National data has advantages like comparability between areas and standard indicators/targets, but local data provides more granular, timely, and useful information for public health. Local data sources in Somerset include population statistics, lifestyle surveys, screening and vaccination rates, deprivation indices, and disease registers from general practices. Examples shown how local cervical cancer and childhood vaccination data can identify poorly performing areas for intervention, and how smoking and deprivation data were used to target communities for smoking cessation programs.

1. Key Data Sources for Public
Health – the local perspective
Public Health Information and Evidence Seminar
Irina Holland
NHS Somerset
4th November 2010

2. 2
Outline
• Advantages and Disadvantages of national compared to local data
• Local data sources
• Examples using local data

3. 3
Advantages of national/regional data compared to local data
• Comparability with other PCTs/LAs/…
• Used for government indicators and targets
• Can be used in conjunction with local data (eg adjusting
populations to get estimates for small areas)
• Other people do the work!

4. 4
Disadvantages of national/regional data compared to local
data
• Timeliness (often very old)
• Granularity (often data not available at small geographies)
• Geographies provided not always the ones required
• Suppression
• Availability
• Not always as useful as it could be (eg not standardised, no
confidence intervals)
• No control of how the data is analysed (definitions, methods)
• No local knowledge used in analysis and interpretation
• Modelled data

5. 5
Data sources

6. 6
Public Health Data - 1
• Populations (including Births, and ethnicity)
• Deprivation
• Lifestyle
• GP consultations
• Prevalence
• Screening
• Cancer registrations
• Immunisations
• Hospital activity (inpatients, outpatients, A&E, referrals)
• Ambulance statistics
• Mortality

7. 7
Public Health Data - 2
• Teenage pregnancy
• Crime and Community Safety (including Drugs and Alcohol)
• Social Services
• Benefits
• Education
• Emergency service activity
• Environment
• Housing
• Income/Employment
• Transport
• …

8. 8
PCT Partners
• Local Authorities (including
Unitary Authorities) and all the
associated sections (eg
Children and Young People,
Transport, Housing, Schools,
Economic, Social Services)
• Police
• Sexual health services
• Emergency services
• Environment agency
• Social Services
• Voluntary Sector
• Health and Wellbeing
Partnership (HSNAG/JSNA)
• Community Safety
Partnership (inc ASPIRE)
• Drugs and Alcohol Action
Team
• Somerset Intelligence
Partnership
• SINe
•

9. 9
Examples using local data

10. 10
Cervical Screening
• Routinely collected and reported on KC53 10 working days after
quarter end at practice level, data only reported nationally at PCT
level
• Rates can be calculated at Federation (group of practices) level
• Monitoring shows that
– Some practices have higher inadequacy rates than others
(interventions can be made at these practices)
– the percentage of smears that are inadequate smears has
fallen over time (partly as a result of improvement at poorly
performing practices and partly with the introduction of the new
technique)

11. 11
Cervical Screening

12. 12
Vaccinations
• Routinely collected and reported on COVER (Cover of Vaccination
Evaluated Rapidly). Provisional data 10 working days after quarter
end at treatment centre level, finalised data 2 months after quarter
end. At least until recently data only reported nationally at PCT
level
• Rates can be calculated at Federation (group of practices) level
• Monitoring shows that
– Decline in MMR uptake following concerns over its safety.
But if less than 95% of children are immunised against
measles outbreaks will occur (concept of herd immunity)
– Some areas are better at achieving high uptakes than others

13. 13
Vaccinations

14. 14
Deprivation
• Indicators describe one or more aspects of deprivation
(material, social, educational…)
• IMD, Jarman, Carstairs, local indicator eg Somerset
Health and Social Needs Analysis Group Child
deprivation measure
• IMD only published at Lower Super Output Area level
• Can use local data and population weighting of LSOA
scores to estimate deprivation for other areas and
groups of people (eg schools, GP practices, wards)
resulting in ability to identify inequalities and target
resources.

15. 15
Lifestyle - Smoking
• Collected through MIQUEST, a system that interrogates
GP clinical systems, for National Service Framework
monitoring
• Related to deprivation
• Smoking prevalence can be used to target communities
with smoking cessation work. Either directly if area
known to have a high prevalence or indirectly if area
known to be deprived.

16. 16
Deprivation and Smoking prevalence

17. 17
Deprivation and Smoking prevalence

18. 18
Quality Outcomes Framework (QOF)
• Is the annual reward and incentive programme detailing
GP practice achievement results and contains Indicators
relating to the care of patients
• National data Includes prevalence (=number on various
disease registers per list size) but no allowance made for
the age/sex structure of the list
• Not designed as a public health tool but can be adapted
by standardising using local data
• Can group practices into deprivation quintiles to look for
inequalities

20. 20
Lifestyle
• Some Somerset information available through national
data based on national surveys
– Most use modelling to provide estimates
– Some use definitions that are not ideal for public
health purposes (eg sport but not all physical activity)
• Every 5 years or so Somerset public health surveys
adults about lifestyle behaviours
• Data can be compared over time appropriately by re-
weighting data from previous surveys to reflect similar
population distributions

21. 21
Lifestyle

22. 22
Equity of revascularisation
• Coronary heart disease mortality by gender for those
aged 35-64
• Revascularisaion procedures by gender for those aged
35-64
• The ratio gives an estimate of the number of procedures
per death
• Highlighted the gender inequality in provision of
intervention
– CHD had been regarded as a “male” disease and this
might have led to under-referral by GPs

23. 23
Equity of revascularisation

24. irina.holland@somerset.nhs.uk
01935 381962
jacq.clarkson@somerset.nhs.uk
01935 381961