Jsna slides for hwbb 27th june 2013


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  • 68.3% of population work, well below England average of 72.9%. Of particular concern is the increase in long term unemployment which grew by 56% 2011 to 2012 and increase in youth unemployment (2,665 in Feb 2008 to 5,475 in July 2012) – far more rapidly than nationally. Concerns regarding the impact of austerity and welfare reforms – especially on those already poor, vulnerable and at risk. Over one fifth of Sheffield households live in poverty and work no longer necessarily route out of poverty. Particular concern about increase in food banks as an indicator of increasing hardship. Performance improving at Key Stage 2 (age 11) and 4 (age 16) and some narrowing of the gap between Sheffield and rest of country – but this must be maintained. We also need greater emphasis on intermediate and technical skills but improvements in these areas have been static of late. Lack of investment, ageing stock and high demand mean reduction in quality of the private rented housing sector – only 64% meets the ‘Decent Homes’ standard. This is a big challenge in context of welfare reforms. Sheffield also experiences higher levels of fuel poverty but realistically will be doing well to hold it at its current rate. Greater emphasis needed on quality and management of land not owned by the Council, particularly as a means to increase outdoor play opportunities for children and alongside other measures such as the ‘Playing Out’ scheme. Good evidence for the health and wellbeing benefits of active travel and accessible transport but we don’t have good enough local data on the choices people make and why.
  • Life expectancy for men is 78.1 years and 81.8 years for women in Sheffield. Both are lower than the national average although the gender gap is narrowing. Cancer and cardiovascular disease account for almost two thirds of all deaths in people under the age of 75 years in Sheffield. Although death rates from these diseases are reducing they still fall short of the national average. We’ve also detected a potentially worrying trend in liver disease, largely connected to alcohol consumption. The numbers of people with dementia are set to increase markedly over the next 10-20 years. Currently long term care needs of this population are met via admission to a care home while earlier on there is significant reliance on informal caring arrangements. This represents a significant area of need for the city. – both now and in the future. The infant mortality rate in Sheffield is high compared with the England average and has been slowly rising. Continued implementation of the infant mortality strategy must therefore be the priority to bring us in line with the rest of the country. Smoking remains the largest, reversible cause of ill health and early death but local evidence suggests that the prevalence of smoking in adults in Sheffield is stubbornly unchanged at around 21.5% of over 18 year olds. Mental health and wellbeing underpins good physical health and wellbeing and vice versa yet local information indicates that it is below average in Sheffield. Equally there are concerns about the physical health and wellbeing outcomes of people with mental problems – which is why this features as part of the Right First Time programme.
  • The life expectancy gap between the most and least deprived women may be widening, linked to changes in types of work and lifestyles. Inequalities generally remain a persistent Sheffield. There are similar inequalities in the health of children and young people and good evidence of the importance of ensuring a healthy start in life to help tackle inequalities later on in life. One specific group that warrant particular attention are Looked After Children. Health inequalities are linked to inequalities in the wider social, economic and cultural context, hence the need to focus on the wider determinants. We use the Index of Multiple Deprivation to do this and this clearly shows that more or less the same areas of Sheffield suffer multiple forms of deprivation and therefore inequality. One of the key areas we need to focus on is the extent to which spend and provision of services matches need and use of those services – the equity dimension. All too often we find that the people most in need of services are unable (for one reason or another) to access services early enough or lack the means for preventing problems before they arise.
  • Our ‘investment profile’ of the City’s health and social care spending shows that we will need to shift the balance of expenditure much more towards prevention and early intervention services if we are to respond effectively and efficiently to increasing population and needs. This is being addressed but there is a long way to go. Analysis of health and social care activity shows that there are certain aspects of Sheffield services that require improvement including average length of stay following an emergency admission to hospital (this is 28% higher than the national average and the joint highest nationally); waiting times for adult social care (NB the data quoted in the report are the latest full year available); and certain aspects related to the outcomes of social care clients (such as self-reported quality of life). In relation to Children and Young People, provision of Speech and Language Therapy services and Child and Adolescent Mental Health Services are identified as areas of particular concern, both in terms of issues such as size and scale of the services available to respond to a population the size of Sheffield and in relation to its needs for these type of services. There has been a steady and worrying increase in the level of need of people accessing housing related support services over the last few years, particularly in relation to managing debt, mental health, self-harm, establishing contact with services/families/friends and maintaining accommodation. At our JSNA events, and in line with national feedback, it is clear that our Voluntary, Community and Faith sector services are playing an increasingly important role in responding to rising need and demand. In the context of economic austerity and public sector service cuts however there are concerns about the extent to which this sector can sustain this role without a similar focus on innovation and asset development.
  • Jsna slides for hwbb 27th june 2013

    1. 1. Sheffield’s Joint Strategic Needs Assessment 27th June 2013
    2. 2. Our Approach • Analyses the current & future health and wellbeing needs of the Sheffield population • Seeks to inform and challenge the JHWS • Uses an extensive range of quantitative and qualitative evidence • Structured around the JHWS outcomes • Identifies the key messages & priorities and gaps in knowledge
    3. 3. Chapter 1 Wider Determinants
    4. 4. Chapter 1 – Key Messages • Long term & youth unemployment • Poverty, welfare reforms & food poverty • Educational attainment & lifelong learning • Private rented housing sector & fuel poverty • Green spaces, outdoor play opportunities and air pollution • Active travel and accessible public transport
    5. 5. Chapter 1 – Priorities • Limit negative impacts of welfare reform: welfare reform will have a huge impact on the City and a negative impact on health and wellbeing, for both those affected and health inequalities more broadly. We must minimise the negative impact where possible and in particular, the potential ‘double negative impact’ for families with children aged under five, families with more than two children and lone parent families. • Focus on housing: conditions in the private rented sector and fuel poverty are both real concerns in Sheffield and interventions should prioritise these two issues and those most at risk. • Improve employment opportunities: Fewer people work in Sheffield than the national average and we need to improve volunteering, training and employment opportunities, particularly for young people.
    6. 6. Chapter 2 Health and Wellbeing
    7. 7. Chapter 2 – Key Messages • Life expectancy • Cancer, cardiovascular and liver disease • Dementia • Infant mortality • Smoking • Mental health and wellbeing
    8. 8. Chapter 2 – Priorities • Better understand mental wellbeing: Sheffield experiences poorer levels of mental wellbeing than the national average. We need a comprehensive understanding of the factors that contribute to wellbeing if we are to improve locally. • Focus on leading causes of mortality & morbidity: long term conditions are among the leading causes of premature death and ill health in Sheffield. These have significant implications for health and social services and end of life care and must be a priority for the foreseeable future. • Reduce infant mortality: Infant mortality needs to be brought in line with the national average. This means tackling the major risk factors of maternal obesity, smoking during pregnancy, teenage pregnancy and poor levels of breastfeeding. • Smoking remains the largest, reversible cause of ill health and early death in Sheffield. Evidence places increasing importance on implementation of a comprehensive tobacco control programme as the means by which to reduce prevalence of smoking in the future.
    9. 9. Chapter 3 Health Inequalities
    10. 10. Chapter 3 – Key Messages • Index of inequality in life expectancy • Children and young people • Wider determinants of health • Distribution of expenditure & need
    11. 11. Chapter 3 – Priorities • Identify geographical health spend: We need to establish how much health spend is distributed geographically within the City and map this against geographical health outcomes. Spend should reflect our aspiration to reduce health inequalities. • Develop a better understanding of health inequality by ‘group’: Whilst we have good data on inequality by geography, we do not have it by group. Groups such as BME communities, children with learning difficulties, homeless people, victims of domestic and sexual abuse, carers are all reported nationally to have below average health, but local data are lacking. • Map assets: If we are to reduce health inequalities, it is not enough to know about need alone, we also need to understand what assets we have so that we can build upon them.
    12. 12. Chapter 4 - Services
    13. 13. Chapter 4 – Key Messages • Sustainability • Length of stay in hospital • Social care waiting times, self-reported quality of life & support into paid work • Children’s speech & language therapy and Child and Adolescent Mental Health Services • Need of people accessing housing support • Voluntary, Community & Faith Sector services
    14. 14. Chapter 4 - Priorities • Reduce dependence on high end health and social care services: The growth in our population means that the current service model is unsustainable. Prioritising spending on prevention, early intervention, integrated working and care in the community will be beneficial for the individual and the system. Although there is a move to do this, there is still a long way to go. • Acknowledge the impact of spending cuts: cuts that are impacting on the NHS, local government and the voluntary sector cannot be overlooked and are beginning to have a negative impact on service provision. It is important to question how realistic the outcomes of the health and wellbeing strategy are in light of these funding changes. • Measure service access and experience: more emphasis must be placed on collecting and analysing service access and experience data. Without this, it is impossible to measure the extent to which “people get the help and support they need and is right for them”.
    15. 15. Gaps in Knowledge • Quality and security of work • Resilience, social isolation & wellbeing • Active travel, healthy lifestyles • Offender health, neurological conditions, autism & sensory impairments • Distribution of spend and need and inequalities by group/protected characteristic • GP access arrangements and patient experience
    16. 16. Next Steps - Offer •Data and reports published and repository of information created •Co-ordinated programme for addressing the gaps and tracking progress •Briefings and engagement activities for commissioners and stakeholders, as required
    17. 17. Next Steps - Expectations • JSNA will be used to shape the Health & Wellbeing Strategy • Commissioners will consult the JSNA in developing their plans • Range of stakeholders will contribute to on-going development, especially identified gaps.