The Public Health Outcomes Framework (PHOF) sets out a high-level overview of public health outcomes, at national and local level, supported by a broad set of indicators. The indicators cover the full spectrum of what is understood as public health and what can be measured at the moment.
The PHOF is used as a tool for local transparency and accountability, providing a means for benchmarking progress within each local authority and across authorities, and driving 'sector-led improvement' where a local authority improves by learning from the experiences of peers. Alongside the NHS Outcomes Framework and Adult Social Care Outcomes Framework, the PHOF reflects the Department of Health's focus on improving outcomes for people and communities, setting expectations for what the system as a whole wants to achieve.
When the PHOF was first published in 2012 there was a commitment not to make any changes for three years to allow it to become established during the transfer of public health responsibilities from the NHS to local authorities. Those three years are up and we need to make sure the PHOF is still as relevant and useful as possible. To do this the Department of Health and Public Health England are consulting on the PHOF indicator set, with a view to updating from April 2016.
Why We Are Consulting
The PHOF consists of 68 public health indicators, with over 140 sub-indicators. There are two overarching indicators and 66 more focused indicators grouped into four domains:
- Improving the wider determinants of health
- Health improvement
- Health protection
- Healthcare public health and preventing premature mortality.
An interactive web tool makes the PHOF baseline data available to local authorities and interested parties. This allows local authorities to determine their own areas of strength and weakness in comparison to national averages and their peers, and shape their work plans accordingly.
There is a general consensus amongst users of the PHOF that it is a useful tool; it is fit for purpose and needs long term stability to continue to be valuable. This view is reinforced by key stakeholders who have told us that:
- the current PHOF has a good balance of public health indicators across all domains, and
- The Department of Health should prioritise ensuring continuity of data series, and undertake a small-scale review of indicators to identify any that are no longer relevant or effective.
To maintain the balance of areas covered and promote continuity, the intention is that this consultation will not result in a wholesale overhaul of the existing structure of the PHOF.
The focus is on reviewing existing indicators with the aim of removing ineffective indicators and replacing or revising others where improvements in data have taken place over the past few years. The review will also consider the possibility of adding a small number of new indicators where there are important public health gaps and information is likely to be available to fill them.
Where possible, we would like to avoid new 'placeholder' indicators and new data collections, principally for time and cost considerations. We recognise though, that there may need to be flexibility with on these points.
We also intend to operate, as far as is possible, a 'one in, one out' principle to ensure that we do not increase the reporting burden on local government.
Consequently the scope of the consultation includes consideration of:
- significant gaps in policy priorities, and proposals for a small number of indicators or sub-indicators;
- indicators that no longer reflect a public health priority, duplicate an existing assurance mechanism, or are not sufficiently robust;
- the extent to which the PHOF, the NHS Outcomes Framework and the Adult Social Care Outcomes Framework could be better aligned.
Out of scope of the consultation is:
- consideration of changing the number and the scope of the domains of the PHOF;
- adding large numbers of new indicators.
We will consider the responses to the consultation over the autumn and intend to publish our response by the end of the year. This will set out the changes to the Public Health Outcomes Framework from April 2016.
Royal College of Physicians of Edinburgh’s response to Department of Health
Refreshing the Public Health Outcomes Framework (2015)
The Royal College of Physicians of Edinburgh is pleased to respond to the Department of Health on its consultation on Refreshing the Public Health Outcomes Framework (2015). These comments were submitted online to the Department of Health.
Comment for the cancer screening indicators 2.20 and others - given the Montgomery case with regards to consent, and controversy with cancer screening information, the quality and lack of bias in the information given is of greater importance, and development of indicators to demonstrate unbiased information in the offer of screening would be beneficial if standards have been developed in this area.
Note that abdominal aortic aneurysm screening the measure is the offer as opposed to uptake.
2.03 suggest smoking at time of maternity booking as an indicator of preconception health.
3.02 Chlamydia detection rate- screening for chlamydia has not been considered by the National Screening Committee, and in Scotland the approach is informed by the SIGN guideline. The use of target levels for diagnosis in young people may therefore be questioned.