1. Developing Nottingham’s LAA Jeanelle de Gruchy and Chris Nield Health Equality, Nottingham City PCT

2. Objectives of session LAA indicator issues LAA partnership working issues Effective indicators

3. SMART Indicators Specific – mental health (support to people known to mental health services) Measurable – mental health (DSH) Achievable – prevalence (smoking, physical activity, alcohol) Relevant – physical activity cf. statins Timed – 1996/97 or 2005? 6 monthly or at the end of 3 years?

4. Measurement Outcome vs process (quitters v. prevalence) Definitions (obesity, PA) Baselines – expense and time measuring (PA) Perverse incentives (mental health employment; CHD – statins v. PA) –Time-scale – needing to show results in 3 years (easier to argue for older people CHD cf. young people and obesity) –Inequalities – overall numbers vs. targetted

5. LAAs in partnership Accountability – it ’ s a political process –Consultation with partner organisations –Conflicting guidance – GOEM, City Council, SHA, ODPM guidance document (eg what is a ‘ stretch ’ ) –Lead organisation control (driven by performance management) –Some lack of understanding of NHS organisation drivers / performance management / limited focus on public health (and limited capacity!) Understanding of health / health outcomes –Valuing professional/technical expertise Is 0.5 of a fruit ‘ unambitious ’ ?

6. Negotiating indicators Time scale to negotiate –Community consultation –Iterative process, but difficult to ensure all kept on board with the process Blocks and cross-cutting issues –Alcohol – crime or medical … ? –Infant mortality (technical expertise) Prioritisation / nos. of indicators allowed –Lobbying by interest groups (avoidable injury; supporting young parents)

7. Effective indicators A health priority (national / local target) Evidence base Build on reality of local situation Be creative – the reality is it needs to be measured –balance between routinely available info – but may need to survey. Particularly NB as we develop our stretch targets