JSNA: duty or pleasure?
How it really felt in Kirklees
Phil Longworth, Adults & Community Services, Kirklees Council
Dr Judith Hooper, Director of Public Health, Kirklees PCT/Council
Margaret Watt, Adults & Community Services, Kirklees Council
Matthew Holland, Children & Young People’s Service, Kirklees Council
Deborah Collis, Public Health, Kirklees PCT
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What we will cover
• what we did to develop our JSNA
• what we included – and what we didn’t
• what our ideas are about further developing our JSNA
15m
From an Adults Services, Children’s Services, PCT perspective:
• how the JSNA is being used locally – and if it’s making any
difference
• how it felt for those involved
• what we have learnt from our experiences
15m
• Table discussion
• Mixed groups
• Q&A
Joint Strategic Needs Assessment for Kirklees
20m
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What does this all mean for leaders in Adult
Services, Children's Services, Public Health?
• Collaboration
• How Directors can work together to improve well being and life
outcomes for people in their locality?
• Challenges
• What are the common and what are the separate challenges
• Leadership development needs
• Group members own leadership development needs – rather than
those of others in the system
• Barriers
• Barriers to effective development of health, children’s and social
care systems that might be ameliorated by good leadership
interventions?
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What we did to develop our
JSNA
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Timeline
• Early discussions
Spring 07
– Commissioning Framework for Health and Well-being March 07
– Guidance due October 07
• Data collection
Summer/Autumn 07
• Workshops
Autumn 07
• Briefings
Autumn 07
– LSP Board, Picture of Kirklees, LAA
• Publication
Feb 08
– Summary – target Councillors/ NEDs
– Detailed report (also DPH report) – commissioners, planners, PBC’ers
• ‘Sign off’
Feb/Mar 08
– Cabinet, PCT Board, LSP Executive, LPSBs
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What we were trying to achieve
• Aim
– to describe the future health and well-being needs of local
population and to inform the strategic direction of services to
meet those needs
• Boundaries of the JSNA
– Adults:
health and social needs
– Children:
start with health issues
Issues not solutions
• Products from the JSNA
– a (well organised!) warehouse of data
– clear set of key issues
– summary and detailed report
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Key principles
• Keep it manageable.
• Start with what we need to know – not what is available
• Ongoing, longer term piece of work
• JSNA is not a commissioning plan
• Some key issues need a joint response, some do not
• Bringing in more partners in the future will make our picture
richer, broader and deeper
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National
Dataset
Public Health
Information
Local
Commissioning
Local Peoples
Views and Experiences
Intelligence
Research and
Health & Social
Trends
Care Prevalence
Information
Informing
Information
Joint Strategic Needs Assessment
Informing
Priority Setting
Influencing
Community
Local Area
Agreement
Strategy
PCT & PBC Business Plans
Locality
Plans
Children &
Young People’s
Plan
Client Group / Issue Based
Commissioning Plans
eg Mental Health,
Older People,
Obesity, Long term Conditions
Housing / Supporting
People Strategies
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The Benefits of JSNA
• improve need assessment and commissioning information
• make our decision making more evidence based
• doing it jointly makes the information more robust, and access
to a wider set of data sources
• think about how we store information and update it
• focuses our minds on the longer term – 5, 10, 20 years
• help us to check out if our priorities are the right ones
• identifies gaps in our knowledge – where we don’t know what we
need to know!
• developed jointly leads to joint ownership
• Independence…. DPH report
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What we included in our JSNA
and what we didn’t
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Sources of needs information
• perceptions of the profiled population (from local surveys)
• data about population characteristics and the severity and size
of the issues i.e. who, when and where has what issues
• relevant national, local or regional priorities
• perceptions of managers of commissioner / provider
organisations
• perceptions of people providing the services
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Data
• Collate indicators
–
–
–
–
–
–
Children: ECM outcomes and JAR relevant to health
Health: existing set of health indicators
Adults: Dartford plus relevant national & local data for each care group
Weeding and adding
Localities data
National data set from Guidance – as cross check
• Assemble data
– tables & maps
• Analysis of data
– draw out ‘big’ messages
– focus on Kirklees level
– developing locality summaries
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Priority themes
Health Conditions
• Emotional well being and mental
ill-health
• Obesity
• Pain
• Dementia
• Heart disease and stroke
• Diabetes
Wider factors
• Housing condition and options
• Work and not being able to work
especially due to illness/disability
• Isolation and social networks
• Educational attainment
Personal Behaviours
• Food
• Alcohol
• Smoking
• Physical activity
Specific populations
• Children and adults with
disabilities
– increasing numbers of people with
profound and multiple disabilities,
including learning disabilities
•
Women of child bearing age
•
Older people
•
Carers
– personal behaviours and infant
deaths
– increasing numbers particularly
more vulnerable
– providing an ever greater
proportion of community care
NB helping people to help themselves
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Vall
Spn
HS
HN
Mirf
Dew
DDK
B&B
Indicator
Health Functioning
Pain
Depression, Anxiety or other Nervous Illness
Cancer registration - Breast
Heart disease
Heart, Stroke deaths
High blood pressure
Stroke
Incontinence of urine
Diabetes
Obesity
Cancer deaths
Deaths All Causes
Personal Behaviours
Smoking
Alcohol over
excess
males
excess
females
Enough physical activity
Living and Working
Low income
Housing - overcrowding
Bat
Local Health Inequalities
adults 2007
Locality
under 65
under 75
under 75
15-64
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Dewsbury
Adults
Worst health in Kirklees for most aspects esp.
– Heart disease no. & early deaths
– Diabetes.
– Low income
Children & Young People
–
–
–
–
–
–
Infant deaths:
women overweight, binging alcohol, smoking @ birth
Rotten teeth: rotten diet
Smoking
Little physical activity
Unhappy at school
GCSEs low levels
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Developing our JSNA
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What next for the JSNA?
• JSNA ‘Technical Group’
• Adults/Children's/Housing Services, Corporate Research, PCT
• For the ‘Intelligence System’
•
•
•
•
•
•
•
•
asking the right questions
more coherent, consistent and appropriate data sets
trends, projections and comparators
use of ‘voice’, service use and market information
strengthen housing
‘factsheets’ on main adult service user groups
regular refresh
developing the capacity to generate, analyse and present the
appropriate data and information – ‘integrated intelligence’
• For the ‘Planning System’
• ensuring the relevant planning systems use the products of the
JSNA
• help Technical Group shape the questions and products
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The right questions?
•
What is the future shape of the population, especially in terms of age and ethnicity
and migration patterns?
–
•
How have the key issues we have identified changed over time and how will they
change over the next 5/10/15 years?
–
–
•
What are the potential impacts of changes in health and social care technology and care
practice?
What are the key challenges in developing self-efficacy related to health and social care
issues? e.g. what are attitudes of different client and professional groups to increasing
emphasis on self-care?
What are the particular issues for the specific population groups we have identified?
–
•
What impact will this changing shape have on the major issues we have already identified,
and will it throw up others?
e.g. people with learning difficulties, older people, carers.
What are the key health challenges our local communities will face as a result of
–
housing, employment and income, transport and communications, climate change
•
What are the key themes emerging from our existing mechanisms to give local
people a ‘voice’?
•
What are the questions local health & social care commissioners need answers to?
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Three Perspective
• How did it feel as a joint process?
• How are we using it?
• What have we learnt?
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How did it feel from an Adult Services
perspective?
• Challenging – because we were all coming from different
perspectives – took time to gain top level agreement on intended
outcomes
• Worthwhile – something we had wanted to do for a long time and
this gave us the push and the top level support
• Useful from day one – because we focused on answering
commissioning questions – so we used the information straight
away to direct commissioning
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How are we using it?
• To engage Members in discussion about longer term planning
– eg focus on ageing population – gained support for “dementia premium”
for care homes
• To direct commissioning plans
– eg accommodation strategy for learning disabilities – what to buy where
• To guide our information planning
– helping to id gaps in knowledge, refining our “commissioning questions”
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What have we learnt from the process?
• Jointly compiled / presented information carries more weight
• We still have a long way to go – the JSNA is an ongoing / rolling
programme
• We need to refine our commissioning questions – to help
guide/prioritise future work
• We can work through the creative tensions!
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Children Services Perspective
• Developed from baseline – APA/JAR
• Survey information – Year 9 & Tell Us 2
• Brought what we knew into focus
• Identified priorities and actions
• Joint Commissioning Manager – Council & PCT
• Fundamental to Children & Young People Plan
• Asking the right questions
• Challenged assumptions
• C&YPP Review 2009
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How did it feel from a PCT perspective?
• Hard work
– data collection, analysis, interpretation
– discussions, reaching agreement
• Frustrating
– different perspectives
– surely we have more than this?
• Opened opportunities not previously available
• Positive
– very well received and discussed widely
– repeatedly cited by all planners including PBC’ers
• Satisfying
– set up better relationships for future work
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How are we using it?
• To ensure people are better informed about health and social care
priorities for action in Kirklees and how we have decided them
• To inform PCT priorities
– Use as a lever in work to address real health inequalities
– Core question in the business planning/business case process
• To ensure the PCT and Local Authority are engaged together on
issues, not separately but on the same issue
• To engage people involved in commissioning services and to get
them thinking about a longer term view
– Commissioners
– Providers
– GPs/GP Consortia/Practice Based Commissioning process
• To focus activities in addressing the gaps identified in our
intelligence about the health of people locally
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1. Strategic Needs Assessment
Health priorities across Kirklees incl. inequalities
Each has HIT group for planning into
Choosing
Health
HITs
Infection
control
HIT
Clinical /
Expert
PBC
Providers
Joint Commissioning
PPI
Long term
conditions
HITs
Urgent
care
HITs
Local Information
-people
-providers
-commissioners
18
Weeks
HITs
Partnership
commissioning
HITs
Role of HITs
2. Planning what should be done
Locality
priorities
planning
3. Identify gaps including £, workforce, IM&T
4. Design services / commissioning plans
for investment / disinvestment / reallocation
of resources
Final commissioning overall plan for Kirklees
Providers
PBC
Joint Commissioning
PBC
Joint Commissioning
Locality
plans
5. Performance management of
commissioning plans
6. Readjust levels and type of activity
7. Reassess need and restart process
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What have we learnt from the process?
• A jointly developed assessment seems to be higher profile and with
more joint ownership than one just devised in the PCT
• Lots of gaps in our knowledge.......
• ........but doing a JSNA is an opportunity to know and understand
the gaps better and to develop our knowledge, together
• Opportunity to explain commissioning and how it really can make a
difference
• Move service focused people to think about needs first!
• The same thing can be done in 3 different ways – so lets do it one
way across all of us in future!
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What does this all mean for leaders in Adult
Services, Children's Services, Public Health?
• Collaboration
• How Directors can work together to improve well being and life
outcomes for people in their locality?
• Challenges
• What are the common and what are the separate challenges
• Leadership development needs
• Group members own leadership development needs – rather than
those of others in the system
• Barriers
• Barriers to effective development of health, children’s and social
care systems that might be ameliorated by good leadership
interventions?
Joint Strategic Needs Assessment for Kirklees
29