Assessing needs in a population

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Assessing needs in a population

• Dr Diane Gray
• Director of Strategy Planning / Deputy DPH
• NHS Milton Keynes

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To come ...

• Technical definitions the what
• Being strategic whats the business the why
• The how
• Information sources
• Information analysis
• Using the information
• And the not quite sorted yet ...
• QA

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The what

• Definition of Competency 5
• Manage knowledge and undertake robust and
  regular needs assessment
• Analytical skills and insight
• Understanding of health needs trends
• Use of health needs benchmarks
• Definition of health needs assessment (Stevens
  and Raftery)
• Epidemiological
• Comparative
• Corporate

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Important distinctions
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The why

• Would I let my mother / best friend / child use
  this service?
• If I was paying for this service from my own
  money, would I?

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Health inequalities mind the gapDifference in
expectation of life by ward from MK average,
2004-8
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Gap is caused by a few key conditions
Life expectancy years gained if the most deprived
quintile of Milton Keynes had the same mortality
rate as the England average for each cause of
death
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The howdeterminants of health Need
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• www.mkiobservatory.org.uk

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The how use of healthcare Demand

• QOF prevalence, outcomes, exceptions
• Child health vaccinations, obesity
• Hospital activity data
• Prescribing data
• Data from community services ...

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Tell the story Practice profiles
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Tell the story Social atlas
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QualityMK a whole system approach to quality
improvement

• To create a self-improving system
• that makes a reality of
• 3 widely used slogans
• Evidence based
• Primary care led
• Patient engagement

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Using the information maternity care

• Identified as high cost, poor outcomes in
  Strategic Plan
• High perinatal mortality rate (altho not
  statistically significant)
• Rising caesarean section rates
• Consistently in Top 10 PCTs in programme
  budgeting
• High number of complaints
• Public health led a 6 month service review
• Service spec written and agreed in hospital
  contract
• Quality review group (including public health)
  monitors outcomes
• Much tighter links with communities and health
  promotion

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Using the information urgent care

• Identified as high cost, high volume, low
  satisfaction in Strategic Commissioning Plan
• Significant proportion of patients bounced
  between providers
• Default to AE no change in activity even with
  new WiC
• Public health set the vision
• Use Big Brands, dont compete against them
• Integrate around the patient, not around the
  services
• Self-care is a therapeutic option!
• Procurement led by Contracts with input from
  public health, PBC, PEC, patients
• Key indicators include health outcomes

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Using the information diabetes

• Identified as high cost, high volume, low
  satisfaction in Strategic Commissioning Plan
• Low QOF scores with high exceptions
• High emergency admission rates for diabetes
  complications
• High programme budget spend
• High number of complaints
• Public health set the vision
• Skill up primary care
• Redefine role of secondary care
• Embrace Care Planning Approach
• Roll-out across practices now underway

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Summary

• Dont tick the box and miss the point
• Do remember that Healthcare ? Health
• Less is most certainly more
• Data is not the same as information
• Information is only useful if its used ...

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The not quite sorted yet

• Timeliness of data (especially national datasets)
• Sharing data
• Different denominators
• Modelling and predicting
• Using sensible and shared assumptions
• Health economics
• Programme budgeting as a blunt instrument

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QA

• The role of joint intelligence units
• Joint with who?
• Possession is 9/10s the law
• Flexibility and responsiveness
• Creating a JSNA
• How to define the right questions
• Link with the Public Health Annual Report and the
  Childrens Young Peoples Plan
• Finding the right benchmarks
• What are health needs benchmarks
• Timely production of comparisons
• How to make them accessible