Joint Strategic Needs Assessment 2010-12

Joint Strategic Needs Assessment 2010-12

A needs assessment in partnership between the London Borough of Bexley and Bexley Care Trust

Executive Summary

Published August 2011

Foreword

We are delighted to present Bexley’s Joint Strategic Needs Assessment 2010-12 which is the responsibility of the Joint Managing Director and Public Health Lead at Bexley Business Support Unit formerly known as Bexley Care Trust and Director of Education and Social Services at London Borough of Bexley.

The process of putting this document together has been fascinating, enabling both organisations to work together from the outset and providing an invaluable insight into the needs of people in Bexley. The general health of Bexley is good and better than the England average as you will see later on. The JSNA 2010-12 has identified the areas for improvement based on the issues and needs that have arisen through data intelligence and front line experience.

Bexley published its first JSNA in 2008, this time we have taken a different approach – bringing a wide range of organisations together. In its production, many colleagues worked together for the first time. This has provided the foundation for working relationships that are set to transform the way public services are delivered in Bexley.

In the process of putting this JSNA together, we worked closely with colleagues who will ultimately be making decisive commissioning plans.

Following the guidance that was published by the Department of Health in 2007, Bexley’s JSNA has helped us realise that this document is only part of establishing the wider determinants of health. The network that has been created as a result of this work will prove invaluable in developing the very best services possible for local people.

Mark Charters Pam Creaven

Executive summary

Bexley Care Trust and London Borough of Bexley including GPs have worked together to develop this year’s Joint Strategic Needs Assessment (JSNA) 2010-12.

The director of adult social services, director of children’s social services and director of public health (borough director at Bexley Care Trust) are responsible for addressing the gaps and needs identified in the JSNA 2010-12. Under the new health and social care sector arrangements outlined in chapter 1, local authorities and GP consortia will each have an equal and explicit obligation to prepare the JSNA, and to do so through the health and wellbeing board.

Bexley’s JSNA process is highlighted in figure 1 and illustrates the three main categories of input as:

Social and demographic data on status and inequalities
Local interpretation of national and regional policies
Service evaluation and community engagement.

Figure 1 JSNA in health and wellbeing planning

Source: Adapted from Arhin D and Lalwani K 2011

Box1 Bexley at a glance

The JSNA 2010-12 has identified the areas for improvement based on the issues and needs that have arisen through the triangulation of data analysis and front line experience. There are a range of issues and needs in the JSNA that describe what Bexley does well and highlight areas for improvement. See table below. The issues and areas of improvement are in line with current organisational corporate and commissioning plans; where plans are being refreshed the JSNA 2010-12 will be used to inform these. There are some areas that require further investigation and these will be addressed separately. They are outlined in Chapter 8 of the JSNA 2010-12.

We have produced a full supporting compendium of information report and JSNA.

Table 1 Summary of Bexley's JSNA 2010-12 findings

Priorities / Providing a healthy start to life and transition into adulthood / Providing safe environments and sustainable development / Enabling Positive Citizen Behaviour Change and Promoting Health / Providing services for residents including those with long term conditions to maximise choice control and wellbeing
Detailed issues and needs arising from the priorities(See JSNA 2010-12)
Main issues, needs and areas for improvement arising from the JSNA 2010-12 /

Early years education programmes to promote healthy living
Parenting programmes to support early childhood development
Tackling risk taking behaviours in certain social groups e.g. teenage pregnancy linked to substance misuse
Improved transition between children and adult services
Improve information and encourage young people to access services
Examine the underlying causes of increasing post-neonatal mortality
Development of services that engage positively with fathers

Ensure people feel safe and secure in their own homes
Reduce the impact of alcohol incidents in the borough
Keep people warm in the winter through advice, information and service provision
Reduce greenhouse gases released into the atmosphere and improve air quality

Ensure residents are able to access appropriate services through a unified support care network
Engagement with seldom heard groups in our communities
Improve men’s health outcomes through focused interventions
Improved standards of food provision in public sector settings e.g. hospital and care home
Reduce obesity levels through sustained public health programmes
Improve services for sexual health services particularly HIV
Universal prevention approach to tobacco control

Improve LTC pathways (e.g. dementia, diabetes, cancer) to encompass the wider wellbeing agenda
Provide coherent stroke rehabilitation services
Support for old people with physical disabilities and/or sensory impairments to live independently through the personalisation agenda (eg personal budgets)
Develop integrated care pathways between health and social care provision (e.g. hospital discharge, falls management)
Ensuring carers needs are assessed and supported

1. Providing a healthy start to life and transition into adulthood

Early years education programmes to promote healthy living

Early years education programmes across all areas of health promotion need to be effectively implemented and communicated to all professionals from all sectors in the borough. Evidence from the Marmot review places enormous importance on this age as interventions in the early years have the largest impact on outcomes in later life such as obesity, heart disease, mental health, educational achievement and economic status amongst others.

Parenting programmes to support early childhood development

Ensure the choice of excellent quality parenting programmes across the social gradient need to be implemented to ensure the foundations for every aspect of human development – physical, intellectual and emotional, are laid in early childhood.

Tackling risk taking behaviours in certain social groups e.g. teenage pregnancy linked to substance misuse

Many risk-taking behaviours such as unsafe sex, teenage pregnancy and anti-social behaviour are closely related to substance misuse. This link needs to be further acknowledged and the issues targeted as a whole rather than individually.

Improved transition between children and adult services

There is a requirement for services for families with children aged 14-21, particularly those with disabilities and mental health difficulties. This will have an immense impact on the continuity of services for young people. This includes appropriate communication and engagement with people in these age groups and making services ‘young people friendly’ against the You’re Welcome programme criteria of the Department of Health

Improve information and encourage young people to access services

A significant number of children and young people who are looked after by the local authority are placed outside Bexley. This has implications for how health services are commissioned and provided for these children. Additionally, remedies are required that take on board cultural sensitivities to ensure uptake by groups likely to experience poorer health than the average person.

Examine the underlying causes of increasing post-neonatal mortality

A gap exists in partners’ understanding of the underlying causes of increasing post-neonatal death rate (death after 28 days of age and before one year) in Bexley. Given that post-neonatal mortality rates are considered to be indicative of wider socio-economic factors, it is crucial that the specific social causes and if relevant their geographic distributions are identified and addressed.

Development of services that engage positively with fathers

There were 2,900 live births in Bexley in 2009 and services engage effectively with the mothers of most of these babies – but engagement is less systematic with fathers.

2. Providing safe environments and sustainable development

Ensure people feel safe and secure in their own homes

People over the age of 65 constitute a large proportion of the population; it is important to ensure that people in this age group feel secure and safe, particularly those living at home alone.

Reduce the impact of alcohol incidents in the borough

There is a large proportion of alcohol related crime that goes unreported through the health services. It is crucial for health professionals to continue to work with public health, community safety partnerships and the police to support them in tackling violence, particularly domestic violence.

Keep people warm in the winter through advice, information and service provision

There is a gap which requires partners to ensure that all groups in society are warm during the winter months.

Reduce greenhouse gases released into the atmosphere and improve air quality

People across the borough need to contribute to the effort to reducing emissions of pollutants from road vehicles; this requires effective communication and training for residents and professionals.

3. Enabling Positive Citizen Behaviour Change and Promoting Health

Ensure residents are able to access appropriate services through a unified support care network

There is a gap in the availability and dissemination of communication that signposts the different services for people provided by health and social care providers. There are currently gaps in the user friendly advice provided to residents, particularly people over the age of 65 and black and minority ethnic groups regarding welfare benefits, paying bills, paperwork and other areas.

Engagement with seldom heard groups in our communities

Further engagement needs to take place with black and minority ethnic groups, particularly the traveller and Polish communities of the borough.

Improve men’s health outcomes through focused interventions

There is a gap in services that are specifically designed for men. The information gathered in chapter five outlines worse outcomes for men in many areas.

Improved standards of food provision in public sector settings e.g. hospital and care home

There is a gap in the procedures for implementing national food quality standards in hospitals and other public sector care settings.

Reduce obesity levels through sustained public health programmes

There continues to be a gap between the goals and the achievements of Bexley’s strategies to increase the number of Bexley residents, both adults and children, who eat a healthy diet and take regular exercise.

Improve services for sexual health services particularly HIV

The rise in the number of people diagnosed with sexually transmitted diseases has led to a gap in the availability of services for sexually transmitted infections (STIs) and Human Immunodeficiency Virus (HIV) testing in all clinical and non clinical care settings.

Universal prevention approach to tobacco control

There is a gap in initiatives that address the wider issues leading to the misuse of alcohol, tobacco and other substances. It is important to build on the success of the smoking cessation service and implement a universal prevention approach in which primary, secondary and tertiary smoking cessation activities are undertaken in all settings including hospitals; making prevention everybody’s business.

4. Providing services for residents including those with long term conditions to maximise choice control and wellbeing

Improve LTC pathways (e.g. dementia, diabetes, cancer) to encompass the wider wellbeing agenda

There is insufficient emphasis on lifestyle behaviour change activities to reduce the risk of type 2 diabetes, coronary heart disease (CHD), stroke, and associated complications. Integration and coordination of primary, community and hospital services for long term conditions (LTC) require strengthening.

Provide coherent stroke rehabilitation services

The provision of coherent stroke rehabilitation services that are easy to navigate and accessible to all people who have had a stroke is seen as a priority in Bexley. Insufficient availability of clinically experienced stroke staff is also a strategic limitation to the provision of community and hospital based stroke rehabilitation care.

Support for old people with physical disabilities and/or sensory impairments to live independently

There is an emerging need for strategies linked to the personalisation agenda that take on board the demographic projections of increasing numbers of Bexley residents with learning and physical disabilities. An associated gap relates to strategies needed to care, house and support increasing numbers of residents who survive illness into old age with physical disabilities and/or sensory impairments (PDSI).

Develop integrated care pathways between health and social care provision (e.g. hospital discharge, falls management)

In order to ensure the best out-of-hospital care and transitional services for people moving out of hospital and into social care, there is a need to ensure full integration of health and social care teams that provide care in transition.

Ensuring carers needs are assessed and supported

There is a gap in understanding the support provided by carers to care pathways in both health and social care.

Conclusion

The evidence presented in the JSNA 2010-12 and Compendium of information report supports our thinking around building on good practice and improving services across the borough.

As a consequence of analysis we have identified gaps and areas of improvements in services and inequalities which need to be addressed. Actions will be agreed by Bexley’s Health and Well Being Board. London Borough of Bexley Corporate Plan 2011 and Bexley’s NHS Commissioning Strategy Plan form the strategic commissioning intentions to deliver services within existing resources. Commissioners across the key organisations will agree on commissioning plans and service deliveries

The Health and Social care Bill and Bexley’s position as a pathfinder, place Bexley at an advantage. This gives the Health and Wellbeing board a unique opportunity to shape priorities in Bexley with a long term vision of delivery for the ultimate benefit of children, young people and adults in Bexley.

Feedback form

Bexley’s JSNA is a process that allows the users and providers of Bexley’s health and social services to jointly identify the ‘bigger picture’ in terms of the needs of residents. This will ensure that everyone has a fair opportunity to have the best possible health and wellbeing.

Bexley would like your feedback about the JSNA, please answer the following questions:

1Does this document depict the health and social care needs of Bexley residents?

Yes / No

If you answered ‘no’, what do you think is missing from the JSNA?

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

2Did any of the results surprise you? If so, what were they?

3Is there any information currently not included in the JSNA that would be useful to you or your organisation? Please describe and explain why the information would be useful:

4Have we addressed the need for equality in local services?

Yes / No

5Was the JSNA easy to read?

Yes / No

6What didn’t you like about the report?

7Do you have any other comments you'd like to make about the JSNA?

8Would you like to join Bexley Care Trust’s membership scheme Your Health Matters to keep in touch with information from your local NHS?

Yes / No

If you answered ‘yes’, please visit: to register.

9Would you like to join TalkBack – the London Borough of Bexley resident panel to have your say on a range of issues and services?

Yes / No

If you answered ‘yes’, please visit:

Please return the form to:

Communications Team
Bexley Business Support Unit

221 Erith Road

Bexleyheath

Kent DA7 6HZ

If you would like more information about Bexley’s JSNA please contact Bexley Business Support Unit Communications Team at .

Every effort has been made to ensure that the information contained within the Joint StrategicNeeds Assessment documents for Bexleyisaccurate, up-to-date and complete. However, it is possible that it may not be representative of the whole body of evidence available and resources may contain errors or out-of-date information. If you have and queries or require any further assistance in obtaining the latest evidence,pleasecontact BexleyBusiness Support UnitCommunications Team at .

Joint Strategic Needs Assessment 2010-12

Executive Summary