JSNA briefing for Royal Borough Windsor and Maidenhead NHS Berkshire East Update 5th November 2009 Dr Pat Riordan Director of Public Health

Guidance on Joint Strategic Needs Assessment The Local Government and Public Involvement in Health Act (2007) places a duty on local authorities and PCTs to undertake Joint Strategic Needs Assessment (JSNA). JSNA is a process that will identify the current and future health and wellbeing needs of a local population, informing the priorities and targets set by Local Area Agreements It should lead to agreed commissioning priorities that will improve outcomes and reduce health inequalities The JSNA should inform the sustainable community strategy as well as WCC strategic and operational plans

Questions the JSNA should address

What has happened since last year? Accomplished Smoking cessation – targets met Alcohol Recommissioned Tier 3 service Introduction of arrest referral officer Pan flu response practice HIV service commissioned Carers respite services Telecare equipment evaluated, positive outcomes Improved delayed discharge arrangements Ongoing/to do Children's Trust priorities for; Pakistani and traveller groups, Healthy Minds programme Childhood obesity Older people; joint commissioning plans for dementia Long term conditions needs assessment Introduce national recommendations for improving the falls service Review Carers Services Transforming Social Care Prevention Agenda

Modelling the effect of the recession Audit Commission report (2009) requires councils and PCTs to have recession management plans in place. There is evidence that Wave 1 has commenced with rising unemployment and negative growth - a reduction in housing prices and a rise in acquisitive crime has also occurred. The Audit Commission report forecasts that in Wave 2 there will be an increase in mental health problems, domestic violence, alcoholism and addiction; with longer term ill health sustained in some areas whereas other areas will recover quickly once the recession ends. A full pdf of valuable interventions that businesses can take is available at http://www.audit-commission.gov.uk/nationalstudies/localgov/Pages/whenitcomestothecrunch12aug2009.aspx#downloads

The next 5-10 years Financial climate: (-) growth PCTs/ LAs need recession management plans Wave 1: increase unemployment, decrease house prices Wave 2: increase mental health problems,domestic violence, alcohol/ addiction Wave 3: unequal recovery, growth back to trend Inequalities increase

rs Significant increase in older people Increased pressure on health and social care services and carers Long term conditions Mental health problems Significant rise in dementia

What do National Health Profiles say? Health of people in RBWM generally better than England average Pockets of deprivation: male life expectancy 5 years lower in most deprived areas 2800 children+ living in poverty, 900 eligible free school meals

JSNA outcomes supported by evidence Violent crime is a problem Rate is higher than England average 18.4 per 1000 population (England 17.4) = 2564 incidents 2007/08

Population % change 2009-2019

RBWM Deprivation Profile

Life expectancy by quintile of deprivation nationally No fifth quintile is shown for Bracknell as the total male or female population is below 5000 (2003-7)

All Age All Cause Mortality New national measure to show how PCTS & Las are tackling inequalities Evidence shows that most effective way to achieve 1 year increase in life expectancy and narrow the gap between worst and best wards is by targeting Male cardiovascular disease Female COPD

RBWM AAAC

Standardised years of life lost <75 2005-7

RBWM Deaths from CVD

RBWM Deaths From Cancer

RBWM LTC Projections 2009 2014 2019 % Change CHD 3902 4198 4460 14% Heart Failure 437 482 550 26% Stroke 1968 2131 2273 15% Hypertension 14700 15520 16229 10% Diabetes 4164 4419 4624 11% Epilepsy 672 686 702 4% COPD 1303 1442 1615 24% Cancer 1124 1182 1241 Hypothyroidism 3298 3590 3858 17% Mental Health 635 644 660 Asthma 7103 7384 7557 6%

Prevalence of stroke

Stroke prevalence forecast

Dementia

Asthma

COPD (Qof prevalence by ward)

Estimates of alcohol misuse

Smoking prevalence by ward (QoF 2008/9)

Percentage of obese children in year 6, 2008/9 The key message is that the RBWM results are below the national rates however not below the LAA trajectory rates. This is because the national information centre pools data from out of the area i.e students may attend schools in Bucks or Surrey

Prevalence adult obesity by ward (QoF)

Questions?