Joint Strategic Needs AssessmentWorkshop Crawley and Horsham & Mid Sussex CCGsMay 2012

Catherine Scott

Consultant in Public Health

Aims of workshop

• Share information on health needs of the population

• Identify key priorities for each locality to inform commissioning intentions 2012/13

• Identify areas where the JSNA needs to be developed to support CCGs

• JSNA document for each CCG to be used for authorisation process

The process of Joint Strategic Needs Assessment (JSNA)

JSNA – what it is

• The overarching primary evidence base on factors that influence the health of a population including the social, environmental, economic determinants of health

• Support for decision making– What are the gaps?– What evidence is there that we could do better?– What do we want to achieve?– What are the most effective and cost effective interventions?

• A dynamic and flexible process

• A range of products

IDEA

Why do we need it?

• Statutory responsibility for CCGs and LAs

• Demand is not the same as need

• Partnership working is the only way to address some issues

• A single agreed picture of needs is essential for strategic planning

JSNA framework

• Data collection– Routine data– Local research eg surveys– Professional views– Public/patient views

• Data analysis– Ad hoc query based analysis– Surveillance for unexpected– Modelling– Area based analysis– Benchmarking– Evaluation– Cost benefit analysis

• Interpretation in context– Statistical and methodological

issues– Evidence from research– Experience of practice– Local knowledge– National policy

• Communication– Website– Reports– Presentations– Briefings

What do we need to know?

• What are the outcomes and why?

• What do we expect to happen in future?

• What evidence is there that we could achieve better outcomes?

• What evidence is there that we could commission more effective and/or cost effective services without getting poorer outcomes?

• If we change one part of the system what impact will it have?

High level priorities for West Sussex• Children and families

– Child poverty– Education

• Working age– Cardiovascular disease– Fair employment

• Older people– Independence/Frail

elderly– Dementia

• Cross cutting issues– Inequalities– Housing– Early intervention– Carers– Ageing population– Mental health

The population

Definitions

Registered population

(June 2011)

Resident population

(2010 mid year estimates)

Crawley 123,900 107,600

Horsham & Mid Sx

223,200 212,235

High level health outcomes

Trend in male life expectancy1991-2010

68.0

70.0

72.0

74.0

76.0

78.0

80.0

82.0

84.0

1991

-93

1992

-94

1993

-95

1994

-96

1995

-97

1996

-98

1997

-99

1998

-00

1999

-01

2000

-02

2001

-03

2002

-04

2003

-05

2004

-06

2005

-07

2006

-08

2007

-09

2008

-10

Crawley

Horsham

Mid Sussex

ENGLAND

Trend in female life expectancy1991-2010

76.0

77.0

78.0

79.0

80.0

81.0

82.0

83.0

84.0

85.0

1991

-93

1992

-94

1993

-95

1994

-96

1995

-97

1996

-98

1997

-99

1998

-00

1999

-01

2000

-02

2001

-03

2002

-04

2003

-05

2004

-06

2005

-07

2006

-08

2007

-09

2008

-10

Crawley

Horsham

Mid Sussex

ENGLAND

Disability Free Life Expectancy

 

Males Females

Lifeexpectancy

at birth(years)

Disability freelife

expectancyat birth(years)

% withoutdisability

Lifeexpectanc

yat birth(years)

Disability freelife

expectancyat birth(years)

% withoutdisability

Crawley 78.6 72.4 92.1% 80.6 73.0 90.6%

Horsham 78.6 74.1 94.3% 82.7 77.0 93.1%

Mid Sussex 78.0 73.5 94.2% 81.4 75.9 93.2%

Infant Mortality Rate in West Sussex and England & Wales: 1974-2009 Source: ONS Vital Statistics

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

1974-1976 1977-1979 1980-1982 1983-1985 1986-1988 1989-1991 1992-1994 1995-1997 1998-2000 2001-2003 2004-2006 2007-2009

3 year period

Infa

nt m

ort

alit

y ra

te p

er

1,0

00

West Sussex England and Wales

Main causes of morbidity in males: UK 2004 : DALYs

Males

0

50

100

150

200

250

300

350

400

450

IHD

Alcohol

Depres

sion

COPD

Stroke

Lung

cance

r

Hearing

loss

Drug

use

Dementia

RTAs

Main causes of morbidity in females: UK 2004 : DALYs

Females

0

50

100

150

200

250

300

350

400

Depres

sion

IHD

Dementia

Stroke

COPD

Breast

canc

er

Hearing

loss

Lung

cance

r

Osteoa

rthrit

is

Alcohol

All Deaths (2011) Crawley and Horsham & Mid Sx CCGs

Registered population structureJune 2011

5.0% 3.0% 1.0% 1.0% 3.0% 5.0%

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+

Crawley Males Crawley Females

England Males England Females

Crawley Horsham and Mid Sx

5.0% 3.0% 1.0% 1.0% 3.0% 5.0%

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+

Horsham & Mid Sussex Males Horsham & Mid Sussex Females

England Males England Females

AGE - Actual and projected TFR, UK, 1951 - 2031

1.50

1.75

2.00

2.25

2.50

2.75

3.00

1951 1961 1971 1981 1991 2001 2011 2021 2031

Year

Ch

ild

ren

per

wo

man

1.50

1.75

2.00

2.25

2.50

2.75

3.00

Replacement level

TFR

Assumed

(Slide from ONS)

Unprecedented growth post-war to mid 1960s

Huge fall afterwards, many baby boomers not having children themselves, increases in recent years

Births

Registered population

2008 2009 2010 Mother aged <20

% low birth

weight

% BME mother

Crawley 1,529 1,579 1,727 75 8.3% 41%

Horsham & Mid Sx

2,369 2,311 2,327 69 5.7% 20%

Behavioural risk factors

‘Most non-communicable diseases are strongly associated and causally linked with four behaviours: tobacco use, unhealthy diet, physical inactivity and the harmful use of tobacco.’

- WHO 2010

Behavioural risk factors for non-communicable diseases in order of importance

Behaviour DALYS

(000s)Tobacco use 5,526

Alcohol use 3,165

Physical inactivity 2,189

Low fruit & veg intake 547

High income European countries, WHO 2009

Smoking rates 2009-11Ap

ril 0

9-M

ar 1

0

April

09-

Mar

10

April

09-

Mar

10

April

09-

Mar

10

April

09-

Mar

10

July

09

- Jun

e 10

July

09

- Jun

e 10

July

09

- Jun

e 10

July

09

- Jun

e 10

July

09

- Jun

e 10

Oct 0

9 - S

ept 1

0

Oct 0

9 - S

ept 1

0

Oct 0

9 - S

ept 1

0

Oct 0

9 - S

ept 1

0

Oct 0

9 - S

ept 1

0

Jan

10 -

Dec

10

Jan

10 -

Dec

10

Jan

10 -

Dec

10

Jan

10 -

Dec

10

Jan

10 -

Dec

10

April

10

- Mar

11

April

10

- Mar

11

April

10

- Mar

11

April

10

- Mar

11

April

10

- Mar

11

July

10

- Jun

e 11

July

10

- Jun

e 11

July

10

- Jun

e 11

July

10

- Jun

e 11

July

10

- Jun

e 11

Oct 1

0 - S

ept 1

1

Oct 1

0 - S

ept 1

1

Oct 1

0 - S

ept 1

1

Oct 1

0 - S

ept 1

1

Oct 1

0 - S

ept 1

1

0%

5%

10%

15%

20%

25%

30%

35%

40%

Crawley Horsham Mid Sussex West Sussex England

Admissions for alcohol-attributable conditions

2008/9-2011/12

0

100

200

300

400

500

600

2008

/9 -

Q1

2008

/9 -

Q2

2008

/9 -

Q3

2008

/9 -

Q4

2009

/10

- Q1

2009

/10

- Q2

2009

/10

- Q3

2009

/10

- Q4

2010

/11

- Q1

2010

/11

- Q2

2010

/11

- Q3

2010

/11

- Q4

2011

/12

- Q1

2011

/12

- Q2

Crawley

Horsham

Mid Sussex

West Sussex

England

Rate per 100,000

LA boundaries

Emergency admissions with a direct link to alcohol

Number Total Cost Rate/1,000 reg pop

£/1,000 reg pop

Crawley 211 £263,051 1.92 £2,397

Horsham 124 £172,399 1.62 £2,256

Mid Sx 236 £180,825 1.77 £1,353

North 571 £616,275 1.79 £1,927

Metabolic/physiological changes

‘These behaviours lead to four metabolic/physiological changes: hypertension, overweight/obesity, hyperglycaemia and hyperlipidaemia.’

- WHO 2010

Metabolic/physiological risk factors for non-communicable diseases in order of importance

DALYs (000s)

High blood pressure 3,807

Overweight & obesity 3,132

High blood glucose 3,208

High cholesterol 1,859

High income European countries, WHO 2009

Diabetes: what evidence is there that we can do better?

Prevalence expected to increase by 12,000 over next 20 years in West Sussex

Diabetes: QOF prevalence as a % of modelled prevalence

114.

1%

100.

7%

107.

0%

107.

6%

107.

7%

118.

1%

139.

7%

102.

7%

103.

7%

101.

3%

103.

4%

104.

1%

106.

8%

108.

3%

108.

6%

111.

6%

116.

2%

122.

8%

91.7

%

156.

3%

157.

4%

196.

7%

0%

20%

40%

60%

80%

100%

Y025

31

H82

088

H82

012

H82

098

H82

064

H82

026

Y003

51

H82

047

H82

050

H82

053

H82

025

H82

052

H82

033

H82

028

H82

017

H82

640

H82

092

H82

089

H82

027

H82

030

H82

036

H82

621

H82

084

H82

003

H82

100

H82

010

H82

063

H82

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H82

044

H82

072

H82

040

H82

008

H82

615

H82

056

H82

035

H82

004

H82

057

NO

RTH

CRA

WLE

Y

HO

RSH

AM

MID

SU

SSEX

WES

T SU

SSEX

National Diabetes Audit 2010

DM28 The percentage of patients with diabetes in whom the last IFCC-HbA1c is <=75 mmol/mol (9%)QMAS 2011/12

0%

20%

40%

60%

80%

100%H

8205

3

H82

047

H82

025

H82

033

H82

026

H82

052

H82

012

H82

064

Y003

51

H82

098

H82

088

H82

050

Y025

31

H82

092

H82

640

H82

027

H82

028

H82

036

H82

017

H82

089

H82

621

H82

010

H82

040

H82

100

H82

005

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035

H82

084

H82

057

H82

008

H82

003

H82

063

H82

004

H82

072

H82

615

H82

044

H82

056

Craw

ley

Hor

sham

Mid

Sus

sex

Nor

th

Wes

t Su

ssex

Achieved (Specifi c colour for each area) Exceptions Not achieved

Diabetes: emergency admissions: Rate/1,000 QOF registered patients: 2011/12

0

5

10

15

20

25

30

35

40

45

Y025

31

Y003

51

H820

64

H820

98

H820

47

H820

26

H820

50

H820

12

H820

53

H820

33

H820

52

H820

25

H820

88

H820

92

H820

89

H820

17

H826

40

H820

27

H820

36

H820

30

H820

28

H820

04

H820

35

H820

57

H820

56

H820

05

H826

15

H820

03

H826

21

H820

72

H820

40

H821

00

H820

63

H820

44

H820

10

H820

84

H820

08

NO

RTH

CRAW

LEY

HORS

HAM

MID

SU

SSEX

WES

T SU

SSEX

Diabetes patients experiencing any medication errors: RSCH 2011 (50% of 26 patients)

Source: National Diabetes Inpatient Audit 2012

Diabetes patients experiencing any medication errors: SaSH 2011 (32% of 68 patients)

Source: National Diabetes Inpatient Audit 2012

Evidence-based actions for CCGs on diabetes1. Set targets to tackle risk factors in primary care to reduce future

prevalence (eg brief interventions, referral to weight management services, Health Checks)

2. Local audits of patients receiving all 9 care processes with defined standards

3. Improve hospital care by specifying in contracts that diabetes care should be delivered by appropriately trained professionals

4. Local audits of medication errors in SaSH and BSUH5. Clarify local costs of treating patients with diabetes and consider

whether they can be reduced without compromising outcomes6. Ensure patients receive education and support to manage their

condition effectively7. Systematically seek patient views to ensure services (primary,

community and secondary care) are accessible, culturally appropriate and acceptable

Questions to consider• What needs to change, and is it something we control, something we can

influence, or something we can do nothing about?• What outcome do we want?• Is it an important health issue (mortality, morbidity, quality of life)?• Will it have a big effect on a few or a small effect on many?• Does an adequate treatment/pathway already exist?• What’s the level of public/patient support?• Will healthcare colleagues and partners support it?• What impact will it have on inequalities?• How quickly will we see the benefit?• Do we know what to do (evidence base) or are we innovating?• If we’re innovating how soon will we know whether it’s worked? And what

would be the consequences of failure?• Is it a national priority?• Is it cost saving, cost neutral or cost effective? • What’s the opportunity cost?