Developing a new public health

intelligence system in the

North West of England
Health Statistics Users Group
25
th
March 2011

James Mechan
Head of Public Health Intelligence

Drivers
PH 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 clear
approach for information and intelligence

will work to eliminate gaps and overlaps and to develop
the specialist workforce required

will bring together public health functions that are carried
out in different parts of the system at present into a new,
streamlined whole so as to remove duplication and drive
efficiencies and innovation
Drivers
Importantly it states that
Public Health England offers a unique opportunity to draw
together the existing complex information, intelligence and
surveillance functions performed by multiple organisations
into a more coherent form and to make evidence more
easily available to those who will use it, in a form that
makes it most likely to be used.

The White Paper also describes the role of public health
evaluation and research as being critical in enabling public
health practice to develop into the future and address key
challenges and opportunities, such as how to handle the
wider determinants of health and how to use behaviour
change science to support better practice
The Current System in the North West
Recent mapping exercise by LJMU (Nov 2010) suggests
a 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 analysts
between March and November 2010 still reducing
Decrease particularly evident in posts at Grades 6 and 7
Major reduction in analysts in training posts
Implications of structural changes (1)
Expanded customer base for public health intelligence
that includes public health, the local authority, GP
Consortia and other agencies represented on the HWBB
Strengthened role of JSNAs and the greater focus on
these through the PCT cluster arrangements/GP
Consortia increases the need for robust public health
information, intelligence and analysis at a LOCAL level
The transfer of public health responsibilities to local
authorities raises issues regarding the relationship
between existing public health intelligence teams and the
research and intelligence functions of local authorities
Implications of structural changes (2)
Growing brokerage role for public health intelligence
teams in reviewing the market to understand what is on
offer, where it can enhance existing work and advising
local authorities and GP Consortia of the quality of
products available from information intermediaries
Reductions in the availability of core data from national
sources may mean that public health intelligence teams
will have to produce more information themselves or
purchase it from a commercial source
Diversion in focus between more centralised national
public health intelligence system and local public health
intelligence teams
Future Public Health Intelligence
System: Core Principles
Subsidiarity: Intelligence work needs to take place as close as
possible to the people and strategies that require it
Localism: Local intelligence professionals and partnerships are the
building blocks for intelligence structures at supra-local level.
Partnership: System based on stronger, more formal, partnerships
with existing intelligence providers rather than on a totally new layer
of intelligence (e.g. a supra-local observatory)
Diversity: Different elements of the intelligence-base may be
provided 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 the
development or expansion of an evidence base for that topic
The Challenge for Public Health Intelligence
The PH White paper asks what are the best
opportunities;

to develop and enhance the availability, accessibility
and utility of public health information and intelligence
To address current gaps such as using the insights of
behavioural science, tackling wider determinants of
health, achieving cost effectiveness and tackling
inequalities?
To ensure that wider partners nationally and locally
contribute to improving the use of evidence in public
health?
Technical Growing demand for increasingly large and complex
pieces of analysis from GPCC and LAs
Potential loss of NHS data following move of public
health teams to local authorities
Reliance on voluntary accreditation and industry-owned
standards of good practice poses threat to data quality
Organisational Greater integration with local authorities may divert
public health analysts to more generic areas of work
Budgetary constraints may lead to a more protectionist
attitude to information and intelligence
Professional Loss or scaling back of existing training routes for public
health analysts
Loss of staff from existing organisations whilst new
structures are in the process of being established
Threats and challenges
Greater Manchester Public Health Intelligence
Transition Project
Aims to describe the different elements of the current
public health intelligence system and articulate what the
system might need to look like in the future in the context
of the changing public health and NHS structures
Recommends moving towards a hub and spokes model
of public health intelligence across GM by April 2012
Future focus to include management, reporting and
sharing of public health data; improved communication
and coordination of intelligence activities; and developing
the professional and non-professional workforce
Agreed by DsPH on 4
th
March 2011
Cheshire and Merseyside
Using Large Scale Approach to develop a new public
health system across Cheshire and Merseyside
Identified public health intelligence and knowledge
management as one of the priorities to review the
functionality and develop a model to support
commissioning
Task and Finish Group established and met in January to
agree functionality and optimum delivery i.e. local, county,
sub-regional etc
Option paper being drafted for consideration by Cheshire
and Merseyside DsPH in March 2011
Intelligence for Healthy Lancashire Group
Proposal to pull together all the public health intelligence
resources within the county into a single Lancashire
Public Health Intelligence Unit (Intelligence for Healthy
Lancashire Team from June 2011)
Initial stage to bring together public health intelligence
staff from 3 Lancashire PCTs but to widen this to include
county-wide analysts in the future (from 1st April 2012)
Primary focus likely to be on providing a range of core
public health intelligence outputs
DsPH agreed proposals in principle in January 2011
Links to an existing data repository facility for PH and
NHS data
The contrast between local and national
public health intelligence system needs

National

Local
Uniform
(e.g. agreed geographical
unit)
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 and
personnel changes)
Vulnerable
(e.g. to changes in structure,
finance and people)
Slow to change
(e.g. bureaucratic and by
consensus)
Quick to change
(e.g. according to perceived
local need)
Typically large time lag from
collection to dissemination
(e.g. data cleaning and
clearance)
Typically short time lag from
collection to dissemination
(e.g. comparatively unclean but
closer to real time)
National

Local
Easy to benchmark
(e.g. how is each area doing
compared to each of its
peers)
Hard to benchmark
(e.g. how is each area doing
compared to each of its peers)
Security higher, access
harder
(e.g. long response time to
bespoke requests)
Security lower, access easier
(e.g. response time to bespoke
requests determined by local
priority setting)
Long distance relationship
with data collectors
(eg. drug treatment and
cancer data)
At hand relationships with data
collectors
(e.g. allows good feedback)
Large robust data systems
and surveys
Smaller sample sizes sensitive
to random effects
Suited to setting national
policy and priorities
Suited to setting local policy
and priorities

Usually strong links with
associated
expertise/specialist support
(e.g. links to academic
departments)
Patchy links with associated
expertise/specialist support
(e.g. often depends on local
institutions)
The contrast between local and national
public health intelligence system needs

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)