Joint Strategic Needs Assessment

Joint Strategic Needs Assessment (JSNA)

Sunderland

2009 Refresh

Produced by the JSNA Steering Group

On behalf of the Director of Children’s Services,

Director of Health, Housingand Adult Services, and

Director of PublicHealth

November 2009

Sunderland Joint Strategic Needs Assessment (JSNA) 2009 Refresh

Foreword…...... ………………………………………………………Page 3

1. Introduction – what do we mean by JSNA……………………….....Page 4

2. Background to Sunderland – ………..………………………………Page 4

JSNA 2008 Recap – how it informed commissioning intentions

and interventions……………………………………………………….. Page 5

4.Priority Local Area Agreement targets………………….………… Page 13

Findings 2009 ...... Page 14

Prioritisation of health needs to inform commissioners……….…..Page 41

Future development of JSNA…………………………………...…. .Page 49

Conclusions……………………………………………………………Page 49

The JSNA, Executive Summary, and accompanying Data Annex and review of evidence can be accessed on

Foreword

Assessing the health needs of local people is a continuous process. This Joint Strategic Needs Assessment builds on work during 2008 which identifies the health and well-being needs (and the inequalities in those needs) of the Sunderland population. The JSNA has been developed by the Director of Public Health, Director of Health Housing and Adult Services, and Director of Children’s Services.

The JSNA in 2008 helped to underpin the development of the Sunderland Community Strategy, and priority Local Area Agreement indicators linked to health and well-being and informed commissioning of key programmes of work e.g. Bridging the Gap, a comprehensive approach to reducing the Life Expectancy gap due to circulatory diseases.

This JSNA refresh builds on 2008. It includes, analysis of up to date health and well-being information, insight into expressed needs of local people, and identification of effective interventions and where these are not taking place.

This JSNA will be used widely: to underpin commissioning plans of the Council and TPCT, as the drive to constantly improve our knowledge of local need and how we focus attention and resources to reduce inequalities and improve health and well-being for the people of Sunderland.

Director of Children’s Services

Director of Health Housing and Adult Services

Director of Public Health

1.0 Introduction: What do we mean by Joint Strategic Needs Assessment?

Joint Strategic Needs Assessment (JSNA) is the process by which Primary Care Trusts and Councils, working in collaboration with their partners, including the Third Sector and patient/public groups, identifies the health and well-being needs of their local population. It does this in two main ways:

Provides an insight into the current and future health, well-being and daily living needs of local people by systematically analysing intelligence and perceptions on inequalities across neighbourhoods and local communities. In this way it informs both the Local Area Agreements, and longer-term future strategic planning;
Informs the commissioning of services and interventions aimed at improving the healthand well-being outcomes of local people and help reduce any unfairness within existing services or interventions.

The JSNA is a statutory duty under the Government and Public Involvement Act (2007), and is linked to the responsibilities of the Directors of Public Health, Adult Social Care and Children’s Services (DCS). The JSNA should be read alongside the Children and Young Peoples Plan, Director of Public Health Annual Report and Health Housing and Adult Services 15 Year Commissioning Strategy and NHS South of Tyne and Wear’s Strategic Plan 2008-2015.It also closely reflects the Regional Strategy for Health ‘Better Health Fairer Health’.

This report covers the lifespan from preconception to end of life, with the report being divided into demography, children and young people, adults and older people throughout. However, this must be seen as a false divide given the interdependence of these groups and that as citizens we live and work in families and communities of all ages.

2.0 Background to Sunderland – the story of place

Sunderland is the largest city in England’s North East Region, with a population of 270,000 (2007 mid year estimate) in 119,000 households. The river Wear runs through the heart of the city, and the city boundary includes the former new town of Washington and the former coal mining areas of Houghton and Hetton. It forms part of the Tyne and Wear city region and has made a significant contribution to the economic growth in the sub region over the last two decades.

Between the early 1980’s and 1990’s the traditional industries on which the city’s economy was founded declined greatly or simply ceased to exist. Sunderland is striving with considerable success to deal with this legacy and is building a modern and dynamic city. In recent years the transformation of the City’s coalfields, city centre and riverside has been striking – the former shipyard areas are now the location of several high profile developments including the National Glass Centre, SunderlandUniversity’s St Peter’s Campus and StadiumPark. Attention has now turned to city centre regeneration and progress is being made to transform key sites.

Over the last 20 years the city has undergone a marked economic and social transition following the decline in the traditional industries of mining, shipbuilding and heavy engineering. Sunderland now functions within a global context, competing at an international level. Thousands of new jobs have been created as part of a large-scale industrial shift towards the automotive manufacturing and service-based “call centre” sectors. Significant success has been achieved, notably through the Doxford International development at which 8,000 jobs have been created. Further development is currently taking place to create additional business sites and premises in RaintonBridgeSouthBusinessPark and Washington. As a measure of our success there are now more people employed in new service industries than were employed in traditional industries.

Sunderland has set out a clear shared vision in its Community Strategy, which sets clear ambitions for the city over the next 15-20 years providing a framework for all partners actions over this time. The vision is:

‘Sunderland will be a welcoming, internationally recognised city where people have the opportunity to fulfil their aspirations for a healthy, safe and prosperous future’.

If we achieve this vision we will have ensured that in 2025 Sunderland will be the place people choose to make their home, to come to work, or study, and to spend their leisure time. The vision is supported through a number of high level aims to ensure Sunderland is a:

Prosperous City
Healthy City
Safe and Inclusive City
LearningCity
Liveable City

Strategic aims have been developed following 18 months of consultation. The JSNA 2008 helped to shape the Health Priority within the Sunderland Strategy and it is this priority that the JSNA 2009 refresh will most influence and be influenced by. The aim of the Healthy City Priority is:

“To create a city where everyone can be supported to make healthy life and lifestyle choices – a city that provides excellent health and social care services for all who need them. Everyone in Sunderland will have the opportunity to live long, healthy, happy and independent lives.”

The Local Area Agreement is the first of the 3 year delivery plans of the Sunderland Strategy.

3.0 JSNA – 2008 Recap

Sunderland’s first Joint Strategic Needs Assessment was produced in 2008 and it helped to shape the Healthy City Priority within the Sunderland Strategy. The health and social care needs of local people compared Sunderland with its neighbours across the North East region and with England and Wales as a whole. In addition any local consultation was incorporated.

The JSNA informed relevant citywide reports, plans, strategies and commissioning priorities, including the PCT’s 5 year Strategic Plan and accompanying one year Annual Operating Plan; Sunderland Director of Public Health Report; the Council’s 15 year Commissioning Framework for the Directorate of Health Housing and Adult Services; and the Children and Young People’s Plan.

The underpinning analysis was also used to inform the TPCT’s prioritisation event in December 2007 which helped to underpin strategic objectives

In particular, the JSNA supported the development of Sunderland’s Community Strategy and Local Area Agreement, particularly prioritisation within the HealthyCity section of the LAA, including the identification of the objectives within this section, and the selection of 13 National Indicators (and their challenging targets) to monitor progress towards their fulfilment. These objectives were:

Provide people with the opportunity to live as long as those with the longest life expectancy in England;
Put in place measures that will identify health risks at an early stage and provide interventions that will enable people to maintain good levels of health and well-being so that they can be as independent as possible at home;
Improve the emotional health and well-being of children;
Reduce the incidence of lifestyle choices that have a clear link with poor health, particularly lack of exercise, obesity, smoking & alcohol abuse;
Enable people to enjoy excellent sense of health and emotional well-being;

Based on these objectives, the 2008 JSNA informed new and ongoing commissioning intentions and interventions to improve health and social care in the city and the key themes and actions taken are outlined below.

Sunderland JSNA 2008 – Summary of need and commissioning response

CHILDREN & YOUNG PEOPLE
Issue / Identified Commissioning Interventions / Outcomes
High levels of smoking in pregnancy – 23% of mothers still smoking at time of delivery / Increased investment into local stop smoking services with an increased focus on smoking in pregnancy – a priority in the PCT’s Strategic Plan / Additional service provision for local people wanting to quit smoking. The LAA target remains very challenging, and ongoing focus on smoking in pregnancy is required.
Low levels of breastfeeding initiation rates – 39% / Increased training of midwives in UNICEF Breastfeeding
Maternity and early year’s services have adopted UNICEF Baby Friendly standards. Parentcraft has been remodelled, providing education. We have been identified as a pilot site for the Family Nurse Partnership by the Department of Health.
We received additional investment from the Department of Health Inequalities to consolidate our approach to Breastfeeding and carry out a social marketing. / Services are more breastfeeding friendly, however this needs to be adopted across the City
High levels of teenage conceptions – Sunderland is ranked 3rd highest in the North East 55.9/1000 / Capacity increased to develop and deliver a coherent Personal and Social Health Education (PSHE) programme across schools, community and targeted settings. We are developing a holistic approach to risk and resilience across Sunderland for all risk taking behaviours – including sexual activity, tobacco and substance – a key part of Children and Young People’s Plan.
The approach to risk and resilience incorporates smoking levels among young people. An increased focus on supporting adults to stop smoking which is the best evidence in what works to prevent smoking in young people / This approach increases access for our young people to high quality sex and relationship education. However the LAA target is very stretching and further work is required to ensure sexual health services for young people are high quality, and delivered in targeted settings.
High levels of smoking among young people – girls in particular -23% compared to the National average of 20% / HRBQ has shown a reduction in young women’s self reported smoking levels
High levels of children who are overweight or obese – 15.6% of reception year (4 and 5 year olds) are overweight and 12.6% obese and 17% of year sic (10 and 11 year olds) are overweight, 21.4% are obese. / Identified the need to develop a range of targeted services that promote physical activity, healthy eating and psychological support for overweight pregnant women, babies and toddlers identified as becoming overweight, children and young people, children and their families identified as overweight and obese as part of the National Child Health Measurement Programme. A National Support Team visit has provided local recommendations. In addition there has been an increased focus on the development of play and urban games. The Food in Schools Team has been sustained beyond the initial phase based on evaluation. The Healthy Schools Programme has had additional support via a newly appointed co-ordinator / Local children, young people and their families should have access to a wider range of services across Sunderland. These services will provide for the prevention of obesity and well as targeted support for those children and young people who are already overweight or obese. Further work is required to develop a city wide strategy for obesity
Emotional well-being of children / Significantly increased capacity to support schools to promote emotional well-being. We have increased support for the Social and Emotional Aspects of Learning (SEAL)Programme. Sunderland is a pathfinder for targeted mental health in schools programme and will deliver a range of services / This indicator was established in the LAA 2009 review.
It will lead to increased support for children and young people to experience positive mental well-being and enable the identification of children and young people as soon as possible for more targeted interventions
ADULTS
Issue / Identified Commissioning Interventions / Outcomes
Average life expectancy for Sunderland men is 75.5 compared to 77.3 for England. For women the average is 79.8 compared to 81.6 for England. In certain wards it is much lower, only 71.3 for men in Hendon and 77.8 for women in Pallion. The gap in life expectancy is not narrowing, especially for men
Deaths from circulatory diseases and cancers / Bridging the Gap – a comprehensiveco-ordinated pathway approach to tackling the life expectancy gap. Investment in early identification of CVD and in lifestyle issues including tobacco control and obesity, and ensuring high quality health care services for those with established disease. This has been identified as a key priority within The TPCTs Strategic Plan due to the potential to reduce the life expectancy gap. The NHS Health Checks Programme has been introduced, aimed at 40-74 year olds. This is to enable every 40-74 year old across Sunderland to access a Health Check to identify their risk of heart disease, type 2 diabetes, stroke and kidney disease over the next 10 years. This service is currently being offered from 46 out of 54 GP surgeries across the City. However work with local people is helping to develop the service into community settings, including local pharmacists, and via Occupational Health in Sunderland City Council
A community stroke service is being commissioned for Sunderland.
Additional capacity has been focused on the development of cancer screening programmes, as well as a Healthy Community Collaborative Approach working with the Community and Voluntary Sector to identify early signs and symptoms of certain cancers. / To date 2318patients have accessed their NHS Health Check. The National Support Team for Health Inequalities suggested further predictive modelling to support the scaling up of this programme to reach all 40-74 year olds, and this work is reflected in Section5 ( findings)
The stroke service is currently being tendered which will improve access for local people to services if they have had a stroke. Further work is required for stroke to ensure all local people have access to stroke services.
While Sunderland has reached its 2010 CHD mortality target the LAA indicator for all age all cause mortality, as well as the reduction in inequalities remains a challenge
Smoking prevalence / Comprehensive investment in stop smoking services and a local approach to tobacco control work with a refocused Sunderland Tobacco Alliance. We have commissioned research into the needs of BME communities in relation to stop smoking services and brief intervention training for front line staff via the community and voluntary sector. / Reaching the LAA indicator for the number of people quit at 4 weeks is still a key challenge within Sunderland
Obesity levels / Predictive modelling was used to suggest to nearly 50,000 adults locally who could benefit from new services. Investment in comprehensive adult obesity services from community to bariatric surgery. The PCT has commissioned a range of services across the City to support adults to increase physical activity and eat healthily and manage weight. These include slimming on referral via GP practices, community based exercise on referral and weight management delivered via the city’s Wellness Centres, and specialist weight management delivered byCityHospitals and Wellness as well as increased access to bariatric surgery. Services are all now in place. A joint approach with SAFC Foundation is underway and with SunderlandUniversity to ensure services are in place. Local people are also being referred to obesity services via the NHS Health Check Programme / There have been x people referred to the obesity services and some promising outcomes are being seen (slimming on referral).