1. Developing a Baseline – How we know we have achieved what we set out to achieve? Angela Baker angela.baker@phe.gov.uk

2. Purpose of the session This session will Who and what is PHE? Look at what baselines already exist Some key national figures Open the debate, what are we going to do then But first, who are we…. 2

3. Public Health England Exists to protect and improve the nation's health and wellbeing, and reduce health inequalities. It does this through advocacy, partnerships, world-class science, knowledge and intelligence, and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health. I am a member of the Thames Valley PHEC. There are three teams within the centre, Health Protection, Healthcare Public Health and Health Improvement. We all work together to achieve the above. 3

4. New Structure from April 2015 4 Dept of Health Public Health England NHS England NHS E Regions (X4) NHS E Local Area Teams (X12) Clinical Commissioning Groups Public Health Local Authority Public Health England Regions (4) Public Health England Centres (8+1)

5. So who does what…. Dept of Health, small unit that decides policy direction NHS England commissions Public Health Services such as bariatric surgery, all primary care services, screening and immunisation services either through areas teams or specialist commissioners CCG commission some tier 2 obesity services, in some areas, but also provide clinical direction to primary care Local Authorities – 2 types, unitary’s provide all the services in one area, also can influence planning, licensing etc, etc. 5

6. Upper tier Local Authorities do not have all the levels of influence but provide public health services and a variety of partnerships dependant on the area All Local Authorities must have a JSNA, a Health and Wellbeing Strategy and a Health and Wellbeing board to monitor the strategy PHE provides evidence base, support and advice to Local Authorities and to NHS England on what works, cost effectiveness, ROI, translation of NICE Guidance. 6

7. The Battenberg effect 7 NHS E Area Team Commissioner NHS E specialist commisisoner Local Authority Commissioning PHE Support and Advice SCN Co-ordination CCG Commissioning

8. What is transition? Transition is the purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centred to adult-orientated health care systems.” (Blum et al, 1993) 8

9. Existing Data and Information… There are 13,486,095 people aged under 20 in England, this equates to just over 23% of the total population 32 per 10,000 will have a life limiting condition which requires specialist input, that equates to 43,156. 577,931live in the Thames Valley (inc MK) that relates to just under 2000 children – approx 100 young people a year transition 9

10. South East FCE 15-19 Females (excluding pregnancy)Males Primary Diagnosis CodeDiagnosesPrimary Diagnosis CodeDiagnoses Total35,072Total20,846 R10 Abdominal and pelvic pain2,813 R10 Abdominal and pelvic pain684 T39 Poisoning by nonopioid analgesics, antipyretics and antirheumatics 1,419 N47 Redundant prepuce, phimosis and paraphimosis 451 J03 Acute tonsillitis964 K50 Crohn's disease [regional enteritis]445 K01 Embedded and impacted teeth529 K35 Acute appendicitis439 K07 Dentofacial anomalies [including malocclusion] 513 M23 Internal derangement of knee435 E10 Insulin-dependent diabetes mellitus438 S02 Fracture of skull and facial bones435 N39 Other disorders of urinary system417 S62 Fracture at wrist and hand level399 K35 Acute appendicitis411 J03 Acute tonsillitis398 K50 Crohn's disease [regional enteritis]396 S82 Fracture of lower leg, including ankle 372 R51 Headache394 K01 Embedded and impacted teeth350 10

11. 15 -19 year olds excluding pregnancy 11

12. Did not attend rates 12

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14. Our Data? Searched HES Data – outpatient Appointments Only 23 Episodes recorded… so Inpatients episodes 2009/10 – 3000 episodes recorded for Thames Valley 2012/13 – 6000+ episodes recorded but not clear why? Self harm caused by Tobacco increased by 4 fold Data not good enough to use therefore Problem 1 WE HAVE NO RLIABLE DATA 14

15. What can we do about it? What data do you collect? What data is comparable across the system? What are the benchmarks for successful transition? Reduced admissions Controlled condition Quantitative versus Qualitative Can we run a pilot in one speciality across the network? If so, what would work? 15

16. What and where are the transition points? Children's Acute/Secondary care to Adult Acute/Secondary Care Children's Social Services to Adult Social Services GP care – stays the same? But what is the role of parents? School versus Work/college/university 16

17. 17Angela Baker, Public Health Consultant in Health Improvement