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

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. 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

9. The population

10. Definitions Registered population (June 2011) Resident population (2010 mid year estimates) Crawley123,900107,600 Horsham & Mid Sx 223,200212,235

11. High level health outcomes

12. Trend in male life expectancy 1991-2010

13. Trend in female life expectancy 1991-2010

14. Disability Free Life Expectancy MalesFemales Life expectancy at birth (years) Disability free life expectancy at birth (years) % without disability Life expectancy at birth (years) Disability free life expectancy at birth (years) % without disability Crawley78.672.492.1%80.673.090.6% Horsham78.674.194.3%82.777.093.1% Mid Sussex78.073.594.2%81.475.993.2%

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

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

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

19. Registered population structure June 2011 Crawley Horsham and Mid Sx

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

21. Births Registered population 200820092010Mother aged <20 % low birth weight % BME mother Crawley 1,5291,5791,727 758.3%41% Horsham & Mid Sx 2,3692,3112,327 695.7%20%

22. Behavioural risk factors

23. ‘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

24. Behavioural risk factors for non-communicable diseases in order of importance BehaviourDALYS (000s) Tobacco use5,526 Alcohol use3,165 Physical inactivity2,189 Low fruit & veg intake547 High income European countries, WHO 2009

25. Smoking rates 2009-11

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

27. Emergency admissions with a direct link to alcohol NumberTotal CostRate/1,000 reg pop £/1,000 reg pop Crawley211£263,0511.92£2,397 Horsham124£172,3991.62£2,256 Mid Sx236£180,8251.77£1,353 North571£616,2751.79£1,927

28. Metabolic/physiological changes

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

30. Metabolic/physiological risk factors for non-communicable diseases in order of importance DALYs (000s) High blood pressure3,807 Overweight & obesity3,132 High blood glucose3,208 High cholesterol1,859 High income European countries, WHO 2009

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

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

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

34. National Diabetes Audit 2010

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

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

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

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

39. Evidence-based actions for CCGs on diabetes 1.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 BSUH 5.Clarify local costs of treating patients with diabetes and consider whether they can be reduced without compromising outcomes 6.Ensure patients receive education and support to manage their condition effectively 7.Systematically seek patient views to ensure services (primary, community and secondary care) are accessible, culturally appropriate and acceptable

40. 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?