The document summarizes a stakeholder workshop on a Joint Strategic Needs Assessment (JSNA) for transport and health in Cambridgeshire. The workshop discussed what a JSNA is, background and aims of the transport and health JSNA, and key topics of access and health, active transport, and air pollution. Attendees provided input on local issues, initiatives, and solutions for each topic. Next steps outlined forming working groups to analyze data and produce the JSNA to inform local decision-making.

1. Transport and Health JSNA
Stakeholder workshop
Angelique Mavrodaris
Emmeline Watkins
Iain Green
Public Health
19/11/2014

2. WELCOME AND
INTRODUCTIONS

3. WHAT IS A JSNA?

4. Joint Strategic Needs
Assessment (JSNA)
Commissioners & LA jointly describe
health, care & wellbeing needs & service
delivery
Focus on:
• Outcomes
• Partnership working
• Consultation
Drives commissioning process

5. The Local Government and
Public Involvement in Health
Act (2007) required upper tier
LA’s to produce a JSNA’s -
Health & Social Care Act 2012
gave this duty to Health &
Wellbeing Boards, with an
additional statutory duty to
prepare a joint health &
wellbeing strategy to identify the
needs identified in the JSNA
Statutory
Background

6. A summary table of the duties and powers
introduced by the Health and Social Care Act
2012 relevant to JSNAs and JHWSs
Key - X* duty must be discharged via HWB
LOCAL DEMOCRATIC LEGITMACY – POWERS AND
DUTIES
CCGs Local
Authority
NHS CB Local
Healthwatch
Health and
Wellbeing
Board
Functions of health and wellbeing board
Duty to prepare assessment of needs (JSNA) in relation
to LA area and have regard to guidance from Secretary
of State
X* X* X (to
participate)
X
Duty to prepare JHWSs for meeting needs included in
JSNA in relation to LA area and to have regard to
guidance from Secretary of State
X* X* X (to
participate)
X
Duty to involve third parties in preparation of JSNAs:
•Local Healthwatch
•People living or working in the area
•For County Councils – each relevant DC
X* X* X
Power to consult any persons it thinks appropriate in
preparation of JSNAs
X* X* X
Duty to have regard to the NHS Commissioning Board
mandate in developing the JSNA and JHWS
X* X* X
Duty to publish JSNAs X* X
Impact of duties on other associated functions
Duty to have regard to relevant JSNAs and JHWSs in
the exercise of relevant functions
X [in exercising
any functions]
X [in exercising
any functions]
X [in exercising
any relevant
commissioning
functions

8. JSNA Impact
Provide clearer idea of what is needed
Deliver what people want
Evidence decisions – enable
stakeholders to but into change
Identify best interventions
Ensure range of interventions available &
accessible
Inform more effective & economic
configuration of services

10. BACKGROUND AND AIMS OF
TRANSPORT AND HEALTH JSNA

11. Background and
context
 The purpose of this JSNA is to support HWB Priority 5,
focus areas 1&3: Create a sustainable environment in
which communities can flourish:
 Develop and maintain effective, accessible and affordable transport links and
networks, within and between communities, which ensure access to services and
amenities and reduce road traffic accidents;
 Encourage the use of green open spaces including public rights of way, and
activities such as walking and cycling’.
 The JSNA will also gather information on long distance
transport to specialist hospital services
Linking to other counties (e.g. NCC) and PHE to ensure a
regional approach where appropriate

12. Transport and Health
JSNA priority areas
Access and health: An evaluation of transport and
social/geographical isolation in Cambridgeshire and the
impact on health; directly or due to barriers in accessing
specialist and every day care.
Active transport: Evaluation of transport strategies and
initiatives that promote physical activity such as utilitarian
walking and cycling and impact on health
Air pollution: An evaluation of Cambridgeshire air
quality, hot spots and their impact on long-term
conditions such as asthma and COPD and their life
course

13. For each topic
 Evidence review
 Assessment of local status and need
 Local access and transport data
 Overlaid with information on health,
deprivation and demand
Identification of inequalities, gaps and
opportunities

14. Transport Policy impacts
health outcomes

15. Syed 2013, Systematic review, mainly US
Missing
appointments
Delays in care
Burden on relatives
No regular source
of care
Links with car
ownership
Inequalities, vulnerable
groups
Lower prescription fill
rates
E.g. Hospital admissions for
diabetic ketoacidosis
67% related to stopping insulin
50% cited lack of money or
transport issues
Access and health

16. What can we find out
locally?
 Access issues
 Availability, eligibility, awareness, use of various transport types
 Travel time to key health services in rural and urban areas in
Cambridgeshire
 Impact of current transport arrangements on patient and carer quality
of life
 Assessment of need for long-distance transport
What the JSNA adds:
 Transport data will be overlaid with potential impact on health
 E.g. mapping of health demand, vulnerable groups, inequalities, high
disease prevalence areas with access issues

17. Active transport and
health
 NICE local government briefing: walking and cycling (Jan
2013)
 ensuring there is a network of paths for walking and cycling between places
locally
 reducing road danger and perception of danger
 ensuring local strategy, policy and planning support walking and
cycling
 using local data, communication and evaluation to develop
programmes
 including practical support, information about options
 focus on key settings
 recognising the health benefits
Models to show health impact of walking/cycling initiatives

18. What can we find out
locally?
 Assessment of current active transport in
Cambridgeshire
 Rates of walking and cycling
 Identification of local gaps, inequalities and
opportunities
 RTAs covered by C&P Road Safety
Partnership
 Potential for building on this by analysis of
 Vulnerable users e.g. pedestrian, >75 years
 Slight injuries

19. Air pollution influences
lung function across the life course
 PHE estimates that there are
257 deaths attributable to air
pollution in Cambridgeshire
 Based on PM 2.5, local population
and 2010 mortality data
 Likely to contribute a small amount
to deaths of a larger number of
exposed
 Impacts
 Lung function,
 Asthma/COPD exacerbations
 Hospital admissions for respiratory
and cardiovascular conditions
 Mortality
 Short and long-term
consequences
Ben-Shlomo 2002

20. What can we find out
locally?
Assessment of current and future hot spots in
Cambridgeshire and their potential health impact on
nearby development
 New growth
 Road changes
 Timeline for Air Quality Strategy for City, South and Hunts has
been delayed to allow for JSNA evidence
Identification of vulnerable groups and potential health
impact

21. WHERE COULD YOU USE
HEALTH DATA?

22. Where could you use
transport and health data?
 Create a timeline showing activities in
the next 2 years where you could use
transport and health evidence
 What sort of information would be useful?
 What are the deadlines for this work?
Flip charts and post-its available for timelines

23. Feedback on timelines

24. TRANSPORT, ISOLATION AND
HEALTH

25. Wendy Otter
Fenland District Council

26. Overview – Fenland District
• Around 20,000 people live in villages or more
sparsely populated areas in Fenland
• 22% of residents are of retirement age, higher than
the national average
• Around 20% of households within the district do not
own a car
• Public transport availability varies across Fenland
but for many of our smaller communities is limited.

27. Transport & Health Issues
• People can’t get to medical appointments,
especially hospital appointments.
• Cost of transport
• Reliance on family and friends
• Older people often have more complex health
needs but also complex travel needs
• A lack of transport Information
• A lack of useable transport information
• Health problems can often be sudden - A change
in circumstances for transport

28. Addressing the Barriers 1
How did we set about addressing the transport and health issues in
Fenland & Why?
•Evidence:
– to address a situation you have to fully understand
what the problem actually is
– Mapping – addresses of concessionary fare pass
holders, bus stops and bus routes, and locations no
more than 400metres from a bus stop
– 2011 research to understand the access to
healthcare needs of patients in Fenland
– 2013 Audits of car and cycle parking. Assessment of
surgeries in relation to bus stops & services

29. Addressing the Barriers 2
• Stakeholders – Understanding who needed to be
involved. Working with colleagues to build relationships
with our GP surgeries and the 2 community hospitals.
Just under 1500 questionnaires were returned in 2011
• A lack of transport Information – Where do I find out
about transport?
• A lack of useable transport information – new ways to
present information:
– Fenland Transport Directory
– Getting from A to B Case Studies

30. Addressing the Barriers 3
• Making information available
- Where do people go to access information?
- Different people access information in different ways
- Information therefore has to be available in many
ways

31. Current Issues
• Early and late appointments are an issue due to a lack
of public and community transport
• Hospital appointments especially those further away
from Fenland e.g. Cambridge & Norwich
• Eligibility for NHS Patient Transport – many people are no
longer able to access patient transport
• Affordability
• Opportunities to link NHS transport and public transport

32. • Any Questions?

33. Transport, isolation
and health
 What are the key transport barriers to
accessing services from your viewpoint?
 How do these impact on health?
Post-its and flip charts provided

34. Prioritise
 Have a look at the issues/barriers that all
tables have identified
 Which are the most important issues
 You have 5 sticky dots to put against topics
you feel are most important
 Distribute, or put all dots on one topic…
 TEA!

35. Feedback on access

36. Solutions
 Each table has been given a key barrier
to accessing services
 How could this be addressed?
 What works/doesn’t work
Post-its and flip charts provided

37. Feedback on solutions

38. ACTIVE TRANSPORT

39. Dr Jenna Panter
Centre for Diet and Activity Research
CEDAR

40. Ongoing initiatives in
Cambridgeshire
 List active transport initiatives in
Cambridgeshire
 Focus on utilitarian active transport
 (Leisure walking/cycling initiative is being
captured through Naturally Healthy)
Please indicate if there is data available
Several A3 tables available per group

41. Active transport initiatives
Name of
initiative
Cycling/
walking
Area
covered
Date
launched
Data
available
Contact

42. What works?
 Why have initiatives been successful?
 What have been the barriers?
 Has health impact been included in
evaluation?
Post-its and flip charts provided

43. Feedback

44. AIR POLLUTION

45. Marcus Bell
Cambridgeshire Pollution Prevention Group

46. Local Air Quality Management - LAQM
The Environment Act 1995 sets out a framework for LAQM.
This requires every local authority to systematically review the air quality
within their boundaries against a set of air quality objectives.
LAQM sets out a reporting structure in the form of annual review and
assessment, where councils must assess the likelihood of achieving the air
quality objectives for key pollutants.
The EC has formally launched infraction proceedings against the UK for
breach of the nitrogen dioxide air quality limit values under
The Government powers under the Localism Act 2011 to transfer this fine
on to Local Authorities that have failed to carry out responsibilities under
LAQM.

47. LAQM annual review and assessment
• A staged investigation into pollutant levels with progressively more
in-depth study depending on the likelihood of exceeding the specified
objective for any given pollutant.
• The first round of review and assessment began in 1998 with each
round taking around three years. The first stage is to undertake an
updating and screening assessment (USA) to identify any changes
since the previous round which may lead to the exceedence of the air
quality objectives (AQOs) .
• If the USA highlights that an exceedance is likely then a detailed
assessment of the pollutants and locations of concern is necessary.
The aim of the detailed assessment is to determine the magnitude
and extent of any likely exceedences of the AQOs. If the USA indicates
that all AQOs will be met then the local authority simply proceeds to
a progress report.
• District Councils operate networks of non continuous monitors (such
as diffusion tubes ) as well as continuous monitors, checking
concentrations of pollutants 24hrs day.

48. Air Quality Management Areas
(AQMA)
• Where an AQO is unlikely to be met the local authority must designate an air quality
management area (AQMA) and draw up an air quality action plan setting out measures to be
introduced in pursuit of the air quality objectives.
• Following declaration of an AQMA, a further assessment needs to be carried out to confirm
that the AQMA declaration is justified, that the appropriate area has been declared, to
ascertain the sources contributing to the exceedence and to calculate the magnitude of
reduction in emissions required to achieve the objective. This information can be used to
inform an Air Quality Action Plan, which will identify measures to improve local air quality.
• Some local authorities develop regional AQAPs. Defra have endorsed preparation of a Joint
Air Quality Action Plan for the AQMAs within Cambridge City, Huntingdonshire District
Council and South Cambridgeshire District Council. There are no AQMAs in East
Cambridgeshire but the Station Road area is being looked at and will be affected by Southern
Bypass.
• Over 220 local authorities have declared AQMAs, mainly for exceedences of the annual
average objective for nitrogen dioxide and also, to a lesser degree, the short term objective
for PM10. Road transport sources are the main cause of AQMA declarations.

49. LAQM IS CURRENTLY UNDER REVIEW. ‘DEFRA WILL EXPLORE ALL ALTERNATIVES WITH KEY DELIVERY
PARTNERS IN THE EARLY PART OF 2014, THE OUTCOME OF WHICH WILL INFORM A SECOND
CONSULTATION (IN MID-LATE 2014) ON REGULATORY CHANGES AND GUIDANCE’.

50. Local air pollution
issues
 What are the key local issues around air
quality?
 How can this be addressed through
transport and planning?
 What health data is needed to help drive
this?
Flip charts and post-its available

51. Feedback

52. Next steps –
producing the JSNA together
Specific Working Groups
 Data and modelling
 Accessibility
 Active Transport
 Air pollution
Evidence review/data analysis work streams
November-February 2015
Additional stakeholder meetings in 1Q 2015
JSNA to Health and Wellbeing Board in April 2015

53. Please get involved
Thanks!
Contact details
angelique.mavrodaris@cambridgeshire.gov.uk
emmeline.watkins@cambridgeshire.gov.uk
iain.green@cambridgeshire.gov.uk