The PHO View

John Wilkinson

APHO

Mental Health Observatory

Core FundingHealth ProfilesOccasional PapersWebsite

Drug &

alcohol monitoring

Maternal &

Infant Health

HES & Commissioning

National Library for Public Health

EU Commission

PHINECancer Registry

Competency 5 – Manage knowledge and assess needs – some examples

• Joint Strategic Needs Assessment • Health Profiles• SHAPE • Mental Health Observatory• Drugs and Alcohol• Cancer data• National Library for Public Health • Regional Maternity Survey Office:• HES Service• Europe

Big Picture

• PHO delivers a number of non core functions

• Core functions now accounts for 25% of annual income

• More capacity and greater skill set in NEPHO

• PHINE

National Library for Public Health

• Single source for evidence for public health workforce

• Evidence-based resources from around the world, UK policy and guidance, news & events, etc. www.library.nhs.uk/publichealth

Drugs and alcohol

• Monthly (about 6 weeks after month end), quarterly and annual outputs to commissioners

• Used by DATs to commission, decommission and performance manage agencies

• Used by NTA and Healthcare Commission to manage whole system

• Alcohol data from April 2008 for PCTs

Training and Development

NEPHO run workshops, teaching training and advice in

areas such as:

• The development of profiles, indicators performance measures and targets

• Health Needs Assessment• Health Equity Audit• Health Impact Assessment• Ethnic (and diversity) monitoring

Example analysesNEPHO Life Expectancy reports

Trend in life expectancy at birth for males in South Tyneside

72

73

74

75

76

77

78

79

80

81

82

1995-1997 1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005

Life

expect

ancy

at

bir

th (

years

)

South Tyneside North East England Spearhead LAs

Example analysesNEPHO Life Expectancy reports

L.E. at birth for males in South Tyneside, projected against target

69

70

71

72

73

74

75

76

77

78

79

80

1995

-199

7

1996

-199

8

1997

-199

9

1998

-200

0

1999

-200

1

2000

-200

2

2001

-200

3

2002

-200

4

2003

-200

5

2004

-200

6

2005

-200

7

2006

-200

8

2007

-200

9

2008

-201

0

2009

-201

1

Life

Expect

ancy

at

Bir

th (

Years

)

South Tyneside ENGLAND Target trajectory Linear (South Tyneside) Linear (ENGLAND)

Example analysesNEPHO Life Expectancy reports

Scenario modelling, males in South Tyneside

73

74

75

76

77

78

79

80

81

82

83

84

40%

red

uctio

n in

circ

ulat

ory

deat

hsat

age

s <

75

20%

red

uctio

n in

canc

er m

orta

lity

atag

es <

75

20%

red

uctio

n in

acci

dent

mor

talit

yat

all

ages

20%

red

uctio

n in

suic

ide

at a

ll ag

es

All

four

tar

gets

Life

Expect

ancy

at

Bir

th (

Years

)

PSA target for England (2009/2011) = 78.6 years

South Tyneside target (2009/2011) = 77.0 years

South Tyneside 2003/2005 = 74.8 years

Mental Health - Discharge to first contact

•Key indicator of post-discharge follow up

•Important for suicide prevention

•Collected through the Mental Health Minimum Dataset

•Data shown are for 2005/6

•Available in the NEPHO Mental Health Workbook

Interval between discharge and first clinical contact(Patients of all ages - 2005/6)

England

0%

10%

20%

30%

40%

50%

60%

70%

80%

Mental Health Local Implementation Areas

Pro

po

rtio

n o

f p

atie

nts

co

nta

cted

By 27th day

By 20th day

By 13th day

By 6th day

North East

0%

10%

20%

30%

40%

50%

60%

70%

80%

Darlin

gton

Co. D

urha

m

Hartle

pool

Gat

eshea

d

Redca

r and

Cle

vela

nd

Stock

ton

Mid

dlesb

roug

h

South

Tyn

eside

Newca

stle

North

Tyn

eside

North

umbe

rland

Sunde

rland

RMSO data

J un-05Mar-03Dec-00Sep-98J un-96Mar-94Dec-91Sep-89J un-87Mar-85

0.0012

0.0010

0.0008

0.0006

0.0004

0.0002

0.0000

Quarter

Rate

1

1

Rate of gastroschisis by quarter of LMP

Europe

• “We want our region to perform best of all the regions in Europe” (SE Coast - Darzi Report)

Percentage of obese persons

0

5

10

15

20

25

Régions

% o

f o

bes

e p

erso

ns

Germany United-Kingdom Austria Belgium Spain France Luxembourg Netherlands

Sweden Estonia Hungary Latvia Malta 1st quartile 3rd quartile Median

Source: ISARE Data Set

SHAPE

Local ProvisionAdmissions to Trusts for PCT A (2004/05)

60.9%

11.8%

11.5%

7.5%

4.6%

1.2%

0.3% 0.3%

0.8%

0.2%0.1%

0.1%

0.7% Trust 1 Trust 2

Trust 3 Trust 4

Trust 5 Trust 6

Trust 7 Trust 8

Trust 9 Trust 10

Trust 11 Trust 12

OTHER

High Volume Emergency HRGs and ALOS

  HRG35 HRG LabelNat

ALOS Trust1 Trust2 Trust3 Trust4 Trust5

1 E36 Chest Pain <70 w/o cc 1.62 1.13 1.40 1.11 0.69 3.67

2 F47 General Abdominal Disorders <70 w/o cc 2.36 1.90 2.87 2.41 2.94 0.83

3 P03 Upper Respiratory Tract Disorders 0.88 0.63 1.31 0.80 1.69 0.17

4 M09 Threatened or Spontaneous Abortion 0.57 0.46 0.82 0.62 0.00  

5 S16 Poisoning, Toxic, Environmental and Unspecified 1.96 1.43 1.07 1.26 0.73 0.00

6 P13 Other Gastrointestinal or Metabolic Disorders 1.49 1.10 1.62 1.14 3.03  

7 D40 COPD or Bronchitis w/o cc 7.39 6.76 5.37 6.55   0.00

8 E35 Chest Pain >69 or w cc 3.49 2.44 3.76 2.21 1.00 0.75

9 P06 Minor Infections (including Immune Disorders) 1.44 0.84 1.00 1.23 2.44 1.67

10 P26 Infectious and Non-Infectious Gastroenteritis 1.07 0.76 1.50 0.88 2.79 1.00

11 E12 Acute Myocardial Infarction w/o cc 7.53 6.56 7.97 6.31 4.00 7.75

12 D99 Complex Elderly with a Respiratory System P.D 16.63 16.18 15.75 11.88   2.00

13 F46 General Abdominal Disorders >69 or w cc 6.13 4.64 5.15 3.85 7.59 1.50

14 D41 Unspecified Acute Lower Respiratory Infection 9.6 9.49 6.12 7.83 5.75 9.00

15 E31 Syncope or Collapse >69 or w cc 7.65 6.66 6.70 5.90 8.67 3.00

16 E22 Ischaemic Heart Disease without intervention 6.32 3.66 4.78 3.23 3.50 13.00

17 P01 Asthma or Wheezing 1.24 0.81 1.21 1.25 2.00  

18 E29 Arrhythmia or Conduction Disorders >69 or w cc 7.32 5.49 5.96 5.64 3.67 10.00

19 L09 Kidney or Urinary Tract Infections >69 or w cc 13.97 13.23 10.80 8.24 7.50 5.00

20 E23 IHD without intervention <70 w/o cc 3.67 2.77 3.09 2.41 1.00 2.50

Future?

• PHINE• PCT chief executives development group• What support is needed?• What could we do better?• What could we do less of?