Julia Waters Public Health Principal for Kingston, presented recommendations for service design, delivery and commissioning.

1. Kingston’s Joint Strategic Needs
Assessment (JSNA)
Julia Waters Public Health Principal, Royal Borough of
Kingston
Health And Wellbeing Network
12th April 2016

3. What is the JSNA?
• describes the current and future health and wellbeing needs of people
who live in the borough.
• identifies the areas where the Local Authority, the NHS and the
voluntary sector need to focus their efforts to improve the health and
wellbeing of the Kingston community.
• is not just about health and social care services, it reflects the many
factors that can affect the health and wellbeing of an individual and a
population. It also focuses on reducing health inequalities that
sometimes exist between different population groups.
• exists in a state of continual assessment & planning, evolving with
changing needs of the population. Stakeholders & partners can formally
put a request in for a Needs Assessment to undertaken; these requests
are reviewed by the JSNA Working Group which considers each request
against a set of criteria.

4. Why have a JSNA?
• The JSNA is a statutory obligation.
• The Health and Social Care Bill (2012) says that Local Authorities and Clinical
Commissioning Groups (CCGs) have an equal duty to prepare JSNAs which will
then inform the priorities of the local Health and Wellbeing Strategy.
• Each area of the country has a Health & Wellbeing Board responsible for
overseeing the delivery of the strategy.
• The JSNA aims to describe the ‘big picture’ in terms of health & wellbeing. This
information is critical to identifying local priorities & making sure that the
correct services are commissioned in order to achieve better health & well
being outcomes of Kingston residents.
• The JSNA provides documented evidence of local need which is a valuable
source of information for many local professionals and stakeholders in the
NHS, Local Authority & voluntary sector, to steer the future direction of their
work. It also provides residents with localised data and information on a wide
range of topics that affect local people’s health and wellbeing.

5. Community Voice
Evidence of ‘what
works’
Data & Statistics
What is the point of the Joint Strategic Needs
Assessment?
Recommendations for service design,
delivery and commissioning

6. CHAPTERS
Core Data Set
• Population
• Wider Determinants
• Lifestyles
• Screening
• Health Status
• Service Utilisation
• Residents Opinions
• Community Assets
Staying Healthy
• Screening – Breast
• Screening – Cervical
• Screening – Diabetic
Retinopathy
• Screening – AAA
• Healthy Weight – Obesity
• Healthy Weight –
Malnutrition
• Physical Activity
• Smoking
• Bone Health
• Alcohol
• Substance Misuse
• Immunisations
• Breastfeeding
• Sexual Health
• Mental Health
Promotion

7. CHAPTERS
Health Conditions
• All Cancers
• Bowel Cancer
• Breast Cancer
• Cervical Cancer
• Gynaecology
Cancer
• Lung cancer
• Prostate Cancer
• Skin Cancer
• Cardiovascular
Health
• Dental
• Eye
• Musculoskeletal
• Respiratory
• Diabetes
• Mental Health
• Autism

8. CHAPTERS
Groups & Communities
• CYP: Antenatal &
Maternal
• CYP: 0-5years
• CYP: Primary
• CYP: Secondary
• CYP: Post 16
• Older People
• PLD
• BME
• LGBT
• Carers
• Disabled Children /
SEND
• Disabled Adults
• Offenders
• Gypsies &
Travellers
• Refugees, Asylum
Seekers &
Migrants
• Homelessness

9. CHAPTERS
Wider Determinants
• End of Life
• Accidents
• Fuel Poverty
• Violence
• Safeguarding – including CSE
• Extreme Weather

10. AUTISM CHAPTER

11. • Approximately more than half a million people (700,000) in England have
autism - equivalent to >1% & similar to the prevalence of dementia. If
families are included then autism touches the lives of 2.7 million people
every day. In Kingston it is estimated that approximately 1803 individuals
have autism. This number can be expected to increase along with the
expected increase in the population.
• Autism is defined as a lifelong developmental disability that affects how a
person communicates with, and relates to, other people. It also affects how
an individual makes sense of the world around them. The core features can
be characterised by a ‘triad of impairments’ in social interaction, imaginative
thought, & communication.
• Autism is a spectrum disorder meaning that although people with autism
share the triad of impairments, it will affect individuals differently and to
varying degrees. Some adults with autism live fulfilling lives, making
successful & important contributions to their communities, the economy &
their own families. Currently, too many adults however, with autism are not
able to do this. Too many are dependent on benefits for their income and on
the care and support of their families, not only for housing but simply to
cope with everyday life.

12. • For those without support the outcome is worse: the risk of severe health and
mental health problems, homelessness & descent into isolation, crime &/or
addiction can be a reality. The costs in financial terms to public services are
enormous, the costs in emotional terms for both adults with autism & their
families are even more significant & difficult to quantify.
• Autism is a developmental disability that cannot be cured; although early &
appropriate intervention can help people fulfil their potential & lead relatively
independent lives. It is found throughout the whole IQ range, from profound
Learning Disability (LD) right up to superior levels of intellectual functioning.
• The government developed a national autism strategy in 2010 setting actions
for local authorities and local NHS bodies (updated in 2014). A set of quality
standards for autism (NICE 51) describing high-priority areas for quality
improvement were produced in 2014. A range of quality services and support
is required for each local area alongside tackling stereotyping &
discrimination. Equality of access is a fundamental principle of UK public
services, but it is clear that too often, adults with an ASC are not currently
able to access the services or support they need. People with autism should
have an equal right to a fulfilling life.

13. Some Recommendations from
Autism JSNA

14. The 2012 (CG142) and the 2013 (CG170) NICE guidelines have identified a series of
priorities which have been used to formulate Kingston’s recommendations in
conjunction with the local data, evidence of what is known to work and user &
stakeholder views.
1. Establish systems to improve the council’s data collection and use it in
conjunction with primary care data. Commissioners need to understanding that
effective services & interventions for people with autism who have learning
disabilities are distinctly different from those for people with autism without a
learning disability.
2. Ensure the Autism Board is responsible for developing, managing & evaluating
the local Kingston autism care pathway in line with NICE guidance, with a lead
professional responsible for overall implementation. This pathway should
promote a range of evidence based interventions & support adults with choice,
allowing them access when needed throughout their lifetime.
3. The local care pathway design should provide an integrated programme of care
across all settings, allowing services to be built around the pathway,
establishing clear links (including access & entry points) to other care pathways
(including those for physical healthcare needs) & have designated staff who are
responsible for the coordination of people's engagement with the pathway.

15. 4. Raise awareness of the single point of referral & expand to include self-
referral to the Kingston specialist service for adults with autism.
5. Utilise the Kingston specialist service for adults with autism to act as the
hub of service provision and specialist knowledge, training and support for
both adults with autism and professionals working with adults with autism
within Kingston
6. General autism awareness training should be available for everyone
working in health and social care key staff – such as GPs and those
responsible for conducting community care assessments should have
specialist training.
7. Explore RBK’s accommodation support for adults with autism in line with
the national housing strategy recommendations.
8. Raise the awareness about identification & assessment for possible autism
so that it is integrated into primary care / secondary care as standard
practice in order for prompt referrals to be made to the local assessment &
diagnostic service

16. Thank you
Any questions?