Central Aberdeenshire

Health Needs Assessment 2003

REPORT

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Table of Contents

(i)List of Tables & Figures3

1.Executive Summary4

2.Background6

3.Getting Started!7

  • An outline of the aim, objectives and methodology

4.A Profile of Central Aberdeenshire 13

5.Findings: A Summary 18

  • Key themes from the quantitative data
  • Key themes from qualitative data

6. Draft Action Plans 27

7.Next Steps 30

8.Acknowledgements 31

LIST OF TABLES

Table 1: Overview of organisations/agencies/individuals identified to take part in the HNA process

Table 2: Drivers for Health Improvement - key national, regional and local documents

Table 3: Population figures for the main settlements

Table 4: Health Facilities in each administrative area

Table 5: SMR for individual practices within Central Aberdeenshire

LIST OF FIGURES

Figure 1. Map of Aberdeenshire showing main settlements

Figure 2:Practice populations

1.Executive Summary

1.1Health services and local authorities increasingly recognise that health needs assessments are an effective way of gathering data from community and/or practice populations, to help develop services and initiatives to meet the needs of their local population.

1.2Health Needs Assessment:

  • Starts with a population, whether defined by geography, age, gender or ethnicity, issue or service user – it creates programmes for improving health and reducing inequalities
  • Is a systematic and explicit process, which identifies the health issues affecting a population, that can be changed
  • Results in clear health priorities for the population and then plans programmes to tackle such problems

1.3Central Aberdeenshire Local Health Care Co-operative (LHCC) identified a need for an in-depth needs assessment of their local population to assist with planning and resource allocation in August 2002. The LHCC Public Health Co-ordinator was tasked with leading the process, and a researcher was recruited to assist with the process in September 2002.

1.4The aim of the Central Aberdeenshire Health Needs Assessment was to:

“develop a planning process and agreed framework for improving health and reducing inequalities, based upon a systematic review of the health issues affecting Central Aberdeenshire, in partnership with key stakeholders and the general public.”

1.5The objectives were:

  • To collate and analyse existing sources of quantitative information on factors which have the most significant impact on health.
  • To identify target population groups with the most to gain and those services which can make the most difference to their needs.
  • To begin to assess equity in provision of these services.
  • To involve the community and key stakeholders working within Central Aberdeenshire to develop priorities and action plans to improve health.
  • To disseminate the findings widely via a report.

1.6The methodology for the project was designed to allow input from a wide range of stakeholders. Both quantitative and qualitative information was gathered to help develop a well-rounded picture of health needs in Central Aberdeenshire. This involved:

  • A review of national, regional and local documents and data
  • Focus groups using semi-structured questionnaires
  • Multi-agency workshops to review evidence and develop action plans

1.7There was a general consensus among all stakeholders about the most significant health needs of the population of Central Aberdeenshire. These identified needs include:

  • Promoting positive mental health for the whole population, and improving mental health services for those with mild to moderate mental health problems.
  • Parenting skills – for parents of children of all ages, but with a focus on parents of young children to help prevent future problems.
  • Tackling alcohol misuse.
  • Providing accurate, clear and up-to-date health information for both professionals and the public, in a format suitable for the audience.

1.8In order to encourage input from the wider community, outline action plans were developed for each of the identified needs. The draft HNA document was widely disseminated within the Central Aberdeenshire area for consultation between mid April and Friday 30 May 2003. Fourteen agencies provided feedback on the draft document. This feedback has been incorporated into the final report. The next stage will be the implementation and monitoring of the action plans by the multi-agency Central Aberdeenshire Public Health Group and the Central Aberdeenshire Consultative Forum.

1.9Comments on the Central Aberdeenshire Health Needs Assessment, and requests for further copies of this summary document, or for the full document including appendices, should be sent to:

Aberdeenshire Central Public Health Co-ordinator, Inverurie Hospital, Upperboat Road, Inverurie, Aberdeenshire, AB51 3UL

2.Background

Planning for health in Grampian is an extremely complex process, involving the distillation and translation of national documents as well as identification and prioritisation of local issues which affect health. Equally, planning within a smaller geographic area can be just as complex, and should also take account of local needs, as these may not be the same as those identified at a national, or even Grampian-wide level.

Resources - in terms of funding, facilities and human resources – are clearly finite, therefore some element of prioritisation will always be required. In order to ensure that these resources are maximised and used in a way which is most likely to bring about a positive health change within a population, health needs assessment (HNA) is necessary.

The Core Management Group of Central Aberdeenshire LHCC, and the multi-agency Consultative Forum for Central Aberdeenshire recognised a gap in local knowledge about health needs which was impacting upon their ability to pro-actively plan and redesign services to address the specific needs of their population, and to ultimately improve health.

The LHCC Public Health Co-ordinator was assigned lead responsibility for managing and co-ordinating a Health Needs Assessment (HNA) for Central Aberdeenshire, in partnership with key stakeholders across the area. A lead researcher was appointed in September 2002, and a deadline for completion of the draft HNA was set for 31 March 2003.

3.Getting Started!

A number of initial questions had to be posed and answered before the HNA could begin in earnest, as effective HNAs require clarity of purpose from the outset.

Key Questions:

  • What is the scope of the HNA, i.e. what population are we assessing the health needs of?
  • What are the specific aim and objectives of this HNA?
  • What methodology will we use?
  • Who should be involved?
  • What are the key drivers in terms of existing documents and initiatives?

Scope of the HNA

This was defined as the population of Central Aberdeenshire LHCC, which encompasses a population of approximately 49,000 people. The LHCC covers the following geographic areas: Inverurie, Kintore, Kemnay, Insch, Huntly, Alford, Rhynie, Strathdon, Fyvie and Oldmeldrum.

Aim and objectives

The aim of the HNA was defined as:

“To develop a planning process and agreed framework for improving health and reducing inequalities, based upon a systematic review of the health issues affecting Central Aberdeenshire, in partnership with key stakeholders and the general public.”

The following objectives were also set:

  • To collate and analyse existing sources of quantitative information on factors which have the most significant impact on our health.
  • To identify target population groups with the most to gain and those services which can make the most difference to their needs.
  • To assess equity in provision of these services.
  • To involve the community and key stakeholders working within Central Aberdeenshire to develop priorities and action plans to improve health.
  • To disseminate the findings widely via a report.

Methodology

There are a range of documents offering advice and guidance to those wishing to undertake an HNA, such as the Health Development Agency ‘Health Needs Assessment Workbook’, and the Scottish Needs Assessment Programme document ‘Needs Assessment in Primary Care: A Rough Guide’. Both documents were found to be useful by the researchers, and the methods used for the Central Aberdeenshire HNA encompass elements of both.

The researchers felt that previous HNAs carried out within geographiccommunities had focused on either the social model of health or the medical model, and there appeared to be little evidence of an HNA that combined both. As the HNA for Central Aberdeenshire was being designed as a partnership endeavour, the researchers wished to ensure that the process was as inclusive as possible – allowing different groups to input to the process in different ways.

In order to gain a rounded view of the health needs of the population, it was agreed that a balance of quantitative and qualitative data was needed - i.e. ‘hard’ data such as causes of death and illness, and also ‘soft’ data such as peoples’ perceptions about the main health needs within their community.

It was therefore agreed that the evidence base for the HNA would be developed from the following sources/activities:

  • A review of relevant national, regional and local documents and data
  • Focus groups using semi-structured questionnaires
  • Multi-agency workshops to review evidence and develop draft action plans

In terms of quantitative data, the researchers collated information from a wide variety of sources, e.g.:

-LHCC health profiles (including those for coronary heart disease and cancer)

-GP Practice profiles

- Grampian Child Health Needs Assessment (Aberdeenshire information)

-Aberdeenshire Council Health Profile

-Public Health Institute for Scotland Constituency Health Profiles

-Grampian Adult and Youth Lifestyle Surveys

-Aberdeenshire Key Statistics

-Aberdeenshire Community Plan

-Grampian Health Plan 2003/04

Who should be involved?

In any HNA, it is extremely difficult to ensure input from a genuinely representative group within a local community. It was therefore decided to engage with a broad range of organisations and individuals to develop a draft document, and then distribute this widely within Central Aberdeenshire for consultation and amendment.

Table 1 : Overview of organisations/agencies/individuals identified to take part in the HNA process.

Aberdeenshire Council / NHS Grampian / Other agencies
Elected members / *Central Aberdeenshire GPs & practice teams / *Grampian Police
*Education and Recreation
Schools (Local Education & Recreation Networks)
Community Learning
Leisure Centres / *LHCC Consultative Forum
& Public Health Group / *Community Councils
Area Managers for Formartine, Garioch & Marr / Community Hospital staff / *‘ Friends’ Groups for:
Insch Hospital
Jubilee Hospital
Inverurie Hospital
*Housing and Social work / *Allied Health Professionals
  • Dietetics
  • Occupational Therapy
  • Physiotherapy
  • Speech and language therapy
/ Gordon Rural Action (Voluntary Sector)
*Planning and Environmental Health / *LHCC Core Management Group / Community safety groups
*Sure Start / *Health Visitors & Midwives / *HomeStart Garioch
*Aberdeenshire Lead Public Health group / *Local Health council
*Joint Future – Health and Community Care teams

* The asterisk highlights groups/agencies who sent a representative to the multi agency workshops. The other partners listed provided information for the needs assessment.

What are the key drivers?

Table 2 – Drivers for Health Improvement - key national, regional and local documents

Type of

Document

/ National / Grampian / Aberdeenshire

General

/ Towards a Healthier Scotland
Our National Health – a plan for action, a plan for change
Partnership for Care
Improving Health in Scotland – The Challenge / Grampian Health Plan (2003-2004)
Strategy for Primary Care (2003-2006) / Aberdeenshire Community Plan
Alford Community Learning Plan
Area plans for Garioch, Marr and Formartine

Children &

Young People / For Scotland’s Children
Integrated Strategy for the Early Years – Consultation
Document
A Scottish Framework for Nursing in Schools
Hall 4 (Health for all Children 4)
Child Health Services Template / Aberdeenshire’s Children’s Service Plan

Older people

/ Joint Future / Ageing with Confidence – A Joint Strategy for Older People in Grampian / Living Life to the Full
Substance Misuse / Plan for Action on Alcohol problems
Tackling Drugs in Scotland / Alcohol & Drug Strategy 2001/04

Mental Health

/ Mental Health: Moving the Agenda Forward

All of the above documents were reviewed by the researchers, in order to identify the ‘fixed points’ of this HNA, i.e. those elements where indicators are set and progress towards these monitored, either nationally or across Grampian. These are particularly important from a funding perspective, and should be kept in mind when developing local action plans.

Key points:

Improving Health in Scotland - The Challenge

This document was launched in mid March. It is an important statement of what is essentially a first annual plan for health improvement in Scotland. The intention is to build on previous success in Scotland and to accelerate the rate of improvement by focusing on life course groups, i.e. infants and children (a good start in life), teenagers (teenage transition), working age people (the workplace) and communities. This will affect the way national policy and priorities are cast and should impact in a similar way locally.

The health improvement section of the Grampian Health Plan is divided into sections as follows:

  • The ‘Focus on Four’ areas from The Challenge document above, i.e. Communities, Early Years, Teenage Transition, and The Workplace
  • Healthy Living, e.g. tobacco, healthy eating, physical activity, substance misuse, sexual health, community safety, and oral health
  • Clinical priorities (cancer, heart disease, stroke and mental health).
  • Chronic conditions (diabetes)
  • Health protection

Aberdeenshire Community Plansets out a strategic vision for Aberdeenshire agreed by the council and eight public sector partners. The four key themes in the Community Plan are:

Community well beingJobs and the economy

Learningsustainable environment

The following health improvement issues have been highlighted in the Community well being section of the plan:

  • Improving access to quality health care
  • More emphasis on prevention and health education
  • More, and better, low cost housing
  • More sheltered housing
  • Better services for older people
  • More support for physical activity and recreational opportunities
  • Support for children at risk
  • More work on community safety e.g. road safety, increased police presence
  • Counselling support for those under pressure
  • Help for young people to keep them away from drugs and alcohol

4.A Profile of Central Aberdeenshire

General

Central Aberdeenshire’s population of 48,999 (Community Health Index, September 2002), live in a mix of urban and rural areas served by Aberdeenshire Council. Central Aberdeenshire Local Health Care Co-operative (LHCC) forms part of 3 administrative areas within Aberdeenshire Council, i.e. Formartine, Marr and Garioch (see map below).

Some areas are affluent and advantaged, while others are less prosperous and disadvantaged, often by being rural and remote. The health of the people of Central

Aberdeenshire is a product of their life circumstances - where they live and work, their lifestyle - as well as their experience of disease.

Figure 1. Map of Aberdeenshire showing main settlements

Table 3: Population figures for the main settlements

The population of the main settlements within Central Aberdeenshire is as follows:

Settlement / Population
Inverurie / 10,657
Huntly / 4,335
Kemnay / 3,873
Oldmeldrum / 2,042
Alford / 2,177
Insch / 1,580
Fyvie / 447

Aberdeenshire Council: Small Area Population Estimates and Forecasts, 2002

Table 4: Health Facilities in each administrative area

Within Central Aberdeenshire, there are 8 Health Centres and 3 Community Hospitals, and these are distributed amongst the Aberdeenshire Council administrative areas as follows:

Administrative area / Health Centres / Community Hospitals
Garioch / Inverurie (& Kintore); Kemnay; Insch / Inverurie
Insch
Marr / Huntly; Alford; Rhynie; Strathdon / Jubilee (Huntly)
Formartine / Fyvie; Oldmeldrum

Figure 2: Practice populations

N.B. Clearly the practice populations are considerably larger than the population figures for the main settlements, and this is due to the intake of patients from more than one settlement area.

Standardised Mortality Ratio (SMR)

The standardised mortality ratio (SMR) is considered to be a key indicator for comparisons of health status. The lower the SMR score, the better the health status (in general). The SMR for deaths (all causes) for residents aged <75 in Central Aberdeenshire is lower than the SMR for Grampian. According to a comparison of Grampian LHCCs, Central Aberdeenshire has the second lowest SMR for under 75’s (1997-2001).

Table 5: SMR for individual practices within Central Aberdeenshire

Practice / SMR
Strathdon / 152.0 *
Huntly / 99.3
Kemnay / 86.0
Inverurie / 85.9
Rhynie / 82.0
Insch / 75.0
Fyvie/ Oldmeldrum / 68.2
Alford / 66.6

* N.B. Not statistically significant due to small numbers in practice population.

Demography

In September 2002 the total population of Central Aberdeenshire LHCC was recorded as 48,999 (Community Health Index).

In terms of projected changes to the local population profile, the trends over the next 6 years can be summarised as follows:

  • a slight increase in the number of infants (0-4)
  • a decrease in the number of older children
  • a marked increase in 45+ and 80+ age groups

Inequalities & Geographic Areas

Within Central Aberdeenshire, the majority of the population would be classified as fairly affluent in terms of deprivation categories (deprivation categories 4 to 1), although there are small numbers of people within the LHCC living in the most deprived category - level 7. However real pockets of relative deprivation do exist. Areas highlighted as being disadvantaged by Aberdeenshire Council statistics and LHCC profiles include: Huntly, Kemnay, Rhynie and Inverurie (South Inverurie ward).

It should be noted that the needs of families living in deprivation category 7 in Central Aberdeenshire are just as great as the needs of families living in larger areas of deprivation.

In addition, all practices have health issues relating to the rural nature of the area, access to services, social isolation, relative deprivation and an increasingly ageing population, as identified in the practice profiles.