1. Key Emerging Themes Health & Wellbeing Board 10th November 2011
Dr John Linnane
Claire Saul

2. Content The Story So Far… Theme Summaries – Content Selection Criteria
Key Emerging Themes
What Next?

3. Purpose of the JSNA
To identify current & future health & wellbeing needs
To establish a shared, evidence based consensus on key local priorities
To form a key element in the Commissioning Cycle

4. The Story So Far…. Just the starting point!
Full annual review of existing work
Produced series of key message summaries
More detailed needs assessment work required
Ongoing programme of work
Analysis of health, social care, demographic, socio-economic, housing data
But…more than just ‘facts & figures’- complete evidence base
Will include broader range of qualitative information
Knowledge, pathway information, consultation activity with stakeholders, service users, professionals, etc.
Purpose of the summaries – to provide a focus for JSNA and HWB Strategy

5. Theme Summaries - Content
1 page summary
Headline data analysis
Findings from consultation activity
Links to outcomes sought
Links to related strategies / further info
‘Who Needs to Know This’
Reviewing current demand/performance/issues

6. Theme Summaries - Content
Not just a look back!
Part of a wider evolving process
Series of web-based tools
JSNA as a vehicle
To move forward/model future need
To inform service commissioning strategies
Series of web-based tools – Website / Local Information System (LIS)

7. Selection Criteria Identification of themes in terms of: Resource gap
Demand
Volume
Significant inequalities
By geography and/or population group

8. Warwickshire JSNA Theme Summaries - 2011
Children
Educational Attainment
Looked After Children
Lifestyle & Reducing Inequalities
Vulnerable Communities
Disability
Safeguarding
Long-Term Conditions
Mental Wellbeing
Ageing
Dementia
Ageing & Frailty
Children/Young People
General Population
Older People

9. 1. Children - Educational Attainment
Current issue/challenge/trend
Although Warwickshire above the national average
– big geographic & population group variation
Importance of education as the key socio-determinant of health & wellbeing.
What is the gap?
63% of children not on FSM achieve 5 A*-C including English & Maths compared with 30% of children on FSM.
What are we doing about it?
Raise awareness in schools and support identified schools.
Promote uptake of FSM to secure funding to tackle impact of social deprivation on attainment
Numbers increased by 32% over last 3 years; from 482 in 07/08 to 636 in 10/11.
In 2009/10, only 4% LAC achieved 5+ GCSEs (Grades A*-C including Maths & English) compared with 59% of all children in Warwickshire.
47% 5+ GCSEs (Grades A*-C including Maths & English) in North Warks v 68% in Stratford-on-Avon.
33 percentage point difference between those eligible for free school meals and those who are
not, in achieving 5+ GCSEs (Grades A*-C including Maths & English).

10. 1. Children - Looked After Children
Current issue/challenge/trend
Numbers increased by one third over last three years.
Huge inequality in attainment levels between LAC & all other children.
Poor health outcomes
Over-representation in the justice system
What is the gap?
Educational attainment & health outcomes to match those of other children
Sufficiency test
Housing needs
What are we doing about it?
Dartington Project
Early intervention
Capital support to foster homes
Numbers increased by 32% over last 3 years; from 482 in 07/08 to 636 in 10/11.
In 2009/10, only 4% LAC achieved 5+ GCSEs (Grades A*-C including Maths & English) compared with 59% of all children in Warwickshire.
47% 5+ GCSEs (Grades A*-C including Maths & English) in North Warks v 68% in Stratford-on-Avon.
33 percentage point difference between those eligible for free school meals and those who are
not, in achieving 5+ GCSEs (Grades A*-C including Maths & English).

11. 2. Lifestyle & Reducing Inequalities
Current issue/challenge/trend
Levels of obesity, alcohol related hospital admissions, STIs, all rising.
Smoking, whilst decreasing, still a key public health issue.
Massive impact on demand for and cost of health & social care services.
Housing
1 in 4 adults (110,000 people) in Warwickshire is estimated to be obese. 20% of Reception age and over 31% Yr 6 children classed as being overweight and obese.
The rate of alcohol-related hospital admissions has more than doubled since 2002/03 and continues to rise.
130,000 people in Warwickshire still smoke. In 2010/11, in Warwickshire, nearly 1,000 babies were born to women who were smoking at the time of delivery.
Total numbers of STIs in Warwickshire has risen by more than 20% since 2003.
All of the top 13 most deprived SOAs from the Index of Multiple Deprivation (IMD) 2007 have shown
considerable deterioration in the IMD 2010 rankings, suggesting that the gap between the most and
least deprived areas of the County is widening.
There is considerable variation in life expectancy at birth across the County ranging
from 75 in Abbey ward, Nuneaton to 88 in Leek Wootton, Warwick

12. 2. Lifestyle & Reducing Inequalities
Current issue/challenge/trend
Latest data shows that the gap between the most & least deprived areas of the County is widening.
13 years variation in life expectancy at birth across the County.
The health of our most disadvantaged in society should be our top priority (Marmot).
1 in 4 adults (110,000 people) in Warwickshire is estimated to be obese. 20% of Reception age and over 31% Yr 6 children classed as being overweight and obese.
The rate of alcohol-related hospital admissions has more than doubled since 2002/03 and continues to rise.
130,000 people in Warwickshire still smoke. In 2010/11, in Warwickshire, nearly 1,000 babies were born to women who were smoking at the time of delivery.
Total numbers of STIs in Warwickshire has risen by more than 20% since 2003.
All of the top 13 most deprived SOAs from the Index of Multiple Deprivation (IMD) 2007 have shown considerable deterioration in the IMD 2010 rankings, suggesting that the gap between the most and least deprived areas of the County is widening.
There is considerable variation in life expectancy at birth across the County ranging from 75 in Abbey ward, Nuneaton to 88 in Leek Wootton, Warwick
Child Poverty Strategy

13. 3. Vulnerable Communities - Disability
Current issue/challenge/trend
Although prevalence rates are lower in Warwickshire than nationally, there are still significant numbers of people with a physical or learning disability.
The complexity of future care provision for disabled people will grow & personalisation will offer much greater choice.
33% of adults with learning disabilities live in institutional care.
What is the gap?
In Warwickshire, 33% of people with LD live in institutional care. Best in practice nationally has single figures.
Six lives audit sets the standards
What are we doing about it?
The market will need developing for personalisation.
Development of supported living
There are estimated to be 80,000 disabled people living in Warwickshire, 19% of the over 16 population. 
All Warwickshire’s Districts and Boroughs have lower proportions of their adult populations who are disabled than the equivalent National and Regional figures.  In the County, North
Warwickshire has the largest proportion of its adult population estimated to be disabled at just below 22%. Prevalence rates indicate that there are 9,310 people aged 14 and over who have some form of learning disability, this is projected to increase to 9,570 by ,756 pupils are defined as having a special educational need (SEN) % of the school population.
LTCs or chronic conditions are those which can be controlled but not cured at present. Health problems or disability which limits daily activities incl problems due to old age.

14. 3. Vulnerable Communities - Safeguarding
Current issue/challenge/trend
20% increase in number of adult referrals
14-16% increase in number of children’s referrals
Partial commitment from partners
What is the gap?
Safeguarding is everyone’s business
What are we doing about it?
Strong children’s safeguarding board
Strengthening adult’s safeguarding board
New strategy & process this financial year

15. 4. Long-Term Conditions Current issue/challenge/trend
An estimated 1 in 3 people in Warwickshire live with one or more long term conditions. In the over 75s, this rises to 2 in 3 people.
WHO – leading cause of morbidity by ‘Invisible Epidemic’
Variation in QoF delivery across County
Acute hospital admission rates are lower with better QoF management
There are estimated to be 80,000 disabled people living in Warwickshire, 19% of the over 16 population. 
All Warwickshire’s Districts and Boroughs have lower proportions of their adult populations who are disabled than the equivalent National and Regional figures.  In the County, North
Warwickshire has the largest proportion of its adult population estimated to be disabled at just below 22%. Prevalence rates indicate that there are 9,310 people aged 14 and over who have some form of learning disability, this is projected to increase to 9,570 by ,756 pupils are defined as having a special educational need (SEN) % of the school population.
LTCs or chronic conditions are those which can be controlled but not cured at present. Health problems or disability which limits daily activities incl problems due to old age.
What are we doing about it?
Community equipment
Telecare
Telehealth

16. 5. Mental Wellbeing Current issue/challenge/trend
Statistics are likely to underestimate the scale of both adults & children in Warwickshire with a mental illness.
53,221 (10.2%) people in Warwickshire provide unpaid care for a relative, friend or neighbour.
‘No Health without Mental Health’
Schools feel unsupported with mental health & behaviour problems.
‘Programme Budgeting’ analysis indicates high levels of comparative spend without outcome benefit
Mental wellbeing - John is doing this one but Wendy had some suggestions too: Gap - Schools feel unsupported with mental health and behaviour problems.         - Significant differences identified between North and South 3rd section - New contract in CAMHS         - school to school support        - mental health strategy refresh ongoing

17. 6. Ageing - Dementia Current issue/challenge/trend
It is estimated that the number of older people with dementia in Warwickshire will double in next 20 years, to more than 13,000.
Are services ready to cope with this future demand?
Early diagnosis
Lifestyle opportunities
By 2030, it is estimated that more than 37,000 people over 65 in Warwickshire will be obese with greater risks for diabetes, heart disease and other associated health problems.
An estimated two thirds of over 75 year olds in Warwickshire live with one or more long term conditions, many of which are not known to the older person’s general practitioner.
In the next 20 years, new cancer cases are expected to increase by 70% in males over 70% and 50% in females.
Dementia is expected to increase by almost 90% in people aged over 60.
Frail older people stay in hospital longer, occupy two thirds of hospital beds and are the main users of long term care services, much of which is unnecessary.
22% of all non-planned emergency inpatient admissions are to people aged over 75.
The proportion of spend for hospital activity on the over 75 year old population is 26% of all activity and 39% of non-elective costs
In 2010/11 8,920 people received a funded social care service from Warwickshire County Council, 2,180 of these were in permanent residential or nursing care
What are we doing about it?
Designing services such as extracare & telecare that support people to continue to live at home.
Communities taking care of themselves

18. 6. Ageing - Ageing & Frailty
Current issue/challenge/trend
Consequences of a rapidly ageing population - Increases in numbers with limiting long-term conditions, cases of cancer, emergency hospital admissions, dementia, etc.
Additional pressures placed upon our services (particularly health & social care). Issue of quality of life experienced by our residents as their life expectancy increases.
By 2030, it is estimated that more than 37,000 people over 65 in Warwickshire will be obese with greater risks for diabetes, heart disease and other associated health problems.
An estimated two thirds of over 75 year olds in Warwickshire live with one or more long term conditions, many of which are not known to the older person’s general practitioner.
In the next 20 years, new cancer cases are expected to increase by 70% in males over 70% and 50% in females.
Dementia is expected to increase by almost 90% in people aged over 60.
Frail older people stay in hospital longer, occupy two thirds of hospital beds and are the main users of long term care services, much of which is unnecessary.
22% of all non-planned emergency inpatient admissions are to people aged over 75.
The proportion of spend for hospital activity on the over 75 year old population is 26% of all activity and 39% of non-elective costs
In 2010/11 8,920 people received a funded social care service from Warwickshire County Council, 2,180 of these were in permanent residential or nursing care
Gap – Keeping people in their own homes
What are we doing about it?
- Cutting the cost of frailty programme, e.g. decide to admit, discharge to assess

19. What next?
Emerging issues & themes will fundamentally underpin HWB Strategy
JSNA Stakeholder Conference – early 2012
Continued consultation & engagement
Delivery of more comprehensive Needs Assessment Programme
Embedding more consistent approaches to producing needs assessments
Transparency of information/content
JSNA Website/Local Information System (LIS)