Developing Nottingham’s LAAJeanelle de Gruchy and Chris Nield
Health Equality, Nottingham City PCT
Objectives of session
• LAA indicator issues
• LAA partnership working issues
• Effective indicators
SMART Indicators
• Specific – mental health (support to people known to mental health services)
• Measurable – mental health (DSH)• Achievable – prevalence (smoking,
physical activity, alcohol) • Relevant – physical activity cf. statins• Timed – 1996/97 or 2005? 6 monthly or
at the end of 3 years?
Measurement
• Outcome vs process (quitters v. prevalence)• Definitions (obesity, PA)• Baselines – expense and time measuring
(PA)• Perverse incentives (mental health
employment; CHD – statins v. PA)– Time-scale – needing to show results in 3 years
(easier to argue for older people CHD cf. young people and obesity)
– Inequalities – overall numbers vs. targetted
LAAs in partnership• Accountability – it’s a political process
– Consultation with partner organisations– Conflicting guidance – GOEM, City Council, SHA,
ODPM guidance document (eg what is a ‘stretch’)– Lead organisation control (driven by performance
management)– Some lack of understanding of NHS organisation
drivers / performance management / limited focus on public health (and limited capacity!)
• Understanding of health / health outcomes – Valuing professional/technical expertise
• Is 0.5 of a fruit ‘unambitious’?
Negotiating indicators
• Time scale to negotiate– Community consultation – Iterative process, but difficult to ensure all kept on
board with the process
• Blocks and cross-cutting issues– Alcohol – crime or medical…?– Infant mortality (technical expertise)
• Prioritisation / nos. of indicators allowed– Lobbying by interest groups (avoidable injury;
supporting young parents)
Effective indicators
• A health priority (national / local target)• Evidence base• Build on reality of local situation• Be creative – the reality is it needs to be
measured – balance between routinely available info –
but may need to survey.
• Particularly NB as we develop our stretch targets