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Health Outcome Framework may include measure on loneliness

Consultation launched to make framework more relevant

Jo Carlowe

Monday, 21 January 2019

An updated Public Health Outcome Framework (PHOF) is set to include a raft of new indicators including those for loneliness.

At the beginning of 2018 the prime minister announced a minister for loneliness and committed to develop a national strategy to help tackle loneliness and a national measure for loneliness.

Today, Public Health England had opened its consultation on the updated PHOF for indicators planned for summer 2019, with the aim of ensuring the PHOF ‘continues to be relevant and meets the needs of users’.

The proposed update includes measures for loneliness comprising four questions: ‘How often do you feel that you lack companionship?’, ‘How often do you feel left out?’, ‘How often do you feel isolated from others?’, and ‘How often do you feel lonely?’.

The newly published strategy includes the commitment to use these four questions as the new national measure, with the idea that it will help inform and focus future work on loneliness at a national and local level, providing a focus to support policy decisions and service commissioning.

In its current format the PHOF is made up of 66 high level indicator categories which include 159 individual indicators across four domains.

In the proposal, a large number of indicators remain the same, but it is proposed that some indicators be removed to allow for the addition of new indicators that may be more relevant.

Indicators that are proposed for updates include those on homelessness, due to the fact that The Homeless Reduction Act was introduced in April 2018, which gives more responsibility to local authorities to take reasonable steps to prevent and relieve homelessness regardless of priority need category.

Other changes include those relating to child development. The original aim of the PHOF in 2012/13 was to measure child development outcomes at age 2-2.5. At the time it was only possible to measure whether or not the assessment had been completed. However, data is now available at national and local level from the Ages and Stages Questionnaire.

Screening coverage indicators for cervical cancer also come under the spotlight, with the proposal that the indicator be split into two age groups (under 50s, and over 50s) to reflect updates made to the NHS cervical screening programme.

It’s proposed the indicator for the proportion of five-year-old children free from dental decay, be reversed from ‘disease-free’ to ‘presence of disease’, so the new indicator would read: ‘Proportion of five-year-old children with dental decay’.

The update also recommends the inclusion of an indicator measuring the directly age-standardised rate of premature mortality in adults with mental health problems to replace the old indicator that stated: ‘Excess under 75 mortality rate in adults with serious mental illness’. While the old indicator: ‘Proportion of adults in the population in contact with secondary mental health services’ would be replaced with: ‘Excess premature mortality ratio for people with mental health problems.’

In addition, it’s proposed that a number of indicators be removed, the rationale being that some of the indicators show low additional benefit or use, and a number of new indicators be added included those on disability free life expectancy, indicators on school readiness, indicators on obesity, as well as those on loneliness.

The consultation closes at 11.45pm on 17 February 2019.

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