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

Commissioning Support for London

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: lho.enquiries@csl.nhs.uk

• 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

Options – type of indicator

• Range indicator

• Lorenz curve based indicator

• Slope indices

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

WCC Datapack – SII results for London

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

SII results by Life Expectancy

0

2

4

6

8

10

12

14

16

London PCTs

Slo

pe

Ind

ex o

f In

equ

alit

y

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

Questions?

Discussion: what are the current priorities for public health

intelligence in London?