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Joint Strategic Needs Assessment
(JSNA)
Seminar
29th July 2010
Objectives of the session
• What is JSNA?
• What can Westminster's JSNA tell us?
• How can I get involved?
• What’s the future of JSNA?
• How can I influence developments?
• Questions?
What is JSNA?
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
Commissioning Cycle
JSNA in WestminsterJSNA steering group
JSNA Oversight Group JSNA Information Group
•JSNA Analyst•Joint Commissioning Support•Children and Young People•Disease Commissioning•WCC analysts
•PH intelligence•Informatics•Involving people•WCC analysts•WCC Comms
Needs assessmentsProfiles
Literature review
Advice on data sourcesData 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?
TASK 1: Understanding need, demand and supply
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 Workbook1. Define the population e.g. Carers
2. Expected numbers, distribution and pattern by person, place and time.
3. Existing Services
4. Comparison with others
6. Information gaps?
7. Conclusions and Recommendations?
5. Evidence of Effectiveness
Summary• Joint Strategic Needs Assessment is:
– Joint between LA and NHS– Strategic – gives an overarching view of need and
informs strategy development and action planning– Health Needs Assessment model
• In Westminster JSNA is:– Rolling Programme of HNAs– Accessible information through the Westminster
Observatory.
What can Westminster’s JSNA tell us?
TASK 2: QUICK QUIZ
1. What is the size of Westminster’s Population?
Westminster’s Population
• ONS 2008 mid-year estimate 236,000
• GLA 2009 - round projection (high) 216,521
• 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
Public Health Annual Report
2. What is the difference in life expectancy between the most
and least deprived wards?
Harrow Road
Lancaster Gate
Bayswater
Hyde Park (ward)
Bryanston &Dorset Square
M: 77.1F: 85.9
M: 75.0F: 81.0
M: 84.0F: 83.6
M: 86.0F: 85.7
M: 82.3F: 85.8
M: 83.0F: 86.4
Westbourne
St. James’s
WarwickM: 77.7 F: 86.2
M: 78.9 F: 85.5
Public Health Annual Report
Inequalities in life expectancy
3. Name three conditions that contribute to the life expectancy gap in
Westminster
Deaths under 28 days, 4%
Other, 13%
Infectious & parasitic diseases, 4%
Digestive, 6%
Respiratory diseases, 14%
All cancers, 22%
All circulatory diseases, 32%
External causes, 5%
0%
20%
40%
60%
80%
100%
1
All circulatory diseases
All cancers
Respiratory diseases
Digestive
External causes
Infectious & parasitic diseases
Other
Deaths under 28 days
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
Mortality
MorbidityCVD 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)
Diversity
Public Health Annual Report
Ethnicity
• 72 ethnicities were identified as having more than 100 people belonging to that group in the census.
• 56% of respondents identified themselves as belonging to one of 334 groups other than “White British”.
• 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.
5. What percentage of Children are obese?
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
Obesity
6. What do you think Westminster residents
perceive to have the biggest impact on their health?
Wider determinants
Local people were asked:
“which of the wider determinants of health had the most significant impact on their health”
They said:
Income
Housing
Where they live
Health Inequalities Strategy
Model of health determinants
Education, Employment and Income
• Educational attainment, employment and income are linked to deprivation.
• 42 (35%) of Westminster SOAs are in the 20% most deprived SOAs in the country.
• Unemployment is associated with higher risk of depression and increased morbidity.
• The number of children in Westminster in low income families is higher than the national average.
Early years needs
assessment
7. Where do Westminster rank for our number of homeless
people out of 400 Local Authorities in England and
Wales?
Homelessness• Westminster has more people
without a roof over their head than any other borough in England.
• In Westminster 2,172 rough sleepers were contacted by building base services in 2008/09 (CHAIN)
• Average life expectancy for someone who sleeps rough is 42.
Fuel Poverty• Increasing energy prices = increasing
numbers of households into fuel poverty;
• 19,000 fuel poor households in Westminster (8% of the population)
• The large population of older people living alone and the relatively old housing stock in Westminster mean that fuel poverty is a particular issue.
Overcrowding• Westminster has a severe shortage of family size accommodation and families wait years for larger homes.• the 2001 Census reported over 5000 households living in overcrowded conditions (5.5% of population) ranking Westminster 12th most overcrowded borough in England. • 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.
Each have an
individual needs
assessment
Housing
8. What is the prevalence of smoking in Westminster?
Smoking
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.
• Estimated that 23% of residents smoke (similar to the average for England)
• 690 smoking attributable deaths in 2006
• Smoking prevalence in Westminster varies by ward - more deprived wards having higher smoking rates 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?
• Over a quarter of the resident population drink over the recommended amounts
• Approximately 6% drink at harmful levels and 3.6% are alcohol dependent
• In 2008-09 16% of residents who accessed services misused both alcohol and at least one drug problematically
• Westminster has an estimated 3,537 resident problematic drug users DAAT needs assessment
Alcohol and drugs
Other needs assessments
• Older People• Sexual health• Mental health• Autistic Spectrum Conditions• Carers• Hepatitis A• Learning disabilities• Physical disabilities• Eye services profile• And many more……
To see what’s coming up check out the JSNA Status Report
Summary
• What can Westminster’s JSNA tell us?– 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
– If the information isn’t available we may already be doing something on this or have something planned
• And what about our population?– Westminster is very diverse: ethnic mix, deprivation– Transient population, visitors and workers– Large working age and student population
How can I get involved?
The JSNA processFill out JSNA registration form available from:
• JSNA website http://westminstercitypartnership.org.uk/default.aspx and click on JSNA tab
• emailing [email protected] or Beth Searle
Submit form to JSNA team
You will be invited to the JSNA Oversight Group to discuss your request in more detail
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
Find out more about Westminster’s JSNA
• Visit http://westminstercitypartnership.org.uk/
And click on JSNA to see our page• Email [email protected]
JSNA and CDSS• Provides rapid 3 week responses to focused questions• Specialists in:
– Public Health intelligence – Public Health Information & Resource Unit and Policy review – Equality and diversity, Patient and public involvement and Inequalities– Economics – Clinical governance
• Examples of CDSS requests that have been submitted include investigating the:– links (if any) between children’s health & education– evidence for the effectiveness of food access projects– most effective community services model for reducing ENT waiting
lists. • Commissioning_Decision_Support_Services@westminster-
pct.nhs.uk • JSNA sometimes uses CDSS
The Westminster Observatory
http://westminstercitypartnership.org.uk/Pages/Observatory.aspx
NHSW employees click hereUsername: NHSWestminster
Password: Monthyear e.g. July2010
Summary
• 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.
• JSNA is different but complementary to CDSS:– CDSS = rapid appraisal using various PH
techniques to answer specific questions.
What’s the future of JSNA?
• The NHS White Paper “Equality and Excellence: Liberating the NHS” under section 4.19, page 35 outlines “Local authorities’ new functions:
• 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: – ……Leading joint strategic needs assessments, and promoting
collaboration on local commissioning plans, including by supporting joint commissioning arrangements where each party so wishes …….”
• Westminster has been asked to input into the development of the Department of Health’s strategy for JSNA.
How can I influence developments?
You said, we did
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
• Improved the internet and intranet
• TED training sessions
• Newsletters
• Induction
What JSNA could do betterNAs 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.”
• Commissioners have different requirements and needs
• JSNA needs to be flexible
Engaging commissioners
• Need to make sure NAs deliver what commissioners want
• Plea to commissioners to ASK and in plenty of TIME!
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”
QUESTIONS?
