Developing a Baseline – How we know we have achieved what we set out to achieve?

Angela Bakerangela.baker@phe.gov.uk

Purpose of the sessionThis 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 EnglandExists 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

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Dept of Health

Public HealthEnglandNHS England

NHS E Regions(X4)

NHS E Local Area Teams

(X12)

Clinical Commissioning

GroupsPublic HealthLocal Authority

Public HealthEngland Regions (4)

Public HealthEngland Centres (8+1)

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

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NHS E Area Team

Commissioner

NHS E specialist

commisisoner

Local Authority Commissioning

PHE Support and AdviceSCN 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) 8

Existing Data and Information…• 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

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South East FCE15-19

Females (excluding pregnancy) MalesPrimary Diagnosis Code Diagnoses Primary Diagnosis Code Diagnoses

Total 35,072Total 20,846

R10 Abdominal and pelvic pain 2,813R10 Abdominal and pelvic pain 684

T39 Poisoning by nonopioid analgesics, antipyretics and antirheumatics

1,419N47 Redundant prepuce, phimosis and paraphimosis

451

J03 Acute tonsillitis 964K50 Crohn's disease [regional enteritis] 445

K01 Embedded and impacted teeth 529K35 Acute appendicitis 439

K07 Dentofacial anomalies [including malocclusion]

513M23 Internal derangement of knee 435

E10 Insulin-dependent diabetes mellitus 438S02 Fracture of skull and facial bones 435

N39 Other disorders of urinary system 417S62 Fracture at wrist and hand level 399

K35 Acute appendicitis 411J03 Acute tonsillitis 398

K50 Crohn's disease [regional enteritis] 396S82 Fracture of lower leg, including ankle

372

R51 Headache 394K01 Embedded and impacted teeth 350

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15 -19 year olds excluding pregnancy

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R10 Abdominal and pelvic painT39 Poisoning by nonopioid analgesics, antipyretics and antirheumatics

J03 Acute tonsillitisK01 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 kneeR51 Headache

S02 Fracture of skull and facial bonesR69 Unknown and unspecified causes of morbidity

T43 Poisoning by psychotropic drugs, not elsewhere classifiedS82 Fracture of lower leg, including ankle

R07 Pain in throat and chestN39 Other disorders of urinary system

N47 Redundant prepuce, phimosis and paraphimosisA09 Other gastroenteritis and colitis of infectious and unspecified origin

S62 Fracture at wrist and hand levelL05 Pilonidal cyst

2,000 1,500 1,000 500 - 500 1,000 1,500 2,000

b) 15-19 year olds excluding pregnancy related diagnoses for Females

Males

Females

Did not attend rates

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Our Data?• Searched HES Data – outpatient Appointments

Only 23 Episodes recorded… so

• Inpatients episodes2009/10 – 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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17 Angela Baker, Public Health Consultant in Health Improvement