Transcript A public health outcomes framework for England, 2013-2016

A public health outcomes framework for England, 2013-2016
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 2010 - 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 secondhand 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
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyA
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
PHOF - Vision
VISION
To improve and protect the nation’s health and wellbeing and improve
the health of the poorest fastest
Outcome measures
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)
PHOF Domain 1
1
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
•16-18 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)
PHOF Domain 2
2
Health improvement
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 2-2.5 years (Placeholder)
•Excess weight in 4-5 and 10-11 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 3
3
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)
PHOF Domain 4
4
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)
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 & Adult Social Care
CURRENT SHARED* OR
LINKED INDICATORS
Public Health
Outcomes
Framework
NHS Outcomes
Framework
• 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]
Adult Social
Care Outcomes
Framework
*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
NHS, Public Health & Adult Social Care
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]
• 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]
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
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyA
ndGuidance/DH_132358
NHS Outcomes Framework 2012/13 (refreshed December 2011)
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyA
ndGuidance/DH_131700
Adult Social Care Outcomes Framework 2011/12
http://www.dh.gov.uk/en/Consultations/Responsestoconsultations/DH_125464
If you have any further questions then please feel free to email them to me at
[email protected]