Post on 08-Jan-2016
description
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
005
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
H82
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?