1. Measuring health improvement – lessons from Nottingham’s LAA Dr. Jeanelle de Gruchy, Health Equality Directorate, Nottingham City PCT EMPHO Public Intelligence Training Course 3 rd October 2006

2. Objectives of session Present key drivers of health improvement; Present Nottingham ’ s LAA and FTAP and discuss dilemmas in developing the indicators; Provide an opportunity to develop your own indicators; Discuss what makes a good indicator; Present brief comment on working in partnership.

3. Drivers of health improvement Local Delivery Plan –PCT 3 yr plan to include local and national priorities for health services and improvement Choosing Health Local Area Agreements –Govt, LA and partners working thru’ local LSPs –4 ‘blocks’: HCOP, CYP, SSC, EDE Floor Target Action Plans –LSPs receiving NRF; to accelerate progress on targets where gap in performance is widest

4. Nottingham’s LAA Healthy Communities, Older People (HCOP): –CVD (physical activity, smoking, diet), child obesity, mental health, avoidable injury Children and Young People (CYP): –Teenage pregnancy, infant mortality, Healthy Schools Safer, Stronger Communities (SSC): –alcohol

5. Nottingham’s FTAP Target: Gap in Life Expectancy Understanding contributory factors and determining focus: –CVD and over 40s Analysing areas for targeted action: District, ward, neighbourhood level –20% SOAs with worst premature CVD mortality Planning evidence-based interventions

6. SMART LAA indicators (1) Priority issues identified, but could we measure performance? Eg. alcohol Outcome vs process: challenging, are we clear on cause and effect? Are there proxy measures? Eg. Infant mortality; alcohol Time-scale: needing to show results in 3 years (!) or even 6 months (!!); yearly or 3 year rolling ave?

7. SMART LAA indicators (2) What areas? 18 most deprived wards; gap between worst centile and the average … Definitions: physical activity Baselines: expense and time measuring (use of other surveys - local MORI, Sport England) Cross-cutting issues: mental health and employment Inequalities: overall numbers vs. targeted

8. Developing LAA indicators for your area 5 Priority issues have been identified: 1.Inequalities in CVD mortality; 2.Low levels of physical activity in adults; 3.Rise in alcohol abuse; 4.Rise in childhood obesity; 5.Poor mental health and well-being. What indicators would you choose? How SMART are they?

9. Effective indicators Direct planning to health priorities; Draw on evidence base where available; Ensure that intervention will be effective; Build on reality of local situation (including what work is already being undertaken; availability of resource); Utilise what measurement is already taking place; Will demonstrate achievement (unless political decision to be aspirational); Are creative – the reality is it needs to be measured: –Are there pragmatic proxy indicators? –balance between routinely available info – but may need to survey

10. LAAs in partnership It ’ s a political process –Consultation with partner organisations – blocks and cross-cutting issues; –Lobbying by interest groups; –Conflicting guidance; –Lead organisation control. It needs to be an evidence-based process –Understanding of health / health outcomes; –Valuing professional/technical expertise: Is 0.5 of a fruit ‘ unambitious ’ ? What is a DSR? See what others are doing … share good ideas