Deborah O’Callaghan, Implementation Consultant - East 14 th October 2014

Overview Quick update from NICE A demonstration of how NICE resources can be used to: –Inform JSNAs and support Local Authorities in delivering their Health and Wellbeing Strategies –identify high impact interventions/service improvements –Support evidence informed commissioning and service review –Develop a clear case for investment

The role of NICE To identify good practice using the best available evidence To help resolve uncertainty for the public, patients and professionals To reduce variation in the availability and quality of practice and care April 2013 – social care guidance and standards

Social care guideline topics Challenging behaviour in people with learning disability Child abuse and neglect Children´s attachment Home care Mental health problems in people with learning disability Social care of older people with multiple long-term conditionsSocial care of older people with multiple long-term conditions Transition between health and social care Transition from children´s to adult services

Supporting quality services – NICE quality standards

What are NICE guidance and quality standards? EvidenceGuidance Quality Standards A NICE quality standard is a concise set of statements designed to drive and measure priority quality improvements. A set of systematically developed recommendations to guide decisions for a particular area of care or health issue Research studies - experimental and observational, quantitative and qualitative, process evaluations, descriptions of experience, case studies

Source guidance Loveday HP, Wilson JA, Pratt RJ et al. epic3: National evidence-based guidelines for preventing healthcare- associated infections in NHS hospitals in England. Journal of Hospital Infection 86 (supplement 1): S1–70 (2014).epic3: National evidence-based guidelines for preventing healthcare- associated infections in NHS hospitals in England Infection: prevention and control of healthcare- associated infections in primary and community care. NICE clinical guideline 139 (2012).Infection: prevention and control of healthcare- associated infections in primary and community care Prevention and control of healthcare-associated infections. NICE public health guidance 36 (2011).Prevention and control of healthcare-associated infections Respiratory tract infections – antibiotic prescribing. NICE clinical guideline 69 (2008).Respiratory tract infections – antibiotic prescribing

Source guidance –Social Care Institute for Excellence (2011) IMCA and paid relevant person's representative roles in the Mental Capacity Act Deprivation of Liberty Safeguards. SCIE guide 41.Social Care Institute for Excellence (2011) IMCA and paid relevant person's representative roles in the Mental Capacity Act Deprivation of Liberty Safeguards. SCIE guide 41. –Social Care Institute for Excellence (2010) Personalisation: a rough guide. SCIE guide 47.Social Care Institute for Excellence (2010) Personalisation: a rough guide. SCIE guide 47. –Social Care Institute for Excellence (2010) Independent mental capacity advocate involvement in accommodation decisions and care reviews. SCIE guide 39.Social Care Institute for Excellence (2010) Independent mental capacity advocate involvement in accommodation decisions and care reviews. SCIE guide 39. –Social Care Institute for Excellence (2010) Dignity in care. SCIE guide 15.Social Care Institute for Excellence (2010) Dignity in care. SCIE guide 15. –Social Care Institute for Excellence (2009) Practice guidance on the involvement of Independent Mental Capacity Advocates (IMCAs) in safeguarding adults. SCIE guide 32.Social Care Institute for Excellence (2009) Practice guidance on the involvement of Independent Mental Capacity Advocates (IMCAs) in safeguarding adults. SCIE guide 32. –Social Care Institute for Excellence (2009) Commissioning and monitoring of Independent Mental Capacity Advocate (IMCA) services. SCIE guide 31.Social Care Institute for Excellence (2009) Commissioning and monitoring of Independent Mental Capacity Advocate (IMCA) services. SCIE guide 31. –Social Care Institute for Excellence (2007) Implementing the Carers (Equal Opportunities) Act SCIE guide 9.Social Care Institute for Excellence (2007) Implementing the Carers (Equal Opportunities) Act SCIE guide 9. –NICE clinical guideline: CG42 Dementia (2006)NICE clinical guideline: CG42 Dementia (2006)

What are NICE guidance and quality standards? EvidenceGuidance Quality Standards A NICE quality standard is a concise set of statements designed to drive and measure priority quality improvements. A set of systematically developed recommendations to guide decisions for a particular area of care or health issue Research studies - experimental and observational, quantitative and qualitative, process evaluations, descriptions of experience, case studies

Accessing NICE resources

HIV Testing Key messages –Definitions and links to further information –Prevalence –Scale of the issue (including gaps) –Summary of intervention (screening) and its impact (reduces number of people who don’t know their HIV status) –Outlines council responsibilities (re commissioning comprehensive sexual health services)

Contents What can local authorities achieve by promoting HIV testing? What NICE says (evidence based recommendations) Developing an action plan Costs and savings Facts and figures Support for planning, review and scrutiny

“Increased HIV testing and earlier diagnosis will save money by both reducing hospital admissions and reducing the costs of caring for someone in the community with HIV. In the first year after diagnosis, it costs the health economy twice as much if the person is diagnosed late [1”1

“The Department of Health's Public Health Outcomes Framework 2013 to 2016 has a specific standard (3.04) relating to HIV infection and the need to reduce the number of people who are diagnosed late.Public Health Outcomes Framework 2013 to 2016 Increasing the number of tests offered will help local authorities to improve this outcome and increase the likelihood that HIV infection will be diagnosed earlier”.

TOPICPUBLICATION 1. TobaccoJuly Workplace healthJuly Physical activityJuly Health inequalities and population healthOctober NICE guidance and Public Health OutcomesOctober AlcoholOctober Behaviour changeJanuary Walking and cyclingJanuary ObesityMay Tuberculosis in vulnerable groupsSeptember Social and emotional wellbeing for children and young peopleSeptember Judging whether public health interventions offer value for money - Funding public health protects our communities and children, saves lives... and can save money - How NICE measures value for money September Body mass index for intervening to prevent ill health among black, Asian and other minority ethnic groupsJanuary Improving access to health and social care services for people who do not routinely use themJanuary Encouraging people to have NHS Health Checks and supporting them to reduce risk factorsFebruary Community engagement to improve healthMarch Contraceptive servicesMarch Tackling drug useMay Domestic violence and abuse: how services can respond effectivelyJune HIV TestingJune Looked after children and young peopleJune 2014

PH52 Costing statement National cost not expected to be significant Background, context and epidemiology –Figures for 2010/11 suggest that an estimated 93,400 people inject opiates such as heroin and/or crack cocaine in England (Hay et al. 2011). –In 2012, there were 10,873 diagnoses of hepatitis C infection in England, of these infections 96% were to people where injecting drug use was indicated (Public Health England, 2013). –In 2012, 29% of people who inject drugs, around 27,000 people, reported the symptoms of injection site infections (Public Health England, 2013).

Economic analysis Scope of economic analysis Cost of £200 per annum for each person who injects drugs Potential saving: significant future healthcare costs estimated to be between £10,000 and £42,000 per individual, per annum. Additional savings in wider societal costs, for example crime costing an average of £26,074 is committed by an addicted person not in treatment.

NICE Evidence Services -

Stay up to date NICE News – new and what’s coming re developments, guidance and support resources Social Care Update Evidence Updates - highlights new evidence relating to published accredited guidance Eyes on Evidence - covers interesting new evidence with an explanation about what it means for current practice.

Public Health England Knowledge and Intelligence Service Health inequalities workstream Allan Baker PHE Knowledge and Intelligence Network East Event 14 October 2014

Health inequalities workstream 2014/15 Collaborative national work programme between London Knowledge and Intelligence Team and East Midlands KIT Analysis of inequalities in social determinants of health and the health inequalities which result from those determinants. Public Health Outcomes Framework Breakdowns of life expectancy gaps – the Segment Tool Marmot Indicators Technical support for inequalities analysis Work with PHE’s Health & Wellbeing Directorate 43

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PHOF overarching indicators Two high-level outcomes: - Increased healthy life expectancy - Reduced differences in life expectancy and healthy life expectancy between communities Inequality is measured by the slope index of inequality 45

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PHOF overarching indicators Healthy life expectancy - upper tier LAs – , SII in HLE – England – , Life expectancy – all LAs – to SII in life expectancy – England & all LAs – to Next update: Tuesday 4 th February,

PHOF Inequalities “…the majority of indicators in the framework have potential to impact on inequalities and we aspire to make it possible for all indicators to be disaggregated by equalities characteristics and socio-economic analysis wherever possible…” Improving outcomes and supporting transparency – Part 1A A public health outcomes framework for England 2013 – 2016 This is the long term aim for indicators within the PHOF Some indicators already added, e.g. school readiness by free school meal status. 48

PHOF Inequalities tab - now 49

PHOF Inequalities tab - November 50

Slope index of inequality in life expectancy Cambridgeshire, Males 7.1 years Females 5.0 years 51

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Segment Tool – next steps 53 Update to Add county districts Change scarf chart methods Add years of life expectancy gained/lost

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Local action on health inequalities Institute of Health Equity – commissioned by PHE to write series of evidence reports and briefings about practical, local actions to tackle health inequalities through the social determinants of health. The papers include evidence, practical points and case studies on approaches and actions that can be taken by local authorities on range of issues to reduce health inequalities. Topics include children and young people, education, employment, the living wage, fuel poverty and understanding the economics of investments in the social determinants of health 56

Inequalities analysis tool Absolute/relative range Linear regression slope Weighted linear regression slope Slope index of inequality Relative index of inequality Gini coefficient Absolute/relative concentration index 57

PHE’s Health & Wellbeing directorate Collaborative work on inequalities among people with protected characteristics, starting with sexual orientation. Model social determinants where clear impact on health can be quantified and broken down by local authority. Modelling to build on Health Inequalities Intervention Toolkit, which models impact of interventions on life expectancy and inequalities in life expectancy, but mainly focuses on NHS interventions. 58

Contacts and links to resources Allan Baker – London KIT: - Segment Tool and Marmot Indicatorswww.lho.org.uk Network of KITs: – Inequality Analysis Toolwww.apho.org.uk PHOF data tool Public Health England – Data and Knowledge Gateway UCL Institute of Health Equity: 59