Health Development Agency response to the NHS Performance

By Sheila Black,2014-06-18 10:15
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Health Development Agency response to the NHS Performance



1. We welcome the Department’s intention to develop a much wider

    range of indicators for both local and national use to present a fully

    balanced view of the NHS performance. Evidence from our work on

    Health Improvement Programmes (A National Review and Analysis of

    Health Improvement Programmes HDA 2000; HImPs: Research into *) Practice HDA 2001 and HIMPs; Next Steps HDA 2001 in progress

    shows that improving the use of and access to cross-sectoral data and

    the development of common NHS/local government local targets and

    indicators is a major development issue, particularly as far as reducing

    health inequalities is concerned.

2. We recognise that there is considerable work to be done to improve the

    quality of data in tracking progress in reducing health inequalities and

    inequity in service provision and use. We welcome the Department’s

    specific consultation on a ‘basket of inequalities indicators’ and are

    involved in supporting the consultation process at national and regional

    levels. We agree strongly that the learning and examples gathered

    through the consultation on inequalities indicators should be used to

    develop the future coverage of the NHS indicators. However, there will

    need to be further investment in the development of health inequalities

    indicators across sectors and in mechanisms for gathering the local

    and regional data to support them.

3. Our current review of community planning and health improvement

    (Community Planning and Health Improvement, HDA 2001 in progress)

    and our forthcoming guidance on developing local health inequalities

    targets (Closing the Gap: Setting local targets to reduce health

    inequalities, HDA 2001 in progress) highlight the need for the NHS

    Performance Assessment Framework to:

    ? reflect local and regional experiences of indicator development (i.e.

    to be more ‘bottom-up’);

    ? give much greater weight to the partnership agenda through

    indicators of cross-sectoral planning and delivery (linked to LSP


     * These reports list the types and sources of data in use in HImPs, from across the country.


    ? recognise action to reduce health inequalities through indicators of

    process as well as outcome (for example, in redirecting mainstream

    funding and services to better serve more deprived populations and


? formalise the contribution of the NHS to neighbourhood renewal

    through joint indicators within the PAF and neighbourhood renewal


? become increasingly aligned with local government performance

    management systems (Best Value) and indicators for quality of life

    (to allow more integrated planning across the HImP and community


? allow for the performance management of whole systems (both

    within the NHS and across sectors) rather than simply of individual

    NHS organisations. This is particularly important in tracking

    progress on reducing health inequalities.

    4. The Department’s intention to develop a full set of primary and

    community based indicators for 2002 is also a significant opportunity to

    raise the profile of public health and inequalities activity across the

    NHS. Considerable work is already underway in Health Action Zones

    to develop local indicator sets and to track progress towards HAZs’

    High Level Performance Indicators (see This learning

    needs to be mainstreamed through the development of the primary and

    community based indicators (see also 6,8 and 9 below). Haznet

    (which the HDA facilitates) is the main communication and learning tool

    for HAZs. It could be a useful mechanism for the Department to

    encourage this mainstreaming.

    5. We welcome the introduction of ‘interface indicators’ spanning health

    and social care, but feel that this terminology may reinforce the idea

    that the NHS and local government can only come together to measure

    progress in these areas, rather than through a co-ordinated approach

    across their performance management systems. It may also reinforce

    the view that health and social care is the only point of overlap across

    sectors. We would like to see the development of indicators that reflect

    a more fundamental alignment and integration of functions to reduce

    health inequalities such as pooled budgets, jointly funded posts and

    services, and the use of Health Act freedoms and flexibilities for cross-

    sectoral funding.

    6. Related to the above, we would like to see the PAF reflect the

    importance of NHS involvement in community development, as part of

    broader cross-sectoral programmes of community involvement and

    engagement in public services and neighbourhood renewal. This

    would also allow the NHS to recognise more explicitly its relationship

    with the voluntary and community sector. Indicators could be

    developed both for processes (e.g. related to the level of funding/posts


for community development;) and for outputs (e.g. related to changes

    in the engagement of communities in NHS planning, the training of lay

    people to work within the NHS and so on).

    7. We welcome the introduction of a capacity and capability area in the

    PAF for Trusts as it provides a focus in NHS organisations for the

    development of indicators for public health capacity and capability a

    neglected area in both performance and development. The HDA’s

    work on the national workforce plan provides a framework for the types

    of public health skills required at different levels of planning and service

    provision. This offers a useful context for the development of indicators

    to track changes in the public health workforce (across NHS and local

    government) and another measure of investment in health

    improvement/reducing health inequalities.

    8. There is almost no mention of the introduction of Best Value in the

    NHS and the relationship between the PAF and Best Value

    performance domains to support the performance management of

    whole systems. As noted above, this is seen as a major barrier to the

    integration of planning across health and local government (HDA 2000

    and 2001 in progress). It is also an area of particular interest to the

    Neighbourhood Renewal Unit, which is concerned with the

    development of appropriate indicators to measure changes in the GIDA

    targets through local neighbourhood renewal strategies. This will

    require the development of an indicator set at local level that links

    health and other inequalities measures and highlights the appropriate

    indicators for tracking progress towards the various targets.

    9. We would like to see greater support for an R&D programme for

    indicator development alongside the Department’s work to extend the

    PAF. There are considerable gaps in:

? Organisational process and output indicators to track changes in

    NHS activity as a local ‘regenerator’ and employer (and therefore its

    contribution to reducing health and other inequalities in the local


    ? Differential indicators of service use, treatment and referral patterns

    among different social groups and minority ethnic communities.

    (For example, the collection of data by socio-economic group in

    primary care is limited).

? The range and type of indicators that can be used to measure

    changes in the attitudes of deprived communities (Report of Policy

    Action Team 18: Better Information Cabinet Office 2000),

    community involvement and social capital. The HDA has recently

    published Assessing people’s perceptions of their neighbourhood

    and community involvement (Part 1) (HDA 2001), which provides a

    guide to questions for use in the measurement of social capital

    based on the General Household Survey module. This lays some


    of the groundwork for the development of indicators of social capital

    that could become standardised across local public services.

    ? Evidence of the ways in which local indicators are developed and

    used to support improved performance in health improvement and

    reducing health inequalities across sectors.

10. On specific indicators, there are some anomalies in the way the

    prevention standards in NSFs are reflected. There is an indicator on

    evidence-based strategy among the proposed health improvement

    indicators for mental health (number 3005). We suggest that the NSFs

    for coronary heart disease and older people provide as strong

    justification for indicators of this sort among the health improvement

    indicators for coronary heart disease and older people. In the case of

    heart disease, the HDA’s guidance for implementing the preventive

    aspects of the NSF (HDA 2000) sets out what the evidence-based

    elements of such a strategy might be.

11. Again on specifics, health inequalities and public health indicator

    number 6018 (exercise levels) should be consistent with CHD indicator

    number 1011, which uses the preferred terminology - physical activity

    and suggests the levels at which the indicator may be applicable.

Health Development Agency

    06 08 01


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