Developing Nottingham’s LAAJeanelle de Gruchy and Chris Nield

Health Equality, Nottingham City PCT

Objectives of session

• LAA indicator issues

• LAA partnership working issues

• Effective indicators

SMART Indicators

• Specific – mental health (support to people known to mental health services)

• Measurable – mental health (DSH)• Achievable – prevalence (smoking,

physical activity, alcohol) • Relevant – physical activity cf. statins• Timed – 1996/97 or 2005? 6 monthly or

at the end of 3 years?

Measurement

• Outcome vs process (quitters v. prevalence)• Definitions (obesity, PA)• Baselines – expense and time measuring

(PA)• Perverse incentives (mental health

employment; CHD – statins v. PA)– Time-scale – needing to show results in 3 years

(easier to argue for older people CHD cf. young people and obesity)

– Inequalities – overall numbers vs. targetted

LAAs in partnership• Accountability – it’s a political process

– Consultation with partner organisations– Conflicting guidance – GOEM, City Council, SHA,

ODPM guidance document (eg what is a ‘stretch’)– Lead organisation control (driven by performance

management)– Some lack of understanding of NHS organisation

drivers / performance management / limited focus on public health (and limited capacity!)

• Understanding of health / health outcomes – Valuing professional/technical expertise

• Is 0.5 of a fruit ‘unambitious’?

Negotiating indicators

• Time scale to negotiate– Community consultation – Iterative process, but difficult to ensure all kept on

board with the process

• Blocks and cross-cutting issues– Alcohol – crime or medical…?– Infant mortality (technical expertise)

• Prioritisation / nos. of indicators allowed– Lobbying by interest groups (avoidable injury;

supporting young parents)

Effective indicators

• A health priority (national / local target)• Evidence base• Build on reality of local situation• Be creative – the reality is it needs to be

measured – balance between routinely available info –

but may need to survey.

• Particularly NB as we develop our stretch targets