SOUTH STAFFORDSHIRE PARTNERSHIPHEALTH MASTERCLASS FRIDAY 6TH JULY 2012

The future role of Joint Strategic Needs Assessments

Sue Wardle FFPH, Public Health Specialist (Health Intelligence)

JSNA – some facts and background

JSNAS AND JOINT HEALTH AND WELLBEING STRATEGIES

JSNAs will be the primary process for local leaders to identify local health and care needs, and building a robust evidence base on which local commissioning plans can be developed

Joint health and wellbeing strategy will set the priorities for collective action.

Taken together they will be the pillars of local decision-making, focussing leaders on the priorities for action and providing the evidence base for decisions about local services

BACKGROUND

JSNAs have been a statutory responsibility jointly held by the NHS and upper tier local authorities since 2007

Joint responsibility - Director of Public Health, Director of Adult Social Care and Director of Children’s Services

Aim is to identify the ‘big picture’ in relation to health and wellbeing needs and inequalities in the local population

Health and Social Care Bill proposes an enhanced and central role for the JSNA to bring together partners to analyse current and future health needs and produce a joint health and wellbeing strategy

From April 2013, LAs and CCGs will have equal and explicit obligations to do a JSNA – a duty discharged through HWBB

AN ENHANCED JSNA

Provide a comprehensive ‘picture of place’.

Look beyond needs to include assets (e.g.

environment, facilities, the local community

itself)

JSNA must consider current and future

health and social care needs

Requirement to involve people living or working

in the area

Requirement to involve district councils

Should cover the whole of the population across the life course from pre-conception to end of life

Include people in the most vulnerable

circumstances and excluded groups

DEVELOPING STAFFORDSHIRE ENHANCED JSNA

Local Authority profiles produced District and Boroughs ‘enhance’ the

profiles by adding Assets Community Voice Wider determinants of health

Produce eJSNAs by October 2012 District Health Leads meeting JSNA Working Group provides

Staffordshire overview Staffordshire eJSNA produced using a

bottom up approach Development of Local Intelligence

System

An Asset Based Approach

AN ASSET BASED APPROACH

A health asset is any factor or resource which enhances the ability of individuals, communities and populations to maintain and sustain health and wellbeing. These assets can operate at the level of the individual, family or community as protective and promoting factors to buffer against life’s stresses

Assets are the collective resources which individuals and communities have at their disposal, which protect against negative health outcomes and promote health status. These can be social, financial, physical, environmental, or human resources, eg employment, education and supportive networks.

KEY MESSAGES: WHAT MAKES US HEALTHY?

“Focusing on the positive is a public health intervention in its own right”

Asset based principles help to understand health of individuals and communities as a positive state and its determinants as factors that protect and promote health. These factors can be changed through social and civil and community action

KEY MESSAGES: WHAT MAKES US HEALTHY? The evidence for the positive impact of community and

individual ‘assets’ such as resilience, self determination, social networks and social support on health and wellbeing is at least comparable to that of more familiar social determinants of health such as housing, income and environment

‘Asset thinking’ challenges the framing of health as the prevention of illness and injury and instead looking at the promotion of wellness. It is possible to ‘get ill better’ because good wellbeing tend to mean that people seek help earlier and recover quicker.

Asset working can promote mental wellbeing which is both a cause and a consequence of inequality and physical ill health. The capacity and motivation to choose healthy behaviours are strongly influenced by mental well being as well as by socio-economic factors.

KEY MESSAGES: WHAT MAKES US HEALTHY? Work to improve health enhancing assets should

focus on psychosocial aspects eg resilience, confidence but also social, economic and environmental factors that influence inequalities and health and wellbeing – the causes of the causes.

Assets are held by individuals, families, neighbourhoods and institutions and they can be mobilised at any level. Communities are strengthened through the realisation of their own resources and connections but also by their ability to mobilise the resources of institutions and agencies and put them under their direction

KEY MESSAGES: WHAT MAKES US HEALTHY? The defining themes of asset based ways of

working are: place based; relationship based, citizen led and they promote social justice and equality.

Locally held assets are not the only answer to improving health and wellbeing and reducing health inequalities. There is a balance between meeting needs to tackle socio-economic disadvantage, tackling risk factors and developing resilience and wellbeing.

New evaluation methods are required for a health asset approach

EXAMPLE: WHY DON’T PEOPLE SMOKE?

The numbers of people not smoking have increased from 48% in 1948 to 79% in 2008, mainly due to the increase in numbers of people who don’t smoke.

An Appreciative Inquiry was commissioned in Salford to find out why people don’t smoke. The AI looked:- for a solution focussed point of viewat people’s motivations and drivers for not smokingat what the council and other partners could do to

support non smokers who live in an area with high levels of smoking and foster a culture of not smoking.

Adapted from p40 ‘What makes us healthy’

EXAMPLE: WHY DON’T PEOPLE SMOKE?

Things to make it easier for people to be non smokers, especially young people: Encourage young people’s own campaigns about smoking

and the tobacco industry Support work in schools on peer support and confidence

building, and open conversations about difficult issues such as peer pressure

Support hobbies, interests and activities that would be impaired by smoking

Work with parents and the local smoke-free homes project on the health impacts and the affect on home life

“I was so involved in dancing that I never wanted to smoke. Dancing gave me the initiative to stay healthy.”

ASSET WORKING MATRIX – WHERE IS SOUTH STAFFORDSHIRE?

Traditional professional service provision

Full co-production

User/community delivery of

professionally planned services

User co-delivery of professionally designed

services

Professional service provision but

users/communities involved in planning

and design

User/community delivery of co-planned or co-designed services

Self-organised community provision

User/community delivery of services

with little formal/professional

Professionals as sole service deliverers

Professionals as sole service planner

No professional input into service planning

Professionals and service

users/community as co-planners

Users/communities as sole deliverers

Professionals users/communities as

co-deliverers

Professionals as sole service deliverers

Responsibility for design of services

Re

spon

sibi

lity

for d

eliv

ery

of s

ervi

ces

Positive Wellbeing in Staffordshire

DISTRIBUTION OF WEMWBS SCORES

The WEMWBS scores for the main sample of residents had a mean of 52.13, a standard deviation of 9.26 and a range of 14 to 70

The chart shows the distribution of WEMWBS scores for the main sample of respondents. It shows that the largest proportion is within the ‘average well-being’ range – this is set to be within one standard deviation of the mean. Almost 16% of residents have ‘below average’ mental well-being as calculated using the WEMWBS. These are the group who may require focused interventions in the coming years

DIFFERENCES BY GENERAL HEALTH STATUS

There is a clear correlation between

perceived health status and mental

wellbeing. Residents with better

general health status have a

significantly higher average WEMWB

score. In addition, those residents who

have limiting long term illness or

disability have a lower mean WEMWB

score.

Cases were weighted by age, gender

and area.

Base sizes 112 173 191 100 37

DIFFERENCES BY SOCIAL NETWORKS

Differences in Mental Well-Being between Strength of Social Networks

Measure Difference Interpretation

Speak to family members

Not significant

Those who speak family regularly have similar levels of mental well-being as those who do not

Speak to friends Significant

Those who speak to friends regularly have a higher level of metal well-being than those who do not. For example, those who speak to friends everyday have WEMWBS score of 53.6, compared with 50.3 for those who speak to friends once a week or less often

Speak to neighbours

Not significant

No overall difference in WEMWBS between those who speak to neighbours regularly or less so

Text friends/family

Significant at 10% level (P=0.054)

Those who text more regularly have higher levels of mental well-being with those who do not

Email friends/family

Significant (see chart below)

Very high WEMWBS for those who email friends/family everyday

Go on chat rooms and social networking sites

Significant at 10% level (P=0.067)

Generally higher WEMWBS score amongst those who use social networking sites more regularly, but overall difference not significant at 10% level only.

Re social networks – generally those

residents who speak to or have other

types of contact with other people

regularly have higher levels of mental

wellbeing. However there are some

interesting exceptions – see table

MENTAL WELLBEING AND PERCEIVED QUALITY OF LIFESTYLE

There is a correlation between mental

wellbeing and perceived quality of

lifestyle There is a significant difference

in WEMWB score between those who

report having a very healthy lifestyle

and those who report less healthy

lifestyles. The WEMWBS score for

those who report having a very healthy

lifestyle is high (57.5)

There are some differences for the two

key lifestyle measures, smoking and

alcohol consumption. Those who

currently smoke had lower WEMWBS

than residents who have never smoked

(50.5 and 52.7 respectively). Smokers

who had now stopped also had higher

WEMWBS (52.2) than current smokersBase sizes 130 366 80 30 7

South Staffordshire District – Towards an Asset Approach?

SOUTH STAFFORDSHIRE LOCALITY DATA PROFILE

Why? ….. Different areas of South Staffordshire have different

needs, issues and priorities. That’s why in 2008 we broke down the districts into ‘localities’….. (we are) …using this data to make sure that our services are intelligence led so that we can target the right level of resources to the right people, at the right time’

Cllr Brian Edwards, Leader of South Staffordshire Council

SOUTH STAFFORDSHIRE LOCALITY DATA PROFILE

Setting the scene

Demographics

Customer insight

Children & Young People

Economic Vibrancy

Environmental Quality

Health and Wellbeing

Housing

Transport

HOW IS THE PROFILE USED?

Data ProfilesPartner agency ‘Health check’

Children and young people

Elected Member forums

V & CS forums

Partner organisation engagement

Face to face consultation

Ward walks & ward drop-in

Review consultation

Development of plans

PACTs

V & CS call for ideas

Draft plans for consultation

Final plans live April 2012

V & CS pilot with funding in each

locality

September

October

October

November

January

January / February

FebruaryJanuary deadline

February / March

February

February / March

March

SeptemberExternal locality planning cycle

End March - Signed off by partners

HOW HAVE THE PROFILES HELPED? SOME EXAMPLESIssues at district level are missed

Tackling a difficult issue – Caddick Farm Estate – “There are several alley ways that are overflowing with rubbish which is blocking escape routes for the residents, should there be a fire.”

Not everything is about extra funding – refocusing existing physical activity services

Taking a more holistic view – healthy families, Bilbrook

Target to achieve best value – Village Agents

Evidence to influence others - Rural Community Transport

Dispels ingrained myths – eg crime statistics

RESOURCES

http://www.thinklocalactpersonal.org.uk/_library/Resources/BCC/Evidence/what_makes_us_healthy.pdf

http://www.local.gov.uk/c/document_library/get_file?uuid=fc927d14-e25d-4be7-920c-1add80bb1d4e&groupId=10171

QUESTIONS/DISCUSSION

How far should we move towards an asset based approach?

What are the challenges to developing an asset approach in South Staffordshire District?

Where might the potential or opportunity be strongest to use an asset approach?

What examples do you already have? What could the next steps be? A Joint Strategic Assets Assessment?

DEVELOPING AN EXAMPLE OF ASSET WORKING IN SOUTH STAFFORDSHIRE

1. Choose an important topic 2. Discuss what an asset based approach to tackling this issue might look like

It might be useful to think about this under the following headings that underpin most asset based approaches: Asset based – values assets and approaches: Place based – works in the neighbourhood as the a space in which

networks come together and shared interests are negotiated and acted upon

Relationship-based – creates the conditions for reciprocity, mutuality and solidarity

Citizen-led – community-driven – empowers individuals and communities to take control of their lives

Social justice and equality – enables everyone to have access to the assets they need to flourish; equality and fairness are both determinants of wellbeing.