Health Inequalities“preventing early death”
Chris Lovitt
Health Inequalities Unit
14h June 2007
Overview
Life expectancy
Early death
What we can do about it
What are we doing
Conclusion
Health Inequalities PSA Target:
By 2010 to reduce inequalities in health inequalities by 10% by 2010 as measured by infant mortality and life expectancy at birth.
This target is underpinned by two more detailedobjectives:
starting with children under one year, by 2010 to reduce by at least 10 per cent the gap in mortality between routine and manual groups and the population as a whole;
Starting with Local Authorities, by 2010 to reduce by at least 10% the gap in life expectancy between the fifth of areas with the “worst health and deprivation indicators”and the population as a whole
Life Expectancy at birth- Male
Inequality Gap*, in years
70
71
72
73
74
75
76
77
78
79
80
1993/4/5 1995/6/7 1997/8/9 1999/2000/1 2001/2/3 2003/4/5 2005/6/7 2007/8/9 2009/10/11
Age in years
Target:
10%minimum reduction in relative gap, from1995-97 baseline
baseline Progress target
2.57%
Male life expectancy at birthEngland 1993-2005 and target and projection for the year ‘2010’
3 year average
2.61%
2.32%
England
SpearheadGroup
Source: ONS data, analysed by DH analysts
TargetProjection of life expectancy for EnglandProjection of life expectancy for Spearhead GroupTarget Reduction
0
Actual Data
* The relative gap between life expectancy at birth in England and in the Spearhead Group. As a proportion of life expectancy for England.
77
78
79
80
81
82
83
1993/4/5 1995/6/7 1997/8/9 1999/2000/1 2001/2/3 2003/4/5 2005/6/7 2007/8/9 2009/10/11
Age in years
Target:
10%minimum reduction in relative gap, from1995-97 baseline
1.77%
Female life expectancy at birthEngland 1993-2005 and target and projection for the year ‘2010’
3 year average
1.91%
1.59%
England
SpearheadGroup
Projection of life expectancy for EnglandProjection of life expectancy for Spearhead GroupTarget Reduction
0
Inequality Gap*, in years
baseline Progress target
TargetActual Data
* The relative gap between life expectancy at birth in England and in the Spearhead Group. As a proportion of life expectancy for England.
Source: ONS data, analysed by DH analysts
Life Expectancy at birth- Female
So did this matter locally?Results of high level review
Lack of engagement with target
Unaware of local “gap”
Little knowledge of interventions thatwould deliver by 2010
Focus of local work on wider determinants
Discounting of target
?Saving a few years at the end of life?
Is there another way of looking at the target?Is there another way of looking at the target?
a more compelling story?a more compelling story?
13,700 13,700
early deaths in early deaths in
Spearhead areasSpearhead areas
D iffe re n c e in % d is tr ib u t io n o f m o r ta li ty b e tw e e n S p e a r h e a d G ro u p a n d E n g la n d in q u in a r y a g e b a n d s , 2 0 0 3 -0 5
-6 .0 %
-5 .0 %
-4 .0 %
-3 .0 %
-2 .0 %
-1 .0 %
0 .0 %
1 .0 %
2 .0 %
< 1
01-04
05-09
10-14
15 - 19
20 - 24
25 - 29
30 - 34
35 - 39
40 - 44
45 - 49
50 - 54
55 - 59
60 - 64
65 - 69
70 - 74
75 - 79
80 - 84
85+
F e m a le d if fe re n c e
M a le d if fe re n c e
There were approximately 13,700 additional deaths for 30 to 59 year olds in Spearhead groups, across the 3 years 2003-2005, compared to the national average for England
The focus needs to be on reducing adult early deaths
Action on the overall PSA target to reduce infant mortality will also help deliver the reduction in life expectancy gap target
Too many people in Spearhead areas are dying early
Know
Your
Gap
1) Know your gap- EnglandWhat is causing the gap for males?
The Gap – for males
35% All circulatory diseases, 70% of which are Coronary Heart Disease (CHD)
18% All cancers, 61% of which are lung cancer
15% Respiratory diseases, 53% of which are chronic obstructive airways disease
10% Digestive, 50% of which are chronic liver disease and cirrhosis5% External causes of injury and poisoning, 60% of which are suicide and undetermined death2% Infectious & parasitic diseases10% Other5% Deaths under 28 days
Contribution to Life Expectancy Gap in MalesBreakdown by disease, 2003
*locally determinedUniversalist:• Smoking reduction in clinics – as at
present• Secondary prevention of CVD:75%
coverage of 35-74yrs• Primary prevention of CVD in hyptensives
under 75 yrs:20% coverage antihypertensivestatin therapy
The Interventions The Impact – for malesTargeted:• Smoking cessation clinics: double
capacity in Spearhead areas for 2 years
• Secondary prevention of CVD: additional 15% coverage of effective therapies in Spearhead areas 35-74 yrs
• Primary prevention of CVD in hypertensives under 75yrs:
40% coverage antihypertensives
statin therapy
• Primary prevention of CVD in hypertensives 75yrs +:
40% coverage antihypertensives
statin therapy
• Other*, including:Early detection of cancerRespiratory diseasesAlcohol related diseasesInfant mortality
1.0%
2.3%
1.0%
0.7%
1.2%
0.7%
2.1%
0.2%
1.4%0.2%0.2%
8.9%
Further modelling of O
ther actions will
need to contribute the remaining 2.1%
11%
The Gap – for males
35% All circulatory diseases, 70% of which are Coronary Heart Disease (CHD)
18% All cancers, 61% of which are lung cancer
15% Respiratory diseases, 53% of which are chronic obstructive airways disease
10% Digestive, 50% of which are chronic liver disease and cirrhosis5% External causes of injury and poisoning, 60% of which are suicide and undetermined death2% Infectious & parasitic diseases10% Other5% Deaths under 28 days
Contribution to Life Expectancy Gap in MalesBreakdown by disease, 2003
*locally determinedUniversalist:• Smoking reduction in clinics – as at
present• Secondary prevention of CVD:75%
coverage of 35-74yrs• Primary prevention of CVD in hyptensives
under 75 yrs:20% coverage antihypertensivestatin therapy
The Interventions The Impact – for malesTargeted:• Smoking cessation clinics: double
capacity in Spearhead areas for 2 years
• Secondary prevention of CVD: additional 15% coverage of effective therapies in Spearhead areas 35-74 yrs
• Primary prevention of CVD in hypertensives under 75yrs:
40% coverage antihypertensives
statin therapy
• Primary prevention of CVD in hypertensives 75yrs +:
40% coverage antihypertensives
statin therapy
• Other*, including:Early detection of cancerRespiratory diseasesAlcohol related diseasesInfant mortality
1.0%
2.3%
1.0%
0.7%
1.2%
0.7%
2.1%
0.2%
1.4%0.2%0.2%
8.9%
Further modelling of O
ther actions will
need to contribute the remaining 2.1%
11%
The Gap – for males
35% All circulatory diseases, 70% of which are Coronary Heart Disease (CHD)
18% All cancers, 61% of which are lung cancer
15% Respiratory diseases, 53% of which are chronic obstructive airways disease
10% Digestive, 50% of which are chronic liver disease and cirrhosis5% External causes of injury and poisoning, 60% of which are suicide and undetermined death2% Infectious & parasitic diseases10% Other5% Deaths under 28 days
Contribution to Life Expectancy Gap in MalesBreakdown by disease, 2003
*locally determinedUniversalist:• Smoking reduction in clinics – as at
present• Secondary prevention of CVD:75%
coverage of 35-74yrs• Primary prevention of CVD in hyptensives
under 75 yrs:20% coverage antihypertensivestatin therapy
The Interventions The Impact – for malesTargeted:• Smoking cessation clinics: double
capacity in Spearhead areas for 2 years
• Secondary prevention of CVD: additional 15% coverage of effective therapies in Spearhead areas 35-74 yrs
• Primary prevention of CVD in hypertensives under 75yrs:
40% coverage antihypertensives
statin therapy
• Primary prevention of CVD in hypertensives 75yrs +:
40% coverage antihypertensives
statin therapy
• Other*, including:Early detection of cancerRespiratory diseasesAlcohol related diseasesInfant mortality
1.0%
2.3%
1.0%
0.7%
1.2%
0.7%
2.1%
0.2%
1.4%0.2%0.2%
8.9%
Further modelling of O
ther actions will
need to contribute the remaining 2.1%
11%
Universalist:• Smoking reduction in clinics – as at
present• Secondary prevention of CVD:75%
coverage of 35-74yrs• Primary prevention of CVD in hyptensives
under 75 yrs:20% coverage antihypertensivestatin therapy
The Interventions The Impact – for malesTargeted:• Smoking cessation clinics: double
capacity in Spearhead areas for 2 years
• Secondary prevention of CVD: additional 15% coverage of effective therapies in Spearhead areas 35-74 yrs
• Primary prevention of CVD in hypertensives under 75yrs:
40% coverage antihypertensives
statin therapy
• Primary prevention of CVD in hypertensives 75yrs +:
40% coverage antihypertensives
statin therapy
• Other*, including:Early detection of cancerRespiratory diseasesAlcohol related diseasesInfant mortality
1.0%
2.3%
1.0%
0.7%
1.2%
0.7%
2.1%
0.2%
1.4%0.2%0.2%
8.9%
Further modelling of O
ther actions will
need to contribute the remaining 2.1%
11%
Universalist:• Smoking reduction in clinics – as at
present• Secondary prevention of CVD:75%
coverage of 35-74yrs• Primary prevention of CVD in hyptensives
under 75 yrs:20% coverage antihypertensivestatin therapy
The Interventions The Impact – for malesTargeted:• Smoking cessation clinics: double
capacity in Spearhead areas for 2 years
• Secondary prevention of CVD: additional 15% coverage of effective therapies in Spearhead areas 35-74 yrs
• Primary prevention of CVD in hypertensives under 75yrs:
40% coverage antihypertensives
statin therapy
• Primary prevention of CVD in hypertensives 75yrs +:
40% coverage antihypertensives
statin therapy
• Other*, including:Early detection of cancerRespiratory diseasesAlcohol related diseasesInfant mortality
1.0%
2.3%
1.0%
0.7%
1.2%
0.7%
2.1%
0.2%
1.4%0.2%0.2%
8.9%
Further modelling of O
ther actions will
need to contribute the remaining 2.1%
11%
8.9%
Further modelling of O
ther actions will
need to contribute the remaining 2.1%
11%
And what can you do about it?
The Gap – for males
35% All circulatory diseases, 70% of which are Coronary Heart Disease (CHD)
18% All cancers, 61% of which are lung cancer
15% Respiratory diseases, 53% of which are chronic obstructive airways disease
10% Digestive, 50% of which are chronic liver disease and cirrhosis5% External causes of injury and poisoning, 60% of which are suicide and undetermined death2% Infectious & parasitic diseases10% Other5% Deaths under 28 days
Contribution to Life Expectancy Gap in MalesBreakdown by disease, 2003
*locally determinedUniversalist:• Smoking reduction in clinics – as at
present• Secondary prevention of CVD:75%
coverage of 35-74yrs• Primary prevention of CVD in hyptensives
under 75 yrs:20% coverage antihypertensivestatin therapy
The Interventions The Impact – for malesTargeted:• Smoking cessation clinics: double
capacity in Spearhead areas for 2 years
• Secondary prevention of CVD: additional 15% coverage of effective therapies in Spearhead areas 35-74 yrs
• Primary prevention of CVD in hypertensives under 75yrs:
40% coverage antihypertensives
statin therapy
• Primary prevention of CVD in hypertensives 75yrs +:
40% coverage antihypertensives
statin therapy
• Other*, including:Early detection of cancerRespiratory diseasesAlcohol related diseasesInfant mortality
1.0%
2.3%
1.0%
0.7%
1.2%
0.7%
2.1%
0.2%
1.4%0.2%0.2%
8.9%
Further modelling of O
ther actions will
need to contribute the remaining 2.1%
11%
The Gap – for males
35% All circulatory diseases, 70% of which are Coronary Heart Disease (CHD)
18% All cancers, 61% of which are lung cancer
15% Respiratory diseases, 53% of which are chronic obstructive airways disease
10% Digestive, 50% of which are chronic liver disease and cirrhosis5% External causes of injury and poisoning, 60% of which are suicide and undetermined death2% Infectious & parasitic diseases10% Other5% Deaths under 28 days
Contribution to Life Expectancy Gap in MalesBreakdown by disease, 2003
*locally determinedUniversalist:• Smoking reduction in clinics – as at
present• Secondary prevention of CVD:75%
coverage of 35-74yrs• Primary prevention of CVD in hyptensives
under 75 yrs:20% coverage antihypertensivestatin therapy
The Interventions The Impact – for malesTargeted:• Smoking cessation clinics: double
capacity in Spearhead areas for 2 years
• Secondary prevention of CVD: additional 15% coverage of effective therapies in Spearhead areas 35-74 yrs
• Primary prevention of CVD in hypertensives under 75yrs:
40% coverage antihypertensives
statin therapy
• Primary prevention of CVD in hypertensives 75yrs +:
40% coverage antihypertensives
statin therapy
• Other*, including:Early detection of cancerRespiratory diseasesAlcohol related diseasesInfant mortality
1.0%
2.3%
1.0%
0.7%
1.2%
0.7%
2.1%
0.2%
1.4%0.2%0.2%
8.9%
Further modelling of O
ther actions will
need to contribute the remaining 2.1%
11%
The Gap – for males
35% All circulatory diseases, 70% of which are Coronary Heart Disease (CHD)
18% All cancers, 61% of which are lung cancer
15% Respiratory diseases, 53% of which are chronic obstructive airways disease
10% Digestive, 50% of which are chronic liver disease and cirrhosis5% External causes of injury and poisoning, 60% of which are suicide and undetermined death2% Infectious & parasitic diseases10% Other5% Deaths under 28 days
Contribution to Life Expectancy Gap in MalesBreakdown by disease, 2003
*locally determinedUniversalist:• Smoking reduction in clinics – as at
present• Secondary prevention of CVD:75%
coverage of 35-74yrs• Primary prevention of CVD in hyptensives
under 75 yrs:20% coverage antihypertensivestatin therapy
The Interventions The Impact – for malesTargeted:• Smoking cessation clinics: double
capacity in Spearhead areas for 2 years
• Secondary prevention of CVD: additional 15% coverage of effective therapies in Spearhead areas 35-74 yrs
• Primary prevention of CVD in hypertensives under 75yrs:
40% coverage antihypertensives
statin therapy
• Primary prevention of CVD in hypertensives 75yrs +:
40% coverage antihypertensives
statin therapy
• Other*, including:Early detection of cancerRespiratory diseasesAlcohol related diseasesInfant mortality
1.0%
2.3%
1.0%
0.7%
1.2%
0.7%
2.1%
0.2%
1.4%0.2%0.2%
8.9%
Further modelling of O
ther actions will
need to contribute the remaining 2.1%
11%
Universalist:• Smoking reduction in clinics – as at
present• Secondary prevention of CVD:75%
coverage of 35-74yrs• Primary prevention of CVD in hyptensives
under 75 yrs:20% coverage antihypertensivestatin therapy
The Interventions The Impact – for malesTargeted:• Smoking cessation clinics: double
capacity in Spearhead areas for 2 years
• Secondary prevention of CVD: additional 15% coverage of effective therapies in Spearhead areas 35-74 yrs
• Primary prevention of CVD in hypertensives under 75yrs:
40% coverage antihypertensives
statin therapy
• Primary prevention of CVD in hypertensives 75yrs +:
40% coverage antihypertensives
statin therapy
• Other*, including:Early detection of cancerRespiratory diseasesAlcohol related diseasesInfant mortality
1.0%
2.3%
1.0%
0.7%
1.2%
0.7%
2.1%
0.2%
1.4%0.2%0.2%
8.9%
Further modelling of O
ther actions will
need to contribute the remaining 2.1%
11%
Universalist:• Smoking reduction in clinics – as at
present• Secondary prevention of CVD:75%
coverage of 35-74yrs• Primary prevention of CVD in hyptensives
under 75 yrs:20% coverage antihypertensivestatin therapy
The Interventions The Impact – for malesTargeted:• Smoking cessation clinics: double
capacity in Spearhead areas for 2 years
• Secondary prevention of CVD: additional 15% coverage of effective therapies in Spearhead areas 35-74 yrs
• Primary prevention of CVD in hypertensives under 75yrs:
40% coverage antihypertensives
statin therapy
• Primary prevention of CVD in hypertensives 75yrs +:
40% coverage antihypertensives
statin therapy
• Other*, including:Early detection of cancerRespiratory diseasesAlcohol related diseasesInfant mortality
1.0%
2.3%
1.0%
0.7%
1.2%
0.7%
2.1%
0.2%
1.4%0.2%0.2%
8.9%
Further modelling of O
ther actions will
need to contribute the remaining 2.1%
11%
8.9%
Further modelling of O
ther actions will
need to contribute the remaining 2.1%
11%
And for females ?
The Gap – for females
30% All circulatory diseases, 63% of which are Coronary Heart Disease (CHD)
16% All cancers, 75% of which are lung cancer
21% Respiratory diseases, 57% of which are chronic obstructive airways disease
9% Digestive, 44% of which are chronic liver disease and cirrhosis5% External causes of injury and poisoning, 40% of which are suicide and undetermined death2% Infectious & parasitic diseases11% Other6% Deaths under 28 days
Contribution to Life Expectancy Gap in FemalesBreakdown by disease, 2003
Universalist:• Smoking reduction in clinics – as at
present• Secondary prevention of CVD:75%
coverage of 35-74yrs• Primary prevention of CVD in hyptensives
under 75 yrs:20% coverage antihypertensivestatin therapy
The Interventions The Impact – for femalesTargeted:• Smoking cessation clinics: double
capacity in Spearhead areas for 2 years
• Secondary prevention of CVD: additional 15% coverage of effective therapies in Spearhead areas 35-74 yrs
• Primary prevention of CVD in hypertensives under 75yrs:
40% coverage antihypertensives
statin therapy
• Primary prevention of CVD in hypertensives 75yrs +:
40% coverage antihypertensives
statin therapy
• Other*, including:Early detection of cancerRespiratory diseasesAlcohol related diseasesInfant mortality
*locally determined
1.0%
1.4%
0.9%
0.5%
3.2%
1.6%
5.6%
0.4%1.0%0.2%0.2%
10.4%
Further modelling of O
ther actions will
need to contribute the remaining 5.6%
16%
The Gap – for females
30% All circulatory diseases, 63% of which are Coronary Heart Disease (CHD)
16% All cancers, 75% of which are lung cancer
21% Respiratory diseases, 57% of which are chronic obstructive airways disease
9% Digestive, 44% of which are chronic liver disease and cirrhosis5% External causes of injury and poisoning, 40% of which are suicide and undetermined death2% Infectious & parasitic diseases11% Other6% Deaths under 28 days
Contribution to Life Expectancy Gap in FemalesBreakdown by disease, 2003
Universalist:• Smoking reduction in clinics – as at
present• Secondary prevention of CVD:75%
coverage of 35-74yrs• Primary prevention of CVD in hyptensives
under 75 yrs:20% coverage antihypertensivestatin therapy
The Interventions The Impact – for femalesTargeted:• Smoking cessation clinics: double
capacity in Spearhead areas for 2 years
• Secondary prevention of CVD: additional 15% coverage of effective therapies in Spearhead areas 35-74 yrs
• Primary prevention of CVD in hypertensives under 75yrs:
40% coverage antihypertensives
statin therapy
• Primary prevention of CVD in hypertensives 75yrs +:
40% coverage antihypertensives
statin therapy
• Other*, including:Early detection of cancerRespiratory diseasesAlcohol related diseasesInfant mortality
*locally determined
1.0%
1.4%
0.9%
0.5%
3.2%
1.6%
5.6%
0.4%1.0%0.2%0.2%
10.4%
Further modelling of O
ther actions will
need to contribute the remaining 5.6%
16%Universalist:• Smoking reduction in clinics – as at
present• Secondary prevention of CVD:75%
coverage of 35-74yrs• Primary prevention of CVD in hyptensives
under 75 yrs:20% coverage antihypertensivestatin therapy
The Interventions The Impact – for femalesTargeted:• Smoking cessation clinics: double
capacity in Spearhead areas for 2 years
• Secondary prevention of CVD: additional 15% coverage of effective therapies in Spearhead areas 35-74 yrs
• Primary prevention of CVD in hypertensives under 75yrs:
40% coverage antihypertensives
statin therapy
• Primary prevention of CVD in hypertensives 75yrs +:
40% coverage antihypertensives
statin therapy
• Other*, including:Early detection of cancerRespiratory diseasesAlcohol related diseasesInfant mortality
*locally determined
1.0%
1.4%
0.9%
0.5%
3.2%
1.6%
5.6%
0.4%1.0%0.2%0.2%
10.4%
Further modelling of O
ther actions will
need to contribute the remaining 5.6%
16%
10.4%
Further modelling of O
ther actions will
need to contribute the remaining 5.6%
16%
So what can we do about this?
Understand cause of local gap
Model interventions
Plan & IMPLEMENT interventions
Know your local gap: Health Inequalities Intervention Tool (1)
Local Planning: Health Inequalities Intervention Tool (2)
Local Planning: Model what to do about it (3)
Summary
• Smoking, CVD prevention & cancer key
• Health services central to delivery
• Life expectancy 2010 is about preventing early death
•Achieve Balance
2010 2010 TargetTarget
Wider SocialWider SocialDeterminantsDeterminants
HealthHealthInequalitiesInequalities
Achieving BalanceAchieving Balance
Web addresses
Health Inequalities Intervention Toolwww.lho.org.uk/HEALTH_INEQUALITIES/Health_Inequalities_Tool.aspx
Commissioning framework for health &Well being
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_072604
Programme Budgetingnww.nchod.nhs.uk/
Health Equity Auditwww.dh.gov.uk/healthineqaulities
Health Poverty Indexwww.hpi.org.uk/
National Planning and Alignment of Incentives Joint Local Planning
DH has aligned incentives for the NHS and LocalGovernment:
New line on All Age All Cause Mortality as proxy for life expectancy is now mandatory for Spearheads as part of the LAA and LDP processes
Same Local trajectories agreed in LAA and LDP, based on nationally provided indicative figures
LDP Refresh: strengthened inequalities elements of existing Blood Pressure, Cholesterol, Practice Based Registers and, in some Spearhead Areas, smoking cessation
Local Planning: Know your SpendingProgramme Budgeting – CVD Correlation
CVD Mortality
CVD Spend
Local Planning: Health Equity Audit
Review progress & assess impact
• Ensure effective monitoring systems are in place using indicators etc
Use data onHealth Inequalities
to support decisions at all levels:make appropriate comparisons by area,ethnicity, socio-economic group, gender,
age etc
Secure changes in investment
& service delivery
• Ensure changes in contracts & commissioning are reaching
areas & groups with highest need
• assess impact on inequalities
• Develop service delivery to match need
• Move resources to match need
5
6Agree partners and issues
• Relate issues to service planning & commissioning, take opportunities where changes are planned
• Identify factors driving low life expectancy• Take on views of front line staff and users
• Scope for joining up services with local government
1 • Choose issue(s) with highest impact eg cancer, CHD, primary care, over 50s, infant health
Agree priorities for actionIdentify highest impact interventions for effective local action, for example:• Diet & physical activity• Promoting healthy life styles
in over 50’s• Ensure choice,
responsiveness & equity forall
4
• Smoking prevalence • Screening• ‘flu vaccinations• accidents• Statins & antihypertensives
• Review progress
Agree high impact local action to narrow the gap
• Quality & quantity of primarycare in disadvantaged areas
• Commission new services, change oramend existing contracts• Develop LIFT projects where
health need is highest• holistic services through
partnerships
3
• Address inequalities through NSF implementation
•Use data to compare service provision with need, access, use & outcome • measures including proxies for
disadvantage, social class, ward in the bottom
quintile,BME, gender or other population group
• Focus on the third of population with
poorest health outcomes
2Equity profile: identify the gap
• Identify local areas or groups wheremore action is required
• Assess the impact of action, has change been made and is it fast enough?
Commissioning Framework for Health & Well Being
Launched March 2007; three month consultationKey development in system reform agendaFocus on promoting health and well-being, including prevention of ill-healthStronger focus on commissioning for outcomesto reduce inequalitiesEmphasises importance of strong partnershipsRecognises potential role of third sector
Duty of strategic needs assessment
Joint Strategic Needs Assessment
Key building block of the commissioning processWill be a duty of the local authority and the PCT (DPH, DASS, DCS)
LAA and local targets based on the SNAMust be focussed on outcomesMust be focussed on the future
3-5 years: improvements in outcomes/reductions in health inequalities5-15 years: for major infrastructure planning(transport, housing, healthcare facilities)1 year: contractual changes at frontline / PBC level
National Planning and Alignment of Incentives Joint Local Planning
DH has aligned incentives for the NHS and LocalGovernment:
New line on All Age All Cause Mortality as proxy for life expectancy is now mandatory for Spearheads as part of the LAA and LDP processes
Same Local trajectories agreed in LAA and LDP, based on nationally provided indicative figures
LDP Refresh: strengthened inequalities elements of existing Blood Pressure, Cholesterol, Practice Based Registers and, in some Spearhead Areas, smoking cessation