JSNA: duty or pleasure How it really felt in Kirklees

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JSNA duty or pleasure? How it really felt in
Kirklees
Phil Longworth, Adults Community Services,
Kirklees Council Dr Judith Hooper, Director of
Public Health, Kirklees PCT/Council Margaret
Watt, Adults Community Services, Kirklees
Council Matthew Holland, Children Young
Peoples Service, Kirklees Council Deborah
Collis, Public Health, Kirklees PCT
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What we will cover

• what we did to develop our JSNA
• what we included and what we didnt
• what our ideas are about further developing our
  JSNA 15m
• From an Adults Services, Childrens Services, PCT
  perspective
• how the JSNA is being used locally and if its
  making any difference
• how it felt for those involved
• what we have learnt from our experiences 15m
• Table discussion
• Mixed groups
• QA 20m

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What does this all mean for leaders in Adult
Services, Children's Services, Public Health?

• Collaboration
• How Directors can work together to improve well
  being and life outcomes for people in their
  locality?
• Challenges
• What are the common and what are the separate
  challenges
• Leadership development needs
• Group members own leadership development needs
  rather than those of others in the system
• Barriers
• Barriers to effective development of health,
  childrens and social care systems that might be
  ameliorated by good leadership interventions?

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What we did to develop our JSNA
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Timeline

• Early discussions Spring 07
• Commissioning Framework for Health and
  Well-being March 07
• Guidance due October 07
• Data collection Summer/Autumn 07
• Workshops Autumn 07
• Briefings Autumn 07
• LSP Board, Picture of Kirklees, LAA
• Publication Feb 08
• Summary target Councillors/ NEDs
• Detailed report (also DPH report)
  commissioners, planners, PBCers
• Sign off Feb/Mar 08
• Cabinet, PCT Board, LSP Executive, LPSBs

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What we were trying to achieve

• Aim
• to describe the future health and well-being
  needs of local population and to inform the
  strategic direction of services to meet those
  needs
• Boundaries of the JSNA
• Adults health and social needs
• Children start with health issues
• Issues not solutions
• Products from the JSNA
• a (well organised!) warehouse of data
• clear set of key issues
• summary and detailed report

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Key principles

• Keep it manageable.
• Start with what we need to know not what is
  available
• Ongoing, longer term piece of work
• JSNA is not a commissioning plan
• Some key issues need a joint response, some do
  not
• Bringing in more partners in the future will make
  our picture richer, broader and deeper

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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 dont
  know what we need to know!
• developed jointly leads to joint ownership
• Independence. DPH report

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What we included in our JSNA and what we didnt
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Sources of needs information

• perceptions of the profiled population (from
  local surveys)
• data about population characteristics and the
  severity and size of the issues i.e. who, when
  and where has what issues
• relevant national, local or regional priorities
• perceptions of managers of commissioner /
  provider organisations
• perceptions of people providing the services

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Data

• Collate indicators
• Children ECM outcomes and JAR relevant to health
• Health existing set of health indicators
• Adults Dartford plus relevant national local
  data for each care group
• Weeding and adding
• Localities data
• National data set from Guidance as cross check
• Assemble data
• tables maps
• Analysis of data
• draw out big messages
• focus on Kirklees level
• developing locality summaries

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Priority themes

• Health Conditions
• Emotional well being and mental ill-health
• Obesity
• Pain
• Dementia
• Heart disease and stroke
• Diabetes
• Wider factors
• Housing condition and options
• Work and not being able to work especially due to
  illness/disability
• Isolation and social networks
• Educational attainment

• Personal Behaviours
• Food
• Alcohol
• Smoking
• Physical activity
• Specific populations
• Children and adults with disabilities
• increasing numbers of people with profound and
  multiple disabilities, including learning
  disabilities
• Women of child bearing age
• personal behaviours and infant deaths
• Older people
• increasing numbers particularly more vulnerable
• Carers
• providing an ever greater proportion of community
  care

NB helping people to help themselves
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Local Health Inequalities adults 2007
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Dewsbury

• Adults
• Worst health in Kirklees for most aspects esp.
• Heart disease no. early deaths
• Diabetes.
• Low income
• Children Young People
• Infant deaths women overweight, binging alcohol,
  smoking _at_ birth
• Rotten teeth rotten diet
• Smoking
• Little physical activity
• Unhappy at school
• GCSEs low levels

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Developing our JSNA
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What next for the JSNA?

• JSNA Technical Group
• Adults/Children's/Housing Services, Corporate
  Research, PCT
• For the Intelligence System
• asking the right questions
• more coherent, consistent and appropriate data
  sets
• trends, projections and comparators
• use of voice, service use and market
  information
• strengthen housing
• factsheets on main adult service user groups
• regular refresh
• developing the capacity to generate, analyse and
  present the appropriate data and information
  integrated intelligence
• For the Planning System
• ensuring the relevant planning systems use the
  products of the JSNA
• help Technical Group shape the questions and
  products

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The right questions?

• What is the future shape of the population,
  especially in terms of age and ethnicity and
  migration patterns?
• What impact will this changing shape have on the
  major issues we have already identified, and will
  it throw up others?
• How have the key issues we have identified
  changed over time and how will they change over
  the next 5/10/15 years?
• What are the potential impacts of changes in
  health and social care technology and care
  practice?
• What are the key challenges in developing
  self-efficacy related to health and social care
  issues? e.g. what are attitudes of different
  client and professional groups to increasing
  emphasis on self-care?
• What are the particular issues for the specific
  population groups we have identified?
• e.g. people with learning difficulties, older
  people, carers.
• What are the key health challenges our local
  communities will face as a result of
• housing, employment and income, transport and
  communications, climate change
• What are the key themes emerging from our
  existing mechanisms to give local people a
  voice?
• What are the questions local health social care
  commissioners need answers to?

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Three Perspective

• How did it feel as a joint process?
• How are we using it?
• What have we learnt?

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How did it feel from an Adult Services
perspective?

• Challenging because we were all coming from
  different perspectives took time to gain top
  level agreement on intended outcomes
• Worthwhile something we had wanted to do for a
  long time and this gave us the push and the top
  level support
• Useful from day one because we focused on
  answering commissioning questions so we used
  the information straight away to direct
  commissioning

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How are we using it?

• To engage Members in discussion about longer term
  planning
• eg focus on ageing population gained support
  for dementia premium for care homes
• To direct commissioning plans
• eg accommodation strategy for learning
  disabilities what to buy where
• To guide our information planning
• helping to id gaps in knowledge, refining our
  commissioning questions

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What have we learnt from the process?

• Jointly compiled / presented information carries
  more weight
• We still have a long way to go the JSNA is an
  ongoing / rolling programme
• We need to refine our commissioning questions
  to help guide/prioritise future work
• We can work through the creative tensions!

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Children Services Perspective

• Developed from baseline APA/JAR
• Survey information Year 9 Tell Us 2
• Brought what we knew into focus
• Identified priorities and actions
• Joint Commissioning Manager Council PCT
• Fundamental to Children Young People Plan
• Asking the right questions
• Challenged assumptions
• CYPP Review 2009

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How did it feel from a PCT perspective?

• Hard work
• data collection, analysis, interpretation
• discussions, reaching agreement
• Frustrating
• different perspectives
• surely we have more than this?
• Opened opportunities not previously available
• Positive
• very well received and discussed widely
• repeatedly cited by all planners including
  PBCers
• Satisfying
• set up better relationships for future work

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How are we using it?

• To ensure people are better informed about health
  and social care priorities for action in Kirklees
  and how we have decided them
• To inform PCT priorities
• Use as a lever in work to address real health
  inequalities
• Core question in the business planning/business
  case process
• To ensure the PCT and Local Authority are engaged
  together on issues, not separately but on the
  same issue
• To engage people involved in commissioning
  services and to get them thinking about a longer
  term view
• Commissioners
• Providers
• GPs/GP Consortia/Practice Based Commissioning
  process
• To focus activities in addressing the gaps
  identified in our intelligence about the health
  of people locally

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What have we learnt from the process?

• A jointly developed assessment seems to be higher
  profile and with more joint ownership than one
  just devised in the PCT
• Lots of gaps in our knowledge.......
• ........but doing a JSNA is an opportunity to
  know and understand the gaps better and to
  develop our knowledge, together
• Opportunity to explain commissioning and how it
  really can make a difference
• Move service focused people to think about needs
  first!
• The same thing can be done in 3 different ways
  so lets do it one way across all of us in future!

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What does this all mean for leaders in Adult
Services, Children's Services, Public Health?

• Collaboration
• How Directors can work together to improve well
  being and life outcomes for people in their
  locality?
• Challenges
• What are the common and what are the separate
  challenges
• Leadership development needs
• Group members own leadership development needs
  rather than those of others in the system
• Barriers
• Barriers to effective development of health,
  childrens and social care systems that might be
  ameliorated by good leadership interventions?