From:	Graham Gibbens, Cabinet Member for Adult Social Care and Public Health

Andrew Scott-Clark, Acting Director of Public Health

To:	Adult Social Care and Health Cabinet Committee

Date:	11th July 2014

Subject:	Public Health Performance - Adults

Classification:	Unrestricted

Summary: This report provides an overview of Public Health key performance indicators which specifically relate to adults.

Community Sexual Health services continue to provide required levels of access to their services and Health Trainers continue to engage expected numbers of new clients. There were improvements in the NHS Health Check Programme in Q4 for both invites sent and checks received.

Despite concerns with levels of performance of the commissioned programmes, it is encouraging that all five indicators have improving performance during the year and is progressing in the right direction. Significant concerns with smoking cessation services remain.

Due to national publication dates, figures for Chlamydia Positivity have not been updated since the previous report, but local figures have been provided as a temporary measure.

Wider Public Health Indicators have been included to provide an understanding of the wide reaching impact of Public Health.

Recommendation(s): The Adult Social Care and Health Cabinet Committee is asked to note the current performance and actions taken by Public Health

1.	Introduction

1.1	This report provides an overview of the key performance indicators for Kent Public Health which relate to services for adults; the report includes a range of national and local performance indicators.

1.2	There are a wide range of indicators for Public Health including the indicators contained in the Public Health Outcomes Framework (PHOF). This report will focus on the indicators which are presented to KCC Cabinet, and which are relevant to this committee.

2	Performance Indicators

2.1	The table below sets out the performance indicators for the key public health commissioned services which deliver services primarily for adults. A more detailed analysis of the performance is included at Appendix A.

Indicator Description	Q4 12/13	Q1 13/14	Q2 13/14	Q3 13/14	Q4 13/14	Direction of Travel
Prescribed and non-prescribed Data Returns
NHS Health Checks - Proportion of target offers received a Health Check	42.0%	28.3%	38.7%	30.4%	46.9%
Community Sexual Health Services – Proportion of clients accessing GUM offered an appointment to be seen within 48 hours	98.5%	97.8%	96.6%	97.4%	99.9%
Community Sexual Health Services – Chlamydia positivity rate per 100,000	1,507	1,292	1,679	Not currently available	Not currently available
Stop Smoking Services – Number of people successfully quitting having set a quit date	2,541	1,536	1,454	1,488	1,653
Local Indicator
Health Trainers – Proportion of new clients against target	163%	77%	109%	95%	109%

2.2	The provider of NHS Health Checks sent out the target number of invites for 2013/14, in total to just over 95,000 eligible Kent residents. Although the target number of Kent residents to receive a health check was not met, there was an increase on the previous year with 32,924 having a NHS Health check, 10,709 of which were received in Q4.

2.3	Public Health has been working this year to provide active feedback to Clinical Commissioning Groups (CCGs) on local results. Alongside this work Public Health will also be appraising future delivery options with a view to contracts being awarded in December in time for start in April 2015. The target remains to achieve 50% uptake rate this financial year.

2.4	GUM (Genitourinary Medicine) clinics in Kent consistently offer the majority of clients an appointment within 48 hours, performing above the high target of 95%. GUM service is open access, available to all ages. This indicator is being monitored in quarterly performance monitoring meetings with the commissioned providers. Community sexual health services, including GUM and Chlamydia testing, are currently out for tender but the access targets will be included in the new contracts.

2.5	The Chlamydia positivity rate remains below the target level of 2,300 per 100,000 of population. The provider has implemented an action plan to tackle the shortfall of including public health campaign activity, radio messaging, promotional materials and the establishment of improved and focused internal performance measures and targeting of at risk groups/communities.

2.6	Provisional figures for the full year 2013/14 on chlamydia positivity indicate a possible 2,095 rate per 100,000; this is an improvement on previous performance however would have Kent still below the nationally set target.

2.7	The number of people successfully quitting smoking also remains below the target. Smoking rates in the county have declined in recent years but approximately 1 in 5 adults in Kent smoke with significantly higher rates in particular parts of the county. Public Health has recently commissioned a review of the current Stop Smoking Services which will inform commissioning plans for the future.

2.8	Although the full year 2013/14 figures for smoking cessation did not met the targeted 9,249 quits, quarter 4 did experience an increase in the number of quitters compared to all other quarters within the year at 1,653.

2.9	The health trainer service continues to engage new clients and work with those in the most deprived areas of Kent; Public Health is working with the provider to move from activity-based metrics towards outcome-focussed indicators.

2.10	Not all of the indicators have met the targets set, although performance in four of the five indicators has improved and is moving in the right direction. This needs continuous review and focus to sustain improved performance.

3	Annual Public Health Outcomes Framework (PHOF) Indicators

3.1	At the previous Committee meeting on 2nd May 2014 it was agreed to include a wider range of indicators to reflect the breadth of the Public Health Agenda. Indicators on alcohol, substance misuse and depression have been presented below in line with requests at the previous Committee. It should be noted that these are annual statistics and will not change for every meeting.

Annual PHOF Indicators	2006-08	2007-09	2008-10	2009-11	2010-12	DoT
Under 75 mortality rates for:
Cardiovascular diseases considered preventable per 100,000	61.2	59.8	57.4	55.9	52.3
Cancer considered preventable per 100,000	85.6	84.3	83.7	82.6	80.5
Liver disease considered preventable per 100,000	12.8	12.4	12.1	12.0	12.4
Respiratory disease considered preventable per 100,000	16.8	17.4	17.4	17.6	16.6
Suicide rate (all ages) per 100,000	8.4	8.4	7.7	8.4	8.1
Proportion of people presenting with HIV at a late stage of infection (%)	Not available	Not available	Not available	49.0	46.8
2008	2009	2010	2011	2012
Percentage of adults classified as overweight or obese	Not available	Not available	Not available	Not available	64.6	-
Prevalence of smoking among persons aged 18 years and over (%)	Not available	Not available	21.7	20.7	20.9
Opiate drug users successfully leaving treatment and not re-presenting within 6 months (%)	Not available	Not available	14.6	14.6	10.9
2008/09	2009/10	2010/11	2011/12	2012/13
Alcohol related admissions to hospital per 100,000. All ages	Not available	Not available	574	557	565
Proportion of adult patients diagnosed with depression (%)	Not available	Not available	Not available	Not available	5.57	-

3.2	Rates of premature mortality in Kent are all showing as either better or similar to national rates. Although cardiovascular disease is showing as similar to the national rate, the rate is continuing to decrease

3.3	With some changes in direction across some of the rates during the time frames under review, all are at lower rates in the most recently available time period of 2010/12 when compared to 2006/08.

3.4	Late diagnosis of HIV is the most important predictor of morbidity and mortality among those with HIV infection; the earlier the diagnosis the better for both the person and the impact on wider services. There are two time periods currently available via the PHOF, Kent is at similar levels to national and is currently decreasing.

3.5	Excess weight in adults is a new indicator and currently 2012 is only available. Kent is very similar to national levels and other authorities in the South East. Milton Keynes is the only authority in the South East showing worse than national at 72.5%.

3.6	The depression indicator is sourced from the Health & Social Care Information Centre (HSCIC). It measures the number of patients on the depression register against the estimated number of GP registered patients aged 18 and over. Figures for Kent have been aggregated from CCG’s. In Kent for 2012/13 there were 66,089 patients on the depression register with the highest percentage occurring in Ashford CCG (7.3%).

4.	Conclusions

4.1	Public Health commissioned programmes continue to be regularly evaluated in performance monitoring meetings and where concerns are identified have been escalated to the Head of Commissioning and Interim Director of Public Health

5.	Recommendation(s)

Recommendation(s): The Adult Social Care and Public Health Cabinet Committee are asked to note the current performance and actions taken by Public Health

6.	Background Documents

6.1	None

7.	Contact details

Report Author

Karen Sharp: Head of Public Health Commissioning

0300 333 6497

Karen.sharp@kent.gov.uk

Relevant Director:

Andrew Scott-Clark: Interim Director of Public Health

0300 333 5176

Andrew.scott-clark@kent.gov.uk

Appendix 1:

Key to KPI Ratings used:

GREEN	Target has been achieved or exceeded the current National Performance
AMBER	Performance at acceptable level or no difference to the National Performance
RED	Performance is below a pre-defined Floor Standard
Performance has improved relative to targets set
Performance has worsened relative to targets set
Performance has remained the same relative to targets set

Data quality note: Data included in this report is provisional and subject to later change. This data is categorised as management information.

NHS Health Checks: Proportion of Target offers receiving an NHS Health Check	AMBER

Trend Data – by quarter	2012/13	2013/14
Q4 (Jan-Mar)	Full 2012/13	Q1 (Apr -Jun)	Q2 (Jul-Sep)	Q3 (Oct-Dec)	Q4 (Jan-Mar)	Full 2013/14
Target Offers	22,811	91,241	22,810	22,810	22,810	22,811	91,241
Actual offers	19,292	67,992	19,761	18,996	27,608	28,639	95,004
Target receive	11,406	45,621	11,405	11,405	11,405	11,406	45,621
Actual receive	9,569	29,845	6,455	8,836	6,924	10,709	32,924
% of target offers received	42.0%	32.7%	28.3%	38.7%	30.4%	46.9%	36.1%
RAG Rating	Amber	Red	Red	Red	Red	Amber	Red
National %	48.2%	40.4%	37.4%	45.3%	42.6%	-	-

Commentary
The provider of NHS Health Checks sent out the target number of invites for 2013/14, in total to just over 95,000 Kent residents. Although the target number of Kent residents to receive a health check was not met, there was an increase on the previous year with 32,924 having a NHS Health check, 10,709 of which were received in Q4. Public Health will be working this year to provide active feedback to CCGs and local Health & Wellbeing Boards on local results. Alongside this work Public Health will also be appraising future delivery options with a view to contracts being awarded in December in time for start in April 2015. The target remains to achieve 50% uptake rate this financial year. Health checks are the Public Health Outcomes Framework Indicators 2.22i and 2.22ii.
Data Notes: Higher values and percentages are better. Source: KCHT. Indicator Reference: PH/AH/01

Community Sexual Health Services : Proportion of clients accessing GUM offered an appointment seen within 48 hours	GREEN

Trend Data –by Quarter	Target	2012/13	2013/14
Q3 (Oct-Dec)	Q4 (Jan-Mar)	Q1 (Apr -Jun)	Q2 (Jul-Sep)	Q3 (Oct-Dec)	Q4 (Jan-Mar)
% offered an appointment seen within 48 hours	95%	98.5%	98.5%	97.8%	96.6%	97.4%	99.9%
RAG Rating	-	Green	Green	Green	Green	Green	Green

Commentary
GUM (Genitourinary Medicine) clinics in Kent consistently offer the majority of clients an appointment within 48 hours, performing above the high target of 95%. Performance of this service is being monitored in quarterly performance monitoring meetings with the commissioned providers GUM figures are not reported Nationally; therefore we are unable to make comparisons.
Data Notes: Higher values are better. Data source: Provider. Indicator Reference: PH/SH/01

Community Sexual Health Services : Chlamydia screening and Positivity rate	RED

Trend Data –by Quarter	Target	2012/13	2013/14
Q3	Q4	Q1	Q2
Screening Uptake	-	10,269	9,268	8,240	10,061
Positive tests reported	7%	750	7.3%	693	7.5%	594	7.2%	772	7.7%
rate per 100,000	2,300	1,631	1,507	1,292	1,679
RAG of Positivity Rate	-	Red	Red	Red	Red
England rate per 100,000	2,300	2,040	2,016	1,872	1,785

Commentary
Concerns have been identified regarding performance of this service. The provider implemented an action plan to tackle the shortfall of positivity; this included public health campaign activity, radio messaging, promotional materials and the establishment of improved and focused internal performance measures and targeting of at risk groups/communities. The target population in Kent of people aged 15 – 24 years old is 183,899. To meet the National target of the positive rate of 2,300 per 100,000, Kent would need 4230 positive diagnoses; using the NCSP calculator tool there would need to be population coverage of 32.9% equalling 60,424 tests. Community sexual health services are currently out for tender and new services will be place for January 2015. Please note Quarter 1 has been amended from the previous report. Q3 figures will not be published Nationally until June alongside Q4. Chlamydia Diagnoses is Public Health Outcome Framework Indicator 3.02
Data Notes: Higher values are better. Data Source: NCSP CTAD. Indicator Reference: PH/SH/02

Stop Smoking Services	RED

Trend Data – quarter end	Full 2012/13	2013/14
Q1	Q2	Q3	Q4	Full 2013/14
Number of quit dates set	16,758	3,055	2,947	2,882	2,885	11,769
Target number of quits	9,249	2,007	2,007	1,849	3,386	9,249
Number of quits	8,412	1,536	1,454	1,488	1,653	6,131
Proportion of target quitting	90.9%	76.5%	72.4%	80.5%	48.8%	66.3%
RAG Rating	Amber	Red	Red	Red	Red	Red

Commentary
Kent Public Health has continued to monitor the poor performance of smoking cessation services in relation to the target number of quits; the provider is attending performance meetings where an action plan and proposed trajectory is monitored. Kent Public Health is currently modelling smoking cessation service targets for 2014/15, with an emphasis at CCG level. Please note the figure for Q1, Q2 and Q3 2013/14 have been amended following an updated Department of Health submission.
Data Notes: Data Source: Department of Health Data return by KCHT. Indicator reference: PH/AH/02

Health Trainers – proportion of new clients	GREEN

Trend Data – quarter end	2012/13	2013/14
Q1	Q2	Q3	Q4	Q1	Q2	Q3	Q4
Number of new Clients	402	486	513	883	482	684	593	679
Target number of new clients	574	572	540	541	625	625	625	625
% of target	70%	85%	95%	163%	77%	109%	95%	109%
RAG Rating	Red	Amber	Amber	Green	Red	Green	Amber	Green

Commentary
The health trainer service is continuing to develop reporting mechanisms with Kent Public Health in order to become more output and outcome focussed. New performance indicators are currently being developed for 2014/15.
Data Notes: Source KCHT. Indicator Reference PH/AH/04

Key to direction of travel arrows is at Appendix A