James Mechan Public Health Workshop

8/10/2019 James Mechan Public Health Workshop

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Developing a new public healthintelligence system in the

North West of England

Health Statistics Users Group

25 th March 2011

James MechanHead of Public Health Intelligence


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DriversPH White paper states that PH England; will continue working closely with the full range of public

health partners involved in surveillance, monitoring,evaluation and intelligence in order to develop a clearapproach for information and intelligence

will work to eliminate gaps and overlaps and to developthe specialist workforce required

will bring together public health functions that are carriedout in different parts of the system at present into a new,streamlined whole so as to remove duplication and driveefficiencies and innovation


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The Current System in the North West

Recent mapping exercise by LJMU (Nov 2010) suggestsa total public health analytical capacity of 89.8 wte 27.2 wte at regional / sub-regional level (incl. NWPHO) 24.1 wte in Cheshire and Merseyside

2.6 wte in Cumbria 10.1 wte in Lancashire 25.8 wte in Greater Manchester

Almost 50% reduction in total number of analystsbetween March and November 2010 still reducing

Decrease particularly evident in posts at Grades 6 and 7

Major reduction in analysts in training posts


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Implications of structural changes (2)

Growing brokerage role for public health intelligenceteams in reviewing the market to understand what is onoffer, where it can enhance existing work and advisinglocal authorities and GP Consortia of the quality ofproducts available from information intermediaries

Reductions in the availability of core data from nationalsources may mean that public health intelligence teamswill have to produce more information themselves orpurchase it from a commercial source

Diversion in focus between more centralised nationalpublic health intelligence system and local public healthintelligence teams


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Future Public Health IntelligenceSystem: Core Principles

Subsidiarity: Intelligence work needs to take place as close aspossible to the people and strategies that require it

Localism: Local intelligence professionals and partnerships are thebuilding blocks for intelligence structures at supra-local level.

Partnership: System based on stronger, more formal, partnershipswith existing intelligence providers rather than on a totally new layerof intelligence (e.g. a supra-local observatory)

Diversity: Different elements of the intelligence-base may beprovided by a range of different suppliers rather than by a single

organisation Evidence-led: Work should only be done at supra-local level where it

is clear that this work will benefit all partners or contribute to thedevelopment or expansion of an evidence base for that topic


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The Challenge for Public Health Intelligence

The PH White paper asks what are the bestopportunities;

to develop and enhance the availability, accessibilityand utility of public health information and intelligence To address current gaps such as using the insights of

behavioural science, tackling wider determinants ofhealth, achieving cost effectiveness and tackling

inequalities? To ensure that wider partners nationally and locallycontribute to improving the use of evidence in publichealth?


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Technical Growing demand for increasingly large and complexpieces of analysis from GPCC and LAsPotential loss of NHS data following move of publichealth teams to local authoritiesReliance on voluntary accreditation and industry-ownedstandards of good practice poses threat to data quality

Organisational Greater integration with local authorities may divertpublic health analysts to more generic areas of workBudgetary constraints may lead to a more protectionistattitude to information and intelligence

Professional Loss or scaling back of existing training routes for publichealth analystsLoss of staff from existing organisations whilst newstructures are in the process of being established

Threats and challenges


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Greater Manchester Public Health IntelligenceTransition Project

Aims to describe the different elements of the currentpublic health intelligence system and articulate what thesystem might need to look like in the future in the contextof the changing public health and NHS structures

Recommends moving towards a hub and spokes modelof public health intelligence across GM by April 2012

Future focus to include management, reporting andsharing of public health data; improved communication

and coordination of intelligence activities; and developingthe professional and non-professional workforce

Agreed by DsPH on 4 th March 2011


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Cheshire and Merseyside

Using Large Scale Approach to develop a new publichealth system across Cheshire and Merseyside

Identified public health intelligence and knowledgemanagement as one of the priorities to review thefunctionality and develop a model to supportcommissioning

Task and Finish Group established and met in January toagree functionality and optimum delivery i.e. local, county,sub-regional etc

Option paper being drafted for consideration by Cheshireand Merseyside DsPH in March 2011


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Intelligence for Healthy Lancashire Group

Proposal to pull together all the public health intelligenceresources within the county into a single LancashirePublic Health Intelligence Unit (Intelligence for HealthyLancashire Team from June 2011)

Initial stage to bring together public health intelligencestaff from 3 Lancashire PCTs but to widen this to includecounty-wide analysts in the future (from 1st April 2012)

Primary focus likely to be on providing a range of corepublic health intelligence outputs

DsPH agreed proposals in principle in January 2011 Links to an existing data repository facility for PH and

NHS data


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The contrast between local and nationalpublic health intelligence system needs

National Local

Uniform(e.g. agreed geographicalunit)

Bespoke(sensitive to local needs)

Departmental(typically DH owned data)

Multi-agency(health, transport, economic,welfare, criminal justice etc)

Methodology established Methodologically variable

High economies of scale Low economies of scale

Sensitive to national needs Sensitive to local needs

Robust

(e.g. to system, finance andpersonnel changes)

Vulnerable

(e.g. to changes in structure,finance and people)

Slow to change(e.g. bureaucratic and byconsensus)

Quick to change(e.g. according to perceivedlocal need)

Typically large time lag fromcollection to dissemination(e.g. data cleaning andclearance)

Typically short time lag fromcollection to dissemination(e.g. comparatively unclean butcloser to real time)


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National Local

Easy to benchmark(e.g. how is each area doingcompared to each of itspeers)

Hard to benchmark(e.g. how is each area doingcompared to each of its peers)

Security higher, accessharder(e.g. long response time tobespoke requests)

Security lower, access easier(e.g. response time to bespokerequests determined by localpriority setting)

Long distance relationshipwith data collectors(eg. drug treatment andcancer data)

At hand relationships with datacollectors(e.g. allows good feedback)

Large robust data systems

and surveys

Smaller sample sizes sensitive

to random effects Suited to setting nationalpolicy and priorities

Suited to setting local policyand priorities

Usually strong links withassociatedexpertise/specialist support(e.g. links to academicdepartments)

Patchy links with associatedexpertise/specialist support(e.g. often depends on localinstitutions)

The contrast between local and nationalpublic health intelligence system needs


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Acknowledgments

Neil Bendel - NHS Manchester/ Greater Manchester(GM) PH Intelligence Network

Paul Langton - Public Health Intelligence Manager,NHS Knowsley / Knowsley MBC Mark Bellis - North West Public Health Observatory

(NWPHO)

James Mechan Public Health Workshop

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