Implementing Choosing Health

Informing Healthier Choices: information and intelligence for healthy populations

John Newton

Securing Good Health for the Whole Population (Wanless II)

• Information is essential when making the case for investment

• Public engagement in health requires a common understanding of local health issues

• Little comprehensive information on health status is available

• Lack of mechanisms for data-sharing• Links not made between health data and

research evidence• Public health capabilities and capacity need to

be developed

Specific Information & Intelligence Commitments in Choosing Health

WP ref Commitment

4.22

We will develop a standard set of local health information that can be linked to other local data sets for publication. Public Health Observatories will produce reports designed for local communities at local authority level which will support directors of public health in promoting health in their area. The first of these local reports will be published in 2006 and we will also publish the first national report that year.

4.30The Department of Health will continue to work closely with the DfES to develop

appropriate systems for recording lifestyle measures, for example obesity through weight and height measurements, among school age children.

8.18

To ensure public accountability and demonstrate continuing progress the Department of Health will publish a six monthly progress report on key indicators for the targets that relate directly to improving health. These reports will reflect the joint contributions of all Departments involved.

Annex B – 24

Following the White Paper, we will establish a Health Information Task Force to lead action to develop and implement a comprehensive public health information and intelligence strategy. Priorities for action are set out on page 191 of the White Paper.

Health and its determinants

Evolutionary not revolutionary

The endless cycle of idea and action, Endless invention, endless experiment, Brings knowledge of motion, but not of stillness;

T.S.Eliot

Communities need Information for:

• Achieving a shared understanding of local health status

• Setting local priorities for action / resource• Monitoring effectiveness of local efforts• Stimulating a dialogue between the public

and responsible Public Health agencies• Surveillance of local Public Health

problems

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The NHS needs information for

• Assessing need• Addressing inequalities• Commissioning cost effective services• Monitoring performance• Financial planning and management• Workforce and capital planning• Audit and quality improvement• Research and Development

Copyright ©2004 BMJ Publishing Group Ltd.

Sunderland, R S et al. Arch Dis Child 2004;89:282-285

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Where is the wisdom we have lost in knowledge?

Where is the knowledge we have lost in information?

T.S. Eliot

Three types of knowledge

• Knowledge from data – “statistics”

• Knowledge from research – “evidence”

• Knowledge from experience – “know-how”

All can be generalisable but must be related by the user to the context (individual or population) being considered

Information supports public health by helping to:

• describe current patterns of health problems in the population including comparisons between groups defined by geography, age, sex, ethnic background or social characteristics;

• identify recent changes over time in health and illness (in the whole population or in groups within it) which require a response;

• guide the design of appropriate responses to a health problem;

• empower communities to act to improve their own health;

• evaluate change after an intervention.

Aim

“To improve the availability and quality of health information and intelligence across England and to increase its use to support population health improvement, health protection and work on care standards and quality.”

Objectives1. To support delivery of Choosing Health and Our health, our care,

our say by making information and knowledge available to local communities to inform their decisions.

2. To meet the information and intelligence needs of key Department of Health and wider health-related Government policy objectives such as commissioning for health and wellbeing, reducing inequalities in health, monitoring the public health function, achieving health literacy, and tracking relevant Public Service Agreement targets locally and nationally

3. To support the work of professionals engaged in improving the health of the population. This includes helping Directors of Public Health (DPHs) to prepare reports for local authority overview and scrutiny committees and joint reviews of the health status, well-being and health needs of their population, as proposed in Our health, our care, our say.

The vision

• Data rich environment

• Problem-orientated system that is:– Accessible to all– Responsive and flexible– Relevant– Timely– Valid– Secure

A national framework for health information and intelligence

Data collection

Data should be collected as a by product of routine public (or private) sector activity as far as possible.Data should be of known validity and completeness.Available data should cover the causes of health and illness including wider determinants as well as health outcomes and information on levels and quality of services provided.Sources of data should include: primary, secondary and community NHS care, local public sector sources, private sector, and voluntary sector sources.

Data management

Data should be efficiently shared, collated, validated, linked, anonymised, and archived as appropriate using secure systems.Person-level data should be handled in such a way that the rights and interests of the individuals concerned are acknowledged and respected while striking a proportionate balance with the public benefit.

Analysis The systems involved should allow a range of approaches to analysis, including:Ad hoc, query-based analysisThe regular production of specified indicatorsSurveillance for unexpected trends and outcomesModelling of health outcomes against targetsData feeds for disease registers including cancer registriesArea based analyses from national to small-area with comparisons

Interpretation in context

The results of the analyses must be interpreted in the context of:Statistical and methodological issues including data qualityEvidence from researchExperience of practiceLocal knowledge.

Communication of messages

The messages derived from the interpretation of the information and evidence must be communicated to relevant audiences using a range of media appropriate to the target audience or audiences.

The 4 Box Strategy

1. More and better data & information

3. Better workforce training and support

2. Stronger organisations 4. A co-ordinated national health information and intelligence system

1. Improved data and information provision•Collecting national child height & weight data•Obtain & collate GP data on lifestyle nationally•Improve the quality & completeness of NHS ethnicity data •Further develop public mental health intelligence•Produce and publish comprehensive Community Profiles for all Local Authorities and for England as a whole•Model key health outcome indicators using information on the effectiveness of interventions•Implement a social marketing communication strategy based on messages from the Community Profiles •Create an accessible population health web portal for professional and public users

4. Development of a National Health Information and Intelligence System

•Data warehouse and data mart•Accessible and flexible interface•Population health indicators•Surveillance systems•Disease registers•Knowledge management systems•Research and central statistics

2. Stronger organisations

•Strengthen the PHOs & APHO•Confirm role of Cancer Intelligence Units•Integrate regional information functions•Develop the population health role of NICE•Commission a National Library for Public Health•Create population health “safe-havens” for linkage of personal data in a secure and confidential environment

3. Workforce training and support

•Collate existing and develop new curricula and training courses in health information and intelligence •Set up an on-line repository of training materials and resources in information and intelligence•Create Health Information and Intelligence workforce steering group and implement a workforce development strategy for information and intelligence•Develop models for information and intelligence roles in different organisations•Develop and support career pathways for specialist information and intelligence staff•Set up a national PCT/LA information analysts forum

The four box strategy

Health Profiles• Designed to be useful summaries of health of communities

for communities• Local Authority level data and target audience for

Technical Profiles• Public version Community Profiles produced from them• Important to DsPH but not a replacement for their own

reports - instead a comparable data foundation• Includes major causes of ill health• Comparable data around the country and from year to year• Sub LA data supports local inequalities work• National report provides an overview and context• Gaps in data will be filled over time• Supported by web-based tools to explore basic indicators

in more depth

4. Development of a national health information and intelligence system

• SUS provides a data warehouse, user-defined data mart and an information governance policy

• Further functions requiring development include– Accessible and flexible interface– Population health indicators– Surveillance systems– Disease registers– Knowledge management systems– Research and central statistics feeds

SUS will provide an ideal basis for a national

health information and intelligence system

Developing the system

• Set up a SUS user group for public health• Agree and secure access to key

components• Implement data management protocols

that allow linkage• Agree a transition plan to preserve existing

flows• Agree data collection standards with

Information Standards Board

Making the system work

• Specify general analytical tools or output formats

• Specify specific modules (cohort management, disease registers, other research uses)

• Integrate with appropriate surveillance systems

• Integrate with knowledge management systems

Taking the strategy forward

• Taskforce stands down in June 2006

• New smaller Strategy Implementation Steering Group accountable to DCMO

• Implementation Team to be appointed

• High level advocacy for the strategy across Government and in Regions

Consultation – response?

• Still early• Support is evident• Capacity in organisations is a big issue• Need to deliver better information (soon)• Develop a robust implementation plan• Seems very dependent on SUS• Ensure that existing data flows continue• Need to engage with Connecting for Health

more explicitly at Cluster level

Implementing Choosing Health

Informing Healthier Choices: information and intelligence for healthy populations

John Newton

“I'm not young enough to know everything.”

J.M. Barrie