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Joint Strategic Needs Assessment (JSNA)


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Joint Strategic Needs Assessment (JSNA)

  1. 1. Joint Strategic Needs Assessment (JSNA) Seminar 29 th July 2010
  2. 2. 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>
  3. 3. What is JSNA?
  4. 4. 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
  5. 5. 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
  6. 6. Why need? Need: what people might benefit from Demand: what people might want to use Supply: what is actually provided Is it cost effective?
  7. 7. TASK 1: Understanding need, demand and supply
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. 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
  12. 12. 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>
  13. 13. What can Westminster’s JSNA tell us?
  14. 14. TASK 2: QUICK QUIZ
  15. 15. 1. What is the size of Westminster’s Population?
  16. 16. 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
  17. 18. 2. What is the difference in life expectancy between the most and least deprived wards?
  18. 19. 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
  19. 20. 3. Name three conditions that contribute to the life expectancy gap in Westminster
  20. 21. 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
  21. 22. 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.
  22. 23. 4. Name three of the most commonly spoken first languages in Westminster Schools (excl. English)
  23. 24. Diversity Public Health Annual Report
  24. 25. 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>
  25. 26. 5. What percentage of Children are obese?
  26. 27. 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
  27. 28. 6. What do you think Westminster residents perceive to have the biggest impact on their health?
  28. 29. 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
  29. 30. Model of health determinants
  30. 31. 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
  31. 32. 7. Where do Westminster rank for our number of homeless people out of 400 Local Authorities in England and Wales?
  32. 33. <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
  33. 34. 8. What is the prevalence of smoking in Westminster?
  34. 35. 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
  35. 36. 9. What proportion of the resident population drink over the recommended amounts of alcohol per week?
  36. 37. 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
  37. 38. 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>
  38. 39. 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>
  39. 40. How can I get involved?
  40. 41. 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 and click on JSNA tab </li></ul><ul><li>emailing 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
  41. 42. Find out more about Westminster’s JSNA <ul><li>Visit </li></ul><ul><li>And click on JSNA to see our page </li></ul><ul><li>Email [email_address] </li></ul>
  42. 43. 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>
  43. 44. The Westminster Observatory http:// NHSW employees click here Username: NHSWestminster Password: Monthyear e.g. July2010
  44. 45. 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>
  45. 46. What’s the future of JSNA?
  46. 47. <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>
  47. 48. How can I influence developments?
  48. 49. You said , we did
  49. 50. Better access to Public Health &quot;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>
  50. 51. 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 &quot;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>
  51. 52. 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”
  52. 53. QUESTIONS?