Measuring health improvement – lessons from Nottingham’s LAA Dr. Jeanelle de Gruchy,

1. Measuring health improvement – lessons from Nottingham’s LAA Dr. Jeanelle de Gruchy, Health Equality Directorate, Nottingham City PCT EMPHO Public Intelligence Training Course 3rd October 2006

2. Objectives of session • Present key drivers of health improvement; • Present Nottingham’s LAA and FTAP and discuss dilemmas in developing the indicators; • Provide an opportunity to develop your own indicators; • Discuss what makes a good indicator; • Present brief comment on working in partnership.

3. Drivers of health improvement • Local Delivery Plan • PCT 3 yr plan to include local and national priorities for health services and improvement • Choosing Health • Local Area Agreements • Govt, LA and partners working thru’ local LSPs • 4 ‘blocks’: HCOP, CYP, SSC, EDE • Floor Target Action Plans • LSPs receiving NRF; to accelerate progress on targets where gap in performance is widest

4. Nottingham’s LAA • Healthy Communities, Older People (HCOP): • CVD (physical activity, smoking, diet), child obesity, mental health, avoidable injury • Children and Young People (CYP): • Teenage pregnancy, infant mortality, Healthy Schools • Safer, Stronger Communities (SSC): • alcohol

5. Nottingham’s FTAP • Target: Gap in Life Expectancy • Understanding contributory factors and determining focus: • CVD and over 40s • Analysing areas for targeted action: District, ward, neighbourhood level • 20% SOAs with worst premature CVD mortality • Planning evidence-based interventions

6. SMART LAA indicators (1) • Priority issues identified, but could we measure performance? Eg. alcohol • Outcome vs process: challenging, are we clear on cause and effect? Are there proxy measures? Eg. Infant mortality; alcohol • Time-scale: needing to show results in 3 years (!) or even 6 months (!!); yearly or 3 year rolling ave?

7. SMART LAA indicators (2) • What areas? 18 most deprived wards; gap between worst centile and the average… • Definitions: physical activity • Baselines: expense and time measuring (use of other surveys - local MORI, Sport England) • Cross-cutting issues: mental health and employment • Inequalities: overall numbers vs. targeted

8. Developing LAA indicators for your area 5 Priority issues have been identified: • Inequalities in CVD mortality; • Low levels of physical activity in adults; • Rise in alcohol abuse; • Rise in childhood obesity; • Poor mental health and well-being. What indicators would you choose? How SMART are they?

9. Effective indicators • Direct planning to health priorities; • Draw on evidence base where available; • Ensure that intervention will be effective; • Build on reality of local situation (including what work is already being undertaken; availability of resource); • Utilise what measurement is already taking place; • Will demonstrate achievement (unless political decision to be aspirational); • Are creative – the reality is it needs to be measured: • Are there pragmatic proxy indicators? • balance between routinely available info – but may need to survey

10. LAAs in partnership • It’s a political process • Consultation with partner organisations – blocks and cross-cutting issues; • Lobbying by interest groups; • Conflicting guidance; • Lead organisation control. • It needs to be an evidence-based process • Understanding of health / health outcomes; • Valuing professional/technical expertise: Is 0.5 of a fruit ‘unambitious’? What is a DSR? • See what others are doing… share good ideas