Manchester Joint Strategic Needs Assessment - 2008 -2013 Supplement 2009/10
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Manchester Joint Strategic Needs Assessment 2008 –2013 Supplement 2009/10
Supplement • Manchester Joint Strategic Needs Assessment
Foreword
The Manchester Joint Strategic Needs Assessment 2008–2013
was published in November 2008. To date, the Manchester
Joint Strategic Needs Assessment (JSNA) has been used to
support the development of the Local Area Agreement (LAA)
and a number of key commissioning strategies across the city,
including the NHS Manchester Commissioning Strategic Plan
(CSP) and the Adult Social Care Prevention Strategy. The JSNA
has fed into the city-wide Children and Young People’s Plan
(CYPP) and it has also been used to inform the latest State
of the City, State of the Wards and State of Communities of
Interest reports.
The process of constructing the JSNA has further strengthened
joint working and provided a useful baseline of data. This will
be further enhanced by the new emphasis on locality analysis
as well as by combining current data with projected trends. A
key element of the JSNA was a series of recommendations for
future action and this supplement provides a progress report
on locality JSNAs, the use of population impact measures and
evaluation. The supplement reflects the fact that the JSNA is
very much an ongoing process to inform the development
of joint commissioning across the NHS and Manchester City
Council, including practice-based commissioning (PBC) and
district level commissioning of services for children and adults.
I do hope that you find the supplement useful and I would like
to acknowledge the excellent work of the JSNA Steering Group,
chaired by the Head of Health Intelligence at NHS Manchester,
in putting this document together.
Signature is low res
Acting Director of Public Health
NHS Manchester and Manchester City Council
3Manchester Joint Strategic Needs Assessment • Supplement Supplement • Manchester Joint Strategic Needs Assessment
Chapter 1: Chapter 2:
Introduction Locality joint strategic
needs assessments
The Local Government and Community Involvement in ●● Developing a detailed evaluation framework to assess the Background knowledge is rarely shared at a strategic level or across
Health Act 2008 placed a statutory duty on Directors of degree to which priorities and actions identified in the disciplines. Furthermore, commissioners working at locality
JSNA are reaching the intended audience and whether One of the next steps highlighted in the Manchester JSNA
Public Health, Directors of Adult Social Care and Directors level rarely have the time or resources to develop as systematic
the process of developing the JSNA has enhanced and was the production of locality JSNAs. This was included in
of Children’s Services to produce a Joint Strategic Needs a picture of local needs as they would like. The workshops also
supported joint working. recognition of the fact that commissioning activities are
Assessment (JSNA) for their local area. The JSNA is intended highlighted the importance of ensuring that the processes,
increasingly being carried out at locality level and, for the
to be ‘the means by which Primary Care Trusts (PCTs) and and the resulting outputs, are owned by individual localities.
This supplement provides an update on the progress that has JSNA to be most useful, it is vital that further analysis and
local authorities will describe the future health, care and It was felt that working with, rather than on behalf of, local
been made against these actions. In particular, it describes interpretation of the data are also performed at locality level.
wellbeing needs of the local population and the strategic commissioners would give local areas a greater stake in the
some of the work that is being undertaken to develop a
direction of service delivery to meet these needs.’ It is Work to develop locality JSNAs is now well underway. The aim outputs of the work and increase the likelihood of the JSNAs
series of locality JSNAs for the city. It also contains a detailed
expected to influence the commissioning process across of this work is to support NHS Manchester, Adult Social Care, becoming a central part of the commissioning cycle.
summary of the results of a piece of work that has been
both health and social care, underpin the development Children’s Services and other commissioning agencies in the
commissioned to calculate a series of population impact With this in mind, three multi-agency locality JSNA working
of the local area agreement (LAA) and support the new city by:
measures (PIMs) for a number of the specific recommendations groups have been established (in north, central and south
comprehensive area assessment (CAA) process.
contained in the JSNA. Finally, this document looks at the ●● Providing analysis and interpretation of the available data Manchester). Although the actual membership of each group
The Manchester JSNA 2008–2013 was published in November progress that is being made in terms of evaluating the JSNA and research evidence at locality level in order to support varies slightly, as a core the groups include:
2008. The document was produced by a multi-agency process to date and its impacts. commissioning activities at local/district level, which in turn ●● Lead Commissioners and Policy Officers from Adult Social
working group, chaired by the Director of the Joint Health feed in to the city-wide priorities.
Care (x2)
Unit, comprising representatives from a number of different ●● Supporting the move towards a common approach to
organisations and professional backgrounds, under the overall
●● Children’s Services District Partnership Co-ordinators (x2)
needs assessment among Children’s Services Districts
sponsorship of the Manchester Public Service Board (PSB). At and other partners to inform District Children and Young
●● PBC hub commissioning leads and Service Improvement
the same time, a public summary of the full document was People’s Plans over the next year and ensure consistency Managers
published as part of the process of engaging local residents between these plans and other local strategies. ●● Public Health leads for each locality
and service users with the on-going development of the JSNA. NHS Engagement Managers.
●● Joining up community engagement work across the three ●●
The first version of the JSNA focused on providing a baseline main partners in order to better understand the needs and Each group has agreed a common set of Terms of Reference
assessment of need across the city as a whole. It described perspectives of local residents, patients and service users. but has adopted slightly different ways of working. The Joint
the local commissioning context, including existing service Providing a greater opportunity to focus on internal
●●
Health Unit provides overarching project management support
provision, and went on to outline the current health and social inequalities by benchmarking within the city and against and liaison between the groups.
care needs of the population, the drivers for change, and their city averages.
likely impact.
The concept of developing locality JSNAs has been identified Outputs
A number of recommendations for future action were as good practice through the city’s involvement in the National
highlighted at the end of the first JSNA (see pages 122–123). To date, the work of the groups has been focused on bringing
JSNA Dataset Project, sponsored by the Department of Health, together available local data and identifying gaps in their
These include: the Information Centre for Health and Social Care, and the knowledge base, as well as establishing a list of existing
●● Producing a series of locality JSNAs that reflect Improvement and Development Agency (IDeA). strategic priorities and local needs assessments.
local commissioning priorities and tie in with local
commissioning structures. Methodology Locality JSNA core dataset
●● Carrying out additional new analysis in response to the
The methodology adopted for the project emerged from a In order to support the work of the locality JSNA working
views of local commissioners and residents, including
series of locality JSNA workshops held in December 2008 groups , a core dataset has been compiled. This contains more
the development of a shared programme of work around
and February 2009. These highlighted the fact that, although than 70 separate indicators grouped within 11 topic areas.
predictive modelling.
individual commissioners often have a good understanding The data has been drawn mainly from existing national and
of the needs of their specific client group or locality, this local datasets and information products (eg. Paycheck) that are
4 5Manchester Joint Strategic Needs Assessment • Supplement Supplement • Manchester Joint Strategic Needs Assessment
Chapter 3:
Population impact measures (PIMs) for
aspects of the Manchester JSNA
accessible to individual partners. In most cases, the content Background Methods
of the dataset is consistent with the information contained
The first Manchester JSNA focuses on five main areas: There are two main population impact measures:
within the Manchester Partnership’s State of the Wards Report,
●● population change
but it has been supplemented with data supplied by partner 1. Population impact of eliminating a risk factor (PINERT) –
agencies, where relevant. ●● socioeconomic and environmental factors this is used to assess the impact of changes in population
The information in the core dataset has been presented at
●● the health of children and young people level of risk factors.(4)
electoral ward level and has been cross-referenced to provide ●● lifestyle factors, risk-taking behaviour and infectious diseases 2. Number of events prevented in your population (NEPP)
a match between each ward and the Adult Social Care and ●● long-term conditions, chronic disease and disability. – this is used to assess the impact of interventions in a
Children’s Services districts, the practice-based commissioning population who already have a health condition.(5)
For each of these areas the document describes the situation
hubs and the Strategic Regeneration Framework (SRF) areas.
in Manchester using local data and identifies initiatives that The detailed formulae for calculating these measures are
The core dataset also contains an in-built charting functionality.
should lead to an improvement in the health of the population. provided in Appendix 1 at the end of this report.
These initiatives are described in the section entitled: ‘What do
Strategic prioritisation matrices commissioners need to consider?’ for each separate priority Results
In recognition of the fact that individual partners have within the five broad areas.(1)
The final project report describes the population impact of
already been through a process of identifying their strategic Although the document identifies several initiatives for each interventions for six conditions highlighted in the JSNA or
priorities for the immediate future, a strategic prioritisation priority, it does not attempt to provide a quantitative assessment identified as of interest by the Steering Group. These are:
matrix has been developed to collate and synthesise these of the proven effectiveness of the initiative or of the impact the
priorities across each of the three localities adopted as part ●● treatment of CHD (JSNA pp 103–106)
initiative might have on the health of the population. In order to
of the locality JSNA process. The matrix will help partners do this, the Manchester Joint Health Unit (JHU) commissioned ●● prevention of CHD (JSNA pp 103–106)
to assess the extent to which their strategic priorities the Manchester Urban Collaboration on Health (MUCH) at the ●● treatment of COPD, (JSNA pp 99–102)
overlap or conflict with those of other organisations in University of Manchester to calculate a range of population impact ●● prevention of COPD, (JSNA pp 99–102)
the localities. It will also help to identify areas where measures in order to estimate the impact of implementing some
working in partnership could strengthen and reinforce
●● drug misuse (JSNA pp 83–85 )
of the recommendations highlighted within the JSNA.
work that is already going on at individual agency level. ●● alcohol misuse (JSNA pp 74–77).
Analysis of information in the locality JSNA core dataset will be Aims These results are summarised in Table 1. Table 2 describes why
used to ‘sense check’ each partner’s choice of priorities and to population impact measures were unable to be calculated for
This piece of work seeks to trial the use of population impact
identify areas for joint action not already highlighted through some aspects of the JSNA that were identified for inclusion in
measures (PIMs) in order to assess the potential impact of
the strategic prioritisation matrix for a particular locality. this project.
interventions recommended in the Manchester JSNA. A similar
It is estimated that the work to develop an initial set of locality approach has been used to assess the potential impact of
JSNAs will be completed by June 2010. This will be followed by the National Service Framework for coronary heart disease in Treatment and prevention of CHD
a refresh of the Manchester JSNA. England and Wales.(2; 3) Individuals with pre-existing CHD are at greatest risk of having a
More information about the locality JSNA work is available More specifically, the aim of this piece of work is to answer heart attack and dying as a result. Therefore, we wished to calculate
online at: www.manchester.gov.uk/info/10020/policies_ two particular questions: the population impact of improved secondary prevention of
and_plans/3954/joint_strategic_needs_assessment/3 CHD by more effective management of these individuals.
1. What would be the impact on population health in
Manchester due to changes in levels of risk factors outlined Statins are proven to reduce the risk of CHD in high risk
as priorities in the JSNA? patients. Among people in Manchester discharged from
hospital with CHD, increased prescribing of statins from the
2. What would be the impact on population health in
current rate of 96% to a target rate of 98% would prevent four
Manchester due to the increased uptake of interventions
CHD events and five deaths from any cause within five years.
suggested in the JSNA?
6 7Manchester Joint Strategic Needs Assessment • Supplement Supplement • Manchester Joint Strategic Needs Assessment
The systematic identification, monitoring and medical People with COPD who smoke are at greatly increased risk in the JSNA, for which the evidence is less clear-cut , have been Conclusions
management of patients with CHD reduces the risk of further of complications and death. If all 1,001 COPD patients in included in the analysis.
Simply applying all the recommendations in the JSNA
deterioration in health, or death. GP practices keep registers Manchester who smoke were referred to smoking cessation
One of the main pitfalls of calculating aggregate would be impractical and in some instances may result in
of patients with CHD and use these to systematically identify clinics and offered nicotine replacement therapy (NRT),
measures is the lack of data on the effect of interventions. the implementation of interventions which have not been
patients requiring assessment and treatment. Everyone with 27 patients would have given up smoking after one year
The lack of appropriate data on this topic can make it proven to be effective. This analysis has attempted to assess
CHD should be recorded on such a register. However, for and 17 would have given up smoking after five years.
impossible to measure the potential impact of some of the the relative impact of several aspects of the JSNA. It has
a variety of reasons, this does not always happen. Patients
In addition, smoking is also a direct cause of COPD. If all recommendations at local level. In general, it is harder to shown that there is much variability in the impact of these
who are not on the register will not receive assessment and
smokers in Manchester who wanted to quit smoking used obtain data for PINERTs (prevention) than for NEPPs (treatment) recommendations, and that in many cases the demonstrable
are unlikely to receive adequate treatment. Improving the
NRT, nine cases of COPD would be prevented. because the data required for PINERTs are often derived from impact may in fact be negligible. Some interventions have
percentage of CHD patients who are on a disease register from
cohort studies while data for NEPPs are derived from clinical the potential to have a considerable impact on the health
the current rate of 77% to a target of 95% would prevent 264
Treatment for problem drug users trials. Clinical trials for interventions are much more widely of the population of Manchester. It must be remembered,
patients from getting an inadequate assessment and would
available than cohort studies for risk factors. however, that the specific analyses able to be undertaken were
prevent 310 from receiving inadequate treatment. Methadone treatment may prevent accidental death in
In general, there is more hard evidence of the effect of clinical constrained by the availability of evidence. It is recommended
The risk of developing CHD depends largely upon lifestyle, problem drug users. Increased methadone treatment among
interventions for medical conditions than for population- that the available evidence is regularly reviewed to identify
with diet being an important factor. The consumption of fruit problem drug users in Manchester who access treatment
based public health interventions. It is very difficult to find cohort studies of population-based public health and social
and vegetables is a reliable indicator of a healthy diet. If the services would prevent 17 deaths from overdose. Increased
hard evidence, in the form of relative risks, associated with care interventions which are conducted, and that the findings
percentage of people in Manchester eating fewer than three methadone treatment among problem drug users over 50
interventions in the field of social care. are used to calculate further PIMs accordingly.
portions of fruit and vegetables per day decreased by one- years old would prevent four deaths from overdose over 15
years. Increasing methadone maintenance treatment from As national programmes, including the NHS Health Check, are
third, 27 CHD events would be prevented. Regular physical
activity also reduces risk of CHD. If the percentage of people current levels to 90% would lead to an additional 935 problem Use rolled out and evaluated, it will be of benefit if data to facilitate
drug users retained in treatment within four to six months. the calculation of PIMs are included in the studies. It must
who are inactive decreased by one-third, 83 CHD events would This analysis has demonstrated that there is a wide variation in the
also be remembered that interventions are rarely delivered in
be prevented. However, owing to the length of time taken for potential impact of the interventions suggested in the Manchester
Treatment for people who abuse alcohol isolation. Patients with COPD may stop smoking and receive
CHD to develop, the impact of these interventions would take JSNA. Furthermore, it has demonstrated that the impact of some
vaccination. A comprehensive approach to the management
longer to be realised. If a single brief intervention was offered to all heavy alcohol interventions cannot be estimated and, indeed, that some of the
of risk and chronic disease will deliver benefits to patients at
users who were admitted to hospital in Manchester with a recommendations have very little empirical evidence in support of
several levels and may, therefore, have a greater total impact
Treatment and prevention of COPD non-alcohol-related condition, 166 deaths could be prevented their effectiveness. However, in some instances, it provides a useful
on population health.
over the course of one year. indication of the potential effectiveness of some interventions,
People with COPD are at greater risk of developing respiratory
especially if applied at population level.
infections and dying from them. This type of infection is more
prevalent during the winter months. Seasonal vaccination Discussion The challenge remains in the implementation of these
against influenza and pneumococcal infection is a proven interventions in order to achieve the impact required.
Methodology One example of this is the universal application of alcohol
preventative action. If current rates of influenza vaccination
among people with COPD in Manchester were increased A key problem with these measures is the difficulty of identification and brief advice for all hospital admissions.
from 80% to a target of 87% (of all people who are eligible), obtaining all the relevant inputs for the local population or While this may seem like a straightforward aim, the logistics of
three deaths and 41 hospital admissions would be prevented. target group (eg. people with CHD, problem drug users, etc). training staff across all specialities and different clinical settings
If current rates of pneumococcal vaccine were increased Literature-based sources, such as the Cochrane Library, can be is complex, although this does not mean that some benefit
from 20% to a target rate of 100%, 13 deaths and 31 hospital used to find some of the information required but it can be may be gained via gradual implementation in priority areas.
admissions would be prevented over a period of six months. more difficult to obtain accurate local data on the prevalence/ Caution may be reflected in rigorous evaluation and audit with
If current rates of influenza vaccination among people aged incidence of risk factors and current uptake of interventions. sample groups to justify investment.
over 65 in Manchester increased from 74% to 90%, six hospital For this reason, the analysis has been limited to higher profile
For details of the methodology used in this analysis and for
admissions for COPD would be prevented. conditions and hard outcomes for which information is easier
further website links, see Appendix 2.
to obtain. However, some of the recommendations suggested
8 9Manchester Joint Strategic Needs Assessment • Supplement Supplement • Manchester Joint Strategic Needs Assessment
Table 1: Summary of the population impact of aspects of the recommendations in the Manchester JSNA Table 2: Reasons why it was not possible to calculate population impact
measures for certain aspects of the Manchester JSNA
Disease Intervention PIM Status Outcome Timescale
Disease Intervention Reason
Treatment Increase statin prescribing(2;6;8;9) NEPP Completed 4 CHD events and 5 deaths prevented 1–5 years
of CHD CHD prevention Statin prescribing for No studies available that have looked at long-term outcomes in terms of CHD events.
Improve accuracy of disease register(6;10;11) NEPP Completed 264 inadequate assessments and 310 no relevant
young children with
inadequate treatments prevented time scale One RCT followed children for five years and measured the effect of statins on carotid intima-
hypercholesterol
media thickness(27). A proposed study has yet to recruit children for a cohort study to examine
Prevention Reduce proportion eating a poor diet by PINERT Completed 27 CHD events prevented 6–10 years
the prevalence of such risk factors for CHD in school children(28).
of CHD one-third(1;3;8)
CVD prevention Set up disease registers No published studies that looked specifically at the impact of CVD registers on CVD or mortality
Reduce proportion physically PINERT Completed 83 CHD events prevented Unknown
outcomes. There were a couple of papers(29;30) available but neither recorded any hard outcomes
inactive by one-third(1;3;8)
that could be used in the calculation of PIMs.
Statin prescription for young children with NEPP Not possible –
People with COPD Increasing use of The only Cochrane review on pulmonary rehabilitation for patients with COPD used QoL
hypercholesterolemia (see Table 2)
pulmonary rehabilitation measures as the outcome and reported mean differences rather than RRs(31).
Prevention Set up disease registers* PINERT Not possible –
COPD prevention Increased public health No published studies that have quantified the effect of increased public health messages and
of CVD
messages about the hard outcomes such as COPD admissions.
Treatment Increase uptake of influenza vaccination(6;12) NEPP Completed 41 hospital admissions and 3 deaths ~6 months links between COPD and
of COPD prevented smoking
Increase uptake of pnuemococcal NEPP Completed 31 hospital admissions and 13 deaths ~6 months Drug misuse Investment in family No published studies that have measured outcomes.
vaccination(6;12;13) prevented interventions for children The only study found was a pilot study which described the experiences of families in a family
at risk centre for drug users(32).
Increased use of pulmonary rehabilitation NEPP Not possible –
(see Table 2) Carers Providing respite A Cochrane review of available studies reported outcomes in terms of mean differences in
for carers scores rather than RRs or RRRs for hard outcomes as required by PIMs(33).
Smoking cessation* (6;14;15) NEPP Completed 27 patients would be non-smokers 1 year
after 1 year and 17 would be non- 5 years
smokers after 5 years
Prevention Smoking cessation services(7;16–19) PINERT Completed 9 COPD cases prevented not reported
of COPD
Influenza vaccination for healthy people over 65* PINERT Completed 6 hospital admissions prevented not reported
(6;20;21)
Increased public health messages about the links PINERT Not possible –
between COPD and smoking (see Table 2)
Drug Increased methadone maintenance treatment(6;22;23) NEPP Completed 935 PDUs retained in treatment 4–6 months
misuse
Increased methadone treatment* (6;22) NEPP Completed 17 deaths by overdose prevented 15 years
Drug intervention programmes NEPP Completed 4 deaths by overdose prevented 15 years
for the over-50s (6;22;24)
Investment in family interventions for Not possible –
children at risk
Alcohol Improving access to brief intervention (1;25;26) NEPP Completed 166 deaths prevented 1 year
misuse
Carers Providing respite for carers NEPP Not possible –
* Not specifically recommended in JSNA
10 11Manchester Joint Strategic Needs Assessment • Supplement Supplement • Manchester Joint Strategic Needs Assessment
Chapter 4: Chapter 5:
Evaluation Other developments
The first JSNA contained a commitment to develop a detailed Evaluation framework The JSNA is now web-enabled, which means that links
evaluation framework to assess the degree to which the and access to other key documents (eg. Strategic Threat
The SWOT analysis has provided a useful stakeholder reflection
priorities and actions identified in the JSNA are reaching the Assessment, State of City, etc) can be made easier and
on the process and outcomes so far. The next stage of the
intended audience, and whether the process of developing discussions are now underway to look at the possibilities of
evaluation will be to gather more detailed feedback from
the JSNA has enhanced and supported joint working. establishing an e-Atlas that will make it easier to access some
a wider range of stakeholders, reflecting on the processes
of the information contained in the locality JSNA core database.
around the JSNA as well as the accessibility, usefulness and
SWOT analysis impact of the JSNA, and in particular whether: The Government is bringing forward new legislation (the Local
A SWOT (strengths, weaknesses, opportunities and threats) analysis Democracy, Economic Development and Construction Bill)
●● The needs analysis has been appropriate and sufficiently that would place a duty on all county councils and unitary
has been undertaken by members of the JSNA Working Group. comprehensive.
The matrix below contains a summary of the main issues raised. authorities to assess the economic conditions of their area
●● There are any gaps or areas of concern that need further via a local economic assessment (LEA). There is a strong
analysis. common purpose to both LEAs and JSNAs in that they are
Strengths Weaknesses
A more detailed outcome evaluation is planned for a later designed to provide a robust evidence base to inform the
‘Further strengthened existing ‘Community engagement –
partnership arrangements’ challenges of getting best bits date. This will enable commissioners to assess the degree community strategy and LAA etc. As well as sharing a common
‘Represents a collaborative and from Children’s Services, ASC and
to which priorities and actions identified in the JSNA are knowledge base, there may be some process-type learning
joined-up approach to needs NHS Manchester and emerging
reaching the intended audience and the degree to which in terms of how best to develop different types of local
assessment between sectors‘ LINk and getting it all to gel strategic assessments and link these in to policy and strategy
together’ these interventions:
‘Strong support and ownership by development. There are also clear links between economic
key players’ ‘Not sure all commissioning staff Demonstrate evidence of impact and improvement.
are aware of/using the information
●●
development and poor health outcomes (and vice versa) and
‘Provides a very sound basis for Adequately reflect the needs of all groups and are delivering tying together the LEA and the JSNA might help address this.
– especially in PBC’ ●●
raising challenging questions
about the future commissioning ‘Available data may not fully meet on the stated aim of the JSNA to identify groups where Furthermore, the health intelligence manager based at
of services’ the needs and expectations of needs are not being met and that are experiencing poor the Joint Health Unit is actively engaged in work on the
commissioners’ outcomes. development of a Greater Manchester JSNA to complement
‘Evaluation of impact on ●● Provide value for money. the Greater Manchester Strategy recently endorsed by the
commissioning – discussed, but as
yet not fully developed’ AGMA Executive Board on 31 July 2009.
Opportunities Threats
‘Links to other needs assessment ‘Lack of consistency of
work under umbrella of PSB (eg. commissioning streams
Crime and Disorder) and LAA eg. PBC x 3; Children’s services;
(review and refresh)’ NHS/MCC shared commissioning
‘Development of Joint not fully developed’
Commissioning Approach – ‘Ensuring that the JSNA is not
Manchester Model and better seen as the answer to everything
access to and utilisation of – rather a crucial part of the
expertise in universities (eg. intelligence required by a range of
predictive modeling)’ services to better understand what
‘To embed intelligent, needs-led provision is required in the future’
commissioning processes across ‘Capacity of PBC and district level
health and social care’ partners (children’s and adults) to
‘Locality JSNAs offer real and take on locality JSNA development’
worthwhile opportunities to
develop the thrust of the JSNA
process and principles’
12 13Manchester Joint Strategic Needs Assessment • Supplement Supplement • Manchester Joint Strategic Needs Assessment
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14 15Manchester Joint Strategic Needs Assessment • Supplement Supplement • Manchester Joint Strategic Needs Assessment
Acknowledgements Appendix 1
Formulae for calculating
NEPP and PINERT
We would like to acknowledge the efforts of the following Each of these population impact measures requires several Calculation of the PINERT is as follows:
individuals in guiding the Population Impact Measures data inputs:
project and helping to produce the material in this report. Pexp (RR – 1)
a. Population size – the size and nature of the population (or PIN – ER – t = n* Ip*
1 + Pexp (RR – 1)
sub-population) to which the intervention is to be applied.
b. Outcome – the outcome that is desired from the
Dr Islay Gemmell where
intervention (eg. reduction in deaths , hospital admission,
Research Fellow
quality of life, cost-effectiveness, etc). n = population size
Faculty of Medical and Human Sciences
University of Manchester c. Baseline risk – the likelihood of this outcome occurring in Pexp = the prevalence of the exposure in the population
the population.
Ip = the incidence of the outcome in the population
Dr Arpana Verma d. Prevalence – the prevalence of the risk factor of interest in
the population. RR = the relative risk of the outcome if the risk factor is present.
Senior Lecturer
Manchester Urban Collaboration on Health e. Benefit – the difference between the rate at which the
Clinical Epidemiology and Public Health Unit intervention is currently used and the rate at which it was
University of Manchester intended (or anticipated) to be used.
f. Relative risk/risk reduction – the degree of risk from the
Sue Longden presence of the factor of interest (or the benefit from the
Consultant in Public Health intervention being introduced) on the intended outcome.
NHS Manchester
Calculation of the NEPP is as follows:
Neil Bendel NEPP = n* Pd* Pe* ru* RRR
Head of Health Intelligence
where
NHS Manchester/Manchester Joint Health Unit
n = population size
Andrew Chase Pd = the prevalence of disease in the population
Policy and Performance Research Officer
Adult Social Care Pe = the proportion eligible for the intervention
Manchester City Council ru = risk in the untreated population (baseline risk)
RRR = the relative risk reduction associated with the treatment.
Julie Jerram
Programme Manager (Projects and Resources)
Manchester Joint Health Unit
Manchester City Council
Gemma Wright
Specialist Project Assistant
Manchester Joint Health Unit
Manchester City Council
16 17Manchester Joint Strategic Needs Assessment • Supplement
Appendix 2
Methodology and website links
In this analysis, two population impact measures have been this can be obtained from a reference document, such as the
used: PINERT and NEPP. The PINERT is used for estimating the Compendium of Statistics for Manchester (A picture of progress
impact of an intervention implemented at the population 2009)(6) or the JSNA itself.(7) Where this data was not available
level on the prevention of a disease while the NEPP is from these sources, national data can be obtained from
used to estimate the impact of preventing further disease websites such as www.heartstats.org/(8) and the Public Health
or deaths among people who already have a disease. Observatories. Estimates for Manchester can also be based on
data derived from published studies found through searching
There are several key websites that are useful for searching
the literature.
for evidence in healthcare treatment interventions.
The NICE website (www.nice.org.uk/), which is linked to the The calculation of PIMs in this project can be done using
NHS evidence website (www.evidence.nhs.uk/), provides an Excel spreadsheet or via an online calculator that is
a comprehensive database of clinical and non-clinical available at www.phsim.man.ac.uk/ Using an Excel
evidence and best practice. It provides access to a range of spreadsheet allows greater flexibility in terms of the way
information, including primary research literature, practical that the data is entered, but in most cases the required
implementation tools, guidelines and policy documents. data is equally suitable for use in the online calculator.
The Centre for Reviews and Dissemination in York website
is a database of all systematic reviews and includes
Cochrane reviews, health technology assessments and
health economic evaluations (www.crd.york.ac.uk/
crdweb/). For some interventions, the library of guidelines
(www.library.nhs.uk/guidelinesfinder/) can be useful
for finding evidence on guidelines in healthcare.
The information in these databases tends to be presented in
summary form, and in order to obtain a numerical estimate
of the actual effectiveness of an intervention the full review
for that particular intervention has to be downloaded
and studied in detail. When searching for the evidence of
effectiveness of an intervention or the evidence of harm of a
risk factor, it is important to be able to quantify how effective
or harmful it is in terms of relative risks and relative risk
reductions. This is not always easy to find out. Furthermore
the NEPP and the PINERT use relative risks (RR) and relative
risk reductions (RRR) as the measures of effectiveness and
therefore the outcome must be a dichotomous (ie. yes/no)
event (eg. death, hospital admission etc). This is not always
the case, particularly in public health and social care.
As well as numerical evidence of the effectiveness of an
intervention, the calculation of PIMs also requires information
on current uptake rates in order to assess the impact of
an increase in the use of the particular intervention or a
decrease in the prevalence of the risk factor. In some cases,
18Manchester Joint Strategic Needs Assessment • Supplement 20 66753 – Manchester City Council 2010
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