“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” “the continuous analysis, interpretation and feedback of systematically collected data, generally using methods distinguished by their practicality, uniformity and rapidity rather than by accuracy or completeness” (Eylenbosch and Noah, 1988).

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” “Action-oriented epidemiology”

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Source: BMJ 2003;326:

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Clinical safety and competence Environmental hazards Unexpected adverse events (drugs & devices) Outbreaks Secular trends Impact of population level interventions

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Actual or potential surveillance systems or data sources that could feed surveillance systems CoSurv – communicable disease reports Spotter GP practices (e.g. RCGP) Large scale GP databases (QResearch and GPRD) Cancer registration Congenital anomaly registers Adverse drug reactions Accident databases (ROSPA HASS/LASS) Occupational health statistics Hospital activity data (especially SUS, A&E data) Mortality statistics NHS Direct Bespoke surveillance systems (e.g. BPSU, UK OSS) Disease registers and device registers (heart valve registers, hip replacement register, CJD etc. etc.)

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Source = National Down Syndrome Cytogenetic Register Down Syndrome Cases in England and Wales

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Number of Tayside residents with known diabetes who were identified independently by each data source used in electronic record linkage Type of treatment Source of data Insulin Oral Diet Encashed prescriptions Hospital diabetes clinics Young adult/paed. clinics Mobile eye unit Biochemistry database Hospital discharge diag Total

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Adequate data collection systems in place before the hypothesis is generated Systematic and sophisticated analysis Timely reporting to those who can act Clear responsibilities for each step Secure resources

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Statutory requirements –International Health Regulations –Water Act 2003 –Others??

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Infectious diseases Effects of environment Occupational health risks Chronic disease and trauma International and tropical risks

“NHS South Central – Improving health and alleviating the causes of poor health for the benefit of patients, the public and taxpayer alike in Oxfordshire, Buckinghamshire, Berkshire, Hampshire and the Isle of Wight” Data collectors / collators Surveillance experts Sponsors / responsible authorities Information Centre, Disease Registers, QResearch, Trusts and Labs etc. HPA, PHOs, Registries, academic groups, institutes DH, MHRA, HPA, NICE, R&D sponsors, PCTs, ONS, ABPI, Regulators, Third Sector, Media, Public, etc. £