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Welcome Joint Strategic Needs Assessment Commissioners Workshop Event.

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Presentation on theme: "Welcome Joint Strategic Needs Assessment Commissioners Workshop Event."— Presentation transcript:

1 Welcome Joint Strategic Needs Assessment Commissioners Workshop Event

2 John Rutherford Director of Adult and Community Services

3 Why is the JSNA important? JSNA identifies what services the people of Bolton want Provides a delivery plan for those services Highlights gaps in service provision Most efficient way of determining needs assessment

4 Why is the JSNA important? Ongoing process Working with partners and partner organisations Contains valuable, detailed information ‘The big picture’ for the health and wellbeing of the people in Bolton

5 WHAT IS JSNA? Tim Bryant Head of Commissioning

6 Agenda for the day Setting the scene Themed presentations ‘World Café’ style discussions Refreshment break Further presentations and discussions Summary and next steps

7 What is the JSNA? ‘A Joint Strategic Needs Assessment (JSNA) is a means by which PCTs and local authorities describe the future of health and wellbeing needs of local populations and the strategic direction of service delivery to meet these needs’ (Commissioning for Health and Wellbeing 2007)

8 Objectives and Outcomes of today To summarise the contents of the JSNA and discuss the ‘wicked’ issues that need to be tackled in Bolton To discuss what the JSNA means for you and how the information will help inform your commissioning strategy To identify any gaps in the information To outline the next steps for the JSNA process

9 What is the JSNA process? Previous versions mainly health Set up a widely representative Council/NHS coordination group Undertook a best practice search and decided on our model Massive undertaking and we have a much more comprehensive JSNA this year We look forward to hearing your views on involvement for next year

10 What it looks like

11 What are the big issues? Bolton’s Demographic and Socio-Economic Profile - Clare Gore Bolton’s ‘Big Killers’ and lifestyle issues – David Holt Long term conditions and disabilities – Mel Carr Children and young people – Anne Gorton

12 What does it mean for you? Highlight the ‘wicked’ issues and influence our commissioning strategies to address these issues Challenge our recommendations Consider our priorities and remodel our services accordingly to deliver better outcomes Your feedback is valuable – please complete and return the feedback forms

13 Bolton’s Demographic and Socio-Economic Profile Clare Gore Housing Strategy Manager (Policy & Research) Strategic Housing Unit

14 Bolton Overview Population Number% Children 54,70020.80% (age 0 - 15) Working Age 159,50060.70% (age: males 16-64, females 16-60) Older People 48,60018.50% (age: males 65+, females 60+) Total262,800 Number% Male129,20049% Female133,50051% 2008 Mid Year Population Estimates

15 Bolton Overview Geographical Variation


17 Bolton Overview Births, Deaths and Migration Fertility rates in Bolton are higher than seen regionally and nationally and have been increasing at a faster rate. The general fertility rate in Bolton for 2008 was 73.3 live births per 1000 women aged 15-44 years, compared to 63.8 in the North West and 63.9 in England as a whole Across the Borough changes in birthrates vary significantly from a decreasing rate of -3.6% in Heaton and Lostock, to an increase of 17.3% in Crompton Between 2007 and 2008 Bolton’s overall population is estimated to have increased by around 480 people. There were an additional 1,190 people as a result of natural change, i.e. there were 1,190 more births than deaths. However, there was also an estimated overall net loss in the population of 730 people due to migration

18 Bolton Overview Ethnicity (2001 Census) Bolton’s White population consists of 232,366 people or 89% of the total The largest of Bolton’s minority groups is that of Indian background. With 15,884 people, 6.1% of the Borough’s population, this is the largest such community in North West England Bolton’s population of Pakistani background numbered 6,487 people in 2001, 2.5% of the Borough’s population. This makes it the sixth largest such community in North West England

19 Bolton Overview Religion (2001 Census) Three quarters of Bolton’s population identifies as Christian, a little higher than the national average (72%) The next largest religious groups in the borough are Muslims, constituting 7% of Bolton’s population and Hindus, constituting 2%. In both cases involving a higher proportion of the population than is the case nationally A much lower proportion of people in Bolton (9%) claim to have no religion compared with England and Wales as a whole (15%)

20 Bolton Overview Deprivation

21 Bolton Overview Unemployment: JSA Claimants

22 Bolton Overview Worklessness In August 2009 there were 28,890 people in Bolton claiming either job seekers allowance, employment support allowance, incapacity benefit, severe disablement allowance, income support for lone parents, or other income-related benefits This gave Bolton a worklessness rate of 18.1%, which was an increase of 2.3 percentage points from last year and an increase of 0.2 percentage points as the previous quarterly figure In August 2009 the largest group of workless people in Bolton were those on sickness benefits, who made up 10.2% of the total working age population This was followed by jobseekers with 5.1% of the working age population, lone parents with 2.3% and others on income related benefits with 0.6%

23 Bolton Overview Income Distribution

24 Bolton Overview Child Poverty

25 Bolton Overview Effects of the Economic Downturn House prices have fallen. In January 2010 they were 16.8% lower than two years ago, and 4.8% lower than the same time last year The number of house sales has also slowed over the past 2 years but this number has begun to increase At the start of the credit crunch (July 2007) repossessions in Bolton increased as a result of people getting into difficulty with mortgage payments. More recently, during 2009, this number has dropped Unemployment in Bolton has continually increased since September 2007 and at January 2010 was 5.4% of the working age population. February 2010 saw the first decrease in unemployment levels since the recession began. Unemployment now stands at 5.3% The last two years have seen a steady decline in the number of business property enquiries, which gives an indication of interest in Bolton as a place to do start up or relocate their business

26 Bolton Overview Effects of the Economic Downturn: Unemployment since 2007 2006 Based Projections by Broad Age Group

27 Bolton Overview Future Projections Bolton’s population is projected to increase by approximately 20,300 people in the next twenty-five years with an average gain of 812 people per year Bolton’s projected increase is below both the national rate of 19%, and the Greater Manchester rate of 15.4% Bolton’s age structure is also due for significant change in the next twenty-five years. The proportion of the population aged 65 and above is set to increase from 15.1% in 2006 to 21.2% in 2031

28 Bolton Overview Future Projections 2006 Based Projections by Broad Age Group

29 Bolton Overview Influence on Health and Wellbeing Differences in demographic factors result in expected inequalities in health and well being i.e. older people suffer more from ill health than younger people. However, differences in health as a result of geography or ethnicity tend to be the main impact of a range of social and environmental factors The Dahlgren and Whitehead model (1991) illustrates the main factors determining health The model shows how demographic and socio-economic factors are integral to determining health

30 Bolton Overview Influence on Health and Wellbeing: Housing

31 Homelessness: –People who are homeless, or living in temporary accommodation are more likely to suffer from poorer physical, mental and emotional health than the rest of the population Older People and Housing: –As the older population tend to spend more time in the home, they are more likely to be at risk from housing that is not suitable to their needs and defective housing –Falls particularly affect the older population because of declining balance, co-ordination or strength as we age. Where falls occur in the older population they tend to have a greater health implication Housing Condition: – Overcrowding and mental health – Damp and mould growth and asthma – Excess cold and mortality

32 Bolton’s ‘Big Killers’ and lifestyle issues David Holt Head of Public Health Intelligence NHS Bolton

33 2006-08MaleFemale Bolton75.579.9 North West76.380.6 England77.982.0 Life expectancy

34 12.8 year gap Geographical inequalities

35 Mortality & Deprivation



38 When grouped% contribution Circulatory disease 31 Other causes14 Overdose & poisoning 11 Digestive Disease 10 Cancers9 Cause of male gap in life expectancy

39 When grouped% contribution Circulatory disease 31 Respiratory disease 15 Infant mortality14 Digestive Disease 11 Cancers11 Cause of female gap in life expectancy

40 Cardiovascular disease Respiratory disease Lung cancer Liver disease Smoking Diet/obesity Alcohol Physical activity Our main killers

41 Inequalities across ethnicity

42 Inequalities across deprivation

43 Lifestyle factors Obesity Childhood obesity – not increasing as expected YET 9.1% reception, 17.5% Yr 6 Consistently below regional and national average Adult obesity – BHS 13.4% to 17.5% 2001 to 2007 Modelled estimate – 25.1% (50,000 people), Eng 23.6% Physical activity Levels of activity seem to be improving Active People Survey – 14% to 19% in last 3 years Lower levels of activity in BME groups

44 Lifestyle factors Smoking Prevalence is falling – slightly faster in women Suggestion of high start up rate still in youths Drug use Estimated 2,788 problematic drug users (16.3/1000) 1,443 in effective treatment Changing drug use trends – moving away from heroine & crack to ACCE

45 Alcohol Estimates of drinkers in Bolton Hazardous 38-55,000 Harmful 11-17,000 Binge 44-58,000 Dependent 5-10,000 Treatment 10% dependent drinkers 1% hazardous/harmful Potentially enormous demand

46 Overview of recommendations Key diseases Early presentation, identification, diagnosis and treatment are key Continue to improve quality of disease management within primary care, particularly management of long term conditions and encouragement of self care techniques Lifestyle factors – intervention/support needs to be focussed on settings – schools, workplaces, particularly high risk groups and communities Obesity & physical activity – ‘leptogenic environment’ – undertake Health Impact Assessments on planning decisions across the borough Alcohol – greater involvement of primary care in both provision of acute care and prevention & lobbying for minimum price Smoking – increase work on smoke free homes and cars Reducing inequalities – pay attention to the slope index of inequality to ensure that interventions are tailored to meet the needs of people in different deprivation deciles –proportionate universalism approach recommended by Marmot

47 Key questions What does the information tell us? What recommendations does the information lead you to? What are the information gaps?

48 Long Term Conditions and Disabilities Melanie Carr Community Information & Research Manager Adult & Community Services

49 Context Nationally: –1 in 3 people have a long term condition (3 in 5 aged 60+) –Estimated that treatment and care of those with long term conditions accounts for 69% of the primary and acute care budget –People with long term illness and disabilities are more likely to be economically disadvantaged and experience social inequalities –Four times as many people with learning disabilities die of preventable causes than the general population

50 Ageing Population

51 Projections of LLTI & Disability Bolton LLTI & Disability Pyramid 2001-21

52 Projections of LLTI & Disability HSE Disability Crude Rates

53 Long term conditions Diabetes continues to rise – BHS 5.7 to 7.2% GP registers 4.8% (14,000 people) Higher in BME (up to 25% in Asian Pakistani pop) COPD – BHS 2.7%, chronic cough 13.5% GP registers 2% (5,700 people) Correlates strongly with deprivation and smoking Mental health – fairly stable Almost a quarter of adult population showing some element of poor mental health

54 Mental Health

55 Learning Disabilities

56 Older People (65+)

57 Carers

58 Key Recommendations for Commissioning (Draft) Focus on early intervention and prevention Improve access to universal services Improved management of long term conditions Continue to improve integration between primary care, social care and secondary healthcare Develop/update key commissioning strategies e.g. –End of Life Care strategy, –Joint commissioning strategy for dementia, –Learning Disability Joint Commissioning Strategy for Health & Social Care –Co-ordinated approach to the needs of people with autistic spectrum conditions More focus on needs of carers

59 Key questions What does the information tell us? What recommendations does the information lead you to? What are the information gaps?

60 Children and Young People Anne Gorton Policy, Performance and Analysis Manager Children’s Services

61 Number of Births

62 Birth Rate by Ward

63 Ethnic Heritage

64 Number Looked After Children

65 Children and Young People’s Health Infant mortality in Bolton higher than regional and national Babies born in UK of women born in Pakistan have higher incidence of infant death rates and low birth weight 20.7% of pregnant women smoke at delivery Breastfeeding rates at initiation and 6-8 weeks are below national targets Bolton is ranked 12 th worse area in England for DMFT in 5 year olds Higher rates of teenage pregnancies in deprived areas Prevalence of obesity in Reception 9.1% & 17.5% in year 6 – lower than regional and national averages – but still an issue Higher prevalence of underweight children

66 Children and Young People’s Health Rates of childhood accidents linked to deprivation 28% of 14-17 year olds in Bolton claimed to binge drink Higher than average admissions for alcohol specific hospital admissions among under 18s Only half of Bolton children report achieving at least three hours of high quality physical education or out of hours school sport in a typical week. Bolton is currently not meeting the target of testing through the National Chlamydia Screening Programme A quarter of 14-17 year olds in Bolton report being current smokers

67 Achievement The areas within Bolton where residents experience poor health outcomes are the same as those with lower levels of achievement including qualifications and skills Average education and skills levels among 19-65 year olds in Bolton is lower than the North West regional average and significantly lower in the most deprived areas of the borough. The % of 16 year olds in Bolton who achieve 5 or more good GCSE passes including English and Maths is below the national average particularly for those living in the more deprived areas of the borough.

68 Key Recommendations for Commissioning (Draft) Development of an overall workforce plan across partner organisations including health visitor and midwifery services Development and implementation of child poverty strategy Increase dental health improvement activity with BME Communities Map current sexual health service provision and undertake skills audit Timely roll out of ‘You're Welcome’ accreditation programme Ensure as many mothers as possible breastfeed up to six months Alcohol prevention work should ideally focus on education in schools, workplaces, and at specific high risk populations.

69 Key questions What does the information tell us? What recommendations does the information lead you to? What are the information gaps?

70 Next steps Feedback forms to be completed and returned by Monday 12 th April JSNA to be updated with commissioners’ feedback Sign off from PCT and DMT mid April Sign off from Health and Wellbeing Partnership in May LSP launch in June Commissioning strategies signed off in October

71 Thank you

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