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Better Intelligence Boosts Quality Sir Muir Gray CBE 23 March 2009.

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Presentation on theme: "Better Intelligence Boosts Quality Sir Muir Gray CBE 23 March 2009."— Presentation transcript:

1 Better Intelligence Boosts Quality Sir Muir Gray CBE 23 March 2009

2 The future is not a destination like Cheviot Hills, waiting for our arrival; it is something like Durham Cathedral that we have to imagine, plan and build.

3 The future is here; it is just not evenly distributed William Gibson

4 Great innovations of the first and second healthcare revolutions  MRI and CT scanning  Statins  Antibiotics  Coronary artery bypass graft surgery  Hip and knee replacement  Chemotherapy  Radiotherapy  Randomised controlled trials  Systematic reviews Gower Street - Doll & Hill Broad Street - John Snow First Second

5 21st C health and healthcare problems  Safety  Errors  Quality  Substandard clinical practice  Poor patient experience  Failure to maximise value  Waste  Overenthusiastic adoption of low value interventions  Failure to get new evidence into practice  Inequalities  Failure to prevent disease

6 The drivers of the third industrial revolution Citizens Knowledge I T Manuel Castells

7 Generalisable knowledge Explicit Tacit From research:  evidence From data:  statistics or information From experience:  casebook Knowledge


9 Knowledge: the enemy of disease The application of what we know will have a bigger impact than any drug or technology likely to be introduced in the next decade


11 “Evidence from recent trials, no matter how impressive, should be interpreted with caution” Claims made in 45 highly cited reports were subsequently contradicted (n=7) or weakened (n=7) for 14 of the interventions Ionnidis JPA (2005) Contradicted and initially stronger effects in highly cited clinical research JAMA 294; 218-228

12 Research reports NICE guidance




16 Who is responsible for… 1.What a new GP in Hartlepool knows about indications for referral for hoarseness? 2.What a citizen in Gateshead knows about PSA screening? 3.What a Year 1 SpR in geriatrics in Darlington knows about fractured neck of femur? 4.What a teacher of children with learning disability in Newcastle knows about epilepsy?

17 Someone on the Board of every healthcare organisation, directly responsible to the Chief Executive, will be given the responsibility of acting as Chief Knowledge Officer

18 Public Health is a knowledge business The application of what we know from research, from data analysis and experience, will have a bigger impact on health than any drug or technology

19  Librarians  Information scientists  Chief Knowledge Officers  Clinical epidemiologists  Public health professionals


21 “most patients were not given clear information about the survival gain of palliative chemotherapy… in most (26/37) consultations discussion of survival benefit was vague or non-existent” Audrey S et al (2008) What oncologists tell patients about survival benefit of palliative chemotherapy and implications for informed consent BMJ 2008; 337;a752





26 Informing Healthier Choices Box 1 Workforce capacity and capability Better workers Box 2 Improved data and information Cleaner clearer knowledge Box 3 Stronger organisations Stronger teams Box 4 Health information and intelligence portal and systems Better pipes

27 Box 1 Workforce capacity and capability Better workers  Improving public health information and intelligence skills and capacity across England for all levels of the public health workforce  PH Specialists  PH Practitioners  Wider PH workforce 2 objectives  Developing a career pathway and supporting infrastructure tools  Developing training resources to build competencies for all those using information and intelligence

28  Suite of Job Descriptions and Person Specifications for information and intelligence staff  10 e-learning modules (5 at specialist and 5 at practitioner levels)  13 modules with.ppt slides, tutor notes and workbooks  hosts training resources for all public health competences Box 1 Available now! Box 1

29 Box 2 Improved data and information provision Cleaner, clearer knowledge Reliable data on key health challenges Special surveys eg  well being  dental health  exercise levels Surveillance systems eg  child health systems  disease registers Centrally from provider data eg general practice  smoking  raised BP

30 Box 2 data workstreams  Health Profiles 3  Primary care data development  Prevalence modelling  Child height and weight  Dental survey data  Drug misuse data  Nutrition & dietary data  JSNA dataset  Local health surveys  Sexual health data  Other initiatives e.g. basket of health inequalities indicators Box 2

31 CHD: expected prevalence in people over 16 Box 2

32 CHD: observed over expected prevalence in over 16s Box 2

33  Competencies for WCC, inc JSNA  Skills to use intelligence for Public Health and commissioning  Health Impact Assessment  Government Impact Assessment (national)  Specific proposal impact (regional, local)  Training  Strategic Environmental Assessment Box 3 Stronger organisations Stronger teams

34 Policies for action on WDH

35  Better presentation and accessibility of data to professional public health people  Better use of information systems and tools by networks of people  web-based  improved ease of use  interactive  Examples and inspiration to promote more productive use of information Box 4 Health information and intelligence portal and systems Better pipes

36 Projects  NLPH – online, free to access  APHO, IC, DH, PHAST development work  Data analytic tools  Knowledge management systems  Single portal for accessing PH intelligence  Plus social networking?  Other Web 2.0 resources? Box 4

37 Public health casebook proposal  Expedites shared learning  All public health practitioners must submit 1 (or more) report pa  Reports contain  Outline of problem  Why prioritised  Objective of PH investment  Project impact  Lessons learned  Signpost to full documentation  Contact details

38 Any thoughts ?     Thank you!

39 PHINE meeting NLPH – busy online library with monthly newsletter (>7500 hits per month) National guidelines Systematic reviews National knowledge weeks (synthesised for quality) eg HIV/AIDS Dec 2008, drug misuse Jun 2009

40 PHINE meeting Capacity development: posts and courses Better understand networks of practitioners, networks of information, networks of quality observatories, relations to wider networks beyond NHS (esp PHOs) eg GOs Distinct role of PHOs Commissioning competencies within PCTs esp competency 5 (NEPHO workshops with SHA on knowledge management) All PCTs aiming for level 3 in coming year, using DOAS CKO group self assessing knowledge management

41 PHINE meeting Comp 5: CEOs across Region have started group led by CEO N Tyne NE Regional Information Partnership with John Carling leading – good online resource Centre for Population Research – UKCRC set up 5 centres of excellence. In NE 5 universities collaborate (quoted by CMO) Has attracted funds for research on 10 important themes (social group – economy environment and mh; lifestyle - tobacco, alcohol, obesity, phys activity; prevention fair and early treatment – provision of healthcare not prioritised in other work stream; life course – early years, good life, good later life, good death

42 PHINE meeting Individual universities tackle specific areas Feedback from pairs – what can IHC do for you? ONS birth – gestational age please ONS website design, hard to find what you want Rationalise web access Provide digests (but NLPH does this) Train CEOs in PH knowledge management – show them the benefits

43 Feedback from pairs Data from OGDs and IC easier to find Access for PHOs to PPA data and NHS central registry for GP registrations at a national level – use a single issue to highlight, maybe statins Promote imp of PH to commissioning – demonstrate risks of not having PH info central to commissioning decisions Help PH people use media their partners use

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