JSNA: duty or pleasure? How it really felt in Kirklees

1. 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 People’s Service, Kirklees Council Deborah Collis, Public Health, Kirklees PCT

2. What we will cover • what we did to develop our JSNA • what we included – and what we didn’t • what our ideas are about further developing our JSNA 15m From an Adults Services, Children’s Services, PCT perspective: • how the JSNA is being used locally – and if it’s making any difference • how it felt for those involved • what we have learnt from our experiences 15m • Table discussion • Mixed groups • Q&A 20m

3. 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, children’s and social care systems that might be ameliorated by good leadership interventions?

4. What we did to develop our JSNA

5. 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, PBC’ers • ‘Sign off’ Feb/Mar 08 • Cabinet, PCT Board, LSP Executive, LPSBs

6. 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

8. 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

9. National Dataset Public Health Information Local Local Peoples Views and Experiences Commissioning Intelligence Health & Social Research and Care Prevalence Trends Information Information Informing Joint Strategic Needs Assessment Informing Priority Setting Influencing Local Area Agreement Community Strategy PCT & PBC Business Plans Locality Plans Client Group / Issue Based Commissioning Plans eg Mental Health, Older People, Obesity, Long term Conditions Housing / Supporting People Strategies Children & Young People’s Plan

10. The Benefits of JSNA • improve need assessment and commissioninginformation • make our decision making more evidence based • doing itjointly 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 • Independence…. DPH report

11. What we included in our JSNA and what we didn’t

12. 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

13. 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

14. 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 Priority themes NB helping people to help themselves

15. Local Health Inequalities adults 2007

16. 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 @ birth • Rotten teeth: rotten diet • Smoking • Little physical activity • Unhappy at school • GCSEs low levels

17. Developing our JSNA

18. 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 What next for the JSNA?

19. 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?

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

21. 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

22. 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”

23. 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!

24. 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 • C&YPP Review 2009

25. 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 PBC’ers • Satisfying • set up better relationships for future work

26. 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

27. 1. Strategic Needs Assessment Health priorities across Kirklees incl. inequalities Each has HIT group for planning into • Local Information • -people • providers • commissioners Choosing Health HITs Infection control HIT Long term conditions HITs Urgent care HITs 18 Weeks HITs Partnership commissioning HITs Clinical / Expert Role of HITs 2. Planning what should be done Locality priorities planning PBC Providers Joint Commissioning PPI 3. Identify gaps including £, workforce, IM&T 4. Design services / commissioning plans for investment / disinvestment / reallocation of resources Locality plans Final commissioning overall plan for Kirklees Providers PBC Joint Commissioning 5. Performance management of commissioning plans PBC Joint Commissioning 6. Readjust levels and type of activity 7. Reassess need and restart process

28. 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!

29. 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, children’s and social care systems that might be ameliorated by good leadership interventions?