1. South West Public Health Observatory NDTMS-South West NDTMS and DAMS Refresher Training 2012

2. South West Public Health Observatory The Team: Georgia Norris – Acting NDTMS SW Regional Manager Aileen McLoughlin – NDTMS Improvement and Development Manager Kadiann Weir-da-Costa - Analyst (part time) Sally Martin – Data Quality Co-ordinator (Training) (on sabbatical) Kate Kelly - Data Quality Co-ordinator (Training) Hayley Smith – NDTMS Administrator

3. South West Public Health Observatory NDTMS Monthly Submission Cycle Treatment data is collected and entered on to the provider software system NDTMS undertake quality checks and load the files up to the NTA. Also produce data quality metrics Around the 21 st of the month the NDTMS team will inform providers that DAMS is open for validations The treatment data is submitted via DAMS by 5pm on the 8 th of the month. DAMS CLOSED DAMS OPEN access reports

4. South West Public Health Observatory What we do - The transfer of your provider data NTA (National Treatment Agency) Monthly upload NDEC – National Drug Treatment Evidence Centre NDEC – National Drug Treatment Evidence Centre Treatment workers Partnership

5. South West Public Health Observatory What is the NDTMS data used for - Provider Performance Reporting (including the Green (drug) and Purple (Alcohol) Reports) Numbers in effective treatment Waiting times Successful Completions Representations Care Plans Healthcare assessment Blood Borne Virus (BBV) Activity Treatment Outcome Profile (TOP)

6. South West Public Health Observatory What is the NDTMS data used for - Partnership Performance Reporting (including the Green and Purple Reports) Pooled Treatment Budget (PTB) Cost Effectiveness Tool (CET) Needs Assessment Diagnostic & Outcome Measure Executive Summary Report (DOMES)

7. South West Public Health Observatory NDTMS Key Guidance NDTMS Business Definitions Details and defines the fields collected by NDTMS Reference Data and Technical Definitions Details the permissible values of the fields collected in the data set and the headers/codes in extracts Confidentiality Toolkit Confidentiality and consent guidance – how to comply with Information Governance

8. South West Public Health Observatory Any Questions?

9. South West Public Health Observatory Recording Data

10. South West Public Health Observatory What is an Episode? An episode runs from the Referral Date through to the Discharge Date (in reports, episode start is taken as the Triage Date). A client should only have one episode open at your provider at any one time. Clients can have episodes open at more than one provider at the same time.

11. South West Public Health Observatory What is a Modality? A modality is an intervention or treatment which is being provided by you to your client. A client can have more than one distinct modality open at any one time.

12. South West Public Health Observatory A client treatment journey at one provider Provider A Episode of treatment at Provider A Modality 1 Modality 2

13. South West Public Health Observatory A client treatment journey across two providers Provider B Provider A Modality 1 Modality 2 Modality 1 +/- 21 day break Modality 2 Episode of treatment at Provider A Episode of treatment at Provider B

14. South West Public Health Observatory Reporting to NDTMS Tier 3 and Tier 4 modalities, as defined in Appendix B of the Business Definitions (Alcohol) or Appendix C of the Business Definitions (Drugs), should always be reported to NDTMS Currently Tier 2 modalities do not have to be reported to NDTMS:- –Advice and Information –Needle Exchange –Aftercare –Outreach –Any treatment which is non-structured or not care planned

15. South West Public Health Observatory What is Structured Treatment? Structured treatment follows assessment and is delivered according to a care plan with clear goals which are regularly reviewed with the client by a key-worker 1. Specialist treatment for substance misuse is defined as a care planned medical or psychosocial modality (Tier 3 or 4) aimed at resolving dependence or the reduction of harm resulting from current drug misuse 2. 1 DET Agency User Guide 2 Core Dataset H Guidance for Adult Drug Users

16. South West Public Health Observatory

17. If Provider offers Tier 2 and Tier 3/4 Modalities –Tier 2 activity is not mandatory to report to NDTMS. This is a local decision. There is less risk of data contamination if Tier 2 activity is only used locally and not reported to NDTMS. –Tier 2 activity, if submitted to NDTMS, should be recorded in a separate episode to any Tier 3 or 4 episode, in order to avoid inaccurate recording of key dates such as Triage date or Discharge date for Structured Treatment.

18. South West Public Health Observatory Treatment at Provider A Modality start Tier 3 Episode Tier 2 Episode Discharge NB: You must close the first modality and episode with the relevant discharge code before opening the second episode. NOT STRUCTURED TREATMENT

19. South West Public Health Observatory Any Questions?

20. South West Public Health Observatory Successful Completions

21. South West Public Health Observatory Successful Completions – What not to do Episode at Provider A Tier 3 ModalityTier 2 Modality (Aftercare) Successful Completion May2012JuneJulyAugSeptOctNovDecJan2013FebMar April2013 Q1 Q2 Q3 Q4 Reason: Tier 3 and Tier 2 modality recorded in same episode – episode closed with relevant discharge code at end of Tier 2. Risk: Tier 2 modality discharge code may be different and may no longer be a successful completion. Risk: Miss Q4 reporting period = full year

22. South West Public Health Observatory Successful Completions – how to do it Treatment at Provider A Tier 3 Episode Tier 2 Episode Successful Completion Reason: The first episode was closed with the relevant discharge code before opening the second episode.

23. South West Public Health Observatory Any Questions?

24. South West Public Health Observatory What Can and Cannot Change

25. South West Public Health Observatory Core Data Set items collected by NDTMS *For the full list of core data set items, please refer to the appropriate NDTMS Business Definitions for your treatment service i.e. Business Definitions for Young People’s Treatment Providers

26. South West Public Health Observatory What can and cannot change Not expected to change (start of Episode)Can change (reflect current situation)  Drug 1, 2 or 3  Any Hep B/Hep C information  Accommodation Need  TOP Care Coordination  Parental Status  DAT of residence  Injecting status  PCT of residence  Pregnant  Local Authority  Units of Alcohol (previous 28 days)  Postcode  Employment Status  Consent NB: These are examples only. A full list of fields which can and cannot change can be found at Appendix A of the Business Definitions

27. South West Public Health Observatory Prevent the creation of Missing Information The following core data set items, if changed, will create Missing Information under “detailed mismatches” tab in your monthly DAMS submission ClientEpisodeModalityTOP First InitialReferral DateModality TypeTOP Date Second InitialAgency Code Date Referred to Modality Date of Birth Sex

28. South West Public Health Observatory Any Questions?

29. South West Public Health Observatory DAMS

30. South West Public Health Observatory What is the Drug and Alcohol Monitoring System (DAMS)? DAMS is an online secure portal which is maintained by the regional NDTMS team and administered by the central NTA. DAMS allows all treatment providers to submit their treatment data securely through a series of strict validation rules and data comparison checks. Data Load and Data Quality percentages indicate how good the data is. Users can only submit a file once when it meets the required load and data quality which is set at 100%. DAMS generates three separate validation summary reports each time a file is validated. They are Current File Data, Previously Submitted Data and Missing Information.

31. South West Public Health Observatory Validation Report 1- Current File Data Summary Current File Data Summary DAMS Extract taken from software system: DET, POPPIE, HALO etc Validates The minimum date parameter for an extract is currently back to 01/01/2010. If you have done any data quality work on clients, episodes, modalities, or TOPS discharged prior to this date, please upload a ‘full extract’ of all of your data in order that the NDTMS Database will update in line with your data.

32. South West Public Health Observatory Validation Report 2 - Previously Submitted Data Summary Previously Submitted Data Summary DAMS Extract taken from software system: DET, POPPIE, HALO etc NDTMS Database Compares Fields

33. South West Public Health Observatory Validation Report 3 - Missing Information Summary DAMS Missing Information Summary Extract taken from software system: DET, POPPIE, HALO etc NDTMS Database Compares Rows

34. South West Public Health Observatory Remember the key fields

35. South West Public Health Observatory Validation Rules, Errors and Warnings

36. South West Public Health Observatory DAMS Validation Rules DAMS Severity Level Key FATAL The file/record contains a severe data error and cannot be loaded into NDTMS. I.E. Missing Header. ERROR The record contains an error that prevents the entire record from being loaded into NDTMS. Any present in the file will affect data load and will need to be resolved. WARNING A record contains an error that requires correcting but has not prevented the entire record from being loaded into NDTMS. Any present in the file will affect data quality and will need to be resolved. CHANGE A record contains a value which has changed from what was previously held on the NDTMS Database. Will only be present in the Previously Submitted Data Summary and does not affect data quality or data load. INFO The record contains a potential error that might need correcting (or might not). Can be present in file and does not affect data quality or data load.

37. South West Public Health Observatory Resolving Errors and Warnings - process Errors affect your Data Load. Warnings affect your Data Quality. In order to be able to ‘submit’ an upload, you must reach 100% for DQ and DL. Errors and Warnings in your current data and Previously Submitted Data need to be resolved in order to achieve the 100% threshold for submission of an upload. To achieve 100% DQ and DL amend your data on your software system using the information in the Error or Warning on DAMS to guide you. Errors in Previously Submitted Data are rare and will affect your Data Load, please call NDTMS if you get one. If applicable, DO NOT resolve any Missing Information on a file which is not 100% DQ and DL.

38. South West Public Health Observatory Monitor Changes and Infos Changes and Infos do not affect your data quality or data load on submission – this is not a reason to ignore them. Changes indicate data has been changed. This may be as a result of a data cleaning exercise or updating information on your system for clients to reflect the current situation (e.g. BBV). An Info acts as an early warning system of potential data quality issues going forward or inaccurate data input. It is important to look at both of these on a regular basis and check against data on your system to ensure it is accurate.

39. South West Public Health Observatory Example Change and Info messages Change: Postcode changed (can change) HEP C Status changed (can change) Alcohol Units changed (not expected to change) Info:Individual over 75 years of age at first presentation – please check (d.o.b wrong?) Individual engaged in more than 24 days paid work – please check (days wrongly recorded?)

40. South West Public Health Observatory Common Errors and Warnings - examples

41. South West Public Health Observatory Resolving the example Error Error: Referral Date cannot be after Modality Start Date Resolution: check your software system against paper records. Amend the dates accordingly if they are wrong and save changes.

42. South West Public Health Observatory Resolving the example Warnings Warning: PCT of residence is missing –Resolution: check the PCT information against your paper file. If in doubt, please refer to the Business Definitions for PCT (proxy – use your provider) and NDTMS Geographic Information document (v8.0) for the correct PCT Code. –If the PCT is non-English, please refer to Appendix C of the CDS-H Reference Data also available on the NTA website. –NB: All primary drug Alcohol clients must have PCT of residence entered for NFA clients.

43. South West Public Health Observatory Resolving the example Warnings Warning: client has been discharged code 5/83 then a Treatment Exit TOP is not required. –Resolution: Client has been transferred and is still in structured treatment therefore they do not require an Exit TOP. –Check the discharge reason is correct, if so, change the Exit TOP to a Review TOP on your software system. –Note 5/83 shows the old code of ‘referred on’ which was ‘5’

44. South West Public Health Observatory Resolving the example Warnings Warning: individual has inconsistent client reference. –Resolution: Thoroughly check if the client is the same client – possibly representing. –If it is, change the references so that they are all the same for that client. –Best practice is to have the same reference for a client for each episode of treatment at your Provider. –If they are different clients with the same initials, sex and date of birth, you have a TWINS issue. –Inform NDTMS as we will need to submit your file for you as you cannot achieve 100% DQ whilst you have two clients with the same attributors at your Provider.

45. South West Public Health Observatory Next Steps Once you have dealt with all Errors and Warnings (including Previously Submitted Data): –Upload another extract to DAMS –Check DQ and DL are now at 100%. If they are... –THEN Deal with any Missing Information on this file... –Only deal with Missing Information on your last 100% DQ and DL uploaded file that you wish to submit. –If there is no Missing Information, ‘Submit your file for Loading’.

46. South West Public Health Observatory Missing Information

47. South West Public Health Observatory Example 1 cont…. Client’s First Initial Change First NameLast NameDOBSexReferral Date Agency… RebeccaSmith11/12/1970Female01/02/2010S9999 … First NameLast NameDOBSexReferral Date Agency… BeckySmith11/12/1970Female01/02/2010S9999 … April 2010 NDTMS File for Agency S9999 includes :- BeckySmith11/12/1970Female01/02/2010S9999 … Becky Rebecca NDTMS Database :-

48. South West Public Health Observatory Example 2 – Correcting an Episode Referral Date March 2011 NDTMS File for Agency S9999 includes :- First Name Last Name DOBSexReferral Date AgencyModality Type Referred to Modality Date Modality Start Date Modality End Date DavidDavis01/03/1965Male01/03/2011S9999Family Therapy 01/03/2011 NDTMS Database First Name Last Name DOBSexReferral Date AgencyModality Type Referred to Modality Date Modality Start Date Modality End Date DavidDavis01/03/1965Male01/02/2011S9999 Family Therapy01/03/2011 DavidDavis01/03/1965Male01/02/2011S9999 Family Therapy01/03/2011 01/02/2011 01/03/2011

49. South West Public Health Observatory Referred to Modality Date corrected for client First Name Last Name DOBSexReferral Date AgencyModality Type Referred to Modality Date Modality Start Date Modality End Date … EvaEvans12/10/1975Female01/02/2011S9999Family Therapy 01/02/2011 … First Name Last Name DOBSexReferral Date AgencyModality Type Referred to Modality Date Modality Start Date Modality End Date … EvaEvans12/10/1975Female01/02/2011S9999 Family Therapy 02/01/201101/02/2011… March 2011 NDTMS File for Agency S9999 includes :- NDTMS Database :- EvaEvans12/10/1975Female01/02/2011S9999 Family Therapy 02/01/201101/02/2011… 02/01/2011 01/02/2011

50. South West Public Health Observatory Resolution Types What you need to know…

51. South West Public Health Observatory Replace Record Consequence If you ‘replace’ a record this means the information in your submission file overwrites the information on the NDTMS Database. Replacing missing records also impacts all associated records for that client in treatment at that provider. This option will only be made available for selection if there is a record in the file being submitted that is similar to the missing record. ‘Soft matching’ is done by DAMS but this ‘matching’ is not always consistent across different software systems. Please note: ‘Replace’ does not always show on the full screen in DAMS, you need to scroll to the bottom to see if there is a Replace option offered. If there is no ‘Replace’ option, ‘Delete’ is usually the next best option...

52. South West Public Health Observatory Delete Record Consequence If you are deleting client records please inform NDTMS as this will delete ALL historic records (episodes, modalities and TOP) associated with that client. The missing record and all associated records will be deleted entirely from the NDTMS database. If using ‘Delete’ as an alternative to ‘Replace’, you must check your extract to ensure that the correct information is contained in your extract which will then be uploaded into the Database in place of the records being deleted. Only use this resolution type if you are absolutely sure that the data needs to be deleted from the NDTMS Database or as an alternative to Replace once you have checked your extract file.

53. South West Public Health Observatory Associated Records

54. South West Public Health Observatory Exclude Record Consequence Any information ‘excluded’ will not be counted in your monthly/quarterly figures, this includes numbers in effective treatment so it is important that missing information is dealt with as soon as possible. The missing record and all associated records will be excluded from the NDTMS data for the current submission. The record will not be deleted from the NDTMS Database but you will be reminded again if the information continues to be missing from subsequent submissions. You can only exclude for 1 month – or your file submission is rejected. You cannot exclude on a quarterly reporting month.

55. South West Public Health Observatory Include Record Consequence If a record is ‘included’, this will create an ‘orphaned’ or ‘second’ or ‘duplicate’ record on the NDTMS Database and this can potentially affect your provider’s data quality and performance reports. If you think a record should be included, you need to investigate why it not being included in your submission or appearing in exactly the same as previously by checking your extract against your own system data. If the data in your extract is different to the data on your system, you need to determine which is correct, then contact your software supplier to resolve matters. You may need to wait for a refresh and then take another extract depending on when changes were made – allow time for refresh If the data is not appearing in your extract at all but is showing on your system, you need to contact your software supplier and determine why it is not appearing in your extract. If you use ‘include’ your submitted file will be rejected.

56. South West Public Health Observatory How to check your extract Open your software system extract which you saved to your computer and subsequently uploaded into DAMS – take a copy and re-save in case you make any mistakes. It is a csv file and can initially be a bit daunting to look at! It works the same as an Excel spreadsheet. You may need to widen some columns to see full dates (appear as ######). Use the attributor information on the Detailed Mismatches Summary in DAMS to filter your extract by first initial, second initial, date of birth and sex to find the client and/or related information to that client DAMS says is missing. You can scroll across the extract to find episode, modality and TOP information. You can hide columns and freeze panes to make it easier to read. If the client or related information is not appearing in your extract but should be, you need to contact your software supplier and ask why. Headings are shortened on the columns and if you need to know what the header is, for the field you are looking for, please refer to the Technical Definitions for the relevant Core Data Set (at present CDS H) and the Reference Data for value codes. You can download these from the NTA website.

57. South West Public Health Observatory Common Headers First Initial*FINITIAL Second initial*SINITIAL Date of Birth*DOB Sex*SEX Referral Date*REFLD Agency Code*AGNCY Date Referred to Modality*REFMODDT Treatment Modality*MODAL Modality Start DateMODST Parental StatusPRNTSTAT ChildrenCHILDWTH Units of AlcoholALCUNITS Discharge DateDISD Discharge reasonDISRSN TOP Date*TOPDATE Treatment Stage (i.e. TOP stage)TRSTAGE * = Missing Information field

58. South West Public Health Observatory Example filtering on CSV file

59. South West Public Health Observatory Final Steps Once all Missing Information has been appropriately resolved, and, if you do not have a Twins issue and have 100% Data Quality and Data Load, please submit your file for loading. If you have a Twins Issue, e-mail NDTMS to submit for you.

60. South West Public Health Observatory DAMS Contingency Planning It is very important in every Provider that one person is not solely responsible for the DAMS upload every month. You should have at least two people, where possible who have been trained on the DAMS upload process, whether internally at your organisation or by NDTMS. NOTE: Some software systems do not update or refresh immediately when a change has been made and therefore sometimes an extra day is required in order that systems can refresh overnight. You should always plan your upload so as not to do it on the afternoon of the last day of submission. DAMS runs particularly slowly on deadline day. Deadlines for submissions are on DAMS. You are also advised by e-mail when DAMS is open, the deadline for the next submission. Please diarise and plan accordingly, especially when you have part time staff.

61. South West Public Health Observatory DAMS Extensions Recently, extensions have become an expectation rather than an exception. If you have been informed of a ‘Provider wide’ extension usually though an issue with DAMS, or a ‘Software user’ extension due to an issue which has been brought to our attention, that will be the final extension. Extensions can still be requested in exceptional circumstances and are granted on an individual basis. Exceptional circumstances do not include, ‘everyone is away on holiday’. You must have a backup. Failure to submit on time without prior agreement with NDTMS, will result in no submission for your Provider (as DAMS will close on the deadline) and your Partnership will be informed.

62. South West Public Health Observatory Any Questions?

63. South West Public Health Observatory Data Quality Issues and Metrics

64. South West Public Health Observatory Data Quality Issues - Multiple Open Episodes and Overlapping Episodes A client should only have one open episode of treatment at any given time at a provider. Episodes of treatment within a provider should not overlap. Multiple open and overlapping episodes are usually created by the Referral Date being changed or no Discharge Date being entered.

65. South West Public Health Observatory Overlapping Episodes – example The episodes are valid but either the discharge date or the referral date needs to be updated AGNCYFINITIALSINITIALDOBSEXREFLDDISDREFLD1DISD1 SC***BB 1967/02/02M2008/01/012008/01/302008/01/262008/04/16

66. South West Public Health Observatory Data Quality Issues - Multiple Open and Overlapping Modalities A client must not have an identical modality type open at the same time at your provider. Overlapping Modalities are usually created by changing the referred to modality date or not entering a modality end date.

67. South West Public Health Observatory Multiple Open Modalities Attributers Agency Code Referral Date Discharge Date Modalit y Code Modality Referral Date Modality Start Date Modality End Date Modality 1 Code Modality 1 Referral Date Modality1 Start Date Modality1 End Date AA01011980M**** 01/01/201 2 301/03/2012 01/04/201 2 3 03/06/201 2 Modality Referral Date: 01/03/2012 Modality Start Date : 01/04/2012 Modality Type: 3 (GP Prescribing ) Modality 1 Referral Date: 01/05/2012 Modality Start Date : 03/06/2012

68. South West Public Health Observatory Data Quality Issues - Alcohol Metrics 0 = a Value Blank = no information entered A01 = No Alcohol Modality recorded –Client is primary Alcohol and is not receiving an Alcohol Modality –Solution: Ensure the modality with pre-fix ALC is chosen A02 = Missing PCT for Alcohol Episode –Resolved through Warning in DAMS – all alcohol clients must have PCT of residence field completed. A03 = mismatch – days and units –Usually resolved through A04 data input and also through DAMS if there are Alcohol Units and no days recorded = Warning. Remember to put in ‘Alcohol Days’ when recording the units. A04 = Alcohol Units not recorded –Client is primary Alcohol and there are no units of alcohol recorded for the previous 28 days to commencing treatment. –Remember 0 is a value (e.g. from Detox could be 0). Blank is no information. –Solution – enter the information from your file. –Ensure this question is asked at the outset or as soon as practicable after modality start.

69. South West Public Health Observatory Data Quality Issues - Parental Status and Children 0 = a Value Blank = no information entered Definitions: Child: someone under the age of 18. M07 = Parental Status: “Whether or not the client has children who are under 18, whether none, some or all of the children live with the client.” –This includes biological, step, foster, adoptive and de facto parents (where client (adult) lives with the parent of a child (younger siblings or grandchildren) and have taken on full or partial parental responsibility. –A client can technically be a ‘parent’ but if none of the children are under 18, you should select ‘not a parent’. M08 = Children: “The number of children under the age of 18 who live in the same household as the client at least 1 night a week. The client does not necessarily have to have parental responsibility for the children.”

70. South West Public Health Observatory Any Questions?

71. South West Public Health Observatory Reports on DAMS

72. South West Public Health Observatory Reports on DAMS The following Reports are located on DAMS:- Performance Reports (Green and Purple) – all activity TOP Exception Report TOP Quarterly Outcome Report Successful Completions Report There is also Guidance for the Completions Report The NDTMS Reporting timetable is also available on DAMS

73. South West Public Health Observatory Reports are located on DAMS in…..

74. South West Public Health Observatory For other reports like the TOP Quarterly Outcomes go to…

75. South West Public Health Observatory Select the report you wish to download….

76. South West Public Health Observatory And Open or Save….

77. South West Public Health Observatory Any questions?

78. South West Public Health Observatory Waiting Times

79. South West Public Health Observatory Where to find Waiting Times Scenarios Waiting times scenarios with flow diagrams can be found at Appendix B of the Business Definition for Adult Drug Use. They cover:- Self Referral Third Party Treatment Provider Tier 4 Prison Referral Subsequent wait within an episode Inpatient detox and residential rehab as a package

80. South West Public Health Observatory Waiting Times Measurement Within NDTMS – Key Points All waiting times are measured in calendar days (including weekends) waiting times will only be calculated when a client actually commences a modality Waiting Time Calculation Wait = days from Modality Referral Date to First Appointment Offered OR ( where Referral date is after Modality Referral Date ) Wait = days from Referral Date to First Appointment Offered

81. South West Public Health Observatory Episode Referral date Triage date Discharge date Modality start (1 st ) 1 st Modality Subsequent Modality First appointment offered (1 st ) Referral to modality date (1 st ) Wait for 1 st modality Referral to modality date (Sub) First appointment offered (Sub) First modality start (Sub) Wait for subsequent modality

82. South West Public Health Observatory Waiting Times Measurement Within NDTMS – Key Points The ‘referral date’ recorded by a provider can be later than the ‘date referred to modality’. This can occur where the client needs funding approval. Waiting times are reported at both a treatment system and treatment provider level. The clock starts on a different date for the Partnership (see scenarios for details).

83. South West Public Health Observatory IMPORTANT JULY UPLOAD DEADLINE Please Note: –July Upload due on Monday 16 th July. Final Deadline. –You MUST include all data to 14 th July (which is a Saturday). –Extract must be dated after 14 th July to ensure all 14 th July data captured (i.e. 15 th or 16 th July). –CQC use this extract for reporting purposes – their snapshot of numbers in treatment etc. –End of Q1 so no includes or excludes. –Please VALIDATE files early in July and RECTIFY ERRORS AND WARNINGS only on your software system. –DO NOT ‘resolve’ any MISSING INFORMATION on these early files. –You can then do a new upload, VALIDATE and deal with any Missing Information and SUBMIT a NEW EXTRACT..... –ON MONDAY 16 TH JULY by 5pm.

84. South West Public Health Observatory Core Data Set J – Training Provider training planned for September. You will be contacted by e-mail in due course when plans are in place

85. South West Public Health Observatory For further information NTA Website: http://www.nta.nhs.uk/

86. South West Public Health Observatory Any Questions?