Transcript A Brand Identity for Bolton

Welcome
Joint Strategic Needs Assessment
Commissioners Workshop Event
John Rutherford
Director of Adult and Community
Services
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
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
WHAT IS JSNA?
Tim Bryant
Head of Commissioning
Agenda for the day
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Setting the scene
Themed presentations
‘World Café’ style discussions
Refreshment break
Further presentations and discussions
Summary and next steps
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)
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
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
What it looks like
• http://www.boltonvision.org.uk/jsna_draft.asp
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
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
Bolton’s Demographic and
Socio-Economic Profile
Clare Gore
Housing Strategy Manager (Policy & Research)
Strategic Housing Unit
Bolton Overview
Population
2008 Mid Year Population Estimates
Children
(age 0 - 15)
Number
%
54,700
20.80%
Working Age
159,500
60.70%
(age: males 65+,
females 60+)
48,600
18.50%
Total
262,800
(age: males 16-64,
females 16-60)
Older People
Number
%
Male
129,200
49%
Female
133,500
51%
Bolton Overview
Geographical Variation
Bolton Overview
Geographical Variation
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
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
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%)
Bolton Overview
Deprivation
Bolton Overview
Unemployment: JSA Claimants
6
5
% Unemployment
4
Bolton (%)
3
North West (%)
Great Britain (%)
2
1
0
Jan-09
Feb-09
Mar-09
Apr-09
May-09
Jun-09
Jul-09
Aug-09
Sep-09
Oct-09
Nov-09
Dec-09
Jan-10
Feb-10
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%
Bolton Overview
Income Distribution
Bolton Overview
Child Poverty
Bolton Overview
Effects of the Economic Downturn
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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
Moth
Feb-10
Jan-10
1.0
Dec-09
Nov-09
Oct-09
Sep-09
Aug-09
Jul-09
Jun-09
May-09
Apr-09
Mar-09
Feb-09
Jan-09
Dec-08
Nov-08
Oct-08
Sep-08
Aug-08
Jul-08
Jun-08
May-08
Apr-08
Mar-08
Feb-08
Jan-08
Dec-07
Nov-07
Oct-07
Sep-07
2.0
Aug-07
3.0
Jul-07
% of Working Age Population Claiming JSA
Bolton Overview
Effects of the Economic Downturn: Unemployment since 2007
2006 Based Projections by Broad Age Group
% Unemployment from July 2007
6.0
8,469
5.0
204,157
4.0
1,370,285
4,294
108,979
713,363
Bolton
North West
England
0.0
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
Bolton Overview
Future Projections
2006 Based Projections by Broad Age Group
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
Bolton Overview
Influence on Health and Wellbeing: Housing
Bolton Overview
Influence on Health and Wellbeing: Housing
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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
Bolton’s ‘Big Killers’ and
lifestyle issues
David Holt
Head of Public Health Intelligence
NHS Bolton
Life expectancy
2006-08
Bolton
Male
75.5
Female
79.9
North West
76.3
80.6
England
77.9
82.0
Life Expectancy gap between Bolton & England: Males & Females
Males
Life Expectancy: Females
3.0
79 83
EnglandEngland
North
West
North
West
Bolton
Bolton
Source: nchod
Source:
nchod
Source:
nchod
78 82
2.5
77 81
Number of years
of years
Number
Number of years
76
2.0
80
75
74
79
1.5
78
73
72
1.0
77
71 76
0.5
70 75
69 74
0.0
19911992-1992199319941995199619971998199920002001200220032004200520062007199119931991- 19921993- 19941994- 19951995- 19961996- 19971997- 19981998- 19991999- 20002000- 20012001- 20022002- 20032003- 20042004- 20052005- 20062006- 200720071993
1994
1995
1996
1997
1998
1999
2000
2001
2002
1993
1994
1995
1996
1997
1998
1999
2000
2001
20022003
20032004
20042005
20052006
20062007
20072008
20082009
2009
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Geographical inequalities
12.8 year gap
Mortality & Deprivation
Directly age standardised premature mortality rates (2002-08) by deprivation
percentile - Bolton LSOAs
900
800
700
DSR/100,000
600
500
400
R² = 0.7031
300
200
100
0
0
10
Least deprived
20
30
40
50
60
Deprivation percentile
70
80
90
Most deprived
100
Bolton's population by deprivation decile
70000
25.0
23.0
60000
20.0
17.0
Population count
50000
15.0
40000
%
30000
9.5
9.2
8.2
8.5
8.2
7.0
10.0
7.7
20000
5.0
10000
1.7
0
0.0
1
2
3
4
5
6
Deprivation decile
7
8
9
10
Cause of male gap
in life expectancy
When grouped %
contribution
Circulatory
disease
31
Other causes
14
Overdose &
poisoning
11
Digestive
Disease
10
Cancers
9
Cause of female gap
in life expectancy
When grouped
%
contribution
Circulatory
disease
31
Respiratory
disease
15
Infant mortality
14
Digestive
Disease
11
Cancers
11
Our main killers
Smoking
Diet/obesity
Alcohol
Physical activity
Cardiovascular disease
Respiratory disease
Lung cancer
Liver disease
Inequalities across ethnicity
Inequalities across deprivation
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
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
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
Overview of recommendations
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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
Key questions
• What does the information tell us?
• What recommendations does the information
lead you to?
• What are the information gaps?
Long Term Conditions and
Disabilities
Melanie Carr
Community Information & Research Manager
Adult & Community Services
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
Ageing Population
Bolton Population Projections (All persons 50+)
120
80
85+ yrs
80-84 yrs
75-79 yrs
60
70-74 yrs
65-69 yrs
60-64 yrs
55-59 yrs
40
50-54 yrs
20
0
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
20
18
20
19
20
20
20
21
20
22
20
23
20
24
20
25
20
26
20
27
20
28
20
29
20
30
20
31
Number of people (Thousands)
100
Year
Source: ONS
Projections of LLTI & Disability
Bolton LLTI & Disability Pyramid 2001-21
86
81
76
71
66
61
56
Age
51
46
41
36
31
26
21
16
11
6
1
3000
2000
1000
0
1000
Population with LLTI
2000
3000
4000
Projections of LLTI & Disability
HSE Disability Crude Rates
2021
Disability and
severity levels
2001
Static
LLTI
Pessimistic
Optimistic
Intercensal
change
Overall disability
17
18
21
17
18
Higher severity
5
6
7
5
6
Lower severity
11
13
14
12
12
12
14
16
12
14
Personal Care
6
7
8
6
7
Hearing
5
5
6
5
5
Sight
2
3
3
2
3
Disability types
Locomotor
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
Mental Health
Learning Disabilities
Estimated Number of People with LD & Autistic Spectrum Conditions
Aspergers 2029
Aspergers 2009
Autistic Spectrum 2029
14-17 yrs
Autistic Spectrum 2009
18-64 yrs
Moderate LD 2029
65+ yrs
Moderate LD 2009
Severe LD 2029
Severe LD 2009
Profound & Multiple LD 2029
Profound & Multiple LD 2009
0
1000
2000
3000
4000
5000
6000
Older People (65+)
Disabilities
Health Problems
Number
35,000
30,000
20,000
2009
2015
2020
2025
2030
Year
15,000
Visual Impairment
10,000
Hearing Impairment
Mobility
5,000
0
Mental Health
2009
2015
2020
2025
2030
Year
Long term limiting illness
Heart attack
Stroke
Bronchitis/Emphysema
Falls
Falls - hospital admission
Continence
Obesity
Diabetes
Number
Number
25,000
30,000
25,000
20,000
15,000
10,000
5,000
0
6,000
5,000
4,000
3,000
2,000
1,000
0
2009
2015
2020
2025
2030
Year
Depression
Severe Depression
Dementia
Carers
Key Recommendations for Commissioning
(Draft)
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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
Key questions
• What does the information tell us?
• What recommendations does the information
lead you to?
• What are the information gaps?
Children and Young People
Anne Gorton
Policy, Performance and Analysis Manager
Children’s Services
Number of Births
Birth Rate by Ward
Ethnic Heritage
4000
3500
2500
2000
1500
1000
500
Reception year intake
White British
BME
Total
20
12
20
11
20
10
20
09
20
08
20
07
20
06
20
05
20
04
20
03
20
02
20
01
20
00
19
99
19
98
19
97
0
19
96
Pupil Numbers
3000
Number Looked After Children
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 12th 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
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
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.
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.
Key questions
• What does the information tell us?
• What recommendations does the information
lead you to?
• What are the information gaps?
Next steps
• Feedback forms to be completed and returned by
Monday 12th 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
Thank you