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SOUTH STAFFORDSHIRE PARTNERSHIPHEALTH MASTERCLASS FRIDAY 6TH JULY 2012
The future role of Joint Strategic Needs Assessments
Sue Wardle FFPH, Public Health Specialist (Health Intelligence)
JSNA – some facts and background
JSNAS AND JOINT HEALTH AND WELLBEING STRATEGIES
JSNAs will be the primary process for local leaders to identify local health and care needs, and building a robust evidence base on which local commissioning plans can be developed
Joint health and wellbeing strategy will set the priorities for collective action.
Taken together they will be the pillars of local decision-making, focussing leaders on the priorities for action and providing the evidence base for decisions about local services
BACKGROUND
JSNAs have been a statutory responsibility jointly held by the NHS and upper tier local authorities since 2007
Joint responsibility - Director of Public Health, Director of Adult Social Care and Director of Children’s Services
Aim is to identify the ‘big picture’ in relation to health and wellbeing needs and inequalities in the local population
Health and Social Care Bill proposes an enhanced and central role for the JSNA to bring together partners to analyse current and future health needs and produce a joint health and wellbeing strategy
From April 2013, LAs and CCGs will have equal and explicit obligations to do a JSNA – a duty discharged through HWBB
AN ENHANCED JSNA
Provide a comprehensive ‘picture of place’.
Look beyond needs to include assets (e.g.
environment, facilities, the local community
itself)
JSNA must consider current and future
health and social care needs
Requirement to involve people living or working
in the area
Requirement to involve district councils
Should cover the whole of the population across the life course from pre-conception to end of life
Include people in the most vulnerable
circumstances and excluded groups
DEVELOPING STAFFORDSHIRE ENHANCED JSNA
Local Authority profiles produced District and Boroughs ‘enhance’ the
profiles by adding Assets Community Voice Wider determinants of health
Produce eJSNAs by October 2012 District Health Leads meeting JSNA Working Group provides
Staffordshire overview Staffordshire eJSNA produced using a
bottom up approach Development of Local Intelligence
System
An Asset Based Approach
AN ASSET BASED APPROACH
A health asset is any factor or resource which enhances the ability of individuals, communities and populations to maintain and sustain health and wellbeing. These assets can operate at the level of the individual, family or community as protective and promoting factors to buffer against life’s stresses
Assets are the collective resources which individuals and communities have at their disposal, which protect against negative health outcomes and promote health status. These can be social, financial, physical, environmental, or human resources, eg employment, education and supportive networks.
KEY MESSAGES: WHAT MAKES US HEALTHY?
“Focusing on the positive is a public health intervention in its own right”
Asset based principles help to understand health of individuals and communities as a positive state and its determinants as factors that protect and promote health. These factors can be changed through social and civil and community action
KEY MESSAGES: WHAT MAKES US HEALTHY? The evidence for the positive impact of community and
individual ‘assets’ such as resilience, self determination, social networks and social support on health and wellbeing is at least comparable to that of more familiar social determinants of health such as housing, income and environment
‘Asset thinking’ challenges the framing of health as the prevention of illness and injury and instead looking at the promotion of wellness. It is possible to ‘get ill better’ because good wellbeing tend to mean that people seek help earlier and recover quicker.
Asset working can promote mental wellbeing which is both a cause and a consequence of inequality and physical ill health. The capacity and motivation to choose healthy behaviours are strongly influenced by mental well being as well as by socio-economic factors.
KEY MESSAGES: WHAT MAKES US HEALTHY? Work to improve health enhancing assets should
focus on psychosocial aspects eg resilience, confidence but also social, economic and environmental factors that influence inequalities and health and wellbeing – the causes of the causes.
Assets are held by individuals, families, neighbourhoods and institutions and they can be mobilised at any level. Communities are strengthened through the realisation of their own resources and connections but also by their ability to mobilise the resources of institutions and agencies and put them under their direction
KEY MESSAGES: WHAT MAKES US HEALTHY? The defining themes of asset based ways of
working are: place based; relationship based, citizen led and they promote social justice and equality.
Locally held assets are not the only answer to improving health and wellbeing and reducing health inequalities. There is a balance between meeting needs to tackle socio-economic disadvantage, tackling risk factors and developing resilience and wellbeing.
New evaluation methods are required for a health asset approach
EXAMPLE: WHY DON’T PEOPLE SMOKE?
The numbers of people not smoking have increased from 48% in 1948 to 79% in 2008, mainly due to the increase in numbers of people who don’t smoke.
An Appreciative Inquiry was commissioned in Salford to find out why people don’t smoke. The AI looked:- for a solution focussed point of viewat people’s motivations and drivers for not smokingat what the council and other partners could do to
support non smokers who live in an area with high levels of smoking and foster a culture of not smoking.
Adapted from p40 ‘What makes us healthy’
EXAMPLE: WHY DON’T PEOPLE SMOKE?
Things to make it easier for people to be non smokers, especially young people: Encourage young people’s own campaigns about smoking
and the tobacco industry Support work in schools on peer support and confidence
building, and open conversations about difficult issues such as peer pressure
Support hobbies, interests and activities that would be impaired by smoking
Work with parents and the local smoke-free homes project on the health impacts and the affect on home life
“I was so involved in dancing that I never wanted to smoke. Dancing gave me the initiative to stay healthy.”
ASSET WORKING MATRIX – WHERE IS SOUTH STAFFORDSHIRE?
Traditional professional service provision
Full co-production
User/community delivery of
professionally planned services
User co-delivery of professionally designed
services
Professional service provision but
users/communities involved in planning
and design
User/community delivery of co-planned or co-designed services
Self-organised community provision
User/community delivery of services
with little formal/professional
Professionals as sole service deliverers
Professionals as sole service planner
No professional input into service planning
Professionals and service
users/community as co-planners
Users/communities as sole deliverers
Professionals users/communities as
co-deliverers
Professionals as sole service deliverers
Responsibility for design of services
Re
spon
sibi
lity
for d
eliv
ery
of s
ervi
ces
Positive Wellbeing in Staffordshire
DISTRIBUTION OF WEMWBS SCORES
The WEMWBS scores for the main sample of residents had a mean of 52.13, a standard deviation of 9.26 and a range of 14 to 70
The chart shows the distribution of WEMWBS scores for the main sample of respondents. It shows that the largest proportion is within the ‘average well-being’ range – this is set to be within one standard deviation of the mean. Almost 16% of residents have ‘below average’ mental well-being as calculated using the WEMWBS. These are the group who may require focused interventions in the coming years
DIFFERENCES BY GENERAL HEALTH STATUS
There is a clear correlation between
perceived health status and mental
wellbeing. Residents with better
general health status have a
significantly higher average WEMWB
score. In addition, those residents who
have limiting long term illness or
disability have a lower mean WEMWB
score.
Cases were weighted by age, gender
and area.
Base sizes 112 173 191 100 37
DIFFERENCES BY SOCIAL NETWORKS
Differences in Mental Well-Being between Strength of Social Networks
Measure Difference Interpretation
Speak to family members
Not significant
Those who speak family regularly have similar levels of mental well-being as those who do not
Speak to friends Significant
Those who speak to friends regularly have a higher level of metal well-being than those who do not. For example, those who speak to friends everyday have WEMWBS score of 53.6, compared with 50.3 for those who speak to friends once a week or less often
Speak to neighbours
Not significant
No overall difference in WEMWBS between those who speak to neighbours regularly or less so
Text friends/family
Significant at 10% level (P=0.054)
Those who text more regularly have higher levels of mental well-being with those who do not
Email friends/family
Significant (see chart below)
Very high WEMWBS for those who email friends/family everyday
Go on chat rooms and social networking sites
Significant at 10% level (P=0.067)
Generally higher WEMWBS score amongst those who use social networking sites more regularly, but overall difference not significant at 10% level only.
Re social networks – generally those
residents who speak to or have other
types of contact with other people
regularly have higher levels of mental
wellbeing. However there are some
interesting exceptions – see table
MENTAL WELLBEING AND PERCEIVED QUALITY OF LIFESTYLE
There is a correlation between mental
wellbeing and perceived quality of
lifestyle There is a significant difference
in WEMWB score between those who
report having a very healthy lifestyle
and those who report less healthy
lifestyles. The WEMWBS score for
those who report having a very healthy
lifestyle is high (57.5)
There are some differences for the two
key lifestyle measures, smoking and
alcohol consumption. Those who
currently smoke had lower WEMWBS
than residents who have never smoked
(50.5 and 52.7 respectively). Smokers
who had now stopped also had higher
WEMWBS (52.2) than current smokersBase sizes 130 366 80 30 7
South Staffordshire District – Towards an Asset Approach?
SOUTH STAFFORDSHIRE LOCALITY DATA PROFILE
Why? ….. Different areas of South Staffordshire have different
needs, issues and priorities. That’s why in 2008 we broke down the districts into ‘localities’….. (we are) …using this data to make sure that our services are intelligence led so that we can target the right level of resources to the right people, at the right time’
Cllr Brian Edwards, Leader of South Staffordshire Council
SOUTH STAFFORDSHIRE LOCALITY DATA PROFILE
Setting the scene
Demographics
Customer insight
Children & Young People
Economic Vibrancy
Environmental Quality
Health and Wellbeing
Housing
Transport
HOW IS THE PROFILE USED?
Data ProfilesPartner agency ‘Health check’
Children and young people
Elected Member forums
V & CS forums
Partner organisation engagement
Face to face consultation
Ward walks & ward drop-in
Review consultation
Development of plans
PACTs
V & CS call for ideas
Draft plans for consultation
Final plans live April 2012
V & CS pilot with funding in each
locality
September
October
October
November
January
January / February
FebruaryJanuary deadline
February / March
February
February / March
March
SeptemberExternal locality planning cycle
End March - Signed off by partners
HOW HAVE THE PROFILES HELPED? SOME EXAMPLESIssues at district level are missed
Tackling a difficult issue – Caddick Farm Estate – “There are several alley ways that are overflowing with rubbish which is blocking escape routes for the residents, should there be a fire.”
Not everything is about extra funding – refocusing existing physical activity services
Taking a more holistic view – healthy families, Bilbrook
Target to achieve best value – Village Agents
Evidence to influence others - Rural Community Transport
Dispels ingrained myths – eg crime statistics
RESOURCES
http://www.thinklocalactpersonal.org.uk/_library/Resources/BCC/Evidence/what_makes_us_healthy.pdf
http://www.local.gov.uk/c/document_library/get_file?uuid=fc927d14-e25d-4be7-920c-1add80bb1d4e&groupId=10171
QUESTIONS/DISCUSSION
How far should we move towards an asset based approach?
What are the challenges to developing an asset approach in South Staffordshire District?
Where might the potential or opportunity be strongest to use an asset approach?
What examples do you already have? What could the next steps be? A Joint Strategic Assets Assessment?
DEVELOPING AN EXAMPLE OF ASSET WORKING IN SOUTH STAFFORDSHIRE
1. Choose an important topic 2. Discuss what an asset based approach to tackling this issue might look like
It might be useful to think about this under the following headings that underpin most asset based approaches: Asset based – values assets and approaches: Place based – works in the neighbourhood as the a space in which
networks come together and shared interests are negotiated and acted upon
Relationship-based – creates the conditions for reciprocity, mutuality and solidarity
Citizen-led – community-driven – empowers individuals and communities to take control of their lives
Social justice and equality – enables everyone to have access to the assets they need to flourish; equality and fairness are both determinants of wellbeing.
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