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Outline of Day 4

Outline of Day 4. Introductions Session 1: The main applications of PHI: surveillance, informing planning, performance monitoring, evaluation Drivers: JSNAs, LOPs, LAAs, performance management and standards and inspection regimes Partnership working. Session 2: HNA, JSNA Session 3:

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Outline of Day 4

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  1. Outline of Day 4 Introductions Session 1: • The main applications of PHI: surveillance, informing planning, performance monitoring, evaluation • Drivers: JSNAs, LOPs, LAAs, performance management and standards and inspection regimes • Partnership working. Session 2: • HNA, JSNA Session 3: • HIA Session 4: • HEA. Session 5: • Evaluation Participants’ Feedback

  2. Day 4 Session 1: • The main applications of PHI: • surveillance • informing planning • performance monitoring and evaluation • Current drivers: • JSNA • LOPs • LAAs • performance management and standards and inspection regimes • Partnership working in PHI • the wider determinants of health • joint working across sectors - JSNA, LAAs • making best use of scarce resources

  3. Applications of PHI: Surveillance Spotting things which are: • odd • worrying • threatening • outliers

  4. Surveillance - communicable disease

  5. Surveillance - communicable disease • How does it work? • Most surveillance is based on anonymised reports of infection that are submitted from doctors and laboratories to the epidemiologists at the Centre for Infection. • These reports are gathered together and analysed to produce information on the frequency (number of cases) and the distribution (who is getting the infection and where they are) of disease. • This is done regularly so that outbreaks and epidemics can be detected as soon as they begin

  6. Surveillance - communicable disease Laboratory-confirmed cases of Measles England and Wales 2000-2007 2000 100 2001 70 2002 319 2003 437 2004 188 2005 78 2006 740 2007 971

  7. Surveillance - communicable disease

  8. Surveillance - communicable disease

  9. Surveillance - chronic disease • congenital anomalies • cancer

  10. Surveillance - cancerclusters are everywhere and don’t always (or usually) mean there’s a problem The grid on the right shows an actual result of generating 25 random numbers between 1 and 25 and putting a dot in the grid corresponding to each number. People tend to notice cases first, e.g. four cancer cases on the same street, and then define the population to be studied as only those in that street ... .... inappropriately drawing a tight boundary around what is probably a chance clustering of a few cases. A study in California calculated the probability of finding cancer clusters due to chance alone. Theory predicts that 85% of the census tracts in Los Angeles (equivalent to an English electoral ward) would have a significantly raised incidence of at least one type of cancer. That is, we would expect to find over 1,000 ‘clusters’ every year in the Los Angeles area.

  11. Surveillance - cancer

  12. Surveillance - cancer • How does it work? • the cancer registration system • cancer cluster investigation http://www.swpho.nhs.uk/resource/item.aspx?RID=9108 http://www.cdc.gov/mmwr/preview/mmwrhtml/00001797.htm

  13. Surveillance - health care

  14. Surveillance - health care

  15. Surveillance - health care http://www.sciencelive.org/component/option,com_mediadb/task,play/idstr,CUSP-BAFOS05-06_DavidSpiegelhalter/vv,-2/Itemid,26

  16. Surveillance - health care

  17. Applications of PHI: Surveillance Spotting things which are: • odd • worrying • threatening • outliers

  18. Applications of PHI: Supporting Planning Issues for the Executives ... • what should our priorities be? • what’s our strategy for ...? • what changes do we need to make to local services? • where and how should we target our resources? Group exercise: In a PCT or health partnership - how can we start to address the first of these questions?

  19. Applications of PHI: Supporting Planning ... translate to Qs for the Public Health Analysts • what are the current and future health problems in our area? • how do we compare with other areas? • within our area where are the health problems worst? • where is there unmet need? • what services are currently available? • what’s the quality of local services? • what’s the likely impact of a proposed initiative?

  20. Applications of PHI: Performance Monitoring and Evaluation Issues for the Executives ... • are we achieving our objectives? • are we meeting our targets? • are our initiatives and service changes having the intended effect? ... translate to Qs for the Public Health Analysts • same as above

  21. Drivers Executives worth their salt will be asking ... • what should our priorities be? • what’s our strategy for ....? • what changes do we need to make to local services? • where and how should we target our resources? • are we achieving our objectives? • are we meeting our targets? • are our initiatives and service changes having the intended effect?

  22. Drivers But just in case they don’t there is legislation and performance management ... • PCTs and LAs have a statutory duty to undertake JSNA • Each PCT needs to have a LOP • Each local partnership needs to have an LAA • Each local organisation is subject to performance management • Each local organisation is subject to a standards and inspection regime

  23. Where to find out more JSNA http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081097 LOPs http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081094 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_082542 LAAs http://www.communities.gov.uk/localgovernment/performanceframeworkpartnerships/localareaagreements/ Performance management, standards and inspection http://www.healthcarecommission.org.uk/healthcareproviders/serviceproviderinformation/annualhealthcheck.cfm http://www.communities.gov.uk/localgovernment/performanceframeworkpartnerships/

  24. Partnership working for health Dahlgren and Whitehead’s diagram showing the wider determinants of health illustrates why partnership working in public health is inevitable and necessary - many different organisations and agencies at national, regional and local level can have an impact on the health of a local population. The job of public health is to make this complex system work for health improvement. The job of public health intelligence is to inform that effort.

  25. Partnership working for health • Local authorities have a specific legal power to promote well-being (Local Government Act 2001) • Direct provision of social care services for children, people with disabilities and older people • Influence over key determinants of health (housing, education, leisure, local and built environment) • Scrutiny of health services in local area • Increasing moves towards greater integration of health, social care and well-being • Local Strategic Partnerships (LSP) • Joint commissioning & service provision (e.g. Children’s Services) • Joint inspection & review (e.g. Comprehensive Area Assessment)

  26. Local Strategic Partnerships (LSPs) • Brings together representatives of public services, local businesses, community groups and residents • Responsible for developing the Sustainable Community Strategy and Local Area Agreement (LAA) • Provides a single overarching local co-ordination framework within which other partnerships can operate • Often made up of thematic partnerships responsible for delivering particular aspects of the Community Strategy (e.g. Crime and Disorder Reduction Partnerships).

  27. LAAs are ... • about what sort of place you want to live in • about focusing on what will make your town, city or community a better place to be • three-year agreements with priorities agreed between all the main public sector agencies working in the area and with central Government • not just decided between public sector agencies - everyone should have a say • bottom-up - around 35 performance targets (from a list of around 200) + 18 statutory education and early years targets • a means for pooling or aligning funding

  28. Partnership working in public health intelligence • Previous slides outline the policy and partnership environment in which we work • Does it translate into local partnership working in public health intelligence in your area? • If so, what is the focus? • ?JSNA • ?LAAs • ?shared resources, e.g. local shared information systems • If not, what do you think are the missed opportunities?

  29. The case for partnership working in public health intelligence • improving communication and coordination and making best use of scarce resources: • within your organisation - across departments • between local areas • cross-regional collaboration (the regional PHI network) • with commercial partners • with academic partners • APHO • encouragement and support from management helps • different types of skills required

  30. Session 1 (recap) • The main applications of PHI: • surveillance • informing planning • performance monitoring and evaluation • Current drivers: • JSNA • LOPs • LAAs • performance management and standards and inspection regimes • Partnership working in PHI • the wider determinants of health • joint working across sectors - JSNA, LAAs • making best use of scarce resources

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