Transcript Public Health presentation – Developing a baseline – How we know

Developing a Baseline – How we know we
have achieved what we set out to achieve?
Angela Baker
[email protected]
Purpose of the session
This session will
• Who and what is PHE?
• Look at what baselines already exist
• Some key national figures
• Open the debate, what are we going to do
then
But first, who are we….
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Public Health England
Exists to protect and improve the nation's health and
wellbeing, and reduce health inequalities. It does this
through advocacy, partnerships, world-class science,
knowledge and intelligence, and the delivery of specialist
public health services. PHE is an operationally
autonomous executive agency of the Department of
Health.
I am a member of the Thames Valley PHEC. There are
three teams within the centre, Health Protection,
Healthcare Public Health and Health Improvement. We
all work together to achieve the above.
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New Structure from April 2015
Dept of
Health
Public Health
England
NHS England
NHS E Regions
(X4)
NHS E
Local Area Teams
(X12)
Public Health
Local Authority
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Public Health
England Regions (4)
Public Health
England Centres (8+1)
Clinical
Commissioning
Groups
So who does what….
• Dept of Health, small unit that decides policy direction
• NHS England commissions Public Health Services such
as bariatric surgery, all primary care services, screening
and immunisation services either through areas teams or
specialist commissioners
• CCG commission some tier 2 obesity services, in some
areas, but also provide clinical direction to primary care
• Local Authorities – 2 types, unitary’s provide all the
services in one area, also can influence planning,
licensing etc, etc.
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• Upper tier Local Authorities do not have all the levels of
influence but provide public health services and a variety
of partnerships dependant on the area
• All Local Authorities must have a JSNA, a Health and
Wellbeing Strategy and a Health and Wellbeing board to
monitor the strategy
• PHE provides evidence base, support and advice to
Local Authorities and to NHS England on what works,
cost effectiveness, ROI, translation of NICE Guidance.
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The Battenberg effect
Local Authority
Commissioning
NHS E
specialist
commisisoner
NHS E
Area Team
Commissioner
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PHE Support and Advice
SCN Co-ordination
CCG
Commissioning
What is transition?
Transition is the purposeful, planned
movement of adolescents and young
adults with chronic physical and
medical conditions from child-centred
to adult-orientated health care
systems.”
(Blum et al, 1993)
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Existing Data and Information…
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•
There are 13,486,095 people aged under 20 in
England, this equates to just over 23% of the total
population
•
32 per 10,000 will have a life limiting condition
which requires specialist input, that equates to
43,156.
•
577,931live in the Thames Valley (inc MK) that
relates to just under 2000 children – approx 100
young people a year transition
South East FCE
15-19
Females (excluding pregnancy)
Males
Primary Diagnosis Code
Diagnoses Primary Diagnosis Code
Total
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35,072Total
R10 Abdominal and pelvic pain
2,813 R10 Abdominal and pelvic pain
T39 Poisoning by nonopioid analgesics,
antipyretics and antirheumatics
1,419
Diagnoses
20,846
684
N47 Redundant prepuce, phimosis and
paraphimosis
451
J03 Acute tonsillitis
964 K50 Crohn's disease [regional enteritis]
445
K01 Embedded and impacted teeth
529 K35 Acute appendicitis
439
K07 Dentofacial anomalies [including
malocclusion]
513 M23 Internal derangement of knee
435
E10 Insulin-dependent diabetes mellitus
438 S02 Fracture of skull and facial bones
435
N39 Other disorders of urinary system
417 S62 Fracture at wrist and hand level
399
K35 Acute appendicitis
411 J03 Acute tonsillitis
398
K50 Crohn's disease [regional enteritis]
396
S82 Fracture of lower leg, including
ankle
372
R51 Headache
394 K01 Embedded and impacted teeth
350
15 -19 year olds excluding pregnancy
b) 15-19 year olds excluding pregnancy related diagnoses for Females
2,000
R10 Abdominal and pelvic pain
T39 Poisoning by nonopioid analgesics, antipyretics…
J03 Acute tonsillitis
K01 Embedded and impacted teeth
K07 Dentofacial anomalies [including malocclusion]
K35 Acute appendicitis
K50 Crohn's disease [regional enteritis]
E10 Insulin-dependent diabetes mellitus
M23 Internal derangement of knee
R51 Headache
S02 Fracture of skull and facial bones
R69 Unknown and unspecified causes of morbidity
T43 Poisoning by psychotropic drugs, not elsewhere…
S82 Fracture of lower leg, including ankle
R07 Pain in throat and chest
N39 Other disorders of urinary system
N47 Redundant prepuce, phimosis and paraphimosis
A09 Other gastroenteritis and colitis of infectious and…
S62 Fracture at wrist and hand level
L05 Pilonidal cyst
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1,500
1,000
500
-
500
1,000
1,500
2,000
Females
Males
Did not attend rates
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Our Data?
• Searched HES Data – outpatient Appointments
Only 23 Episodes recorded… so
• Inpatients episodes
2009/10 – 3000 episodes recorded for Thames Valley
2012/13 – 6000+ episodes recorded but not clear why?
Self harm caused by Tobacco increased by 4 fold
• Data not good enough to use therefore
Problem 1
WE HAVE NO RLIABLE DATA
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What can we do about it?
• What data do you collect?
• What data is comparable across the system?
• What are the benchmarks for successful transition?
• Reduced admissions
• Controlled condition
• Quantitative versus Qualitative
• Can we run a pilot in one speciality across the network?
• If so, what would work?
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What and where are the transition points?
• Children's Acute/Secondary care to Adult
Acute/Secondary Care
• Children's Social Services to Adult Social Services
• GP care – stays the same? But what is the role of
parents?
• School versus Work/college/university
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Angela Baker, Public Health Consultant in Health Improvement