Leeds JSNA 2011Embedding JSNA In Our Future

Welcome and Introductions

Purpose Of The Event:• Place the JSNA within the context of the changing

landscape for the NHS and Local Authority• Share with all stakeholders the emerging findings of the

JSNA from the refreshed quantitative data set• Share the main themes gathered from the qualitative

analysis • Ensure we are producing a quality JSNA for Leeds• Ensure the JSNA leads to outcomes and actions across

the whole system

Leeds JSNA 2011

The Journey So FarLucy Jackson

A Picture Of Leeds- 2008/9 JSNA

It gave Clear priorities for partners:• Responding effectively to demographic change

- Over 75s and Children & Young People

• Responding effectively to specific health and well being challenges - Obesity, Alcohol, Drugs and Smoking

• Counteracting widening inequalities between neighbourhoods and key vulnerable groups

- Fragmentation across neighbourhoods and communities

Key Actions From The JSNA 2008/9Processes:• Embed the governance and accountability into wider partnership

arrangements • Closer alignment of planning and commissioning cycles (LCC and

NHS)• Joint Information Group and Strategic involvement group-

quantitative and qualitativeWork programme:• Populate data gaps (e.g. mental health needs assessment) and

improve projections and predictive modelling• Locality Profiling : Development of neighbourhood profiles at

MSOA level

Improving Quality • Review of HNA since 2009- common issues• HNA template agreed for improved quality• Using a wider source of data –CAB• Qualitative data- library- over 100 items and

counting• Intelligence not just information- story behind; key

recommendations from the data; down another level

JSNA In The New World• At the heart of the role of the new Health and Well Being

Boards is the development of the joint strategic needs assessment (JSNA).

• This provides an objective analysis of local current and future needs for adults and children, assembling a wide range of quantitative and qualitative data, including user views

• The JSNA will be the primary process for identifying needs and building a robust evidence base on which to base local commissioning plans

• Integral to the State of the City report – one source

2011 preparation• Refreshed over 100 data items from the core

data set• Analysed qualitative data library • 3 workshops to pull together • 108 MSOA profiles completed• Initially pulling of key themes together

Cross cutting priorities • Wider programmes that impact on health and well being –

focus on children, impact of poverty, housing, education , transport etc• Prevention programmes – focussing on smoking, alcohol weight

management, mental health, support• Early identification programmes – NHS Health Check/NAEDI; risk,

early referral for wider support• Increased awareness – e.g. of symptoms of key conditions, or

agencies/information• Secondary prevention programme –effective management health

and social • Increasingly move towards having a holistic focus - e.g. rather

than a long specific disease pathways, focussing instead on the person and their needs

• Impact assessment in terms of inequalities in health

Agenda09:00 Registration and Tea/Coffee

09:15 Welcome and Introduction Chair – Ian Cameron

09:30 Presentation Lucy Jackson/Nichola Stephens

10:15 Group Work Session A – Key Topic Areas

All

11:00 Break All

11:15 Group Work Session B – Quality Markers

All

12:15 Feedback From Group Work Alastair Cartwright

12:40 Closing Session Ian Cameron

13:00 Lunch in the Atrium All

Leeds JSNA 2011

This is LeedsJacky Pruckner and Nichola Stephens

Current Population• Latest ONS estimates show the Leeds’s population has

increased to 798,800 (an 11.6% increase from the 2001 Census)

• Leeds has a significantly higher proportion of people in the 20-29 age bracket

• The number of older people has been rising steadily since 2001, with the number of very elderly (85+) increasing by 20%

• Between 2000/01 and 2009/10 the number of births has increased by 35% with 10,202 children born in 2009/10

• GP registered population is currently just over 800,000

Population Projections• ONS projections show that the population could increase to

878,000 in the decade to 2018 and could reach 1 million by 2033 The 75+ population is expected to increase from 54,000 to

84,000 by 2033 (55% increase) with the number of very elderly (aged 85+) more than doubling in the same period (from 15,500 to 32,600)

Work done by the University of Leeds suggests the projected population may be closer to 950,00 by 2033

Results from the 2011 Census will provide a new population baseline

BME Population• The BME population has increased from 77,900 in 2001 (10.8%) to

137,200 in 2009 (17.4%)• Largest BME communities are Pakistani (22,500) and Indian (20,700)• 140 different ethnic groups living in the city• In 2009/10, 6,010 non-UK nationals registered for NI numbers from

addresses in Leeds• In April 2010, there were 1,390 asylum seekers known to be living in

the city• 22.5% of pupils are of BME heritage and there are now over 170

different first languages spoken in schools in Leeds

Population Groups That May Have Specific Needs

• Carers – 70,500 people provide some level of unpaid care– 2,000 young carers

• 21,312 pupils with Special Educational Needs• 1,488 Looked After Children• At least 10% of the population would identify as Lesbian, Gay

or Bisexual• Leeds currently has an estimated 2,600Roma

Population Groups That May Have Specific Needs

• During 2010 a total of 453 people were accepted as homeless and in priority

• 27,630 people aged 75+ are estimated to be living alone• In 2001, 18% of people felt that they had a limiting long-term

illness (proxy indicator for disability)• It is estimated that 15,500 people have a learning disability• Over 60,000 students studying in the city’s universities• There are just over 64,000 people claiming “out of work”

benefits (11.8%) and in June 2011 there were 22,047 Job Seekers Allowance claimants in Leeds (4.1%)

Income Deprivation• 45 of all the LSOAs in Leeds (9.5%) are in the most

deprived 10% on the National Scale for Income Deprivation Domain

• 33,000 Children under the age of 20 living in poverty in Leeds, 22.9% of children in this age range (compared to 21.6% for England) (2008 data)

• Child poverty is concentrated in the inner city areas • GP registered population under the age of 20 in

‘Deprived Leeds’ 38,799 (2011)

Social Care• 14,000 adults in Leeds receiving social care services

• 8603 service users identified as having a physical disability and receiving an Adult Social Care service during 2010/11

• Social Care in Leeds has lower numbers of service users for formal community care services than other local authorities but a higher proportion receiving direct access services.

The Cost To Health Care • The estimated costs to the NHS in Leeds of

diseases related to overweight and obesity were £197.4 million in 2007 and £204 million in 2010

• Obesity is the second most important preventable cause of ill health and death after smoking

• Alcohol related harm was estimated to have economic and social costs totalling £430 million in Leeds 2009 – these were costs to health, social care, criminal justice system, workplace and lost productivity.

• Costs for smoking attributable admissions to hospital in Leeds for adults over 35 £13 million

• Each smoking quitter will save the NHS £658 per year

The Cost To Health Care

A&E Attendances• A&E Attendances

– Leeds 255,672– Deprived Leeds 72,563

• A&E Attendances for Children– Leeds 64,408– Deprived Leeds 20,713

Emergency Admissions in 2010• Emergency Admissions

– Leeds 88,839– Deprived Leeds 26,152

• Emergency Admissions for Children– Leeds 14,273– Deprived Leeds 4,642

Admissions to hospital 2010• Alcohol Related Admissions

– Leeds 15,885– Deprived Leeds 4,731

• Respiratory Admissions– Leeds 11,449– Leeds Deprived 3,481

• Asthma Admissions Under 20s– Leeds 367– Leeds Deprived 105

Life Expectancy• At birth Life Expectancy 2007 – 2009

– Leeds 79.91– Deprived Leeds 76.08– Best ward Adel WhDale 83.61– Worst ward City Hunslet 74.08– Difference of 9.53 years across Leeds

Mortality deaths 2007 - 2009• CHD

– Leeds 2,989– Deprived Leeds 716

• Cancer– Leeds 2,534– Deprived Leeds 636

• Smoking– Leeds 10,069– Deprived Leeds 2,411

People On Disease RegistersCHD 28,681Heart Failure 5,637Stroke/TIA 13,646Hypertension 97,999Diabetes 31,920COPD 14,115Epilepsy 4,994Hypothyroidism 19,702Cancer 11,978Palliative Care 1,182Mental Health 7,285Asthma 46,648Dementia 4,068CKD 26,858Atrial Fibrillation 10,721Obesity 62,988Learning Disabilities 2,548

Drug Use• 6055 problematic drug users resident in Leeds

(2008/09 data)

• 23% boys and 21% of girls aged 11-15 had participated in taking illegal drugs (Leeds Estimates based on Smoking, Drinking and Drug Use Among Young People In England 2009)

Headlines from Qualitative analysis – Healthy Lifestyles

• Only half of young people do recommended exercise• Increase in older children eating unhealthy snacks• Improvement required for leisure services• Further advice and knowledge of services particularly

alcohol and sexual health • Costs high for buying healthy food

Access to services• Services preferred on a locality basis and within

neighbourhoods• More information required about services and how to access• People with learning disabilities felt that health workers

needed training to help them communicate and felt they often did not understand the information given about services

• Isolation a concern for families with children of ill health/carers and lack of support and advice

• Increase in leisure facilities and amenities

Older People• Limited knowledge on what services are available

and how to access• Increase in older women caring for grandchildren

often have multiple roles and needs• Poverty in later life for those who have taken on

carers roles• Locality based services preferred

Children• Anti social seen as a problem for young children• Concerns over not enough services for teenagers• Expectations play parks and facilities should be local and

within walking distance• References made to ill health and poor housing conditions• Support for carers around mental health issues and

depression was mentioned as need that seems to go ignored • Lack of information about services

Transport• Free travel off peak seen as a discrimination• An increase in access bus service required• Improvements required for public transport• Satisfaction declining over maintenance of

pavements and roads• Reluctance to travel far for services and facilitites

Quality Markers Discussion Feedback

Alastair Cartwright

Quality theme 1: Learn from the past. Review your JSNA and strategic partnerships to date.

Key issues to debate • Was it clear what partners wanted from the JSNA process last

time? Was a clear vision agreed? • Did our JSNA impact on commissioning and decision-making?

What worked and what didn’t? • What is our local experience of strategic partnership working?

How far have we come? (For example since five, ten, or 15 years ago?)

• Thinking in more detail – use the following prompts to help you.

Quality theme 2: Agree the scope and mandate for the JSNA

Key issues to debate • To what extent do we want our JSNA to drive all health and

wellbeing decisions? What influence and levers will it have to support this?

• To what extent will a health and wellbeing rationale drive all strategies across our locality? (For example, economic, regeneration, housing, etc)?

• Will the JSNA process drive our strategic collaboration with the non-statutory sector? (For example, business, voluntary sector, housing associations)?

Quality theme 3: Know your audience. Agree the users of your JSNA and what they need

from the process

Key issues to debate • Who will our JSNA primarily speak to – elected members,

commissioners, service providers, the voluntary sector, other non-statutory organisation, the public, or all of these?

• How do the needs of the JSNA differ? Are the needs of decision-makers on the Health and Wellbeing Board similar to the day-to-day needs of commissioners?

• To what extent is our JSNA expected to cater equally to these users? Are some more important than others?

Quality theme 4: Build trust and agree a shared process of strategic priority setting through

your JSNA and JHWS

Key issues to debate • How ready are we for a debate about shared, priority-setting

processes that scrutinise value and redirect money? • How will we handle the needs-assessment process moving

from hard data, through analysis and interpretation, to priority setting?

• How do we bridge the gap between the different needs, perspectives and languages of partners?

Quality theme 5: Match form to function and specify your JSNA products

Key issues to debate • Looking at products overleaf, what products will best meet

our intentions so far for JSNA? • Is our JSNA there to simply facilitate access to quality data or

is it also to provide intelligence and drive priority-setting? • How responsive will our JSNA be to the needs of audiences as

and when they arise?

Quality theme 6: Secure the capacity, skills, data and knowledge needed to deliver your

JSNA

Key issues to debate • Where is data on health and wellbeing found? What is needed

from outside of health, social care, public health and children’s services, for example schools, planning, economic regeneration, housing, the voluntary and private sector?

• Are existing JSNA analytical skills sufficient? Who is needed to complement the existing JSNA skill set?

• What is the capacity of wider partners to participate in the JSNA process? What could be done to encourage and facilitate this?

Quality theme 7: Agree governance and consolidate your vision into a clear

specification

Key issues for the health and wellbeing board to debate • Roles and responsibilities – who will need to do what, and

when, to make this work? • How will actions and priorities be set and recorded? • How will we know if our JSNA and JHWS are working? • Who will evaluate and review the process, and when?

Next Steps• Qualitative Analysis• Leeds Observatory - JSNA Portal • Key Recommendations and Summary

Document Production• Health and Well Being Board

Thank You