Indices of Need for and Outcome of Services

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1.  Deprivation scores
Exploring health differences between population groups may require analysing information by age or by ethnicity or gender or social and economic circumstances[1].  Poverty (the term ‘deprivation’ is also used) is an important determinant of health and increasingly inequalities in health are examined through analyses based on measures of social and material deprivation rather than, for example, occupation.  A variety of indicators have been developed, which differ according to different concepts of deprivation under consideration.  The underlying concepts of deprivation are complex. Care must be taken when using the scores; the indices are indirect indicators rather than direct measures.

See: https://digital.nhs.uk/data-and-information/publications/ci-hub/compendium-indicators

Under Statistical methods see Annex 1 Measuring deprivation  Annex 1 - Measuring Deprivation [pdf, size: 357.4 kB]

  1. Jarman Score
    The Jarman score was developed as a measure of General Practice workload in the mid-eighties.  It used responses from GPs about their workload and combined this information with 8 Census variables into a single deprivation index.  It was originally designed to measure need for primary care and has sometimes been used as a proxy for deprivation.  It has been used by the Department of Health to determine additional 'deprivation' payments to GPs.  The scores were re-calculated for the 1991 census, using the same census variables as 1981.

    The variables used include:
    1.  % elderly living alone
    2.  % children under 5
    3.  % unskilled workers
    4.  % overcrowded households
    5.  % changed address in last year
    6.  % residents living in a household where the head was born in the New Commonwealth or Pakistan
    7.  % unemployed
    8.  % households containing lone parents

    A positive score equates with deprivation.  The mean for England and Wales is 0.  An area with a high score has a greater demand for primary care, based on the characteristics of the resident population, than an area with a low score.  Extreme scores are those above 32 (rounded to 30 by the Department of Health).

    Example:  
    South Gloucestershire has a Jarman score of -21.38 meaning that it has a lower demand for primary care than England and Wales mean, but Bristol UA has a score of 17.85, higher than the England and Wales mean.

    Pros:
    -  Can be used for small areas
    -  A diverse range of measurement make up the score.

    Cons:
    -  Differences within wards are often masked as there can be great variation of      deprivation within a particular ward
    -  The data are nearly 30 years out of date as of 2018
    -  It does not indicate the proportion of people in an area that are deprived  
    -  It is biased toward the urban population.

     

  2. Townsend Material Deprivation Score
    The Townsend score is made up by looking at four variables census: 

    0.  unemployment - % of economically active residents aged 16-59/64 who are     unemployed
    1.  car ownership - % of private households who do not possess a car
    2.  owner occupation - % of households not owner occupied
    3.  overcrowding (over 1 person per room) - % of private households with more   than 1 person per room. 

    The data are taken from the 1991 census.  The variables combine to form an overall score ranking a particular area relative to others.  The higher the score, the more deprived the area. The average is 0. The scores can only be used to rank areas. This is because the actual score has no value, i.e. an area with a score of 4 is not twice as deprived as an area with a score of 2.

    Pros:
    -  It can be used to look at small areas
    -  Highly correlated with measures of ill health, e.g. SMRs or limiting long-term illness
    -  As it is the sum of standardised scores, it is easy to calculate.

    Cons:
    -  The data are nearly 30 years out of date, as of 2018. In particular, housing tenure has changed significantly since 1991 due to sales of council housing
    -  It does not indicate the proportion of people in an area that are deprived
    -  It is a better indicator of deprivation of urban areas than rural areas (e.g., car ownership in rural areas is often essential. However, lack of car ownership in London, for example, may well not correlate with low income).
     

  3. Index of multiple deprivation (IMD)
    Originally developed by the Office of the Deputy Prime Minister and now overseen by the Department for Communities and Local Government, this index is NOT census based, but made up from routine data sources such as data on benefit recipients, hospital emergency admissions, educational attainment, local authority homelessness figures, crime statistics and road traffic injuries. 

    The latest release, as of 2018, was the 2015 IMD
    https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/464431/English_Index_of_Multiple_Deprivation_2015_-_Infographic.pdf [accessed 23/08/2018]

    It comprises 7 domains: Income, Employment, Education, Health, Crime, Barriers to Housing and Services, and Living environment.  Ranks of income score and employment score are available separately, in addition to an average score.  This is useful depending on the public health issue under consideration.  For example, the overall score takes road traffic injuries into consideration.  If an investigation into road traffic was being conducted and comparisons were being made across areas by deprivation, the average score could potentially lead to incorrect conclusions as road traffic injuries have been taken into account.

    The Government infographic source above notes:

    It can be used for:
    -  Comparing small areas across England
    -  Identifying the most deprived areas
    -  Exploring the domains (or types) of deprivation
    -  Comparing larger areas, e.g. local authorities
    -  Looking at changes in relative deprivation between versions (i.e. changes in rank).

    It should not be used for:
    -  Quantifying how deprived a small area is
    -  Identifying deprived people
    -  Saying how affluent a place is
    -  Comparing with small areas in other UK countries
    -  Measuring real changes in deprivation over time.Mental health needs index

 

2.  Mental health needs index

The Mental Health Needs Index (MINI) provided an estimate of the need for inpatient mental health services for adults (ages 16-59) by ward and borough. It is calculated using a number of population variables likely to indicate need for access to services, such as deprivation; proportion of economically active adults unemployed; proportion of adults living in households not self-contained, etc. The MINI provides both predicted admission rates and a ratio of need compared to the England average.

However, according to a Medway Joint Strategic Needs Assessment

“The Mental Health Needs Index 2000 (MINI 2000) has not been updated since 2000 and is therefore the information it contains is out of date. Using it as a predictor of need for hospital admission is also likely to be misleading as it does not take into account the development of new models of care such as crisis resolution home treatment services which means that the threshold for admission is likely to have increased. However, it does provide some comparison of need for mental health services for those with severe mental health services in different areas in Medway.”

http://medwayjsna.info/ua/233.html  [accessed 23/08/2018]

It is now likely to be better to use currently available tools e.g. PHE profiling tools:

Understanding mental health locally using profiling tools
PHE has created mental health profiling tools and guidance to help commissioners and other health professionals understand the mental health
needs and services in their local area.

The tools bring together a wide range of publicly available data. The data is grouped by clinical commissioning group (CCG) or local authority. This means the tools can be used to benchmark one area against another. They can also be used to see trends and compare indicators.

Mental health and wellbeing toolkit
The mental health and wellbeing joint strategic needs assessment profile provides a starting point for thinking about mental health. It spans the life course and covers the whole mental health pathway. It shows prevalence, risk and protective factors for a range of conditions. Service related information relating to quality, outcomes and finance is also included.

The knowledge guide is for use alongside the profile. It provides an overview of many of the topics to consider when thinking about the mental health needs in a local area. The guide begins with a focus on understanding the local population and then follows the care pathway along the life course.

Children and young people's mental health and wellbeing
The children and young people’s mental health and wellbeing profiling tool can be used to understand the prevalence of children with, or vulnerable to, mental illness and what the risk factors are. It shows the range of health, social care and education services that support these children and information on the cost of these services.

Public Health England has published an update to 4 indicators on the proportion of children living with at least one parent reporting symptoms of emotional distress. Data is up to 2010 to 2016 and is by family type and work status. Previously, the Department of Work and Pensions (DWP) published these indicators.

Guidance on how to use available information to assess and develop interventions which improve the mental wellbeing of children and young people is available in the measuring mental wellbeing in children and young people briefing.

Common mental health disorders
The common mental health disorders profiling tool shows the prevalence of common mental health disorders, including depression and anxiety disorders, and what the risk factors for these disorders are. It can also be used to find out more about early intervention, assessment and treatment locally, as well as the outcomes and costs of these services.

Crisis Care
The crisis care profiling tool shows the prevalence of pre-existing mental health conditions, the risk factors and what access to care and treatment people experiencing a mental health crisis have.

Use the crisis care catalogue to find out about all the currently available datasets and indicators on crisis care. It includes information about national data as well as CCG, local authority, GP practice and service provider level data.

Perinatal mental health
The perinatal mental health catalogue is a source of perinatal mental health datasets and indicators available at a national level and at CCG, local authority, GP practice and provider level. This data can be used to find out more about perinatal mental health and services locally and nationally.

The perinatal mental health profile shows data on mental health in pregnancy, the postnatal period and babies under 1 year old. It shows data on the demographics, risk and related factors, prevalence, and identification and access, during the perinatal period. It includes metrics at local authority, CCG and Acute Trust level.

Severe mental illness
The severe mental illness profiling tool shows the prevalence and risk factors of severe mental illness. It can also be used to find out more about early intervention, assessment and treatment locally, as well as the outcomes and costs of these services.

The tool includes a set of indicators that relate to psychosis care.

The psychosis data report explains the variation in numbers of people with psychosis and their access to care and support across England by CCG or local authority. It also highlights where there are quality issues or gaps in current data relating to psychosis, meaning extra data collection might need to be organised.

Substance misuse and mental health issues

The co-occurring substance misuse and mental health issues profiling tool can be used to understand how and why substance misuse and mental health issues are linked. It shows data on smoking, alcohol and drug use alongside related mental health data.

Suicide prevention

The suicide prevention profiling tool brings together a range of data on suicide to show how often it occurs, the risk factors, and what contact people with increased risk have with services.

Further information
PHE’s National Mental Health, Dementia and Neurology Intelligence Network (NMHDNIN) produces these resources for commissioners and other health professionals to help them improve services and outcomes for patients. For further guidance and information about the tools and analysis please email mhdnin@phe.gov.uk.” https://www.gov.uk/guidance/mental-health-data-and-analysis-a-guide-for-health-professionals [accessed 23/08/2018]
 

3.  Health poverty index
The Health Poverty Index (HPI) tool allows groups, differentiated by geography and cultural identity, to be contrasted in terms of their 'health poverty'. A group's 'health poverty' is a combination of both its present state of health and its future health potential or lack of it

http://hpi.org.uk/ [accessed 23/08/2018].

This site notes “The NHS Information Centre no longer supports the Health Poverty Index (HPI) website. St Andrews University will continue to support this website and respond to queries until March 2012 but there will be no additional updates or developments during this period.”

4.  Gini coefficient
This is a widely used summary measure of inequality in household income. It represents an overall measure of the cumulative income share against the share of households in the population. The lower the value of the Gini coefficient, the more equally household income is distributed.  The Gini coefficient is used to show the degree of income inequality between different groups of households in the population. It can also be used to show how inequality of incomes has been changing over a period of time

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/families/methodologies/theginicoefficient [accessed 23/08/2018]

An example of the use of GINI coefficients to investigate the effect of private sector data on inequality of revascularisation admissions across London can be found at:

https://pdfs.semanticscholar.org/7b5e/b003aa886e08498328574419041cc7420e85.pdf [accessed 23/08/2018].

 

References

[1] Donaldson L.J., Donaldson R.J Essential Public Health (2nd Edition, revised) Petroc Press 2003
 

 

                                          © M Goodyear & N Malhotra 2007, D Lawrence 2018