LEEDS JSNA

A whole system approach to assess the current and future needs of the

local population

Lessons from our journey so far…..

• Ownership

• Integration – into the health and social care system

• Community involvement

• Analysis – intelligence not information

• Qualitative and quantitative

• Localism – localities are key

This is Leeds – population 787,700 ( at present!) –rising to over 1million by 2033

Index of Multiple Deprivation 2010 – 150,00 living in the most deprived SOAs nationally

2001-2009 components of change

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M id 2001-02 M id 2002-03 M id 2003-04 M id 2004-05 M id 2005-06 M id 2006-07 M id 2007-08 M id 2008-09

Live Births

Deaths

Net migration & Other change

Total change

Understanding the geography• 33 electoral wards

• 8 Parliamentary constituencies (with one extending beyond the Leeds MD boundary)

• 3 Management Areas

• 10 Area Committees

• 108 Middle Super Output Areas

• 476 Lower Super Output Areas

• 3 Police Divisions

• 17 Neighbourhood Policing Teams

• 3 ALMOs and 1 TMO

• 28 Extended Services Clusters (school based)

• 38 Neighbourhood Networks (Adult Social Care)

• GP consortia

Ownership across all required!

A picture of Leeds – 2008/9 JSNA

It gave clear priorities for partners:

• Responding effectively to demographic change

- Over 75s and children and young people

• Responding effectively to specific health and wellbeing challenges

- Obesity, alcohol, drugs and smoking

• Counteracting widening inequalities between neighbourhoods and key vulnerable groups

- Fragmentation across neighbourhoods and communities

Key actions from the JSNA 2008/9

• Embed the governance and accountability into wider partnership arrangements (through Healthy Leeds, Joint Strategic Commissioning Board)

• Closer alignment of planning and commissioning cycles (LCC and PCT)

• Process in place – Joint Information Group and Strategic involvement group for a continuous process/review of HNA and HNA template agreed for improved quality

• Populate data gaps (e.g. equalities and mental health data in particular) and improve projections and predictive modelling

• Locality profiling : Development of 108 neighbourhood profiles at MSOA level

Locality profile – example Little London

Neighbourhood Indexes were developed for each middle level SOA, these are

now being revised to include more detailed data

Example of Impact – Area Committees

• Joint Health Improvement Managers

• Locality Partnerships

• Prioritisation and Investment

• Actions

– Alcohol

– Multi-Agency Referral Scheme (MARS)

– COPD

– Smoking Cessation

Reducing Infant Mortality rates – a locality

approach

Target to Reduce the IM rate in ‘deprived Leeds’ to 7 per 1000 live births by 2013. (Leeds average 5.8; deprived Leeds – 8)Two demonstration sites – Chapeltown and Beeston - multi agency response

Mortality under 1 year per 1,000 live births

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Chapeltown Beeston Hill Leeds

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source: NHS Leeds Cluster Information Service

Impact of housing on health

Report commissioned from Sheffield Hallam and YorkUniversity• Investing in Leeds’ housing stock will enhance the health of

residents • Improving the energy efficiency of the Leeds housing stock

will reduce fuel poverty• There should be an integrated programme of investment in

home safety measures and home adaptations to maintain the independence of older residents

• Leeds Council should invest in home security measures as part of an integrated package to improve health by reducing crime and fear of crime

Leeds Housing Strategy

Built on the Leeds JSNA: 3 priorities- Increasing the supply of affordable housing- Improving housing quality- promoting independent living

Research is now leading to:- an assessment of impact across partners – e.g. police and

burglary reduction due to safety in homes- An invest to save model now produced to enable LCC to

estimate saving from investments in the housing stock e.g. energy efficiency and saving on health care for chronic conditions

Financial Inclusion

• Leeds city council led multi-agency financial inclusion steering – 3 priorities with key initiatives = affordable credit, debt/money advice, financial literacy

• Engagement with the voluntary sector – working with CAB to establish how voluntary sector information on their clients and areas of need can

add value to the JSNA with a focus on debt.

Key challenges going forward –Qualitative data

• 2009 JSNA acknowledged this as a gap – gathered surveys on City Council portal; established SIG

• 2010 – Analysis of common themes – using grounded

theory (Nvivo 9 software) – 105 sources gathered

• Aim – to develop a comprehensive consultation library of qualitative information, analyse the information and establish themes and recommendations to feed into the refreshed JSNA

Emerging themes

• Children/Young people

• Mental Health

• Transport

• Older People

• Access to Services

• Healthy Lifestyles

Analysis – intelligence not information

Review of all Health Needs Assessments completed since 2008

with the aims of:

• To undertake a content review of recently completed needs assessment, against the priorities and data gaps identified by the JSNA

• To identify the main themes and priorities arising from needs assessments

• To develop a proforma for locally produced needs assessments to lead to quality intelligence

Embedding within the commissioning process

• In 2009 NHS Leeds was recognised for its work on the JSNA within the WCC process

• The JSNA was taken through both Executive within Leeds City Council and Scrutiny Committee – embedded in strategies (e.g the Housing strategy)

• Programme of work used the JSNA analysis in their commissioning process – maternity services

• However there remains the challenge to embed it through all commissioning in the city to ensure services are delivered in relation to needs – the new Health and Wellbeing Board and Clinical Commissioning groups are an opportunity to revisit this

Where are we now?

• Refreshing quantitative data set and analysis of qualitative data to feed into shadow Health and Wellbeing Board in September and LCC State of the City report

• Two joint workshops held to consider quantitative and qualitative data and add ‘the story behind the data’

• Wider workshop planned for all partners in September to consider the 7 quality themes identified by Local Government Improvement and Development to ensure ownership

• Shadow Health and Wellbeing Board first meeting to explore their role in relation to the governance of the Leeds JSNA to ensure a whole system approach to assessing need and agreeing priorities for Leeds for now and the future.

Future governance