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Welcome Joint Strategic Needs Assessment Commissioners Workshop Event
Welcome
Joint Strategic Needs AssessmentCommissioners Workshop Event
John Rutherford
Director of Adult and Community Services
Why is the JSNA important?
• JSNA identifies what services the people of Bolton want
• Provides a delivery plan for those services
• Highlights gaps in service provision
• Most efficient way of determining needs assessment
Why is the JSNA important?
• Ongoing process
• Working with partners and partner organisations
• Contains valuable, detailed information
• ‘The big picture’ for the health and wellbeing of the people in Bolton
WHAT IS JSNA?
Tim BryantHead of Commissioning
Agenda for the day
• Setting the scene • Themed presentations• ‘World Café’ style discussions• Refreshment break• Further presentations and discussions• Summary and next steps
What is the JSNA?
• ‘A Joint Strategic Needs Assessment (JSNA) is a means by which PCTs and local authorities describe the future of health and wellbeing needs of local populations and the strategic direction of service delivery to meet these needs’
(Commissioning for Health and Wellbeing 2007)
Objectives and Outcomes of today
• To summarise the contents of the JSNA and discuss the ‘wicked’ issues that need to be tackled in Bolton
• To discuss what the JSNA means for you and how the information will help inform your commissioning strategy
• To identify any gaps in the information
• To outline the next steps for the JSNA process
What is the JSNA process?
• Previous versions mainly health• Set up a widely representative Council/NHS coordination
group• Undertook a best practice search and decided on our
model• Massive undertaking and we have a much more
comprehensive JSNA this year• We look forward to hearing your views on involvement
for next year
What it looks like
• http://www.boltonvision.org.uk/jsna_draft.asp
What are the big issues?
• Bolton’s Demographic and Socio-Economic Profile - Clare Gore
• Bolton’s ‘Big Killers’ and lifestyle issues – David Holt
• Long term conditions and disabilities – Mel Carr
• Children and young people – Anne Gorton
What does it mean for you?
• Highlight the ‘wicked’ issues and influence our commissioning strategies to address these issues
• Challenge our recommendations
• Consider our priorities and remodel our services accordingly to deliver better outcomes
• Your feedback is valuable – please complete and return the feedback forms
Bolton’s Demographic and Socio-Economic Profile
Clare GoreHousing Strategy Manager (Policy & Research)Strategic Housing Unit
Bolton OverviewPopulation
Number %
Children 54,700 20.80%
(age 0 - 15)
Working Age
159,500 60.70%(age: males 16-64, females 16-60)
Older People
48,600 18.50%(age: males 65+, females 60+)
Total 262,800
Number %
Male 129,200 49%
Female 133,500 51%
2008 Mid Year Population Estimates
Bolton Overview Geographical Variation
Bolton Overview Geographical Variation
Bolton OverviewBirths, Deaths and Migration
• Fertility rates in Bolton are higher than seen regionally and nationally and have been increasing at a faster rate. The general fertility rate in Bolton for 2008 was 73.3 live births per 1000 women aged 15-44 years, compared to 63.8 in the North West and 63.9 in England as a whole
• Across the Borough changes in birthrates vary significantly from a decreasing rate of -3.6% in Heaton and Lostock, to an increase of 17.3% in Crompton
• Between 2007 and 2008 Bolton’s overall population is estimated to have increased by around 480 people. There were an additional 1,190 people as a result of natural change, i.e. there were 1,190 more births than deaths. However, there was also an estimated overall net loss in the population of 730 people due to migration
Bolton OverviewEthnicity (2001 Census)
• Bolton’s White population consists of 232,366 people or 89% of the total
• The largest of Bolton’s minority groups is that of Indian background. With 15,884 people, 6.1% of the Borough’s population, this is the largest such community in North West England
• Bolton’s population of Pakistani background numbered 6,487 people in 2001, 2.5% of the Borough’s population. This makes it the sixth largest such community in North West England
Bolton OverviewReligion (2001 Census)
• Three quarters of Bolton’s population identifies as Christian, a little higher than the national average (72%)
• The next largest religious groups in the borough are Muslims, constituting 7% of Bolton’s population and Hindus, constituting 2%. In both cases involving a higher proportion of the population than is the case nationally
• A much lower proportion of people in Bolton (9%) claim to have no religion compared with England and Wales as a whole (15%)
Bolton Overview Deprivation
Bolton OverviewUnemployment: JSA Claimants
0
1
2
3
4
5
6
Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10
% U
nem
plo
ym
en
t
Bolton (%)
North West (%)
Great Britain (%)
Bolton OverviewWorklessness
• In August 2009 there were 28,890 people in Bolton claiming either job seekers allowance, employment support allowance, incapacity benefit, severe disablement allowance, income support for lone parents, or other income-related benefits
• This gave Bolton a worklessness rate of 18.1%, which was an increase of 2.3 percentage points from last year and an increase of 0.2 percentage points as the previous quarterly figure
• In August 2009 the largest group of workless people in Bolton were those on sickness benefits, who made up 10.2% of the total working age population
• This was followed by jobseekers with 5.1% of the working age population, lone parents with 2.3% and others on income related benefits with 0.6%
Bolton Overview Income Distribution
Bolton Overview Child Poverty
Bolton OverviewEffects of the Economic Downturn
• House prices have fallen. In January 2010 they were 16.8% lower than two years ago, and 4.8% lower than the same time last year
• The number of house sales has also slowed over the past 2 years but this number has begun to increase
• At the start of the credit crunch (July 2007) repossessions in Bolton increased as a result of people getting into difficulty with mortgage payments. More recently, during 2009, this number has dropped
• Unemployment in Bolton has continually increased since September 2007 and at January 2010 was 5.4% of the working age population. February 2010 saw the first decrease in unemployment levels since the recession began. Unemployment now stands at 5.3%
• The last two years have seen a steady decline in the number of business property enquiries, which gives an indication of interest in Bolton as a place to do start up or relocate their business
Bolton OverviewEffects of the Economic Downturn: Unemployment since 2007
2006 Based Projections by Broad Age Group
% Unemployment from July 2007
0.0
1.0
2.0
3.0
4.0
5.0
6.0
Jul-
07
Au
g-0
7
Se
p-0
7
Oct
-07
No
v-0
7
De
c-0
7
Jan
-08
Fe
b-0
8
Ma
r-0
8
Ap
r-0
8
Ma
y-0
8
Jun
-08
Jul-
08
Au
g-0
8
Se
p-0
8
Oct
-08
No
v-0
8
De
c-0
8
Jan
-09
Fe
b-0
9
Ma
r-0
9
Ap
r-0
9
Ma
y-0
9
Jun
-09
Jul-
09
Au
g-0
9
Se
p-0
9
Oct
-09
No
v-0
9
De
c-0
9
Jan
-10
Fe
b-1
0
Moth
% o
f W
ork
ing
Ag
e P
op
ula
tio
n C
laim
ing
JS
A
Bolton
North West
England
4,294
8,469
108,979
204,157
713,363
1,370,285
Bolton OverviewFuture Projections
• Bolton’s population is projected to increase by approximately 20,300 people in the next twenty-five years with an average gain of 812 people per year
• Bolton’s projected increase is below both the national rate of 19%, and the Greater Manchester rate of 15.4%
• Bolton’s age structure is also due for significant change in the next twenty-five years. The proportion of the population aged 65 and above is set to increase from 15.1% in 2006 to 21.2% in 2031
Bolton OverviewFuture Projections
2006 Based Projections by Broad Age Group
Bolton OverviewInfluence on Health and Wellbeing
• Differences in demographic factors result in expected inequalities in health and well being i.e. older people suffer more from ill health than younger people. However, differences in health as a result of geography or ethnicity tend to be the main impact of a range of social and environmental factors
The Dahlgren and Whitehead model (1991) illustrates the main factors determining health The model shows how demographic and socio-economic factors are integral to determining health
Bolton OverviewInfluence on Health and Wellbeing: Housing
Bolton OverviewInfluence on Health and Wellbeing: Housing
• Homelessness:
– People who are homeless, or living in temporary accommodation are more likely to suffer from poorer physical, mental and emotional health than the rest of the population
• Older People and Housing:
– As the older population tend to spend more time in the home, they are more likely to be at risk from housing that is not suitable to their needs and defective housing
– Falls particularly affect the older population because of declining balance, co-ordination or strength as we age. Where falls occur in the older population they tend to have a greater health implication
• Housing Condition:
– Overcrowding and mental health
– Damp and mould growth and asthma
– Excess cold and mortality
Bolton’s ‘Big Killers’ and lifestyle issues
David HoltHead of Public Health IntelligenceNHS Bolton
2006-08 Male Female
Bolton 75.5 79.9
North West 76.3 80.6
England 77.9 82.0
Life expectancy
0.0
0.5
1.0
1.5
2.0
2.5
3.0
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
2006-2008
2007-2009
Nu
mb
er o
f ye
ars
Life Expectancy gap between Bolton & England: Males & Females
Source: nchodSource: nchod
12.8 year gap
Geographical inequalities
Mortality & Deprivation
When grouped % contribution
Circulatory disease
31
Other causes 14
Overdose & poisoning
11
Digestive Disease
10
Cancers 9
Cause of male gap in life expectancy
When grouped % contribution
Circulatory disease
31
Respiratory disease
15
Infant mortality 14
Digestive Disease
11
Cancers 11
Cause of female gap in life expectancy
Cardiovascular diseaseRespiratory diseaseLung cancerLiver disease
SmokingDiet/obesityAlcoholPhysical activity
Our main killers
Inequalities across ethnicity
Inequalities across deprivation
Lifestyle factors
Obesity• Childhood obesity – not increasing as expected YET
9.1% reception, 17.5% Yr 6
Consistently below regional and national average• Adult obesity – BHS 13.4% to 17.5% 2001 to 2007
Modelled estimate – 25.1% (50,000 people), Eng 23.6%
Physical activity
• Levels of activity seem to be improving• Active People Survey – 14% to 19% in last 3 years• Lower levels of activity in BME groups
Lifestyle factors
Smoking• Prevalence is falling – slightly faster in women• Suggestion of high start up rate still in youths
Drug use• Estimated 2,788 problematic drug users (16.3/1000)• 1,443 in effective treatment• Changing drug use trends – moving away from heroine & crack to
ACCE
Alcohol
Estimates of drinkers in Bolton
Hazardous 38-55,000Harmful 11-17,000Binge 44-58,000Dependent 5-10,000
Treatment
10% dependent drinkers1% hazardous/harmful
Potentially enormous demand
Overview of recommendations• Key diseases• Early presentation, identification, diagnosis and treatment are key• Continue to improve quality of disease management within primary care,
particularly management of long term conditions and encouragement of self care techniques
• Lifestyle factors – intervention/support needs to be focussed on settings – schools, workplaces, particularly high risk groups and communities
• Obesity & physical activity – ‘leptogenic environment’ – undertake Health Impact Assessments on planning decisions across the borough
• Alcohol – greater involvement of primary care in both provision of acute care and prevention & lobbying for minimum price
• Smoking – increase work on smoke free homes and cars
• Reducing inequalities – pay attention to the slope index of inequality to ensure that interventions are tailored to meet the needs of people in different deprivation deciles –proportionate universalism approach recommended by Marmot
Key questions
• What does the information tell us?
• What recommendations does the information lead you to?
• What are the information gaps?
Long Term Conditions and Disabilities
Melanie CarrCommunity Information & Research ManagerAdult & Community Services
Context
• Nationally:– 1 in 3 people have a long term condition (3 in 5 aged 60+)– Estimated that treatment and care of those with long term
conditions accounts for 69% of the primary and acute care budget
– People with long term illness and disabilities are more likely to be economically disadvantaged and experience social inequalities
– Four times as many people with learning disabilities die of preventable causes than the general population
Ageing Population
Bolton Population Projections (All persons 50+)
0
20
40
60
80
100
120
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
Year
Nu
mb
er o
f p
eop
le (
Th
ou
san
ds)
85+ yrs
80-84 yrs
75-79 yrs
70-74 yrs
65-69 yrs
60-64 yrs
55-59 yrs
50-54 yrs
Source: ONS
Projections of LLTI & DisabilityBolton LLTI & Disability Pyramid 2001-21
3000 2000 1000 0 1000 2000 3000 4000
1
6
11
16
21
26
31
36
41
46
51
56
61
66
71
76
81
86
Ag
e
Population with LLTI
Projections of LLTI & Disability HSE Disability Crude Rates
Static LLTI
Pessimistic OptimisticIntercensal
change
Overall disability 17 18 21 17 18
Higher severity 5 6 7 5 6
Lower severity 11 13 14 12 12
Locomotor 12 14 16 12 14
Personal Care 6 7 8 6 7
Hearing 5 5 6 5 5
Sight 2 3 3 2 3
Disability types
Disability and severity levels
20212001
Long term conditions
• Diabetes continues to rise – BHS 5.7 to 7.2%
GP registers 4.8% (14,000 people)
Higher in BME (up to 25% in Asian Pakistani pop)
• COPD – BHS 2.7%, chronic cough 13.5%
GP registers 2% (5,700 people)
Correlates strongly with deprivation and smoking
• Mental health – fairly stable
Almost a quarter of adult population showing some element of poor mental health
Mental Health
Learning Disabilities
Estimated Number of People with LD & Autistic Spectrum Conditions
0 1000 2000 3000 4000 5000 6000
Profound & Multiple LD 2009
Profound & Multiple LD 2029
Severe LD 2009
Severe LD 2029
Moderate LD 2009
Moderate LD 2029
Autistic Spectrum 2009
Autistic Spectrum 2029
Aspergers 2009
Aspergers 2029
14-17 yrs
18-64 yrs
65+ yrs
Older People (65+)
Health Problems
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
2009 2015 2020 2025 2030
Year
Nu
mb
er
Long term limiting illness Heart attack
Stroke Bronchitis/Emphysema
Falls Falls - hospital admission
Continence Obesity
Diabetes
Disabilities
05,000
10,00015,00020,00025,00030,000
2009 2015 2020 2025 2030
Year
Nu
mb
er
Visual Impairment Hearing Impairment Mobility
Mental Health
01,0002,0003,0004,0005,0006,000
2009 2015 2020 2025 2030
Year
Nu
mb
er
Depression Severe Depression Dementia
Carers
Key Recommendations for Commissioning (Draft)
• Focus on early intervention and prevention• Improve access to universal services • Improved management of long term conditions• Continue to improve integration between primary care, social care
and secondary healthcare • Develop/update key commissioning strategies e.g.
– End of Life Care strategy, – Joint commissioning strategy for dementia, – Learning Disability Joint Commissioning Strategy for Health &
Social Care– Co-ordinated approach to the needs of people with autistic
spectrum conditions• More focus on needs of carers
Key questions
• What does the information tell us?
• What recommendations does the information lead you to?
• What are the information gaps?
Children and Young People
Anne GortonPolicy, Performance and Analysis ManagerChildren’s Services
Number of Births
Birth Rate by Ward
Ethnic Heritage
0
500
1000
1500
2000
2500
3000
3500
4000
Reception year intake
Pu
pil
Nu
mb
ers
White British BME Total
Number Looked After Children
Children and Young People’s Health
• Infant mortality in Bolton higher than regional and national• Babies born in UK of women born in Pakistan have higher incidence
of infant death rates and low birth weight• 20.7% of pregnant women smoke at delivery• Breastfeeding rates at initiation and 6-8 weeks are below national
targets• Bolton is ranked 12th worse area in England for DMFT in 5 year olds• Higher rates of teenage pregnancies in deprived areas• Prevalence of obesity in Reception 9.1% & 17.5% in year 6 – lower
than regional and national averages – but still an issue• Higher prevalence of underweight children
Children and Young People’s Health
• Rates of childhood accidents linked to deprivation• 28% of 14-17 year olds in Bolton claimed to binge drink• Higher than average admissions for alcohol specific hospital
admissions among under 18s• Only half of Bolton children report achieving at least three hours of
high quality physical education or out of hours school sport in a typical week.
• Bolton is currently not meeting the target of testing through the National Chlamydia Screening Programme
• A quarter of 14-17 year olds in Bolton report being current smokers
Achievement
• The areas within Bolton where residents experience poor health outcomes are the same as those with lower levels of achievement including qualifications and skills
• Average education and skills levels among 19-65 year olds in Bolton is lower than the North West regional average and significantly lower in the most deprived areas of the borough.
• The % of 16 year olds in Bolton who achieve 5 or more good GCSE passes including English and Maths is below the national average particularly for those living in the more deprived areas of the borough.
Key Recommendations for Commissioning (Draft)
• Development of an overall workforce plan across partner organisations including health visitor and midwifery services
• Development and implementation of child poverty strategy• Increase dental health improvement activity with BME Communities• Map current sexual health service provision and undertake skills
audit• Timely roll out of ‘You're Welcome’ accreditation programme• Ensure as many mothers as possible breastfeed up to six months• Alcohol prevention work should ideally focus on education in
schools, workplaces, and at specific high risk populations.
Key questions
• What does the information tell us?
• What recommendations does the information lead you to?
• What are the information gaps?
Next steps
• Feedback forms to be completed and returned by Monday 12th April
• JSNA to be updated with commissioners’ feedback
• Sign off from PCT and DMT mid April
• Sign off from Health and Wellbeing Partnership in May
• LSP launch in June
• Commissioning strategies signed off in October
Thank you
