Lancashire’s Joint Strategic Needs Assessment: Older People’s health and wellbeing

1. Lancashire’s Joint Strategic Needs Assessment: Older People’s health and wellbeing Debs Harkins

2. Overview • Background to the Lancashire JSNA • Lancashire’s health and wellbeing strategy • The health and wellbeing of older people in Lancashire – our priorities

3. What is a JSNA? • JSNA required for each upper tier council • Initially joint responsibility of Directors of Public Health, Adult Social Care and Children and Young People • 2012 Health Act – Undertaking a JSNA one of the four roles of the Health and Wellbeing Board • CCGs to ‘have regard to the JSNA’ in their commissioning decisions

4. Lancashire’s JSNA High level strategic analyses to inform priority setting: Health inequalities;children and young people; mental health and wellbeing; older people; alcohol, drugs and tobacco; learning disability

5. Lancashire JSNA – limitations and areas for development • Needs to systematically include intelligence about community assets as well as needs • Needs to systematically include intelligence about community’s own perceptions of their health and wellbeing needs • Need to further engage Clinical Commissioning Groups in the development of the JSNA

6. What should the JSNA inform? • Strategic decisions about health and wellbeing • Health and Wellbeing Strategy • Strategic commissioning plans of partners • Children and Young People’s plans • CCG commissioning plans • Adult social care commissioning intentions • Public health commissioning plans

7. Lancashire’s Health and Wellbeing Strategy

8. Purpose of the strategy Work together... • Achieve shifts in the way that partners work; resulting in more effective collaboration and greater impact on health and wellbeing. • Learn the lessons arising from this collaboration to strengthen future working together. ... Get results • Deliver improvements in ‘priority outcomes’. • Deliver early interventions i.e. specific areas for action that will help deliver the priority outcomes whilst ‘modelling’ desired shifts in the ways that partners work together.

9. Priority shifts • Prevention - Shift resources towards interventions that prevent ill health and reduce demand for acute and residential services. • Assets approaches - Build and utilise the assets, skills and resources of our citizens and communities. • Self-care - Promote and support greater individual self-care and responsibility for health; making better use of information technology and advice. • Accessible, joined up services - Commit to delivering accessible services within communities; improving the experience of moving between primary, hospital and social care. • Share resources - Pool budgets and resources to focus on priority outcomes. • Equity - Work to narrow the gap in health and wellbeing and its determinants.

10. Health and Wellbeing Strategy 2012-2020 MMmmm • Maternal and child health • To provide accessible and effective support and services to new and expectant families • To promote and safeguard the health and wellbeing of pre-school age children • Mental Health and Wellbeing • To promote emotional health and wellbeing in children and adults • To support people of all ages who are affected by mental health play a full and active role in society • Long term conditions • To reduce the incidence of, and morality from, long term conditions • To improve quality of life for people with long term conditions and their carers • Improve health and independence of older people • To increase health life expectancy for those aged 65 • To support older people and their carers play a full and active role in society Identify those who are at risk of admission into hospital and provide appropriate intervention Holistic support to vulnerable families (from first pregnancy) Early response to domestic abuse Support for carers Address loneliness in older people Affordable warmth AlcAlc Healthy Weight -environmental measures Tackling smoking in pregnancy Self-care – encourage people to take control of their own health and wellbeing Alcohol liaison nurses

11. The health and wellbeing of older people in Lancashire

12. Older people background • Leadership group agreed need to do a large JSNA on older people • Project group established involving mainly analysts from PCTs & LCC • Difficulties identifying a sponsor • Decision taken to develop a data compendium instead of going through the complete JSNA process • Project group (analysts) identified key issues • Prioritisation workshop with partners

13. Scope • People aged 50+ (Age UK definition) • Lancashire-12 the 12 district and county council area

14. Key issues Long term conditions • Numbers with cardio vascular disease, cancers, respiratory disease and diabetes are on the increase • Increase healthy life expectancy, not just life expectancy • Improving management including self-management - keeping people out of hospital and moving services from secondary to primary and community care • Prevention of LTCs - lifestyles • There are some low cost quick wins: identification and brief advice for lifestyle issues, identification and intensive management of repeat attendees etc • Shortage of intermediate care services can cause hospital discharge delays and readmissions

15. Key issues Falls • Almost 20,000 A&E attendances for falls in Lancashire in 2010 • A third were in people aged 60+ and two thirds of these occurred in the home • Causes include mobility/balance difficulties, poor eyesight, illness (stroke, arthritis etc), home hazards (unsuitable footwear, loose carpet, steep stairs etc) external (snow/ice) • Lack of social support • Immobility after a fall can lead to respiratory problems in the elderly Dementia • Increase in numbers affected at a time of reducing resources – 14,000 people in 2010  21,000 in 2025. • Identifying the unknown sufferers – many cases undiagnosed • Provision of information and support services even if no medical treatment is available

16. Key issues End of life and palliative care • Difference between the number of people who want to die at home and those who actually do - most deaths in England occur in NHS hospitals, with deaths at home and in care homes collectively accounting for around 35% of all deaths • Good range of services for cancer but not for other illnesses • More support needed for patients, their carers and families

17. Key issues Lifestyles • Alcohol consumption, particularly males and those confined to the home - increased risk of falls and obesity • Tobacco - increased risk of COPD and cancers • Physical activity - keeping mobile for longer, bone density, preventing obesity • Diet – obesity • Prescription medication: medicines management for those on multiple treatments

18. Key issues – care and support Carers • Identifying unknown carers • Many don’t consider themselves carers, two thirds don’t access carers’ allowances • Economic costs from non-participation in labour market • A rise in the number of older carers due to the increasingly older population Social care • Changes to eligibility criteria will leave some current service users without provision • Illnesses become worse during delays accessing services, this also impacts on carers

19. Key issues Loneliness and social isolation • Depression and social isolation impacts on mortality and morbidity • Older people are more likely to fear harassment or intimidation than people of other ages • Lack of social support means older people are increasingly reliant on social services: Over 95% of ‘Supporting People’ users say support helps them avoid moving into residential care accommodation; ‘Help Direct’ has seen a fourfold increase in contacts since 2009. • Rural isolation • Approx. 40,000 people aged 65+ have mobility difficulties; predicted to increase by 25% by 2020 • 93,000 older people predicted to have a hearing impairment (only 3,500 of these registered)

20. Key issues – Living conditions Housing • Safety – falls • Affordable warmth – reducing excess winter deaths • Availability of appropriate social or private housing that enables older people to retain connections with the community • Maintaining independence for as long as people want it Fuel poverty and affordable warmth • Reducing excess winter deaths – main causes are COPD, flu, pneumonia and cardiovascular disease • Pan-Lancashire 141,096 households (23.1%) were in fuel poverty in 2009 • 627 excess winter deaths across Lancashire county in 2008-10

21. Priorities • Prevention and protection in a Safe Environment • Support for healthy lifestyles • Improve mental health and wellbeing • Address long term conditions and improve end of life care • Support carers • Ensure integrated Services and pathways for older people

22. Conclusions • Priorities strongly align with shifts and outcomes in Health and Wellbeing Strategy • Priority interventions • Support carers • Address loneliness in older people • Self care • Affordable warmth • Prevent hospitalisation in those with long term conditions

23. Thanks for listening Any questions?