1. South West Public Health Observatory South West Regional Public Health Group Joint Strategic Needs Assessment Paul Brown Deputy Director South West Public Health Observatory

2. South West Public Health Observatory South West Regional Public Health Group Outline Background Tools that might help (handout available) –Health Inequalities Intervention Tool –POPPI –NCHOD: Program Budgeting –APHO –Disease Management Information Toolkit –CSCI –Audit Comission SWPHO example Proposed SWPHO Future work Discussion – what should we be doing next?

3. South West Public Health Observatory South West Regional Public Health Group Background Scoping exercise undertaken. Opinions of DPHs, Local Authority JSNA leads and information managers SWPHO Started to develop tools in response to specified needs Only the start! JSNA work ongoing and there are still outstanding issues needing to be addressed.

4. South West Public Health Observatory South West Regional Public Health Group Suggestions from JSNA leads Start Now! Increase Public Consultation Integrate with wider health and social needs

5. South West Public Health Observatory South West Regional Public Health Group Some tools that might be of help Health Inequalities Intervention Tool POPPI NCHOD: Program Budgeting APHO Disease Management Information Toolkit CSCI Audit Commission. SWPHO

6. South West Public Health Observatory South West Regional Public Health Group Health Inequalities Intervention Tool

7. South West Public Health Observatory South West Regional Public Health Group Action on cardiovascular disease can deliver most of the gap (now 11% for men). Action on other causes of death can contribute. These modelled interventions are a guide, to demonstrate the achievability of the target, and will need to be interpreted in the light of local demography and performance. The NHS can have high impact, but modelling will need local interpretation. The Gap – for males 35% All circulatory diseases, 70% of which are Coronary Heart Disease (CHD) 18% All cancers, 61% of which are lung cancer 15% Respiratory diseases, 53% of which are chronic obstructive airways disease 10% Digestive, 50% of which are chronic liver disease and cirrhosis 5% External causes of injury and poisoning, 60% of which are suicide and undetermined death 2% Infectious & parasitic diseases 10% Other 5% Deaths under 28 days Contribution to Life Expectancy Gap in Males Breakdown by disease, 2003 *locally determined Universalist: Smoking reduction in clinics – as at present Secondary prevention of CVD:75% coverage of 35-74yrs Primary prevention of CVD in hyptensives under 75 yrs: 20% coverage antihypertensive statin therapy The InterventionsThe Impact – for males Targeted: Smoking cessation clinics: double capacity in Spearhead areas for 2 years Secondary prevention of CVD: additional 15% coverage of effective therapies in Spearhead areas 35-74 yrs Primary prevention of CVD in hypertensives under 75yrs: 40% coverage antihypertensives statin therapy Primary prevention of CVD in hypertensives 75yrs +: 40% coverage antihypertensives statin therapy Other*, including: Early detection of cancer Respiratory diseases Alcohol related diseases Infant mortality 1.0% 2.3% 1.0% 0.7% 1.2% 0.7% 2.1% 0.2% 1.4% 0.2% 8.9% Further modelling of Other actions will need to contribute the remaining 2.1% 11%

8. South West Public Health Observatory South West Regional Public Health Group For women the gap is even wider For women the gap is now 16%. Action on CVD will be significant but will need to be supplemented by action on other causes. The modelled interventions will need to be interpreted in the light of local demographics and performance. High quality primary care and case finding are vital. The Gap – for females 30% All circulatory diseases, 63% of which are Coronary Heart Disease (CHD) 16% All cancers, 75% of which are lung cancer 21% Respiratory diseases, 57% of which are chronic obstructive airways disease 9% Digestive, 44% of which are chronic liver disease and cirrhosis 5% External causes of injury and poisoning, 40% of which are suicide and undetermined death 2% Infectious & parasitic diseases 11% Other 6% Deaths under 28 days Contribution to Life Expectancy Gap in Females Breakdown by disease, 2003 Universalist: Smoking reduction in clinics – as at present Secondary prevention of CVD:75% coverage of 35-74yrs Primary prevention of CVD in hyptensives under 75 yrs: 20% coverage antihypertensive statin therapy The InterventionsThe Impact – for females Targeted: Smoking cessation clinics: double capacity in Spearhead areas for 2 years Secondary prevention of CVD: additional 15% coverage of effective therapies in Spearhead areas 35-74 yrs Primary prevention of CVD in hypertensives under 75yrs: 40% coverage antihypertensives statin therapy Primary prevention of CVD in hypertensives 75yrs +: 40% coverage antihypertensives statin therapy Other*, including: Early detection of cancer Respiratory diseases Alcohol related diseases Infant mortality *locally determined 1.0% 1.4% 0.9% 0.5% 3.2% 1.6% 5.6% 0.4% 1.0% 0.2% 10.4% Further modelling of Other actions will need to contribute the remaining 5.6% 16%

9. South West Public Health Observatory South West Regional Public Health Group Further information Background information about the tool available at http://www.lho.org.uk http://www.lho.org.uk Go to Health Inequalities>Inequalities Intervention tool SWPHO will keep up-to-date with tool development and roll-out to non-spearheads

10. South West Public Health Observatory South West Regional Public Health Group Projecting Older People Population Information System (POPPI) Projects the future health needs of an older population Provides projections of: –numbers of older people; –those living alone, –in care homes, –with /without central heating, –receiving unpaid care, –ability to carry out domestic tasks and self care Projections based on estimates of limiting long term illness, depression, severe depression, dementia, heart attack, stroke,bronchitis\emphysema, falls, continence, visual impairment, mobility and obesity

11. South West Public Health Observatory South West Regional Public Health Group POPPI : Population Projections

12. South West Public Health Observatory South West Regional Public Health Group POPPI : Ethnicity and illness

13. South West Public Health Observatory South West Regional Public Health Group POPPI : Older people relative to total population

14. South West Public Health Observatory South West Regional Public Health Group POPPI : General Health/ unpaid care

15. South West Public Health Observatory South West Regional Public Health Group NCHOD: National Clinical Health Outcomes Database

16. South West Public Health Observatory South West Regional Public Health Group NCHOD: Program Budgeting

17. South West Public Health Observatory South West Regional Public Health Group NCHOD: Program Budgeting

18. South West Public Health Observatory South West Regional Public Health Group NCHOD: Program Budgeting

19. South West Public Health Observatory South West Regional Public Health Group NCHOD: Program Budgeting

20. South West Public Health Observatory South West Regional Public Health Group NCHOD: Program Budgeting

21. South West Public Health Observatory South West Regional Public Health Group NCHOD: Program Budgeting

22. South West Public Health Observatory South West Regional Public Health Group NCHOD: Program Budgeting : Incidence vs Expenditure

23. South West Public Health Observatory South West Regional Public Health Group APHO: Disease Prevalence Models Hypertension Diabetes Heart Disease Respiratory Disease

24. South West Public Health Observatory South West Regional Public Health Group Disease Management Information Toolkit Aimed at PCTs and the commissioning of services for people with long-term conditions Provide a disease management pack containing data and information that will help organisations strengthen their approach to disease management. Based on HES data Concentrates on Long Term Conditions (LTCs) which are largest contributors to emergency bed days.

25. South West Public Health Observatory South West Regional Public Health Group Commission for Social Care Inspection (CSCI) Inspect and report on care services and councils Performance assessed using a range of indicators. Indicators include: stability of placement of looked after children, intensive home care, older people helped to live at home….

26. South West Public Health Observatory South West Regional Public Health Group A range of indicators have been assessed

27. South West Public Health Observatory South West Regional Public Health Group Which can be summarised graphically….

28. South West Public Health Observatory South West Regional Public Health Group Audit Commission (Local Quality of Life Indicators) 44 indicators that measure the quality of life in individual localities Performance assessed using a range of indicators grouped into several themes. Themes include –People and place, –community cohesion and involvement –Community Safety –Culture and leisure –Economic wellbeing –Education and life long learning –Environment –Health and Social Wellbeing –Housing –Transport and Access –Other indicators

29. South West Public Health Observatory South West Regional Public Health Group Local Quality of Life Indicators Health and Social Wellbeing indicators include –Age standardised mortality (Cancers, Circulatory disease, Respiratory disease) –Infant Mortality –Life expectancy at birth (males and females) –Percentage of Household with limiting or long term illness –Teenage pregnancy (conceptions under 18 years)

30. South West Public Health Observatory South West Regional Public Health Group Can look at summaries by QOL themes….

31. South West Public Health Observatory South West Regional Public Health Group …and by LAA indicators….

32. South West Public Health Observatory South West Regional Public Health Group www.swpho.nhs.uk

33. South West Public Health Observatory South West Regional Public Health Group SWPHO JSNA Tools Handout Demonstration Example……… Healthy Life Expectancy at 65 in Swindon

34. South West Public Health Observatory South West Regional Public Health Group Healthy Life Expectancy at 65 Low for males compared to SW

35. South West Public Health Observatory South West Regional Public Health Group HLE for females….also low compared to SW

36. South West Public Health Observatory South West Regional Public Health Group “But Swindon isn’t comparable to the South West”

37. South West Public Health Observatory South West Regional Public Health Group HLE at 65 (males) – compared against ONS cluster

38. South West Public Health Observatory South West Regional Public Health Group HLE at 65 (females) – compared to ONS cluster

39. South West Public Health Observatory South West Regional Public Health Group “Swindon has a young population structure, so this may not be a major problem”

40. South West Public Health Observatory South West Regional Public Health Group Population in a unitary compared to England (2007)

41. South West Public Health Observatory South West Regional Public Health Group A unitary: Population structure compared to England (2012)

42. South West Public Health Observatory South West Regional Public Health Group A unitary: Population Structure Compared to England (2017)

43. South West Public Health Observatory South West Regional Public Health Group A unitary: Population structure compared to England (2022)

44. South West Public Health Observatory South West Regional Public Health Group A unitary: Population Structure compared to England (2027)

45. South West Public Health Observatory South West Regional Public Health Group Why is HLE at 65 lower in Swindon? To help answer this, SWPHO will be making available: Small area data Top 10 causes of mortality by age group and gender Variations in hospital admissions Inequalities analysis by: –Cause –Lifestyle factors (some) –People and places (segmentation tool)

46. South West Public Health Observatory South West Regional Public Health Group Differences in AAAC mortality

47. South West Public Health Observatory South West Regional Public Health Group Example of Health Intervention tool applied to another area

48. South West Public Health Observatory South West Regional Public Health Group What should we (APHO) be doing next? Value for Money and return on investment Inequalities Analysis Projection Methods Data Sharing Protocols Statistical Validity Target setting

49. South West Public Health Observatory South West Regional Public Health Group www.swpho.nhs.uk