A public health outcomes framework for England,

Outline of the presentation Background Developing the Public Health Outcomes Framework Content of the first Public Health Outcomes Framework Alignment with other outcomes frameworks How will the Public Health Outcomes Framework be used? Next steps

The purpose of the Public Health Outcomes Framework The whole public health system is going to be refocused around achieving positive health outcomes for the population and reducing inequalities in health, rather than being focused on process targets The Public Health Outcomes Framework sets out the strategic direction for the new system: To improve and protect the nation’s health and wellbeing and improve the health of the poorest fastest The framework will not be used to performance manage the public health system Rather, it will provide a framework for transparency and accountability across the public health system and set out the broad range of opportunities for local government, the NHS and Public Health England to work in partnership to improve and protect health across the life course and to reduce inequalities in health that still persist

Timeline November 2010: Public health white paper - Healthy lives, healthy people: Our strategy for public health in England - published December March 2011: Public consultation on Healthy Lives, Healthy People (including consultation on outcomes framework) July 2011: Healthy Lives, Healthy People: Update and way forward published 23 January 2012: First Public Health Outcomes Framework published Autumn 2012: Updated Public Health Outcomes Framework documents and baseline data to be published April 2013: Public Health Outcomes Framework comes into operation

Developing the Public Health Outcomes Framework The development of the Public Health Outcomes Framework has been firmly based on a set of principles that were developed through consultation with stakeholders (and with our partners) A first proposed structure and set of indicators were included in a public consultation on Healthy Lives, Healthy People which ran from December 2010 – March 2011 Some key themes in responses to the consultation: Widespread welcome for our approach to the framework, in particular the use of domains to group public health priorities Suggested use of the “3 pillars of public health” The need for clarity of how the different outcomes frameworks fit together 25 improved / additional indicators were put forward for consideration

Developing the Public Health Outcomes Framework We worked with a variety of key stakeholders to develop a rigorous set of criteria against which the 87 candidate indicators could be consistently assessed We decided upon 13 criteria and asked PHOF indicator leads to conduct an assessment of their indicator(s) against a standard set of guidance. Major cause of premature mortality or avoidable ill health Y Smoking is the primary cause of preventable morbidity and premature death, accounting for 81,400 deaths in England in 2009, some 18 per cent of all deaths of adults aged 35 and over. In 2008/09, some 463,000 hospital admissions in England among adults aged 35 and over were attributable to smoking, or some 5 per cent of all hospital admissions for this age group. Illnesses among children caused by exposure to second- hand smoke lead to an estimated 300,000 general practice consultations and about 9,500 hospital admissions in the UK each year.

Developing the Public Health Outcomes Framework Out of the 13 criteria that we decided on, we identified a number of key criteria, namely that an indicator: Aligns with the government’s direction for public health Is amenable to public health intervention, e.g. by PH professionals, Local Authorities, PHE, NHS Represents a major causes of premature mortality or avoidable ill health Is linked to improvements in health-related quality of life (including mental health) Is linked to helping reduce inequalities in health Is linked to helping improve healthy life expectancy Is statistically appropriate, fit for purpose Is at least feasible at national level and upper tier local authority level If an indicator did not meet one (or more) of these key criteria then they were sifted out of the list of candidate indicators

Developing the Public Health Outcomes Framework Once we had conducted the first sift of indicators, we allocated each of the remaining indicators to the most relevant domain of the framework on the basis of their likely impact meeting the objectives of a domain We then worked with key public health colleagues in DH, other government departments and the public health system to develop the final set of indicators via a series of stakeholder engagement workshops. Following the sift and engagement workshops, we were left with 66 indicators which went forward to form the first Public Health Outcomes Framework

Publication of the first Public Health Outcomes Framework Launched by the Secretary of State for Health on 23 January 2012 in three parts: Part 1: Introduces the overarching vision for public health, the outcomes we want to achieve and the indicators that will help us understand how well we are improving and protecting health Part 2: Specifies all the technical details we can currently supply for each public health indicator and indicates where we will conduct further work to fully specify all indicators Part 3: Impact Assessment and Equalities Impact Assessment These documents are found at ndGuidance/DH_ ndGuidance/DH_132358

Content of the first Public Health Outcomes Framework Focused on two high level outcomes we want to achieve across the public health system and beyond: Increased healthy life expectancy Reduced differences in life expectancy and healthy life expectancy between communities through greater improvements in more disadvantaged communities Supported by a set of 66 supporting public health indicators to help focus our understanding of how well we are doing year by year. Split over four domains: Improving the wider determinants of health Health improvement Health protection Healthcare public health and preventing premature mortality

VISION To improve and protect the nation’s health and wellbeing and improve the health of the poorest fastest Outcome 1) Increased healthy life expectancy, i.e. taking account of the health quality as well as the length of life Outcome 2) Reduced differences in life expectancy and healthy life expectancy between communities (through greater improvements in more disadvantaged communities) Outcome measures PHOF - Vision

Improving the Wider Determinants of Health Objective Improvements against wider factors which affect health and wellbeing and health inequalities Indicators Children in poverty School readiness (Placeholder) Pupil absence First time entrants to the youth justice system year olds not in education, employment or training People with mental illness or disability in settled accommodation People in prison who have a mental illness or significant mental illness (Placeholder) Employment for those with a long-term health condition including those with a learning difficulty/disability or mental illness Sickness absence rate Killed or seriously injured casualties on England’s roads Domestic abuse (Placeholder) Violent Crime (including sexual violence) (Placeholder) Re-offending The percentage of the population affected by noise (Placeholder) Statutory homelessness Utilisation of green space for exercise/health reasons Fuel poverty Social contentedness (Placeholder) Older people’s perception of community safety (Placeholder) 1 PHOF Domain 1

Health improvement 2 Objective People are helped to live healthy lifestyles, make healthy choices and reduce health inequalities Indicators Low birth weight of term babies Breastfeeding Smoking status at time of delivery Under 18 conceptions Child development at years (Placeholder) Excess weight in 4-5 and year olds Hospital admissions caused by unintentional and deliberate injuries in under 18s Emotional well-being of looked after children (Placeholder) Smoking prevalence – 15 year olds Hospital admissions as a result of self-harm Diet (Placeholder) Excess weight in adults Proportion of physically active and inactive adults Smoking prevalence – adult (over 18s) Successful completion of drug treatment People entering prison with substance dependent issues who are previously not known to community treatment Recorded diabetes Alcohol-related admissions to hospital Cancer diagnosed at stage 1 and 2 (Placeholder) Cancer screening coverage Access to non-cancer screening programmes Take up of the NHS Health Check Programme – by those eligible Self-reported well-being Falls and injuries in the over 65s PHOF Domain 2

Health Protection Objective The population’s health is protected from major incidents and other threats, whilst reducing health inequalities Indicators Air pollution Chlamydia diagnoses (15-24 year olds) Population vaccination coverage People presenting with HIV at a late stage of infection Treatment completion for TB Public sector organisations with board approved sustainable development management plan Comprehensive, agreed inter-agency plans for responding to public health incidents (Placeholder) 3 PHOF Domain 3

Healthcare public health and preventing premature mortality Objective Reduced numbers of people living with preventable ill health and people dying prematurely, whilst reducing the gap between communities. Indicators Infant mortality Tooth decay in children aged 5 Mortality from causes considered preventable Mortality from all cardiovascular diseases (including heart disease and stroke) Mortality from cancer Mortality from liver disease Mortality from respiratory diseases Mortality from communicable diseases (Placeholder) Excess under 75 mortality in adults with serious mental illness (Placeholder) Suicide Emergency readmissions within 30 days of discharge from hospital (Placeholder) Preventable sight loss Health-related quality of life for older people (Placeholder) Hip fractures in over 65s Excess winter deaths Dementia and its impacts (Placeholder) 4 PHOF Domain 4

Alignment with other outcomes frameworks The NHS Outcomes Framework was first published in December 2010 and a refreshed version was published in December 2011: Primary alignment with the PHOF is a set of shared indicators on premature mortality from specific disease areas (in domain 4 of the PHOF) Different contribution of public health and the NHS to reducing these mortality rates - represented by the inclusion in the PHOF of measures on preventable mortality from CVD, cancer, respiratory disease and liver disease and the inclusion in the NHSOF of cancer survival rates The Adult Social Care Outcomes Framework was published in March 2011: There are complementary indicators across this and the PHOF relating to improving outcomes for specific client groups, e.g. those with mental illness, learning disabilities or long term conditions Alignment not restricted to the three DH-sponsored outcomes frameworks

NHS & Public Health Employment of people with long-term conditions* Infant mortality* Under 75 mortality rate from all cardiovascular diseases* Under 75 mortality rate from cancer* Under 75 mortality rate from liver disease* Under 75 mortality rate from respiratory diseases* Excess under 75 mortality in adults with serious mental illness* Emergency readmissions within 30 days of discharge from hospital NHS, Public Health & Adult Social Care Employment of people with mental Illness [In the PHOF the indicator compares the rate of employment amongst those with mental illness to the overall employment rate] Public Health & Adult Social Care People with mental illness or disability in settled accommodation [In the ASCOF the indicator on adults with learning disabilities covers those who live in their own home or with their family] Proportion of adults with learning disabilities in paid employment [In the PHOF the indicator compares the rate of employment amongst those with learning disabilities to the overall employment rate] Public Health Outcomes Framework NHS Outcomes Framework Adult Social Care Outcomes Framework NHS & Adult Social Care Proportion of older people (65 and over) who were still at home 91 days after discharge into rehabilitation Health-related quality of life for carers [In the ASCOF the indicator is carer-reported quality of life] Health-related quality of life for people with long-term conditions [In the ASCOF the indicator is on social care related quality of life for those with care and support needs] CURRENT SHARED* OR LINKED INDICATORS *Those indicators that are starred are defined as having shared responsibility between the named frameworks Where indicators are in italics, this indicates that there are different measures in the named frameworks that look at the same issue

How will the Public Health Outcomes Framework be used? Data for PHOF indicators will be published in one place by Public Health England at England and upper tier LA level – and at lower geographical levels and by various inequalities and equalities breakdowns where feasible. This will enable national and local democratic accountability for performance against public health outcomes enabling: Easy comparison by local areas with others / peers across the countries An incentive to improve outcomes Tracking of progress at a national level to inform interventions that will make health improvements across the country The use of the data within the outcomes framework for benchmarking makes the Public Health Outcomes Framework an essential tool alongside the NHS, Adult Social Care and other sectors’ frameworks for driving local sector led improvement.

Next steps The Public Health Observatories (led by the London Health Observatory) will be leading the upcoming development work on the PHOF indicators. 29 of the 66 PHOF indicators (and indicators corresponding to the two overarching outcomes) are already ready in terms of having a confirmed definition and data source, which will provide data at national and upper tier local authority level Development work will be ongoing to fully define and identify / improve data sources for those indicators that are not yet ready with the aim of publishing an updated technical specification in Autumn 2012

Next steps In addition to this we will be working to improve the information we have published already on the availability of different geographical and inequalities / equalities breakdowns: Using this and the updated technical specifications the PHOs will be working to produce a set of baseline figures for the indicators to be published in Autumn 2012 to support local planning

Next steps Although the first phase of work will take us up to Autumn 2012, the development work will not stop there! The Public Health Outcomes Framework is a multi-year framework, with a built-in expectation that it should be refreshed each year as data quality improves, technical capability across the public health system develops, and importantly as we maintain an aligned approach across the NHS, Local Authorities and PHE Building on the extensive engagement we have already enjoyed, we wish to see any future development of the Public Health Outcomes Framework as a joint effort – as a result of strong partnerships between national and local government, between the NHS and Local Government, and most importantly with the citizens and communities whose health we need to improve and protect.

Useful links / contact details Public Health Outcomes Framework ndGuidance/DH_ NHS Outcomes Framework 2012/13 (refreshed December 2011) ndGuidance/DH_ Adult Social Care Outcomes Framework 2011/12 If you have any further questions then please feel free to them to me at