Public Health Intelligence What is it ? The role of PHI in the NHS

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Public Health IntelligenceWhat is it ? The role
of PHI in the NHS

• Evidence-
• The key to v GP consortia commissioning

Margaret Eames Head of Public Health
Intelligence The Acorns Public Health Research
Unit
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PHI-what is it?

• Information- to support PH and commissioning-
• Inference using statistical models to show how
  health variables ( eg obesity ,and smoking)
  relate to other determinants for shaping fairer
  local health policy changes
• Integration and Partnership working with DPHs,
  commissioners and LAs-saving money for better
  health outcomes

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PHI-what is it ?

• Information-
• Produce local PH evidence.
• GPs /LAs need to know benchmarks for their health
  profiles, time trends, comparative outcomes
  across LAs, within LAs , across Regions, and
  across England for best commissioning.

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Child Health

• An example
• - not all health data is held by GPs

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National Target Childhood Obesity

• To halt, by 2010, the year-on-year increase in
  obesity among children under 11 (from 2002
  baselines)
• GPs /LAs need to know baselines, and areas of
  most need
• Joint responsibility health, education and sport.
• Data Information PHI communication-partnership
  intervention- monitor data, (PHI) record
  evidence of improvement (or not)-
• Evidence of what works .

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CHANGING CHILDRENS LIFESTYLES-Reducing
Childhood Obesity

• Summary of Findings
• Childhood Obesity in Bedfordshire
  Hertfordshire (2005)
• Herts and Beds
• Public Health Intelligence Team (NHS)
• Margaret Eames
• School nurses from Beds and Herts

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Choosing HealthEvidence from Bedfordshire
Hertfordshire

• Changing Childrens Lifestyles
• Measure the baselines
• Weights and heights measured by school
  nurses (for BMI) for
• All Children aged 5 for entry to school in 1998
  and 2002 in Herts, Beds and Luton

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Boys Overweight (including Obese)
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Girls Overweight (including Obese)
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Demography and Intelligence

• Life expectancy
• Census 2011 Results
• aged 75
• Reporting Health not good (maps)
• Long term Limiting Illness
• Carers in the adult population
• Living in Medical or Care Establishments

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Aged 75
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living in medical and care establishments
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Proportion in care establishements against
aged 75 by PCT in E.Region
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Relationship between percentage of carers
(gt20hrs pw) and of the population with LLT
illness by PCT in E.Region
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PHI-in the NHS

• Inference -
• using statistical models for evidence to change
  local health policy
• Health Needs Assessment
• Health Equity Audit/impact assessment
• Priorities
• Cost-effectiveness

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Inequity?

• Inequality the difference in the distribution
  of a health measure (by person or
  place)-univariate measure
• Inequity an inequality in the distribution of
  health intervention in relation to health need
  that is considered unfair -bivariate

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• Objectives for Improving Health Inequalities
• NHS improvement, expansion and reform should
  narrow the health gaps by
• ensuring that service planning is informed by a
• health equity audit and supported by an annual
  public health report by the Director of Public
  Health.
• Improvement, Expansion Reform The Next Three
  Years. (2004) Page 20

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Health Equity Audit compares the provision of a
service with a measure of the need for it
y
Service
x
Measure of Need
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Inequity those with most need get the lowest
level of service- the undesirable inverse care
law (this case even worse than ve linear
relationship)
y
Service
x
Measure of Need
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Equity high need is matched by high service
provision- the desirable situation
y
Service
x
Measure of Need
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Health Equity Audit cycle
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Agree partners and issues

• Choose issue(s) with highest impact eg cancer,
  CHD, primary care, over 50s, infant health

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• Relate issues to service planning
  commissioning,
• take opportunities where changes are planned

Review progress assess impact
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• Identify factors driving low life expectancy

• Ensure effective monitoring systems
• are in place using indicators etc

• Take on views of front line staff and users

Equity profile identify the gap

• Scope for joining up services with local
  government

• Review progress

Use data on Health Inequalities to support
decisions at all levels make appropriate
comparisons by area, ethnicity, socio-economic
group, gender, age etc

• Use data to compare service provision with need,
  access, use
• outcome
• measures including proxies for
• disadvantage, social
• class, ward in the bottom
• quintile,BME, gender or
• other population group

• Assess the impact of action, has change been
  made and is it fast enough?

• Identify local areas or groups where more
  action is
• required

• Focus on the third of
• population with
• poorest health
• outcomes

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Secure changes in investment service delivery
3

• Move resources to
• match need

Agree high impact local action to narrow the gap

• Develop service delivery
• to match need

• Quality quantity of primary
• care in disadvantaged areas

• Ensure changes in contracts
• commissioning are reaching
• areas groups with highest
• need
• assess impact on
• inequalities

• Address inequalities through NSF
• implementation

• Commission new services,
• change or amend existing contracts

• Develop LIFT projects where
• health need is highest
• holistic services through
• partnerships

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Smoking Cessation Uptake Health Equity Audit in
Beds and Herts QUIT RATE IS NOT ENOUGH!
M.Eames and C.Dummett Beds and Herts PHI team
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Smoking cessation uptake data

• DH should use Uptake from high Smoking
  Attributable Mortality areas(for targets) rather
  than quit rate alone, to measure service access

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Some examples of health equity audit Smoking
-Welwyn Hatfield PCT males
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Health Equity audit Smoking St Albans PCT males
Quit Rate 68
Note St. Albans had the lowest overall SMR in
the SHA and is considered a healthy, rich PCT
(Fig 1). But this figure and the high quit rate
of 68 disguises the inequity of uptake of SCS
between wards within the PCT. The negative and
low r indicates poor wards without smoking
cessation services, SCS (e.g Sopwell).
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St.Albans Male smoking cessation uptake against
smoking attributable mortality for all males age
35 years and over (1998- 2002)
Fig 2a)
Fig 2b)
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PHI-in the NHS and LAs

• 3. Integration and Partnership
• Sharing Intelligence with LA , GPs and other
  Partners.
• Sharing Resources, enabling joined up programme
  budgeting , observing overlapping roles
• Participating in Communication, and
  decision-making

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Public Health Issues in Bedfordshire and Luton
How to make a difference-by health
partnerships
GPCs coterminous with LAs for meaningful
partnership?

• Bedfordshire County Council

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GP partnership with PH and LAs- for better
health outcomes

• Making healthy choices easier
• Informed choice
• Personalisation
• Working together

• Key Health Areas
• Stop smoking,
• Reduce obesity,
• Increase exercise,
• Sensible drinking,
• Improve sexual health,
• Improve mental health

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Enabling children to choose health

• Local Policy making a difference
• Our local evidence was used to invite tenders
  from LAs (schools and communities with most need
  in Hertfordshire) for
• RUFit 4IT funding.
• Money allocated to projects based on evidence,
  aimed at reducing childhood obesity- within 6
  months

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Demography and Wider Determinants of Health

• Age and Distribution of the Population
• Black and Ethnic Minority distribution
• Social Class- occupation
• Public Transport accessibility
• Housing
• Access to play areas and green spaces
• Education, knowledge of healthy eating
• Lifestyle Choices e.g smoking, alcohol
• Locus of control at work(improving working lives)
  

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Bedfordshire Heartlands PCT
Bedfordshire Population pyramids Age and
Gender Distribution (2003)
Bedford PCT
Total Population 149,907 Over 75's7.19 Under
15's 19.12
Luton PCT
Total Population 185,165 Over 75's 5.20 Under
15's 21.42
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Other Key Health Indicators

• Low Birth weight
• Teenage Pregnancy
• All Cause Mortality
• Life expectancy
• All Cancer Mortality
• Lung cancer mortality
• Smoking attributable mortality
• CHD and MI mortality

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The Hub and Spoke Model of Public Health
Intelligence for GP consortia within a Public
Health Network

• county councils or unitary authorities
• PH network GP consortia- replacing PCTs

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PHI- its role in the NHS

• Career, Training and recruitment
• Valuing the skills and training needed for good
  statistical analysis in public health.
• Understanding good design of data collection,
• and quality of data
• Robust statistical analyses needed alongside
  finance data, projections and modelling for
  decision-making .
• for appropriate PCT, LA, and GP commissioning,
• (not just excel spread-sheet skills!)

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PHI- valuing statistical skills

• Career, training and recruitment (ctd)
• PHI is a new career pathway in the NHS (AFC)
• Now a defined specialist area recognised by FPH
• Growing field of work in the NHS (most medical
  statisticians in academic or pharmaceutical
  world)
• but we NEED them in the NHS.
• PHI teams -nerve-centre a place of training

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The current challenges

• GP commissioning outcomes need to be measured by
  local PHI (past and future)- not much in White
  Paper.
• PHI the bridge between PH and GPCs
• Will consortia be co-terminous with LA boundaries
  to match PHI data ?
• 2) Can GPCs share the role of commissioning
  across LAs by each having specialist clinical
  fields?
• 3) Joint programme budgets in the LA/GPC (social
  care/health) ?

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Contact Address

• Margaret Eames
• Head of Public Health Intelligence
• The Acorns Public Health Research Unit
• 38, Hazel Grove
• Hatfield
• Herts AL10 9DN (01707-884502)
• Website www.phi-bedsherts.nhs.uk
• email meames_at_btinternet.com

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PHI for GP commissioning

• Over to you !
• Any questions?