This report provides the Audit and Performance Committee with an overview on HSCP performance at quarter one of 2025-2026 focusing on indicators agreed as part of the IJB approved Performance Framework. The report also includes some key highlights which demonstrate the extent to which the HSCP is delivering on the Integration Joint Board’s Strategic Plan 2024-2027. 1. Recommendation(s) 1.1 The Audit and Performance Committee (A&PC) is asked to: (i) Scrutinise strategic performance in relation to the delivery of integrated health and social care services. (ii) Approve the range of performance indicators included for future reporting. (iii) Request that the HSCP develops targets for key performance indicators ahead of the next report. 2. Background/Proposal 2.1 This is the first performance report of 2025-2026 and takes a revised format providing a wider range of performance indicators. The IJB approved the Performance Framework in June 2025, with the aim of bringing performance reporting closer to strategic planning of health and social care services so that the connections between planning, delivery, performance and improvement can be better understood and used to improve health and social care delivery. To put the framework into action, new plans are required for Older People, Adult Services, and Primary Care Services. These plans will explain what steps are being taken to deliver the Strategic Plan. They will include clear ways to measure progress and set stretching and future focused targets. Revised delivery plans are currently being drafted but are not yet finalised. During their development, several indicators have been identified that expand the range
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PKC - GENERAL and type of measures which can be reported routinely. A proposed list is set out in Appendix 1 and this report provides an overview of performance against these indicators to the end of Q1 (quarter one) of 2025-2026. 2.2 The data used in this report is the most up-to-date available. It is provided at an early stage and, in some instances, ahead of national publication. As further quality assurance is undertaken in respect to this data, it may change. It is however useful for management purposes and the readiness of the data is therefore balanced against the potential delays which would be necessary to validate the data more fully. Financial Context 2.3 The Health and Social Care Partnership delivered £12 million in savings between 2022 and 2025 and is projected to achieve an additional £2.5 million by the end of March 2026. This has been achieved through a financial strategy focusing on efficiency and redesign, including £1.1 million savings since 2023-2024 within central support and management functions, with a 15% savings target applied across all HSCP functions. These savings were achieved during a period of population growth and increasing need and Audit Scotland in September 2025 reported that significant progress had been made towards recurring savings targets. 2.4 Due to the significant level of savings and efficiencies already delivered within social care to meet additional population growth and increased demand, the remaining options to further reduce expenditure, without adversely affecting performance and outcomes, are limited and extremely challenging. Based on the most recent verified Local Financial Return (LFR) for 2023-2024, for the level of adult social care expenditure per 1,000 population, Perth and Kinross ranks as the 29th lowest of the 32 local authorities in Scotland. Further demonstrating that, to date, the social care budget has been managed efficiently and effectively; leaving the scope for achieving further material savings without impacting on service delivery or worsening outcomes for people who use services, very restricted. 2.5 The relationship between performance and the HSCP transformation programmes is central to addressing the financial position of the HSCP and achieving sustainable health and care services. Workstreams are prioritised with the dual aim of improving care and achieving greater efficiency. Workforce capacity, rising demand and increasing complexity present significant challenges and quarterly reporting on performance is fundamental to demonstrating impact in this challenging environment. 3. Overview The following provides an overview of key performance for quarter one of 2025- 2026. Services for Older People 3.1 Work is underway in transforming Services for Older People, shifting the balance of care for people aged 65+ from hospital-based to community-based models and enabling them to live independently at home or in a home-like setting for as long as possible. The key objectives are to prevent hospital admissions and support independent living and to improve hospital discharge and post-hospital support. 3.2 The transformation programme includes the establishment of integrated locality teams (via “hubs in each of the three localities) made up of health and social care
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PKC - GENERAL professionals that will identify and support people at risk of frailty, falls, and delirium early and include reablement and care at home staff with streamlined processes. These teams will also support smooth transitions home from hospital and prevent readmissions, strengthen links between hospital discharge teams, community hospitals, and care at home services, shift rehabilitation from hospitals to homes or step-down beds and ensure occupational therapy/physiotherapy services are available in the community. The Perth City Hub was established in November 2024 and the learning from this initial development is now being taken into the roll out of this model/approach to other areas with similar teams in the North and South Localities being assembled to work in similar ways. The programme is also working to develop a single point of contact for people, carers and professionals to access services more easily. 3.3 A new Discharge2Access (D2A) service redesigned internal care at home services and will replace HART+ and Living Well Care. Based in Perth Royal Infirmary and working across localities D2A will streamline processes and focus on urgent need ensuring care is available for people in the right place at the right time, to support them to live healthy, independent, and dignified lives. 3.4 Delivery of reablement support ensures better outcomes. Since January 2025 incremental improvements made to how services are accessed and delivered have improved performance significantly. This has led to a large reduction in unmet need (Chart 1 – unmet need for reablement support) and reduced people experiencing a delayed discharge from hospital (Chart 2 – Total number of hours of unmet need per week). In Q1 of 2025-2026 the number of hours yet to be provided has increased for people in hospital as well as in the community. The continuation of the transformation programme to implement the D2A model and integrated hubs will be essential to recovering the progress made from December 2024 to June 2025. Chart 1 Source: Adult Social Work Systems
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PKC - GENERAL Chart 2 Source: Adult Social Work Systems After a sharp increase during and after the pandemic, the HSCP has consistently reduced unmet need since August 2022 (Chart 3). People are now waiting less time for the support they need to live independently from the time they are identified as requiring social care support (both from hospital and in the community). This is ensuring that they get the right care at the right time and before their circumstances deteriorate and they require higher levels of personal care. Chart 3 Source: Adult Social Work Systems The number of attendances at Accident and Emergency (A&E) can provide insight on the level of demand for emergency care. Combined with other measures, like emergency admission, it can indicate how accessible other services are. For example, when people are unable to access the care they feel they need, they may resort to A&E. Making community-based services more accessible for people can help to limit demand on hospital-based services. Over the last year, to the end of Q1 2025-2026, A&E attendances for the 65+ population are broadly stable with a marginal upward trend.
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PKC - GENERAL Chart 4 Source Ministerial Steering Group Indicator 3a The number of admissions from A&E for the 65+ age group has also increased marginally however more than half of all people who attended A&E in this age group did not require admission to hospital. Chart 5 Source Ministerial Steering Group Indicator 1b People can be admitted to hospital as an emergency without attending A&E and over the same period overall emergency admissions have trended similarly.
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PKC - GENERAL Chart 6 Source Ministerial Steering Group Indicator 1a Chart 7 provides a similar view to chart 6 but expresses the measure per 100,000 people of 75+ (data for 65+ is not available currently). The trend is similar, which supports the indication that emergency admissions are rising as it removes the variability which comes from changes in population size. Chart 7 Source: Trakcare Looking more closely at where the rise in emergency admission occurs it indicates that most admissions of this type come from people residing in Perth City and that the rising trend exists in all GP cluster areas except Strathearn.
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PKC - GENERAL Chart 8 Source: Trakcare Once people have been admitted to hospital it is important that they are discharged as soon as it is safe to do so. There are a number of measures which are helpful in this respect. Unscheduled hospital bed days provides an overview of the consumption of inpatient bed days by the population. In Perth and Kinross unscheduled bed days (chart 9) have reduced over the last year, meaning that people stay in hospital for less time once admitted, and this is particularly the case in the first quarter of 2025-2026. Chart 9 Source: Ministerial Steering Group Indicator 2a This reduction can also be seen when expressed as a rate per 100,000 population which is helpful in describing overall performance as it removes variances in population size and allows for better comparisons. Although Tayside overall continues to have a lower rate of occupied bed days the gap is narrowing (improving) and it is anticipated that this trend will continue.
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PKC - GENERAL Chart 10 Source: Trakcare The average time that a person spends in hospital combines well with unscheduled bed days as it measures the ‘Average Length of Stay’ (ALOS) for a person and chart 11 shows that ALOS are significantly trending down (improving) over the reporting period. Chart 11 Source: Trakcare Reducing the number of days people spend in hospital when they are ready to be discharged (delayed discharge) is key to ensuring good outcomes for people when they transition to community-based care services. This is because they experience less of the negative impacts of bed rest. Prolonged periods in hospital can lead to significant physiological, psychological and functional decline also known as “deconditioning syndrome”. This can mean that people take much longer to recover their previous capabilities, if at all, and can unfortunately require greater care and support.
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PKC - GENERAL Chart 12 Source: Ministerial Steering Group Indicator 4 Delayed discharges (chart 12) have reduced significantly over the last year and this trend has continued into 2025-2026. The number of people experiencing a delay in their discharge has been reducing over time since 2022. The HSCP has maintained a position below the nationally determined rate for the last year. The national target is 34.6 delays per 100,000 people. National data shows that on 17 October 2025, the HSCP had 30.7 delays per 100,000 people across all sites and was maintaining a position lower than the Scottish average of 44.6 delays per 100,000 people. An alternative way to consider this measure is in relation to the percentage of people who are not delayed. Chart 13 shows that ‘discharges without delay’ have continued to improve to the extent that 98.2% of people were discharged without delay in Q1. For the 75+ population the average was 95.3%. Chart 13 Source: Trakcare Services for Adults 3.5 The transformation programme across services for adults is being updated as the current underpinning strategies come to an end in 2025. 3.6 For mental health services, a key focus will be alignment with the Tayside Mental Health whole system change programme to support a common approach and implement a Model of Care for Adult Mental Health in 2026. The redesign is focused
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PKC - GENERAL on ensuring sufficient services are in place to intervene at the earliest opportunity and prevent escalation. Drug and alcohol services are included in the community mental health redesign to remove any unhelpful or artificial boundaries and to support more coordinated and effective care. 3.7 Older people’s mental health services experience intense challenge with people living longer and presenting with high levels of frailty as well as cognitive deterioration. It is increasingly difficult to support people back into the community from hospital as care home placements for those with such complex needs are hard to find. Discussions are underway with Tayside partners to consider economies of scale along with proposals to strengthen enhanced community responses to both reduce the need for admission but also achieve safe and supported discharge into appropriate placements and avoid delay. 3.8 Services for people with a Learning Disability face specific challenges related to increasing demand, need and complexity and high costs. Individuals with very high levels of care requirements are supported within communities, placing new demands on services, but also the skills and expertise required from our workforce. Opportunities for service transformation are being taken forward with wider Tayside partners, both in terms of achieving economies of scale and to ensure that care providers are supported by a sufficient infrastructure to prevent breakdown. Collaborative commissioning and resource transfer approaches are being explored. The HSCP is working with Housing, Education, and Children’s social work services to establish a more streamlined and long-term approach to managing the increasing numbers and to support effective transitions., 3.9 Measuring the level of demand for emergency mental health care provides a good insight into how well people are able to access the right services in the community. Over the last year to the end of Q1 2025-2026, mental health attendances to A&E have improved steadily. Chart 14 Source: Trakcare Occupied bed days in mental health settings provides an indication of the extent to which people require inpatient support. Over the past year to the end of Q1 the number of occupied bed days used by the 18-64 population has remained stable across Perth and Kinross overall.
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PKC - GENERAL Chart 15 Source: Trakcare Occupied bed days for the populations of each locality have also remained broadly stable with only marginal increases seen for Perth City and South Perthshire. Chart 16 Source: Trakcare Delayed Discharges of mental health and learning disability patients increased in late 2024 but has improved significantly since then and has trended down (improved) over the course of the year. It should be noted that these delays relate to a very small number of people (approx. 5 or less). Some of these patients have been in long-stay hospitals and resourcing the right level of care for people within community settings when their needs can be very complex is challenging.
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PKC - GENERAL Chart 17 Source: Trakcare Psychiatry of Old Age (POA) - Demand for support through psychiatry of old age has remained largely stable overall in the last year in Perth and Kinross. Chart 18 Source: Trakcare This overall stability however masks significant increases in demand within Perth City where demand has increased by around 50% from last year (Chart 19).
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PKC - GENERAL Chart 19 Source: Trakcare Community Mental Health - Demand for Community Mental Health Services in Perth and Kinross mirrors that of Tayside more generally and has remained largely stable over the reporting year to the end of Q1 2025 (chart 20). However, chart 21 shows the variability in the demand for Mental Health services across different localities with Perth City seeing far greater demand. Chart 20 Source: Trakcare
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PKC - GENERAL Chart 21 Source: Trakcare Waiting times for people to access services remain high and have increased over the reporting period with the complexity of the conditions people present with being a factor in this. Chart 22 Source: Trakcare Recently the IJB received an update on the provision of Mental Health services in Perth and Kinross and across Tayside. This report is available here and describes work being undertaken to develop a new Community Mental Health and Wellbeing Strategy, and how this will link to the wider programme of improvement and a Model of Care for adult mental health which is being taken forward across Tayside. As this work develops, further performance measures are being agreed across Tayside and will be included within routine reporting. Primary Care Services 3.10 Health and Social Care Partnership Primary Care services cover a variety of managed services which support all aspects of delivery. Examples of this are Community Treatment and Care Services where the number of appointments being
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PKC - GENERAL offered, and the number booked, have increased since December 2024. This is improving access to this valuable service. Failure to attend appointments (DNA) rates relate to people who have booked appointments but ‘did not attend’ for their treatment. Reducing these instances to a minimum remains a priority. Chart 23 Source: Vision Similar to CTAC the First Contact Physio service is funded via primary care. The service offers people swift access to a physiotherapy consultation and treatment with appointments made via GP practices. Chart 24 shows the level of service demand over the past year with 12,256 appointments booked from an available 13,334, a service utilisation of 91.9%. For Q1 this has improved to an average utilisation of 95.3%. Chart 24 Source: FCP Dashboard/Vision Most (83.7%) people who accessed the service in the year to the end of Q1 were new to the service (chart 25).
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PKC - GENERAL Chart 25 Source: FCP Dashboard/Vision Outcomes for people accessing the service are also very good with 69.8% discharged from the service with no further need for treatment. Chart 26 Source: FCP Dashboard/Vision Workforce 3.11 Sickness absence across Health and Social Care services is recorded in slightly different ways across different systems for health and Council employees. Charts 27 and 28 show the trends over Q1 for Perth and Kinross Council and NHS Tayside staff working in the HSCP.
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PKC - GENERAL Chart 27 Source: Perth & Kinross Council HR Chart 28 Source: NHS Tayside Air Report Sickness absence has increased slightly in Q1 to 6.47% for the NHS Tayside staff and 8.0% for the Perth and Kinross Council staff in the HSCP. There are a wide variety of reasons for this with a very small number (less than 5) relating to work related stress. Where this is the case measures are in place to support those members of staff to return to work. iMatter Directorate Report 3.12 The iMatter report at Directorate level in 2025 was completed by 62% of staff, with an overall employee engagement index of 78 compared to 79 for last year. Overall performance remains high across a broad range of metrics. In particular all measures in relation to Staff Governance Standards achieved scores of at least 73, chart 29 sets this out in more detail.
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PKC - GENERAL Chart 29 Strand Weighted Index Value RAG Status Well Informed 79 Green Appropriately Trained and Developed 79 Green Involved in Decisions 73 Green Treated Fairly and Consistently, with Dignity and Respect, in an Environment where Diversity is Valued 80 Green Provided with a Continuously Improving and Safe Working Environment Promoting the Health and Wellbeing of Staff, Patients and the Wider Community 80 Green While the weighted index values remain positive in 2025, all five strands used to measure the extent to which staff governance standards are being experienced have declined by one point since 2024. This will be monitored closely. A small number of areas for improvement were identified from within the report. These relate to the lack of visibility of board members, staff confidence in board members, staff involvement in decisions relating to their organisation, and the extent to which performance is managed well across the organisation. An improvement action plan will be developed to take these issues forward. The HSCP has managed higher levels of demand through a workforce plan which seeks to deploy expertise in key service areas supporting positive recruitment and retention. Research shows that high demand in health and social care creates a significant negative impact on staffing, leading to increased vacancies and turnover, staff burnout, and decreased quality of care. The constant pressure can result in stress, exhaustion, and a decline in job satisfaction. Looking after the health and social care workforce in the current climate is a key priority as quality health and care delivery are directly linked to appropriate staffing levels and a workforce whose wellbeing is actively promoted. The health and social care workforce is to be commended for their central role in addressing higher levels of need and demand and in achieving the current levels of performance through service redesign and without significant increases in staffing. However, the workforce remains vulnerable to the negative impacts outlined and even small increases in sickness levels as indicated in this report are a concern. Patient & Service User Feedback 3.13 Hearing about the experience that people have when they access health and social care services is important to better understand what is working well and where improvements can be made. Although feedback is gained via a range of sources, Care Opinion is the primary feedback mechanism as it allows people to tell their story and share their experience. More information can be found here. By the end of Q1 2025-2026, 142 stories were shared on Care Opinion with stories viewed 10,367 times (by 10 September 2025). In the same period last year, 99 stories were shared, demonstrating an increase of 43.4% in feedback received. Staff are responding in a timely manner to published stories with a mean response
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PKC - GENERAL time of 58 hours and 100% of responses are rated as helpful (4% higher than last year). As a result of feedback in Q1, a change has been made to improve the clinic environment and patient experience. The word cloud below gives a summary of feelings expressed, with “thank you” “thanks”, “put at ease”, “relaxed”, “reassured” and “supported” some of the most used words for Q1. Chart 30 Source: Care Opinion People using Care Opinion can rate the service received. Chart 31 shows that all services were rated 4.38 or above out of 5. Service punctuality/timeliness has improved since the same period last year with other areas down slightly. Chart 31 Source: Care Opinion The majority of stories were submitted via the website (82%), 8% via kiosk, 6% via phone and 4% by leaflet.
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PKC - GENERAL Chart 32 Source: Care Opinion In the stories posted, 40% identify themselves as a service user, 49% as the patient and 6% as a relative. Others were submitted by carers, parent/guardians or staff member posting for a carer/relative. This demonstrates that feedback is received from a range of people including people that use services as well as the people that care for them. Chart 33 Source: Care Opinion 4 Conclusion 4.1 This is the first performance report of 2025-2026 and covers Quarter 1 (April-June 2025). The report expands the breadth and depth of measures included in routine reporting. This will continue to evolve as new delivery plans for Older People’s Services, Services for Adults, and Primary Care are developed with measures and targets confirmed.
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PKC - GENERAL 4.2 Demand for health and social care services is high and performance in delivering against that demand is good with people spending less time in hospital and access to services improving. Areas for improvement are informing the programme of service development and transformation to improve access to high quality health and care services and outcomes for people who require integrated health and care services. Author(s) Name Designation Contact Details Chris Jolly Service Manager (Business Planning and Performance) tay.pkijbbusinesssupport@nhs.scot Claire McCarthy Team Leader, Performance Management and Reporting tay.pkijbbusinesssupport@nhs.scot
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PKC - GENERAL ANNEX 1. IMPLICATIONS, ASSESSMENTS, CONSULTATION AND COMMUNICATION Strategic Implications Yes / None IJB Strategic Plan Yes Transformation Programme No Resource Implications Financial No Workforce No Assessments Equality Impact Assessment No Risk No Other assessments (enter here from para 3.3) No Consultation External No Internal Yes Legal & Governance Legal No Clinical/Care/Professional Governance No Corporate Governance Yes Directions No Communication Communications Plan No 1. Strategic Implications 1.1 Strategic Plan This the delivery of the Strategic Priorities identified within the Perth and Kinross IJB Strategic Plan 2024-27: 1. Target Resources to where people and communities need help most. 2. Make it easier for people to get the help and support they need. 3. Provide health and social care supports close to home. 4. Work with communities to design the health and social care supports they need. 5. Improved integrated working. 6. Promote self-management and living well. 7. Value our workforce, support them to keep well, learn and develop. 1.2 Transformation Programme This report has no direct Transformation Programme implications however the work of the transformation programme is taking a whole system approach to improvement and in doing so feeds into improvements in performance. 2. Resource Implications 2.1 Financial This report has no direct financial implications. 2.2 Workforce This report has no direct workforce related implications.
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PKC - GENERAL 3. Assessments 3.1 Equality Impact Assessment This report sets out progress in respect to performance in against the nationally agreed integration indicators. In doing so it provides an update on progress in relation to the delivery of the IJB’s Strategic Plan which includes the reduction of the impact of inequalities. 3.2 Risk This report has no direct risk implications. 3.3 Other assessments This report provides an assessment of performance against national integration indicators. 4. Consultation 4.1 External N/A 4.2 Internal The contents of this report have been reviewed internally with the Senior Management Team. 4.3 Impact of Recommendation N/A. 5. Legal and Governance 5.1 N/A. 5.2 This report supports the delivery of the IJB’s public reporting responsibilities. 6. Directions 6.1 N/A. 7. Communication 7.1 N/A. 8. BACKGROUND PAPERS/REFERENCES 8.1 The documents that have been relied on in preparing the report, other than those committee reports already referenced within the main body of the report will be kept available for inspection by the public for four years from the date of the meeting at which the report is presented. 9. APPENDICES 9.1 Data sources.
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PKC - GENERAL Appendix – Data Sources Portfolio Chart Measure Source Older People’s Services 1 Number of hours of care yet to be provided split for that hospital and in the community Adult Social Work Systems 2 Total number of hours of unmet need Adult Social Work Systems 3 Total number of hours of unmet need (since 2021) Adult Social Work Systems 4 Number of A&E Attendances 65+ (All P&K) Ministerial Steering Group 5 Number of Admissions from A&E 65+ (All P&K) Ministerial Steering Group 6 Number of Emergency Admissions 65+ (All P&K) Ministerial Steering Group 7 Rate of Emergency Admissions per 100,000 population 75+ (All P&K) Trakcare 8 Rate of Emergency Admissions per 100,000 population 75+ (Locality Level) Trakcare 9 Unscheduled hospital bed days 65+ (All P&K) Ministerial Steering Group 10 Rate of Emergency Occupied Bed Days per 100,000 by Admissions 75+ Trakcare 11 Average Length of Stay 75+ (All P&K) Trakcare 12 Delayed discharge bed days 75+ (All P&K) Ministerial Steering Group 13 Discharge without delay as % of all discharges split by age group 18-74, 75+ and all ages Trakcare Services for Adults 14 Number of A&E Attendances (Mental Health) (All P&K) Trakcare 15 Number of Occupied bed days Mental Health 18-64 (All P&K) Trakcare 16 Number of Occupied bed days Mental Health 18-64 (Locality Level) Trakcare 17 Number of days spent in Mental Health hospital when ready to be discharged 18-64 (All P&K) Trakcare 18 Number of new POA referrals (All P&K) Trakcare 19 Number of new POA referrals (Locality Level) Trakcare 20 Number of referrals to Community Mental Health and Wellbeing Teams (All P&K) Trakcare 21 Number of referrals to Community Mental Health and Wellbeing Teams (Locality Level) Trakcare 22 Average number of weeks people wait for a service CMHT (Locality level) Trakcare Primary Care 23 Community Treatment and Care Services demand: - Number of appointments offered per month Vision/CTAC Dashboard
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PKC - GENERAL - Number of appointments booked per month - % DNA (Did not attend) per month 24 First Contact Physiotherapy demand - % of appointments used Source: FCP Dashboard/Vision 25 First Contact Physiotherapy demand - % split of new/repeat users Source: FCP Dashboard/Vision 26 First Contact Physiotherapy - % people discharged following first appointment Source: FCP Dashboard/Vision Sickness absence 27 % Time lost to sickness absence HSCP PKC workforce Perth & Kinross Council HR 28 % Time lost to sickness absence HSCP NHST Tayside workforce NHS Tayside Air Report iMatter 29 Staff Governance Standards – Strand Score Index iMatter People’s experience of Health and Social care 30 Summary of language used to describe the experience people have when accessing HSCP services. Care Opinion 31 Overall ratings that people provided in relation to their experience of HSCP services Care Opinion 32 Number of Care Opinion stories posted by service users or their carers. Care Opinion 33 How people identify themselves within Care Opinion (supports better understanding of the who is providing feedback) Care Opinion