Joint Strategic Needs Assessment Workshop Crawley and Horsham & Mid Sussex CCGs May 2012

1. Joint Strategic Needs AssessmentWorkshop Crawley and Horsham & Mid Sussex CCGsMay 2012 Catherine Scott Consultant in Public Health

2. 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

3. The process of Joint Strategic Needs Assessment (JSNA)

4. 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

5. 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

6. 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 JSNA framework

7. 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?

8. 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 High level priorities for West Sussex

9. The population

11. Definitions

12. High level health outcomes

13. Trend in male life expectancy1991-2010

14. Trend in female life expectancy1991-2010

15. Disability Free Life Expectancy

17. Main causes of morbidity in males: UK 2004 : DALYs

18. Main causes of morbidity in females: UK 2004 : DALYs

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

20. What do we expect to happen in future?

21. Registered population structureJune 2011 Horsham and Mid Sx Crawley

22. AGE - Actual and projected TFR, UK, 1951 - 2031 Unprecedented growth post-war to mid 1960s Huge fall afterwards, many baby boomers not having children themselves, increases in recent years (Slide from ONS)

23. Births Registered population

24. Behavioural risk factors

25. ‘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

26. Behavioural risk factors for non-communicable diseases in order of importance High income European countries, WHO 2009

27. Deprivation Crawley Horsham & Mid Sx

28. Smoking rates 2009-11

29. Admissions for alcohol-attributable conditions 2008/9-2011/12 Rate per 100,000 LA boundaries

30. Emergency admissions with a direct link to alcohol

31. Metabolic/physiological changes

32. ‘These behaviours lead to four metabolic/physiological changes: hypertension, overweight/obesity, hyperglycaemia and hyperlipidaemia.’ - WHO 2010

33. Metabolic/physiological risk factors for non-communicable diseases in order of importance High income European countries, WHO 2009

34. Hypertension: QOF prevalence as a % of modelled prevalence 2011/12

35. Childhood obesity

36. Prevalence of multimorbidity by age and socioeconomic status: Scotland 2007 Barnet et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study The Lancet 10 May 2012

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

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

39. Diabetes: QOF prevalence as a % of modelled prevalence

40. National Diabetes Audit 2010

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

42. Diabetes spend and outcome: emergency admissions 2010/11 Source: SPOT tool YHPHO

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

44. Diabetes patients experiencing any medication errors: RSCH 2011 (50% of 26 patients) Source: National Diabetes Inpatient Audit 2012

45. Diabetes patients experiencing any medication errors: SaSH 2011 (32% of 68 patients) Source: National Diabetes Inpatient Audit 2012

46. Mortality of inpatients with diabetes by hospital: BSUH 2010/11

47. Mortality of inpatients with diabetes by hospital: SaSH 2010/11

48. Evidence-based actions for CCGs on diabetes • Set targets to tackle risk factors in primary care to reduce future prevalence (eg brief interventions, referral to weight management services, Health Checks) • Local audits of patients receiving all 9 care processes with defined standards • Improve hospital care by specifying in contracts that diabetes care should be delivered by appropriately trained professionals • Local audits of medication errors in SaSH and BSUH • Clarify local costs of treating patients with diabetes and consider whether they can be reduced without compromising outcomes • Ensure patients receive education and support to manage their condition effectively • Systematically seek patient views to ensure services (primary, community and secondary care) are accessible, culturally appropriate and acceptable

49. 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?