Transcript An overview of public health and its practice

Applied Methodologies in Public Health
Information: Health Needs Assessment and
Joint Strategic Needs Assessment
Day 4 Session 2
Kate Saffin PHRU
May 2009
Based on material developed by
Dave Jenner EMPHO
James Hollinshead EMPHO
Learning Objectives
1.
To understand what is meant by HNA and JSNA
2.
To increase awareness, through case studies, of how HNA and
JSNA are applied in practice
Starting understandings
HNA… JSNA… HIA… HEA… EqIA…
EIA… SEA… SA… IIA
HNA: Key Resources
• Health Needs Assessment: A Practical
Guide June 2005
http://www.nice.org.uk/aboutnice/whoweare/aboutthehda/hdapublications/hda_publications.jsp?o=705
• HDA. Clarifying approaches to: HEA,
HIA, Integrated impact assessment, HEA
and race equality impact assessment
http://www.nice.org.uk/aboutnice/whoweare/aboutthehda/hdapublications/p101.jsp
HNA: definitions
The epidemiological approach to needs assessment
• Prevalence and incidence
• Services available and their costs
• Effectiveness and cost-effectiveness of services
• Quantified models of care and recommendations
• Outcome measures, audit methods and targets
• Information and research requirements
http://hcna.radcliffe-oxford.com/ 1994 & 1997
The systematic method of identifying
unmet health and healthcare needs of a
population and making changes to meet
those unmet needs.
Wright J, Williams R & Wilkinson J. BMJ 1998; 316:
1310-3.
A systematic review of the health
issues facing a population leading
to agreed priorities and resource
allocation that will improve health
and reduce inequalities.
Health Needs Assessment: A Practical
Guide (NICE 2005)
An HNA:
• Is SYTEMATIC i.e. there is a process or method
behind it
• IDENTFIES NEED or REVIEWS HEALTH ISSUES
(element of looking at information or talking to
communities to find out how they can benefit)
• Supports MAKING CHANGE as a result of these
assessments (i.e. they should result in a change to
address need)
• Contributes to AGREEING priorities/resource
allocation. It implies involvement of others, partners,
communities etc.
HNA terminology
BMJ 1998;316:1310-1313
Development and importance of health needs assessment
John Wright, Rhys Williams, John R Wilkinson
HNA: different models/common ground
•
a disease
•
a service
•
a community or social experience
Why undertake HNA?
• provide evidence about a population on which
to plan services and address health
inequalities
• provide an opportunity to engage with specific
populations and enable them to contribute to
targeted service planning and resource
allocation
• an opportunity for cross-sectoral partnership
working and developing creative and effective
interventions
Drivers for HNA
NHS Planning Guidance 2005-2008
PCTs and their partners will need to consider the particular
needs of their population, taking into account different
needs and priorities within each community.
PCTs should demonstrate that, as well as using
epidemiological data and general survey data to identify the
differing needs of their populations, they have listened to
the views of patients and the public and in particular have
taken account of the results of patient and user surveys ....
Drivers for HNA
Core Standard C23
The PCT collects, analyses and shares
data about its patients/service users and
services, including where relevant data on
ethnicity, gender, age, disability and socioeconomic factors, including with its
commissioners,
to influence health needs assessments
and strategic planning to improve the
health of the community served.
Drivers for HNA
World Class Commissioning (2008)
By identifying current needs and anticipating future trends,
PCTs will be able to ensure that current and future
commissioned services address and respond to the needs
of the whole population, especially those whose needs are
greatest.
PCTs should .... undertake robust and regular needs
assessments that establish a full understanding of current
and future local health needs and requirements
Cycle of health needs assessment
1
What population?
... and who to involve?
5
Review
measuring impact
learning
2
Identifying problems
and challenges
population profiling
perceptions of needs
IMPLEMENTING ACTION
4
Action planning
for change
3
Prioritisation
which issue(s) to tackle?
what are effective and acceptable interventions?
Cycle of health needs assessment
1
What population?
... and who to involve?
5
Review
measuring impact
learning
2
Identifying problems
and challenges
population profiling
perceptions of needs
IMPLEMENTING ACTION
4
Action planning
for change
3
Prioritisation
which issue(s) to tackle?
what are effective and acceptable interventions?
Step 2: Identifying Problems and
Challenges
• Not only .... Population profiling
• But also .... How does the population perceive its needs?
– workshops or focus groups - representatives from the local
population and local service providers
– interviews of key people
– consider a survey of those concerned
– consider how to reach individuals/groups who might otherwise
be excluded
Cycle of health needs assessment
1
What population?
... and who to involve?
5
Review
measuring impact
learning
2
Identifying problems
and challenges
population profiling
perceptions of needs
IMPLEMENTING ACTION
4
Action planning
for change
3
Prioritisation
which issue(s) to tackle?
what are effective and acceptable interventions?
Cycle of health needs assessment
1
What population?
... and who to involve?
5
Review
measuring impact
learning
2
Identifying problems
and challenges
population profiling
perceptions of needs
IMPLEMENTING ACTION
4
Action planning
for change
3
Prioritisation
which issue(s) to tackle?
what are effective and acceptable interventions?
Case Studies
• examples from Health Needs Assessment: A Practical
Guide (NICE 2005).
– a secondary school population
– residents of Greenwich and Bexley at risk of self-harm and
suicide
• local case study
– Bullingdon prison, Oxfordshire
National case study: secondary
school pupils in Newcastle
• 3 schools in Newcastle
• Aim to ascertain health issues to target Health Promotion
initiatives
• Involved health, education, CAHMS- high level buy in Chief
Executive PCT and Director of Education
• Survey of all year 9 pupils
• Issues: sexual health, drugs, smoking
• Health drop in centres formed (sexual health and lifestyle issues)
• Well implemented
• Main learning: involve young people in the development of the
HNA
National case study: people at risk of
self harm and suicide Bexley
• To examine the scope for preventing suicide and self
harm in Bexley
• Group involved Directors of A&E, voluntary agencies
and coroner, representatives of the Mental Health
Trust
• Reviewed mortality data and case notes
• Found high suicide rates in young deprived males
• Plan to target at risk people in A&E
• Action plan formulated but only partially implemented
• Main message: HNA may not be effective if local
decision makers not involved
Prison HNA
• Main health and wellbeing issues?
• Information sources?
Case Study: Bullingdon Community Prison
•
•
•
Describe prison - e.g. type and number of prisoners, turnover
Collect data on prisoners’ health - collate existing data
Collect perceptions of major health and health care issues staff/prisoner views, across the whole prison
Describe prison services– gap analysis
Identify options for addressing need - use evidence on effective
interventions
The PCT then went on to:
•
•
•
–
–
Develop and implement plan for change - set achievable standards
and targets, implement changes
Monitor progress
based on ...
•
Toolkit for health care needs assessment in prisons, University
of Birmingham, February 2000.
Applied Methodologies in PHI: JSNA
“Strong leadership for health and
wellbeing is key. This will be provided
by Directors of Adult Social Services,
and Directors of Public Health (jointly
appointed across health and local
government), working alongside
Directors of Children's Services.
Together they will lead local strategic
needs assessments, then plan for
the delivery of more effective health
and wellbeing outcomes, alongside
reductions in local health inequalities”.
•
Part of “Our Health Our Care
Our Say” implementation.
•
Focus on:
–
–
–
•
keeping people healthy and
independent
bringing together health and
social care
joint working across NHS
and local authorities
First detailed description of
JSNA
http://www.dh.gov.uk/en/Publicationsandstatistics/Public
ations/PublicationsPolicyAndGuidance/DH_072604
http://www.dh.gov.uk/en/Publicationsandstatistics/Public
ations/PublicationsPolicyAndGuidance/DH_081097
The duty to produce a Joint Strategic Needs Assessment
• A new statutory requirement for PCTs and responsible local
authorities (from April 1st 2008) to produce a JSNA of the current and
future health and social care needs of their local community.
• Applies to unitary or upper tier local authorities (upper tier authorities
to consult with district councils within their geographical area).
• To be carried out jointly by the Director of Public Health, the Director
of Adult Social Services and the Director of Children’s Services.
• The JSNA will inform:
– the Sustainable Community Strategy
– priorities and targets in the Local Area Agreement
– commissioning priorities
JSNAs are about ...
• ... understanding the current and future health and wellbeing needs of
the population ...
– over both the short term (three to five years) to inform Local Area
Agreements, and
– the longer term future (five to ten years) to inform strategic planning
• ... in order to inform the commissioning of services and interventions
that will achieve better health and wellbeing outcomes and reduce
inequalities
• ... addressing outcomes described in both the National Indicator Set
for local authorities and local authority partnerships, and the “vital
signs” referred to in The Operating Framework for 2008/09
JSNA
cycle
JSNA
core dataset
APHO JSNA resources (work in progress)
•
APHO have been commissioned by DH to input into the JSNA
process.
AIMS:
•
Recommendation of core dataset
•
Development of JSNA data tool
•
Guidance on inequalities analysis
•
Guidance on data sharing protocols
•
Methods of forecasting and projections
•
Guidance on statistical validity
Local Case Study: Nottinghamshire County
•
Formation of multi agency JSNA groups (steering group and
workgroup)
•
Review of the JSNA guidance (and the updates)
•
Agreement on three themes
•
Older people, Children and Young People, Vulnerable Groups
and Adults
•
Collection of all the information and evidence
•
Consultation with stakeholders
•
Focussed by the Steering Groups
•
Prioritisation and interpretation by the PH and LA teams
Summary
•
•
•
•
•
•
HNA definitions
HNA resources
HNA policy context
HNA cycle
Examples of HNA
Introduction to JSNA