Effective public health intelligence for London Justine Fitzpatrick, Allan Baker London Health Observatory

Learning objectives Understand the networks and partnerships working to provide public health intelligence for London Understand the LHO and its role in supporting public health and commissioning in London

What will be covered? What is the London Health Observatory? Overview of health intelligence partners in London Overview of current work at London Health Observatory An example: the health inequalities indicator in the World Class Commissioning Framework A discussion: What are the current priorities for public health intelligence in London?

LHO lead areas: Health inequalities Ethnicity Smoking NICE APHO: The Observatory Network and Lead Areas

The functions of PHOs in England To work in partnership with researchers, regional and local health policy makers and practitioners to: Monitor trends in health and its determinants, highlighting areas for action Highlight future health problems Assess the health impact of potential and past policies Draw together information from different sources and to identify gaps in information Provide standard sets of community health information at local government and regional level To support the development of skills in public health practitioners and NHS staff, for example in equity audits and health impact assessments, and build capacity in public health intelligence. Adapted from “Saving Lives - Our Healthier Nation” a “Choosing Health – Making Healthier Choices Easier”

What sort of work does LHO do? : RESPONSIVEPRO-ACTIVE Enquiry service Signposting data and information In depth analysis/ interpretation of health data Public health performance monitoring Tools and methods for data analysis Support health practitioner and intelligence networks Communication and advocacy for better public health information. Widening access to data

Collating/ Processing Data Turning Data into Health Intelligence Collecting Data/ Information Using Health Intelligence To Improve Health & Care Other Agencies Public Health Observatory role Role of PHOs in health intelligence

Department of Health Office for National Statistics Regional Office of DH and NHS London LHO (CSL) Greater London Authority Government Office for London Health Protection Agency Thames Cancer Registry Primary Care Trusts Regional Organisations National Organisations Local Organisations Local AuthoritiesAcute Trusts Universities

Commissioning Support for London

LHO Governance Chief Medical Officer for England National Steering Group for PHOs Regional Director of Public Health London Health Observatory London’s Primary Care Trusts Chief Executive of CSL Medical Director of CSL APHO Executive LHO Advisory Board LHO Core WorkLHO PCT Intelligence Work

Examples of current LHO Work CSL (PCT Intelligence) Health needs assessment toolkit Health performance dashboard National Programme Local smoking profiles The Health Inequalities Intervention Tool The Local Basket of Inequalities Indicators Physical activity social marketing tool London Programme London boost of the Health Survey for England (mental health and social capital) Child health profiles Local authority health profiles 2009 Enquiry service (HES and general enquiries) Small area indicators for PCTs Practice profiles refresh Public health performance reports

Who uses our services?

How is LHO work commissioned? LHO enquiry service Individual PCTs CSL business partners London’s DsPH Other London partners (NHS London, RPHG, GOL, GLA etc) APHO Executive Department of Health Information Centre

Useful links Recommended to explore website! Enquiry service: LHO website APHO website CSL website

World Class Commissioning Assurance Framework - Health Inequalities Indicator Allan Baker London Health Observatory

WCC Assurance Framework 54 Indicators PCTs select 8 to reflect strategic priorities 2008 – 2 compulsory indicators: Life expectancy Index of Multiple Deprivation DH requested advice for replacing IMD

Selection of a new indicator 30 th July – APHO meet with DH London Health Observatory – leads on health inequalities East Midlands PHO – recently researched methods for measuring health inequalities within a PCT

Criteria Mortality indicator to show extent of inequalities within PCTs Easy to understand and interpret Robust Relate to other health inequality resources Consistent over time Available quickly

Options Which measure of mortality All ages, all causes - or subsets Sex-specific – or all persons Time period Geography

Options – type of indicator Range indicator Lorenz curve based indicator Slope indices

Recommendation for a new indicator 7 August – recommendation to DH Life expectancy at birth – 5 years data Deprivation deciles within PCTs Deciles based on LSOAs Sex-specific Slope index of inequality

Slope Index of Inequality

Timetable for delivery 18th August – DH agree to proposal 7 th Sept – APHO provide data 15 th Sept – APHO provide metadata 16 th Sept – WCC Datapacks launched

WCC Datapack – SII results for London

SII Results by IMD scores

SII results by Life Expectancy

Distribution of deprivation – percentage of population in national deprivation quintiles Barking and Dagenham – 92% in Q4 & Q5 Richmond – 82% in Q1 & Q2 Westminster – spread between Q2 – Q5 Tower Hamlets – 90% in Q4 & Q5

Next steps Analysis of results Trend data – and Latest data – Guidance on trajectory setting

APHO website APHO recommendation Slope Index of Inequality dataset Guide to interpretation Life expectancy results for deprivation deciles Summary charts for each PCT LSOA to deprivation decile look-up

Questions? Discussion: what are the current priorities for public health intelligence in London?