Transcript Health Inequalities in the East Midlands

Applied Methodologies in Public Health
Information: Health Needs Assessment
(HNA) and Joint Strategic Needs
Assessment (JSNA)
Day 4 Session 3
Sarah Jane Flaherty EMPHO
James Hollinshead EMPHO
6thth July 2010
Learning Objectives
• Understand the principles of a health needs
assessment
• Work through an example of a health needs
assessment
• Introduction to JSNA
HNA: Key Resources
• Health Needs Assessment: A Practical Guide June 2005
http://www.nice.org.uk/aboutnice/whoweare/aboutthehda/hdapublication
s/hda_publications.jsp?o=705
• 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
What is a Health Needs Assessment?
• At your tables
• Discuss how you would define a Health
Needs Assessment
• Feedback with some key words that would
be in this definition
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)
Put simply!
• Systematic process
• Identify health problems
• Identify services required
• Supports priority setting
• Leads to action
HNA: different models/common ground
•
a disease
•
a service
•
a community or social experience
Who has undertaken a HNA?
WHY?
Why undertake HNA?
• Provide evidence about a population on which to plan
services and address health inequalities
• Opportunity to engage with specific populations
– Enable them to contribute to targeted service planning and
resource allocation
• Opportunity for cross-sectoral partnership working
• Develop creative and effective interventions
Why undertake HNA?
NHS Planning Guidance 2005-2008
• Undertake needs assessment in conjunction with partners
• PCTS need to demonstrate the use of needs assessment in their
planning
Health care commission PCT core standards 2007/08:
Core standard C23
• The PCT assesses the health needs of its local population, including
analysis of its demography, health status, health and social care use
and patient and public views.
• The PCT’s commissioning decisions and local target setting are
informed by its assessment of health needs ....
• The PCT commissions or provides targeted programmes and services
.... based on the needs of its local population.
*NB The Healthcare Commission are an Independent regulator of health and social care in England
Why undertake HNA?
World Class Commissioning (2008)
• WCC competency 5 to manage knowledge and assess needs:
• 'Manage knowledge and undertake robust and regular needs
assessments that establish a full understanding of current and
future local health needs....’
• Commissioning decisions should be based on sound knowledge
and evidence. 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.
Questions?
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?
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?
Key steps
• Define population
• Population profile - demographics
• What are the health problems?
• What services are currently in place?
• What services should we have in place to
address these health problems?
• Identify service gaps
• Identify priorities – lead to action
Define the population
• Geographic location e.g. living in deprived
neighbourhoods or housing estates
• Settings e.g. schools, prisons, workplaces
• Social experience e.g. asylum seekers, specific age
groups, ethnicity, sexuality, homelessness
• Experience of a particular medical condition e.g.
mental illness, diabetes, respiratory disorders
Population profile
• Demographics:
– Age
– Sex
– Ethnicity
• Different population subgroups experience differing
health needs
• Profiling can be a good way to identify inequalities
What are the health problems?
• Collecting + interpreting various sources of data
• How to measure health problems?
• Depends on defined population
• Disease frequency vs risk factors vs social wider
determinants of health
• National vs local epidemiological data
• Comparative data
How to measure health problems?
• Measure disease frequency? Incidence vs
prevalence?
• Describe:
– Time - time trend
– Person – age / sex/ ethnic groups
– Risk factors
– Wider determinants of health (deprivation)
– Morbidity / mortality
What are the health problems?
• Take into account range of stakeholder viewpoints
• Perceptions and expectations of the profiled population
(public, patients, carers)
• Perceptions of professionals providing the services
• Perceptions of managers of commissioner/provider
organisations
• Relevant national, regional or local priorities
• Qualitative data – surveys/interviews/focus groups
What are the health problems?
• Provide evidence about a population on which to
plan services and address health inequalities
• An opportunity to engage with specific populations
and enable them to contribute to targeted service
planning and resource allocation
• Provides an opportunity for partnership working and
developing creative and effective services
Routine surveillance systems
• Mortality data (ONS available on NCHOD)
• Morbidity data: e.g. Service use
– Primary care – QOF data (NHS Information Centre)
– Secondary care – HES data (NCHOD/EMPHO)
– Sexual health e.g. Chlamydia – KC60 returns
• Cancer registry
• Lifestyle data (surveys, NHS Information Centre)
• Literature search – primary research studies
• Always be aware of limitations of data sources
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?
Exercise: Planning a 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?
Applied Methodologies in PHI: JSNA
"Joint Strategic Needs Assessment
describes a process that
identifies current and future
health and wellbeing needs in
light of existing services, and
informs future service planning
taking into account evidence of
effectiveness.“
"Joint Strategic Needs Assessment
identifies 'the big picture' in
terms of the health and
wellbeing needs and
inequalities of a local
population."
http://www.dh.gov.uk/en/Publicationsandstatistics/Public
ations/PublicationsPolicyAndGuidance/DH_081097
The duty to produce a Joint Strategic Needs Assessment
• Section 116 of Local Government & Public Involvement in Health Act
(2007) set out 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
Joint strategic needs assessment
JSNA is a development of HNA - bigger and better!
Key features:
-
Jointness!
Big picture
Whole population
Includes focus on future needs
Well-being as well as health
Social care as well as health care
Maintains the focus on inequalities
Engagement with local communities
Joint strategic needs assessment
A good JSNA will:
•Provide analyses of data to show the health and well-being
status of local communities
• Concentrate on current and future health and wellbeing needs
of the population (short term (3-5 years) to inform Local Area
Agreements, and the longer term future (5-10 years) to inform
strategic planning
•Define where inequities exist
•Inform the commissioning of services and interventions to
achieve better health and wellbeing outcomes and reduce
inequalities
•Use local community views and evidence of effectiveness of
interventions to shape the future investment and disinvestment in
services
Joint strategic needs assessment
What information should a good JSNA include:
- Which groups are getting a raw deal?
- How many children are living in poverty?
- What are people dying of?
- Which of our communities dies youngest?
- Roughly when do people die?
- How many people are there over 75?
- Are we spending our money on the right things?
- What illnesses are people living with?
- What are people living with that makes their lives difficult?
- What help do the groups who are getting a raw deal want
and need?
- Where do the groups getting a raw deal live?
JSNA
cycle
The Benefits of JSNA
• Improve need assessment and commissioning information
• make our decision making more evidence based
• doing it jointly makes the information more robust, and
access to a wider set of data sources
• think about how we store information and update it
• Focuses our minds on the longer term–5, 10, 20 years
• help us to check out if our priorities are the right ones
• identifies gaps in our knowledge–where we don’t know what
we need to know!
• developed jointly leads to joint ownership
• [Source: Kirklees PCT]
Useful JSNA resources
• APHO resource pack http://www.apho.org.uk/resource/view.aspx?RID=53885
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•
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Introducing the Core Dataset
Statistical validity
Projection methods for use in JSNA
Data sharing for JSNA – principles and examples
Measuring health Inequalities
• The NHS Information Centre JSNA web pages
http://www.ic.nhs.uk/services/in-development/joint-strategic-needs-assessment-jsna
• DH JSNA pages
http://www.dh.gov.uk/en/Managingyourorganisation/JointStrategicNeedsAssessment/index
.htm
• EMPHO JSNA webpages
http://www.empho.org.uk/methodologies/jsna/jsna1.aspx
The Department of Health JSNA web pages
http://www.dh.gov.uk/en/Managingyourorganisation/JointStrategicNeedsAssessment/index.htm
APHO Resource Pack
http://www.apho.org.uk/resource/view.aspx?RID=53885
NHS Information Centre for Health and Social Care
http://www.ic.nhs.uk/services/in-development/joint-strategic-needs-assessment-jsna
Local Case Study: Nottinghamshire County
http://www.nottinghamshire.gov.uk/factsaboutnotts.htm
•
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
•
Prioritisation and interpretation by the PH and LA teams
Nottingham City PCT JSNA
http://www.nottinghaminsight.org.uk/insight/jsna/jsna-home.aspx
• Interactive document
• Chapters; demography, life expectancy,
Behavioural factors, children young people and
families, adults
• Small subsections e.g. LTC within chapter. ‘bite
sized chunks for commissioners’
• Template for each subsection (consistent
format)
Future of JSNA
•
•
•
•
•
Broad vs focussed
Static vs interactive
Finances and disinvestment
Future of health and social care integration
New structures for commissioning teams
(GP consortia)
Summary
• Understand the principles of a health needs
assessment
– HNA definitions
– HNA resources
– HNA policy context
– HNA cycle
• Work through an example of a health needs
assessment
• Introduction to JSNA
Any questions?
If there are any comments please
email:
[email protected]
[email protected]