Effective public health intelligence for London
Justine Fitzpatrick, Allan BakerLondon Health Observatory
Learning objectives
• Understand the networks and partnerships working to provide public health intelligence for London
• Understand the LHO and its role in supporting public health and commissioning in London
What will be covered?• What is the London Health Observatory?• Overview of health intelligence partners in
London• Overview of current work at London Health
Observatory• An example: the health inequalities indicator in
the World Class Commissioning Framework• A discussion: What are the current priorities for
public health intelligence in London?
LHO lead areas:•Health inequalities•Ethnicity•Smoking•NICE
APHO: The Observatory Network and Lead Areas
The functions of PHOs in EnglandTo work in partnership with researchers, regional and local health policy makers and practitioners to:
• Monitor trends in health and its determinants, highlighting areas for action
• Highlight future health problems• Assess the health impact of potential and past policies• Draw together information from different sources and to identify
gaps in information• Provide standard sets of community health information at local
government and regional level• To support the development of skills in public health practitioners
and NHS staff, for example in equity audits and health impact assessments, and build capacity in public health intelligence.
Adapted from “Saving Lives - Our Healthier Nation” a “Choosing Health – Making Healthier Choices Easier”
What sort of work does LHO do?
:
RESPONSIVE PRO-ACTIVE
Enquiry serviceSignposting dataand information
In depth analysis/interpretation of health data
Public healthperformancemonitoring
Tools and methodsfor data analysis
Support health practitionerand intelligence networks
Communication and advocacy for better public health information.Widening access to data
Collating/ Processing Data
Turning Data into Health
Intelligence
Collecting Data/ Information
Using Health Intelligence To
Improve Health & Care
Other Agencies
Public Health Observatory role
Role of PHOs in health intelligence
Department of Health
Office for National Statistics
Regional Office of DH and NHS
London
LHO (CSL)Greater London Authority
GovernmentOffice for London
HealthProtection
Agency
Thames Cancer Registry
PrimaryCare
Trusts
RegionalOrganisations
National Organisations
Local Organisations Local AuthoritiesAcute Trusts
Universities
LHO Governance
Chief Medical Officer for England
London’s Primary Care Trusts
Chief Executive of CSLNational Steering Group
for PHOs
Medical Director of CSLRegional Director of Public Health
London Health ObservatoryAPHO Executive
LHO Advisory
Board
LHO Core Work LHO PCT Intelligence Work
Examples of current LHO Work
• CSL (PCT Intelligence)• Health needs assessment toolkit• Health performance dashboard• National Programme• Local smoking profiles• The Health Inequalities Intervention
Tool• The Local Basket of Inequalities
Indicators• Physical activity social marketing
tool
• London Programme• London boost of the Health Survey
for England (mental health and social capital)
• Child health profiles• Local authority health profiles 2009• Enquiry service (HES and general
enquiries)• Small area indicators for PCTs• Practice profiles refresh• Public health performance reports
Who uses our services?LHO Enquiry Service - summary of sources of enquiries, January to September 2009
(454 enquiries)
42%
6%6%4%3%
3%
2%
3%
9%
5%
3%
14%London PCTs
Outside London PCTs
London NHS bodies (e.g.NHS forLondon, Healthcare for London) GLA and Government Office forLondonLondon local authorities
London NHS trusts
Other NHS
Government depts
Academics
Consultants / private companies
Public
Other (Media, Charities, Other PHOsetc.)
How is LHO work commissioned?
• LHO enquiry service• Individual PCTs• CSL business partners• London’s DsPH• Other London partners (NHS London, RPHG,
GOL, GLA etc)• APHO Executive• Department of Health• Information Centre
Useful links
• Recommended to explore website!
• Enquiry service: [email protected]
• LHO website www.lho.org.uk
• APHO website www.apho.org.uk
• CSL website www.csl.nhs.uk
World Class CommissioningAssurance Framework -
Health Inequalities Indicator
Allan BakerLondon Health Observatory
WCC Assurance Framework
• 54 Indicators
• PCTs select 8 to reflect strategic priorities
• 2008 – 2 compulsory indicators:
Life expectancy
Index of Multiple Deprivation
• DH requested advice for replacing IMD
Selection of a new indicator
• 30th July – APHO meet with DH
• London Health Observatory –
leads on health inequalities
• East Midlands PHO –
recently researched methods for measuring health inequalities within a PCT
Criteria
• Mortality indicator to show extent of inequalities within PCTs
• Easy to understand and interpret• Robust• Relate to other health inequality resources• Consistent over time• Available quickly
Options
• Which measure of mortality
• All ages, all causes - or subsets
• Sex-specific – or all persons
• Time period
• Geography
Recommendation for a new indicator
• 7 August – recommendation to DH
• Life expectancy at birth – 5 years data
• Deprivation deciles within PCTs
• Deciles based on LSOAs
• Sex-specific
• Slope index of inequality
Slope Index of Inequality
L ife E x p ec ta n c y b y D ep riv a tio n D ec iles , s h o win g th e S lo p e In d ex o f In eq u a lityC a m d en P C T , Ma les , 2003-07
S lo p e In d ex o f In eq u a lity = 11.2 y ea rs (95% C o n fid en c e In terv a l: 9 .3 to 13.0)
60
65
70
75
80
85
90
95
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
P erc en tag e o f p o p u latio n , ran k ed fro m h ig h to lo w IMD s c o re
Life
Exp
ecta
ncy
at B
irth
(yea
rs)
Inequa lity S lope
L ife E xpecta ncywith 95%confidence limits
Timetable for delivery
• 18th August – DH agree to proposal
• 7th Sept – APHO provide data
• 15th Sept – APHO provide metadata
• 16th Sept – WCC Datapacks launched
SII Results by IMD scores
0
5
10
15
20
25
30
35
40
45
50
0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0
Slope Index of Inequality
Dep
riva
tio
n -
IM
D 2
007
Distribution of deprivation – percentage of population in national deprivation quintiles
• Barking and Dagenham – 92% in Q4 & Q5
• Richmond – 82% in Q1 & Q2
• Westminster – spread between Q2 – Q5
• Tower Hamlets – 90% in Q4 & Q5
Next steps
• Analysis of results
• Trend data – 2001-05 and 2002-06
• Latest data – 2004-2008
• Guidance on trajectory setting
APHO website
www.apho.org.uk/resource/view.aspx?RID=75050
APHO recommendation
Slope Index of Inequality dataset
Guide to interpretation
Life expectancy results for deprivation deciles
Summary charts for each PCT
LSOA to deprivation decile look-up