Statutory requirement Joint between LA and PCT Strategic Health Needs Assessment
JSNA oversight group have responsibility for undertaking and overseeing the JSNA workbook workstreams Information Gaps – data is being collected but needs to be analysed, data isn’t being collected but could, data can’t be collected.
ONS projection predicts a 15% increase – greater than any other London borough
A Journey on the No. 36 bus from Queen’s Park to Vincent Square There is a marked difference in life expectancy between electoral wards which can be explained by deprivation There was a difference of nearly 13 years in the life expectancy of males born in Churchill ward (72.5 years) and Lancaster Gate ward (85.2 years) during the period 2002–06. For females, the life expectancy gap was also nearly 13 years – ranging from 77.5 years for those born in Church Street to 90.1 years for those born in Knightsbridge and Belgravia. Along the no. 36 bus route there is a varied difference in life expectancy – Queens park to Knightsbridge and Belgravia 10 years of life are gained for a male and 7 years of life gained for a female. From Knightsbridge and Belgravia down to Vincent Square, 6 years of life are lost for males and 8 years of life are lost for females Health inequalities is the biggest concern in Westminster and plays a part in all other health priorities
Excess deaths from circulatory diseases accounted for 32% of the gap in life expectancy - 35% for men and 27% for women. A further 22% was accounted for by deaths from cancer (22% for both men and women) – and a further 14% by deaths from respiratory diseases (14% for men and 13% for women). Death rates and premature death rates are decreasing; however mortality rates and premature mortality rates are highest in the most deprived areas of the city. The main causes of death in males and females are circulatory disease, cancer and respiratory disease
The ethnic mix across Westminster mirrors the pattern of health inequality. The prevalence of a number of diseases and health problems varies by ethnic group. Bangladeshi, Other Asian, Pakistani, Black African, Black Other and Other ethnic groups have higher hospital admission rates than the average for Westminster, in particular for CVD. The Westminster ‘other# ethnic group category is the greatest contributor to hospital admissions. This evidences the ethnic diversity of Westminster’s population.
50% of children in year 6 are reported to be overweight or obese – this is predicted to increase (NCMP) The highest prevalence of obesity is found in children who live in the most deprived areas of Westminster Adult obesity is also expected to rise Obesity can lead to significant health complications, including an increased risk of CVD and cancer (two of the biggest killers in the developed world), diabetes and physical disability. In Westminster, it is estimated that nearly 13% of all deaths over the period 2002-07 were attributable to obesity. 690 deaths between 2005 and 2007 would have been saved in Westminster if the prevalence of obesity had been lowered by 10%. Obesity is strongly associated with other health problems, it is associated with a higher risk of hypertension. Prevalence of CVD in Westminster is 3.60%, 58% of people who have CVD are either overweight or obese. The odds of having CVD are 2.43 times higher in an obese person. Among older persons, the risk of osteoarthritis and lower back pain rises with increasing body weight. Research has shown that people who are overweight are at risk of developing osteoarthritis of the knee and that being overweight can also (to a lesser extent) exacerbate the condition where it already exists - Interventions to tackle obesity and promote weight reduction help in the treatment and prevention of osteoarthritis. Obesity is a leading cause of preventable death worldwide and is considered by many authorities to be one of the most serious public health challenges of the 21st century. The number of people who are overweight or obese in England has risen rapidly in the last three decades, with the prevalence of obesity more than trebling since the 1980s. The fact that the increasing prevalence of obesity in adults is mirrored in children is a particular cause for concern, as there is a growing body of evidence to suggest that excess weight in childhood will continue into adult life. This highlights the importance of the life course approach in tackling obesity. As with many other diseases and health problems, the prevalence of obesity in children varies by ethnic group. Children from lower income households are also more likely to be obese than those from more affluent households.
Health inequalities exist within each of the major health determinants in Westminster and are therefore at the centre of Westminster’s strategic objectives. ‘Our strategy for tackling health inequalities in Westminster 2009-2016’ was developed through the views of stakeholders in the Westminster City Partnership, views of the public via the Westminster Health Debate and the findings of the Director of Public Health’s 2006-2007 Annual Report which focused on health inequalities (this report was published in 2008 and contained the most up to date information).
There is strong evidence to suggest that an individual’s eating, drinking and activity behaviours are linked to psychological factors. It has been suggested that depression is linked to obesity as a result of its impact on psychological wellbeing, such as low self image, lack of confidence and isolation which may accompany being obese. Obesity is also more common in people with serious mental health issues (SMI).
Homelessness: Housing and health are inextricably linked with homeless populations experiencing significant health inequalities. In a local survey of rough sleepers and hostel residents, 72% of participants reported having at least one long term illness Fuel poverty: Fuel poverty is a complex social issue related to the inability to afford adequate warmth for health and comfort; not only is it an important issue for Westminster, but is also a national Government priority. Overcrowding: Overcrowding is concentrated in North West and South of the City and mirrors closely patterns of deprivation and health inequalities. Most overcrowded wards are - Westbourne, Queens Park, Church Street, Harrow Road, and Churchill, which account for over half of all overcrowded households in social housing across the borough. Ethnic minority groups are more likely to be overcrowded than their White British counterparts – with 29% of them overcrowded compared with 16% of White British households.
This is the latest available data from the Health Survey for England 2006. Next Public Health Annual Report will be focussed on smoking. NHSW currently have a major health campaign focussing on smoking.
Drugs: Problematic Drug Users (PDU) = opiate and or crack cocaine misusers) Alcohol: Alcohol misuse is a wider problem within Westminster
Objectives of the session <ul><li>What is JSNA? </li></ul><ul><li>What can Westminster's JSNA tell us? </li></ul><ul><li>How can I get involved? </li></ul><ul><li>What’s the future of JSNA? </li></ul><ul><li>How can I influence developments? </li></ul><ul><li>Questions? </li></ul>
Commissioning Cycle Identifying needs of the local community Monitoring and evaluating Specifying a service to meet those needs Developing a service through a service agreement The Commissioning Cycle
JSNA in Westminster JSNA steering group JSNA Oversight Group JSNA Information Group <ul><li>JSNA Analyst </li></ul><ul><li>Joint Commissioning Support </li></ul><ul><li>Children and Young People </li></ul><ul><li>Disease Commissioning </li></ul><ul><li>WCC analysts </li></ul><ul><li>PH intelligence </li></ul><ul><li>Informatics </li></ul><ul><li>Involving people </li></ul><ul><li>WCC analysts </li></ul><ul><li>WCC Comms </li></ul>Needs assessments Profiles Literature review Advice on data sources Data analysis Filing information gaps
Why need? Need: what people might benefit from Demand: what people might want to use Supply: what is actually provided Is it cost effective?
Dentistry two years ago in NHSW: “We knew we had a ‘need’ for dentistry, because we’ve got poor dental health in the borough and clear guidelines about how frequently people should visit. But people were just not going to our practices. We actually had far fewer practices than the national average, but they still had spare capacity to see more people” Demand is than need Supply is than need Demand is than supply lower lower lower
Dentistry Example NEED Supply= demand More demand than need (+) Less demand than need (-) More supply than need (+) Less supply than need (-) Spare capacity, DNAs Waiting lists Dentistry
What is a health needs assessment? It is a review of the health issues facing a certain population. It focuses particularly on the gaps between current conditions and desired conditions. It should eventually lead to better allocation of resources, which will improve health and reduce inequalities
Westminster JSNA Workbook 1. Define the population e.g. Carers 6. Information gaps? 7. Conclusions and Recommendations? 2. Expected numbers, distribution and pattern by person, place and time. 3. Existing Services 4. Comparison with others 5. Evidence of Effectiveness
Summary <ul><li>Joint Strategic Needs Assessment is: </li></ul><ul><ul><li>Joint between LA and NHS </li></ul></ul><ul><ul><li>Strategic – gives an overarching view of need and informs strategy development and action planning </li></ul></ul><ul><ul><li>Health Needs Assessment model </li></ul></ul><ul><li>In Westminster JSNA is: </li></ul><ul><ul><li>Rolling Programme of HNAs </li></ul></ul><ul><ul><li>Accessible information through the Westminster Observatory. </li></ul></ul>
1. What is the size of Westminster’s Population?
Westminster’s Population <ul><li>ONS 2008 mid-year estimate 236,000 </li></ul><ul><li>GLA 2009 - round projection (high) 216,521 </li></ul><ul><li>Thought to increase to around one million on working days; between 320,000 and 355,000 during evening and night-time hours; and between 390,000 and 434,000 at weekends </li></ul>Public Health Annual Report
2. What is the difference in life expectancy between the most and least deprived wards?
Inequalities in life expectancy Harrow Road Lancaster Gate Bayswater Hyde Park (ward) Bryanston & Dorset Square M: 77.1 F: 85.9 M: 75.0 F: 81.0 M: 84.0 F: 83.6 M: 86.0 F: 85.7 M: 82.3 F: 85.8 M: 83.0 F: 86.4 Westbourne St. James’s Warwick M: 77.7 F: 86.2 M: 78.9 F: 85.5 Public Health Annual Report
3. Name three conditions that contribute to the life expectancy gap in Westminster
Mortality Contribution to the life expectancy gap between the most deprived and the least deprived quintiles of the population, by disease group. Westminster 2003-2007 Public Health Annual Report
Morbidity CVD is the biggest cause of mortality and premature death in Westminster Accountable for 33% and 26% of premature deaths in men and women respectively. Around 150 people die annually under the age of 75. It is estimated that type 2 diabetes in the UK affects 1 in 20 people over 65 years, and 1 in 5 people over the age of 85. The prevalence of diabetes rises steeply with age and is more common in individuals over the age of 40. The overall annual incidence of cancer in Westminster during the three year period 2003-2005 was 348.6 per 100,000. Cancers contribute 32% of the gap in life expectancy between the least and most deprived fifths of the population.
4. Name three of the most commonly spoken first languages in Westminster Schools (excl. English)
Ethnicity <ul><li>72 ethnicities were identified as having more than 100 people belonging to that group in the census. </li></ul><ul><li>56% of respondents identified themselves as belonging to one of 334 groups other than “White British”. </li></ul><ul><li>The ethnic mix across Westminster mirrors the pattern of health inequality. The prevalence of a number of diseases and health problems varies by ethnic group. </li></ul>
Obesity 65% 56% More men than women are overweight or obese In Year 6 27% of boys and 23% of girls are obese 27% 23% Public Health Annual Report - Obesity
6. What do you think Westminster residents perceive to have the biggest impact on their health?
Wider determinants <ul><li>Local people were asked: </li></ul><ul><li>“ which of the wider determinants of health had the most significant impact on their health” </li></ul><ul><li>They said: </li></ul><ul><li>Income </li></ul><ul><li>Housing </li></ul><ul><li>Where they live </li></ul>Health Inequalities Strategy
Education, Employment and Income <ul><li>Educational attainment, employment and income are linked to deprivation. </li></ul><ul><li>42 (35%) of Westminster SOAs are in the 20% most deprived SOAs in the country. </li></ul><ul><li>Unemployment is associated with higher risk of depression and increased morbidity. </li></ul><ul><li>The number of children in Westminster in low income families is higher than the national average. </li></ul>Early years needs assessment
7. Where do Westminster rank for our number of homeless people out of 400 Local Authorities in England and Wales?
<ul><li>Homelessness </li></ul><ul><li>Westminster has more people without a roof over their head than any other borough in England. </li></ul><ul><li>In Westminster 2,172 rough sleepers were contacted by building base services in 2008/09 (CHAIN) </li></ul><ul><li>Average life expectancy for someone who sleeps rough is 42 . </li></ul>Housing <ul><li>Fuel Poverty </li></ul><ul><li>Increasing energy prices = increasing numbers of households into fuel poverty; </li></ul><ul><li>19,000 fuel poor households in Westminster (8% of the population) </li></ul><ul><li>The large population of older people living alone and the relatively old housing stock in Westminster mean that fuel poverty is a particular issue. </li></ul><ul><li>Overcrowding </li></ul><ul><li>Westminster has a severe shortage of family size accommodation and families wait years for larger homes. </li></ul><ul><li>the 2001 Census reported over 5000 households living in overcrowded conditions (5.5% of population) ranking Westminster 12th most overcrowded borough in England. </li></ul><ul><li>Overcrowding has strong links with symptoms of poorer health such as spread of infectious diseases, respiratory conditions, mental illnesses and accidents in the home and links have been found between overcrowding and lower educational attainment. </li></ul>Each have an individual needs assessment
8. What is the prevalence of smoking in Westminster?
Smoking <ul><li>Smoking is the main cause of preventable illness and death in the UK and the single biggest preventable cause of the socio-economic gradient in infant mortality and life expectancy. </li></ul><ul><li>Estimated that 23% of residents smoke (similar to the average for England) </li></ul><ul><li>690 smoking attributable deaths in 2006 </li></ul><ul><li>Smoking prevalence in Westminster varies by ward - more deprived wards having higher smoking rates </li></ul>MSOA smoking prevalence per 100 population – all ethnicities A comprehensive needs assessment on smoking is being commissioned as part of the Major Health Campaign. Public Health Annual Report 06/07
9. What proportion of the resident population drink over the recommended amounts of alcohol per week?
Alcohol and drugs <ul><li>Over a quarter of the resident population drink over the recommended amounts </li></ul><ul><li>Approximately 6% drink at harmful levels and 3.6% are alcohol dependent </li></ul><ul><li>In 2008-09 16% of residents who accessed services misused both alcohol and at least one drug problematically </li></ul><ul><li>Westminster has an estimated 3,537 resident problematic drug users </li></ul>DAAT needs assessment
Other needs assessments <ul><li>Older People </li></ul><ul><li>Sexual health </li></ul><ul><li>Mental health </li></ul><ul><li>Autistic Spectrum Conditions </li></ul><ul><li>Carers </li></ul><ul><li>Hepatitis A </li></ul><ul><li>Learning disabilities </li></ul><ul><li>Physical disabilities </li></ul><ul><li>Eye services profile </li></ul><ul><li>And many more…… </li></ul><ul><li>To see what’s coming up check out the JSNA Status Report </li></ul>
Summary <ul><li>What can Westminster’s JSNA tell us? </li></ul><ul><ul><li>A wealth of resources on our population and the needs of our population are available from the needs assessments, public health annual reports and Westminster Observatory </li></ul></ul><ul><ul><li>If the information isn’t available we may already be doing something on this or have something planned </li></ul></ul><ul><li>And what about our population? </li></ul><ul><ul><li>Westminster is very diverse: ethnic mix, deprivation </li></ul></ul><ul><ul><li>Transient population, visitors and workers </li></ul></ul><ul><ul><li>Large working age and student population </li></ul></ul>
The JSNA process Does it fit with JSNA priorities? Refer to CDSS or other PH team Postpone Establish needs assessment Steering Group Needs assessment undertaken in line with JSNA Workbook Add to JSNA status report <ul><li>Fill out JSNA registration form available from: </li></ul><ul><li>JSNA website http://westminstercitypartnership.org.uk/default.aspx and click on JSNA tab </li></ul><ul><li>emailing firstname.lastname@example.org or Beth Searle </li></ul>Submit form to JSNA team You will be invited to the JSNA Oversight Group to discuss your request in more detail
Find out more about Westminster’s JSNA <ul><li>Visit http://westminstercitypartnership.org.uk/ </li></ul><ul><li>And click on JSNA to see our page </li></ul><ul><li>Email [email_address] </li></ul>
JSNA and CDSS <ul><li>Provides rapid 3 week responses to focused questions </li></ul><ul><li>Specialists in: </li></ul><ul><ul><li>Public Health intelligence </li></ul></ul><ul><ul><li>Public Health Information & Resource Unit and Policy review </li></ul></ul><ul><ul><li>Equality and diversity, Patient and public involvement and Inequalities </li></ul></ul><ul><ul><li>Economics </li></ul></ul><ul><ul><li>Clinical governance </li></ul></ul><ul><li>Examples of CDSS requests that have been submitted include investigating the: </li></ul><ul><ul><li>links (if any) between children’s health & education </li></ul></ul><ul><ul><li>evidence for the effectiveness of food access projects </li></ul></ul><ul><ul><li>most effective community services model for reducing ENT waiting lists. </li></ul></ul><ul><li>[email_address] </li></ul><ul><li>JSNA sometimes uses CDSS </li></ul>
The Westminster Observatory http:// westminstercitypartnership.org.uk/Pages/Observatory.aspx NHSW employees click here Username: NHSWestminster Password: Monthyear e.g. July2010
Summary <ul><li>The JSNA website is on the Westminster City Partnership site and linked from the NHSW intranet. This has access to all needs assessments, public health annual reports and the Westminster Observatory. </li></ul><ul><li>JSNA is different but complementary to CDSS: </li></ul><ul><ul><li>CDSS = rapid appraisal using various PH techniques to answer specific questions. </li></ul></ul>
<ul><li>The NHS White Paper “Equality and Excellence: Liberating the NHS” under section 4.19, page 35 outlines “ Local authorities’ new functions: </li></ul><ul><li>Each local authority will take on the function of joining up the commissioning of local NHS services, social care and health improvement. Local authorities will therefore be responsible for: </li></ul><ul><ul><li>…… Leading joint strategic needs assessments, and promoting collaboration on local commissioning plans, including by supporting joint commissioning arrangements where each party so wishes …….” </li></ul></ul><ul><li>Westminster has been asked to input into the development of the Department of Health’s strategy for JSNA. </li></ul>
Better access to Public Health "I needed more help on the process, who needed to be involved when, and what the potential problems are.” “Training/awareness sessions, getting Head Commissioners on board is key.” “ Where stakeholders are not from a health background an initial introduction on NA's should be offered.”, senior management “buy-in” collaboration <ul><li>Improved the internet and intranet </li></ul><ul><li>TED training sessions </li></ul><ul><li>Newsletters </li></ul><ul><li>Induction </li></ul>
What JSNA could do better NAs to link to the strategic goals and objectives of the organisations and consider political implications There was a feeling that conclusions and recommendations were not explicit or thorough enough to base decisions on Benchmarking and forecasting local analysis "Robust economic analysis - long term vs. short term” vs. “Commissioners need to take [their own cost analysis] into account when making decisions against needs assessments.” <ul><li>Commissioners have different requirements and needs </li></ul><ul><li>JSNA needs to be flexible </li></ul>
Engaging commissioners <ul><li>Need to make sure NAs deliver what commissioners want </li></ul><ul><li>Plea to commissioners to ASK and in plenty of TIME! </li></ul>NAs have a vital role to play in informing strategy and recommending outcome measures. “[commissioners] should be involved every step of the way” vs. “Useful in some cases, but as long as the commissioners feel involved as stakeholders this element may not be necessary.” “Commissioners need answers today so do not use PH” “Research targeted to answer commissioners questions. Using research methods which deliver results in the time scale needed”