Ealing Joint Strategic Needs Assessment 2009-10. Page 1 of 105

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Ealing Joint Strategic Needs Assessment (JSNA)

2009-10 update

Part One: Summary JSNA, pages 1 – 33 of 105

Contents of Part One

1.Summary of the JSNA 2009-10

1.1.Context and Partnerships

1.2.Developing and using JSNA

1.3.Key points from the JSNA

2.Introduction to the JSNA

2.1.What is needs assessment?

2.2.Consultation, engagement and equalities

2.3.Criteria for setting priorities

3.Ealing: people and place

4.Health in Ealing

4.1.Summary measures of health

4.2.Healthy life-styles

4.3.Coronary heart disease

4.4.Stroke

4.5.Diabetes

4.6.Cancers

4.7.Tuberculosis

4.8.Mental Health

4.9.Alcohol

4.10.Sexual health

5.Ealing’s Neighbourhoods

5.1.Ealing & Acton

5.2.Southall

5.3.Northolt and Greenford, including Perivale

5.4.West Ealing

6.Children and young people

6.1.Child and maternal health

6.2.Young people and substance misuse

6.3.Looked after children

6.4.Child and Adolescent Mental Health

6.5.Children with Additional Needs

6.6.Key issues for public health and commissioning:

6.6.1.Be Healthy

6.6.2.Stay Safe

6.6.3.Enjoy and Achieve

6.6.4.Make a Positive Contribution

6.6.5.Achieve Economic Well-being

7.Adults of working age

7.1.Mental health

7.2.Substance misuse

7.3.Long Term Conditions, Physical disabilities, sensory impairment

7.4.Learning disabilities

7.5.Carers

7.6.Older people

Ealing Joint Strategic Needs Assessment (JSNA)

2009-10 update

1.Summary of the JSNA 2009-10

1.1.Context and Partnerships

Ealing’s Joint Strategic Needs Assessment 2008 – 11 is updated annually by NHS Ealing and Ealing Council. This update document notes emerging or changing factors and restates issues of continuing importance. The JSNA underpins NHS Ealing’s Strategic Plan and the forthcoming Joint Health and Wellbeing and Health Inequalities Strategy.

NHS Ealing and Ealing Council are in the process of developing a joint Heath Inequalities and Well-being Strategy to address long-standing health inequalities in terms of determinants of health (e.g. income, housing, education), lifestyle, access to services and health outcomes (mortality and illness).

The JSNA will also underpin the Children and Young People’s Plan, which will be produced by the new Children’s Trust Board, and which will focus on a number of partnership priorities for joint working. The Children’s Trust Board was re-launched in September 2009 having been updated to meet the new national legislative requirements.

There are major changes in national policy, in particular personalisation which will give social service users more choice and direct control over meeting their needs. In Ealing, the impact of this policy is mostly in relation to adult services.

1.2.Developing and using JSNA

  • Producing a JSNA is a statutory duty on local authorities and PCTs.
  • The JSNA assesses the needs of local people, looking ahead 3 – 5 years and beyond where possible. It underpins the strategic direction of health and social care services for adults and children.
  • The JSNA ensures that services are shaped by local communities. It helps to tackle inequalities and promote health, well being and social inclusion.
  • The JSNA will underpin the Sustainable Communities Strategy, the Children and Young Person’s Plan, the Health Inequalities and Well-being Strategy and other relevant plans and will provide a data bank of relevant information.
  • The JSNA will influence commissioning, but is not in itself a detailed commissioning plan.
  • Through the Health and Well-being Board and the Children’s Trust Board, the Local Strategic Partnership oversee production, monitoring and evaluation of the JSNA.

1.3.Key points from the JSNA

Ealing’s population grew from 305,000 to 309,000 between 2007 and 2008. These figures have been contested by local sources and there is a strong case for arguing that the figures are understated. The size of Ealing’s population is the strongest determinant of need for health services in the future.

Population growth is occurring at both ends of the age spectrum, with longer life expectancy and increasing births. There are plans for new primary schools and there is a continual need to monitor the capacity of maternity units.

There are large health inequalities, marked by differences between wards or neighbourhoods in terms of deprivation, life expectancy, mortality and use of health and social care services. A separate chapter of the JSNA update outlines the key health inequalities and criteria for prioritising these in the Heath Inequalities and Well-being Strategy.

The major issues of health, well-being and delivery of effective services have not substantially changed in the last year. Key areas are covered below and are reflected in NHS Ealing’s Strategic Plan for 2010 – 13.

Ealing has seen a large increase in hospital admissions for alcohol-related conditions over the last five years. Regional and national trends have also been upwards, but Ealing has seen a steeper rise and admissions are the highest of all London Boroughs.

2.Introduction to the JSNA

Ealing has high average levels of good health and prosperity. There are, however, large inequalities in health. Some wards or neighbourhoods are amongst the most deprived in England and the health experience of different communities varies greatly.

The Joint Strategic Needs Assessment (JSNA) describes the key issues that affect the people of Ealing and defines the strategic direction of services that will affect health and well-being for the next three to five years. It is produced jointly by Ealing Council and Ealing Primary Care Trust for the Local Strategic Partnership.

Joint strategic needs assessment considers a range of factors, including:

  • The burdens of disease and ill-health
  • Services currently provided and their effectiveness and costs
  • The views of patients, service users and the public
  • Levels of need and provision in comparable areas
  • National policy, such as National Service Frameworks, Healthcare for London, and the Local Area Agreement.

The JSNA is not a commissioning plan or a statement of commitments to develop particular services. It will not serve all purposes of commissioning, because more detailed work will be required in particular areas to justify specific service developments and changes. It will underpin commissioning strategy, however, by highlighting key issues such as:

  • Changes in Ealing’s population that arise from migration, ageing and other factors
  • The influence of major determinants of health such as income, housing and educations
  • Rising levels of demand in particular areas of health and social care, including acute and emergency care
  • Improvements in over-all measures of health, but continuing inequalities in health status and access to services
  • Opportunities to provide more services in primary care and reduce reliance on hospital care in the longer term
  • Hidden need, for example undiagnosed long-term conditions such as diabetes and cardiovascular disease
  • Developments in care and treatment, creating new opportunities for benefit at a cost
  • The benefits to be gained from integrating health and social care and from promoting health, well-being and independence and preventing disease

The JSNA is intended as a practical resource book for commissioning, to set and justify priorities in health and social care. It is evolving in line with the PCT’s development of competencies in World Class Commissioning and with emerging needs.

2.1.What is needs assessment?

Needs assessment is a systematic method of gathering information about health, wellbeing, disease and effectiveness of interventions, to bring about beneficial change. Its focus may vary from specific diseases or services to whole populations. There are three main complementary approaches, which should be used in combination in order to give as complete an account of needs as possible:

Epidemiological needs assessment considers the burden of disease in a population and the effectiveness of interventions to relieve it.

Comparative needs assessment considers the provision of services and burdens of disease in one area in comparison with another or a national or regional average.

Corporate needs assessment considers the views of local stakeholders and the capacity of systems to respond to identified problems.

  • All factors that affect health and wellbeing are potentially relevant to needs assessment.
  • Needs assessment can help address problems of unmet need and ineffective, inefficient or inappropriate care.
  • There are different kinds of need. For planners, need as ‘capacity to benefit’ is a helpful definition with some limitations. ‘Need’ is not the same as demand and supply. Levels of service use are an inadequate gauge of need.
  • To be successful needs assessment should ask well-defined questions and consider the cost-effectiveness of possible solutions. It should be integrated with wider planning and commissioning.

Modelling and needs assessment

We have used modelling and projection in various ways in JSNA. In particular we compared the recorded prevalence of key long-term conditions with the prevalence that would be expected from models based on the age, sex and ethnic structure of Ealing’s population. We have used this information to estimate numbers of undetected cases, identify problems with recording of cases and estimate the scale of list inflation. We have used information at both PCT and GP practice-level to identify inequalities and variations in performance.

We have used prevalence models, benchmarking of best practice (for example through National Service Frameworks) and programme budgeting data to frame our polysystem strategy, by which we will establish polysystems in each of four quadrants in Ealing, beginning with Southall as the neighbourhood experiencing the greatest health inequalities.

2.2.Consultation, engagement and equalities

The JSNA draws on the results of partnership, involvement and consultation with stakeholders, including service users, in many specific areas of health, social care and well-being. Key sources of views from stakeholders include:

  • Ealing Council Residents’ Survey
  • Healthcare for London consultation
  • Patient Advice and Liaison Service reports
  • Complaints
  • GP Patient survey
  • Integrated Commissioning Strategy consultation and feedback from Partnership Boards
  • Presentations to stakeholders, including voluntary and community sector organisations.
  • The local health related behaviour survey of children and young people, undertaken every two years

The PCT recognises that some groups barriers both to services and to the process of consultation and engagement. Often it is advisable to develop additional arrangements for involvement, so that these groups can be appropriately included. For example:

  • Disabled People, involved through the Disability Equality Scheme and Disability Speak Out events, Partnership Boards and Closing The Gap conference in January 2009.
  • Black and Minority Ethnic communities, including Gypsies and Travellers, involved through the Black Minority Ethnic and Refugee Health and Social Care Forum, Travellers Interagency Forum
  • Refugees and Asylum Seekers, involved through the West London BMER Forum and the PCT’s Race Equality Scheme
  • Lesbian, Gay, Bisexual, Transgender people: specific issues relating to health were addressed at the LGBT Forum conference in 2007
  • Older People: the PCT and Council sponsor an Older People’s Forum and Older People’s Network
  • Young people: regular presentations are made by the Ealing Youth Forum to the Children’s Trust Board

We have engaged with Ealing Community Network and Ealing LINk on developing the JSNA and Health Inequalities Strategy and have worked with voluntary sector forums on issues for BME communities, older people and people with multiple and profound disabilities.

We are currently working with other voluntary sector forums and LSP Partnership Boards on the same topics.

2.3.Criteria for setting priorities

The following criteria were agreed to select priorities, in consultation with clinicians and other stakeholders:

  • High population burden of disease
  • High disease burden on individuals
  • Significant local, regional or national inequalities
  • Effectiveness and cost-effectiveness of interventions
  • Stakeholder views, including patients, the public and health and other professionals and the views of under-represented groups.
  • Wider impact on society
  • Measurability of progress
  • Affordability of intervention

Local and national strategies such as the existing Local Area Agreements were also taken into account for the sake of synergy and efficiency.

Priorities were set in consultation with clinicians and Ealing Council stakeholders at a Visioning Workshop in September 2009. At this workshop we presented key findings from the JSNA together with proposals for priorities. The priorities were validated at Professional Executive Committee and NHS Ealing Board.

3.Ealing: people and place

Ealing’s population grew from 305,000 in 2007 to 309,000 in 2008. It is the third most populous Borough in London. Ealing spans inner and outer London but has an identity built around its seven town centres and a green, suburban character. The general prosperity of the borough is not shared by all of our communities. Poor standards of health and education, low household incomes and high benefits dependency are concentrated in the borough's poorer areas and among particular communities.

The vision of Ealing's Sustainable Communities Strategy is that in 2016, Ealing will be a successful borough at the heart of West London, where everyone has the opportunity to prosper and live fulfilling lives in communities which are safe, cohesive and engaged.

  • Ealing has a resident population of 309,000 (Office for National Statistics), expected to rise to around 347,000 by 2026 (GLA).
  • The GP registered population was 350,000 in 2008/9reduced from 359,000 the previous year on account of a major exercise to remove invalid registrations.
  • The population is growing and dependency is also increasing, that is, the proportion of non-working-age to working age residents, at both ends of the age range.
  • Currently there are 47 dependent people to every 100 people of working age (16-60/64 years). This is expected to increase to 55 per 100 working age people in 2026, taking Ealing higher than the London average, expected to be at 49 per 100.
  • There are expected to be various long term impacts of population change on the health and well-being of Ealing residents, for example:
  • A rising birth rate is creating demand for maternity, child care and nursery places and will affect planning for schools provision
  • The prevalence of common diseases of old age will rise with the ageing population
  • Rising numbers of people over-all will create demand for health and social services, as well as potential workforce
  • Areas that are amongst the 10% most deprived nationally are in Southall, South Acton, Northolt and Greenford and West Ealing.
  • There will be higher proportions of people in older age groups and this will affect need for many kinds of health and social care.
  • There are 120,000 properties in Ealing and around 130,000 households. The Housing Market Survey, 2009, shows 19.1% of homes in Ealing were overcrowded, much higher than the national figure of 7.1%. The survey reveals 15.6 % overcrowding in all tenures.
  • In school education, in 2007, 50% of pupils achieved 5A*-C grades including English and Math’s in GCSE or equivalent qualifications compared with a national average of 47%. Results in Ealing schools have improved by 11% points in 3 years, which is nearly three times the national rate of improvement. 62% of students are now achieving five A* to C grades or equivalent by the end of Key Stage 4, while 94 percent are achieving five A* to G grades or equivalent. Achievement of Black African pupils is lower than average, but improving. Over half of Ealing pupils do not speak English as a first language.
  • The crime rate in Ealing stands at 37.5 per 1,000 population, below the Metropolitan Police Service average of 39.9 per 1,000 population. The borough experiences similar levels of crime to Brent, Hounslow, Croydon and Lewisham. During the period 1st April – 2nd August 2009 the wards of East Acton, Ealing Broadway and Greenford Broadway experienced the highest levels of overall crime. Northfield, Hanger Hill and Lady Margaret experienced the lowest.
  • Burglary levels are highest in Greenford Green, Norwood Green and North Greenford, whilst Theft from Motor Vehicles is a particular issue in East Acton and Norwood Green. Violence Against the Person is of particular concern in Southall Broadway and Norwood Green.
  • The number of domestic violence incidents reported in the borough dropped 6.1% between 2008 and 2009. This is a change from 767 incidents to 720. Meanwhile the number of domestic violence incidents has increased by 3.2% across London. During the same time period racist crime has increased by 21.1% as opposed to 3.2 % for the Metropolitan Police Service. Homophobic Crime is increasing at rates far above those experienced across the Metropolitan Police Service.

4.Health in Ealing

4.1.Summary measures of health

All age all cause mortality

This measure considers the rate at which people die, from any cause and at any age. In order to make rates comparable, the figures are adjusted to take into account the age structure of a population. A Standardised Mortality Ratio (SMR) of 120 means that 20% more people die than would be expected, if rates for a standard population were applied.

For all Southall wards there is a SMR of between 110 and 120, the worst in Ealing, showing that the mortality experience of Southall is the worst in Ealing.

Fourteen of Ealing’s 23 wards have a SMR of less than 100.

The SMR for the whole Borough is 97.5, showing that the mortality is slightly better than a European standard.

All cause mortality has been declining since at least the early 1990’s. Ealing’s SMR has reduced by about 2.5 points each year since 1993. This is in line with declining mortality in London and England as a whole.

People with a long term limiting illness

There are wards, particularly in Southall, in which over 40% of households have one or more members living with a long term limiting illness. In Ealing as a whole, however, 29% or households are in this category, slightly less than the national figure of 32%.

Perception of own health

Ealing residents generally have a positive perception of their health status , with approximately 72% reporting their health as being good, 20% fairly good and 8% not good. These proportions are generally in keeping with those for England, London and West London, although slightly fewer report good health on a national level (69%).