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

Andrew Scott-Clark, Interim Director of Public Health

To:	Adult Social Care and Health Cabinet Committee

4th December 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.

Performance of the NHS Health Checks has improved substantially in recent months with the targets being met in Quarter 1 and Quarter 2. Community Sexual Health Services continue to provide the required levels of access and Health Trainers continue to engage the expected number of new clients.

A broader range of indicators has been included in this report to highlight some of the important wider trends in public health in Kent. Future reports will include performance indicators relating to the commissioned Substance Misuse Services.

Recommendation: The Adult Social Care and Health Cabinet Committee are 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 is a wide range of indicators for Public Health, including some from 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.

1.3	Following the transition of the Kent Drug and Alcohol Action Team (KDAAT) to the Public Health Department, future reports to the Cabinet Committee will include a number of indicators focusing on the key activity and outcomes of the commissioned substance misuse services across Kent.

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. The RAG status relates to the target. A more detailed analysis of the performance where the RAG status is Red is included at Appendix 1.

Indicator Description	Q4 12/13	Q1 13/14	Q2 13/14	Q3 13/14	Q4 13/14	Q1 14/15	Q2 14/15	Direction of Travel
Prescribed and non-prescribed Data Returns
Percentage of annual target population completing a health check	10.5% (R)	7.3% (R)	9.9% (R)	7.8% (R)	12.0% (A)	11.3% (G)	15.0% (G)
Clients accessing community sexual health services offered an appointment within 48 hours	98.5% (G)	97.8%(G)	96.6% (G)	97.4%(G)	99.9% (G)	100% (G)	100% (G)
Chlamydia positivity rate per 100,000	1,517 (R)	1,376 (R)	1,735 (R)	1,625 (R)	1,949 (R)	1,514 (R)	Not Available
Proportion of smokers successfully quitting, having set a quit date	47% (A)	50% (A)	50% (A)	51% (A)	57% (G)	51% (A)	Not Available
Local Indicator
Health Trainers – Proportion of new clients against target	163% (G)	77% (R)	109% (G)	95% (A)	109% (G)	125% (G)	Not Available

2.2	The provider of NHS Health Checks in Kent has exceeded the quarterly targets for the number of invitations and the number of completed checks in the first half of the year. For Q1 and Q2, a total of 81,020 invitations were sent, this covered 91% of the eligible population for the year. Over this period, 23,438 health checks were given, which exceeds the 6 month target of 20,150. In total, 26.4% of the estimated annual eligible population for 2014/15 has received an NHS Health check.

2.3	In September this year, the committee endorsed the proposal to extend the existing contracts for NHS Health Checks for 9 months. This will allow more time for the improved performance to continue but will also provide an opportunity to evaluate the impact of pilot projects which have been commissioned to further increase uptake of health checks in designated areas. Public Health has been working this year to provide active feedback to Clinical Commissioning Groups (CCGs) on local results of the programme.

2.4	GUM (Genito-urinary Medicine) clinics in Kent consistently offer the majority of clients an appointment within 48 hours, performing above the target of 95%. GUM service is open access and available to all ages. This indicator is being monitored in quarterly performance monitoring meetings with the commissioned providers. Integrated sexual health services, including GUM, contraceptive services and HIV outpatient services are currently out for tender. The new services are due to start operating from April 2015 and access targets will be included in the new contracts.

2.5	The Chlamydia positivity rate remains below the national target level of 2,300 per 100,000 of 15-24 year old population. The provider has implemented an action plan to tackle the shortfall. The campaign includes radio messaging, promotional materials and the establishment of improved and focused internal performance measures and targeting of at risk groups/communities.

2.6	Figures for Q1 2014/15 on chlamydia positivity indicate a rate of 1,514 per 100,000. Although remaining below target this quarter is higher than Q1 2013/14 on the number of tests given, positives found and the positivity percentage and rate.

2.7	Smoking quit rates fell slightly below the target in Q1; 51% of those setting a quit	date reported that they were still not smoking after 4 weeks, compared to a target of	52%.

2.8	Smoking rates among adults in Kent have declined in recent years as have the	number of people that access the Stop Smoking Services that are commissioned by	Public Health. However, smoking remains one of the most significant causes of	premature death in the county, particularly in the most deprived areas. Public Health	is currently reviewing the current Stop Smoking Services with a view to
commissioning a reshaped service which is well targeted and can respond effectively
to a rapidly changing environment that includes increasing use of electronic
cigarettes.

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 report and monitor outcomes.

3	Annual Public Health Outcomes Framework (PHOF) Indicators

3.1	The table below presents the most recent nationally-verified and published data; all indicators now include data up to 2013. The RAG is in relation to National figures.

Annual PHOF Indicators	2006- 08	2007- 09	2008- 10	2009- 11	2010- 12	2011- 13	DoT
Under 75 mortality rates for:
Cardiovascular diseases considered preventable per 100,000	61.2 (G)	59.8 (G)	57.4 (G)	55.9 (A)	52.3 (A)	49.3 (A)
Cancer considered preventable per 100,000	85.6 (G)	84.3 (G)	83.7 (G)	82.6 (G)	80.5 (G)	78.2 (G)
Liver disease considered preventable per 100,000	12.8 (G)	12.4 (G)	12.1 (G)	12.0 (G)	12.4 (G)	13.2 (G)
Respiratory disease considered preventable per 100,000	16.8 (A)	17.4 (A)	17.4 (A)	17.6 (A)	16.6 (A)	16.7 (A)
Suicide rate (all ages) per 100,000	8.4 (A)	8.4 (A)	7.7 (A)	8.4 (A)	8.1 (A)	9.2 (A)
Proportion of people presenting with HIV at a late stage of infection (%)	Not available	Not available	Not available	49.0 (A)	46.8 (A)	Not available
2008	2009	2010	2011	2012	2013
Percentage of adults classified as overweight or obese	Not available	Not available	Not available	Not available	64.6 (A)	Not available	-
Prevalence of smoking among persons aged 18 years and over (%)	Not available	Not available	21.7 (A)	20.7 (A)	20.9 (A)	19.0 (A)
Opiate drug users successfully leaving treatment and not re-presenting within 6 months (%)	Not available	Not available	14.6 (G)	14.6 (G)	10.9 (G)	10.3 (G)

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 (G)	557 (G)	565 (G)
Proportion of adult patients diagnosed with depression (%)	Not available	Not available	Not available	Not available	5.57	-

3.2	Rates of preventable premature mortality of liver disease in Kent continue to increase, however, currently, Kent continues to show a lower rate than national; increases have occurred in Canterbury, Dartford, Dover, Gravesham, Sevenoaks, Shepway, Swale and Thanet (please refer to PHOF for detail).

3.3	The latest available data show a significant reduction in smoking prevalence has reduced to 19.0% of the adult population; this reduction is similar to the national trend. All but four districts (Ashford, Dover, Gravesham and Thanet) have decreased in the proportion of adults smoking between 2012 and 2013; the highest rates are in Thanet (24.8%) and Dover (24.3%).

3.4	While the national rate of alcohol-related admissions to hospital has decreased between 2011/12 and 2012/13, Kent has increased. The highest rate within Kent was for Shepway at 715 per 100,000, although this is a decrease from 2011/12.

4.	Conclusions

4.1	The performance data for the first half of 2014/15 highlight improved performance in some critical areas, including NHS Health Checks. Public Health is working to ensure that this improved performance is maintained and that weaker performance in other areas, such as smoking cessation and chlamydia positivity, is addressed through target improvement plans.

5.	Recommendations

Recommendation: The Adult Social Care and Health Cabinet Committee is 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:

(G) GREEN	Target has been achieved or exceeded the current National Performance
AMBER	Performance at acceptable level or no difference to the National Performance
(R) 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.

Sexual Health Services : Chlamydia screening and Positivity rate	RED

Trend Data –by Quarter	Target	Q1 13/14	Q2 13/14	Q3 13/14	Q4 13/14	Q1 14/15
Screening Uptake	-	9,013	10,690	10,095	11,829	9,105
Positive tests reported	7%	636	7.1%	802	7.5%	751	7.4%	901	7.6%	700	7.7%
rate per 100,000 15-24 year olds	2,300	1,376	1,735	1,625	1,949	1,514
RAG of Positivity Rate	-	Red	Red	Red	Red	Red
England rate per 100,000 15-24 year olds	2,300	1,947	1,974	2,048	2,154	1,901

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. All local Authorities in England have a nationally-set target for positive Chlamydia tests of 2,300 per 100,000 of the 15-24 year old population. For Kent, using the diagnosis rate calculator tool, 60,752 tests are required, covering 32.9% of 15-24 year olds, with 4,253 positives to meet the target rate each year. A new contract for this service is being awarded to commence from April 2015. Chlamydia Diagnoses is PHOF Indicator 3.02
Data Notes: Higher values are better. Data Source: CTAD. Indicator Reference: PH/SH/02

Key to direction of travel arrows is at Appendix 1