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

1. 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

2. 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

3. 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.

4. Child Health • An example • - not all health data is held by GPs

5. 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 .

6. CHANGING CHILDREN’S 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

7. 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

8. Boys Overweight (including Obese)

9. Girls Overweight (including Obese)

10. 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

11. % Aged 75+

12. % living in medical and care establishments

13. Proportion in care establishements against % aged 75+ by PCT in E.Region

14. Relationship between percentage of carers (>20hrs pw) and % of the population with LLT illness by PCT in E.Region

15. 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;

16. 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

17. Objectives for Improving Health Inequalities NHS improvement, expansion and reform should narrow the health gaps by: • ensuring that service planning is informed by a healthequity 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

18. y Health Equity Audit compares the provision of a service with a measure of the need for it Service x Measure of Need

19. 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

20. Equity : high need is matched by high service provision- the desirable situation y Service x Measure of Need

21. 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

22. 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

23. Quit rate 59% (2002-3) Some examples of health equity audit – Smoking -Welwyn Hatfield PCT males

24. Health Equity audit: Smoking St Albans PCT males QuitRate= 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).

25. St.Albans Male smoking cessation uptake against smoking attributable mortalityfor all males age 35 years and over (1998- 2002) Fig 2a) Fig 2b)

26. 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

27. Public Health Issues in Bedfordshire and LutonHow to make a difference-by health partnerships Bedfordshire County Council – GPC’s coterminous with LAs for meaningful partnership?

28. 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 GP partnership with PH and LAs- for better health outcomes

29. “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

30. 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)

31. Bedfordshire Population pyramids Age and Gender Distribution (2003) Bedfordshire Heartlands PCT Bedford PCT Total Population: 149,907 Over 75's:7.19% Under 15's: 19.12% Luton PCT Total Population: 185,165 Over 75's: 5.20% Under 15's: 21.42%

32. 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

33. The Hub and Spoke Model of Public Health IntelligenceforGP consortia within a Public Health Network • county councils or unitary authorities; • PH network –GP consortia- replacing PCTs

34. 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!)

35. 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

36. 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 GPC’s share the role of commissioning across LAs by each having specialist clinical fields? 3) Joint programme budgets in the LA/GPC (social care/health) ?

37. 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@btinternet.com

38. PHI for GP commissioning Over to you ! Any questions?