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Strategic Needs Assessment

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Strategic Needs Assessment Strategic Needs Assessment Version 2 CONTENTS Page No. 1.0 CONTEXT 1 1.1 Health and Social Care Integration 1 1.2 Strategic and Commissioning Plan 1 1.3 Strategic Commissioning Process 1 1.4 Strategic Needs Assessment (SNA) 1 1.5 Strategic Needs Assessment at Care Group Level 2 1.6 The Case for Change 3 1.7 Strategic Priorities, Shifts and Actions 4 1.8 Outcomes and Performance Monitoring 4 1.9 Commissioning of Services 5 2.0 STRATEGIC NEEDS ASSESSMENT IN DUNDEE 6 2.1 Profile of City 6 2.2 Key Findings from the Strategic Needs Assessment 7 3.0 DEMOGRAPHICS 7 3.1 Population of Dundee 7 3.2 Ethnicity 9 3.3 Life Expectancy 10 4.0 DEPRIVATION 14 4.1 Scottish Index of Multiple Deprivation 14 4.2 Benefit Claims and Income Deprivation 15 4.3 Employment Support Service 17 4.4 Health, Wellbeing and Lifestyle Factors 18 4.5 Smoking 18 4.6 Obesity 20 4.7 Drug Misuse 21 4.8 Alcohol Misuse 26 4.9 Sexual and Reproductive Health and Blood Borne Virus 30 4.10 Teenage Pregnancies 30 5.0 LONG TERM HEALTH CONDITIONS 32 5.1 Prevalence of Long Term Health Conditions 32 5.2 Prevalence of Multi-Morbidities at a Younger Age 35 5.3 Community Pharmacy Data 39 Page No. 6.0 PUBLIC PROTECTION 41 6.1 Child Protection 41 6.2 Adult Support and Protection 41 6.3 Violence Against Women (VAW) and Domestic Abuse 43 6.4 Levels of Crime and Supervision of Offenders 43 7.0 HOUSING AND HOMELESSNESS 50 7.1 Housing Tenure in Dundee 50 7.2 Homelessness in Dundee 52 8.0 SHIFTING THE BALANCE OF CARE 56 8.1 Unscheduled Care 56 8.2 Variation in Unscheduled Care Rates Between LCPP Areas 57 8.3 Variation in Unscheduled Care Rates Within LCPP Areas 61 8.4 Homecare Services 63 8.5 Care Homes 67 8.6 Falls 69 9.0 PERSONALISED SERVICES 76 9.1 Self Directed Support 76 10.0 CARERS 77 10.1 Carers in Dundee 77 10.2 Known Carers by LCPP Area 78 10.3 Inequalities for Carers in Dundee 80 10.4 Older Carers Aged 65+ Years 82 10.5 Respite Care 84 11.0 CHILDREN AND YOUNG PEOPLE 85 11.1 Care Leavers 85 11.2 Children with Disabilities 86 12.0 STRATEGIC PLANNING GROUP CARE GROUPS 89 12.1 Older People 89 12.2 Dementia 93 12.3 Physical Disabilities 93 12.4 Sensory Impairment 96 12.5 Learning Disabilities 104 12.6 Mental Health 108 12.7 Mental Health Officer Services 112 12.8 Cancer 115 Page No. 13.0 END OF LIFE CARE 125 13.1 Location at Death 125 13.2 Time Spent at Home or Community Setting in Last 6 Months of 126 Life 14.0 STRATEGIC NEEDS ASSESSMENT IN DUNDEE: NEXT STEPS 128 Context 1.0 CONTEXT 1.1 Health and Social Care Integration The Public Bodies (Joint Working)(Scotland) Act 2014 (the Act) requires NHS Boards and Local Authorities to integrate the planning for, and delivery of, identified adult health and social care services. As specified in the Regulations made under the terms of the legislation, NHS Tayside and Dundee City Council have delegated community health and social care functions for adults and older people to the Dundee Integration Joint Board (IJB). From 1st April 2016 the Dundee Health and Social Care Partnership (the Partnership) assumed its full operational responsibilities for all of these delegated functions and for the planning, oversight and delivery of integrated services. The main purpose of integration is to use the available resources to improve the wellbeing of people who receive health and social care services, in particular those whose needs are complex and who require support from both health and social care at the same time. 1.2 Strategic and Commissioning Plan One of the key functions of the IJB is to prepare a Plan for integrated functions in accordance with national and local outcomes and integration principles. A Strategic and Commissioning Plan (the Plan) which identifies a range of strategic priorities, shifts and actions has been developed for the Partnership. The Plan describes how health and social care services for adults in Dundee will be developed and delivered over the next five years from 1st April 2016. 1.3 Strategic and Commissioning Process A strategic commissioning approach has been adopted in the development of the Plan. This approach is defined as follows: Strategic Commissioning is the term used for all the activities involved in assessing and forecasting needs, links investment to all agreed desired outcomes, considering options, planning the nature, range and quality of future services and working in partnership to put these in place. Joint Improvement Team Advice Note, February 2014 1.4 Strategic Needs Assessment (SNA) The purpose of SNA as a process is to gather information to assist understanding of the type and distribution of services required for a population to achieve positive outcomes. In the context of health and social care an understanding of the health and wellbeing needs of the population is required in order to determine the outcomes that are being sought and the changes and improvements that require to be made in the planning and delivery of services. 1 | P a g e Context The approach adopted in this SNA involves three stages: 1. assessing the level of need for health and social care services 2. describing the current pattern and level of supply of these services 3. identifying the extent of the gap between need and supply Population needs assessment is therefore an essential component of the commissioning process, and the understanding gained can be used to help make decisions about how to prioritise and allocate resources to meet identified needs. The findings from the SNA undertaken in Dundee have been used to identify the changes required in order to integrate and improve the quality of health and social care services in Dundee. In particular they have informed the strategic priorities, shifts and actions that are included in the Plan. 1.5 Strategic Needs Assessment at Care Group Level The process of SNA undertaken in Dundee includes detailed individual Care Group SNAs, each of which has then fed into the overarching SNA outlined in this document. Strategic planning and commissioning in Dundee is being undertaken at a Care Group level under the direction of the following Care Group Strategic Planning Groups (SPGs): Older People Carers Older People with Dementia Drugs and Alcohol Learning Disabilities Homelessness Physical Disabilities Mental Health Sensory Impairment Choose Life 2 | P a g e Context 1.6 The Case for Change The analysis of the demographic and socio-economic situation in Dundee undertaken through the SNA has made a significant contribution to the case for change in Dundee. The findings from the SNA have been included in the Case for Change section of the Plan (at Section 5) and identified as key ‘drivers for change’. These drivers for change have been grouped into three main driver themes, and the analysis for change is presented under each of these three themed headings in the Plan, as follows: 1 Population Health and Wellbeing a) Demographic changes b) Deprivation and inequalities c) Prevalence of multi-morbidities experienced at a younger age d) Prevalence of key morbidities and multi-morbidities e) Variation in deprivation and multi-morbidity levels within LCPP areas f) Prevalence of morbidities and impact on use of health and social care services g) Palliative and end of life care h) Levels of risk and need for public protection i) Population health and wellbeing summary 2 Delivery of Right Support at Right Time a) Centralised service development and decision making b) Services are not tailored to address community/locality differences c) Contribution of unpaid carers d) Support is not sufficiently individualised e) Palliative and end of life care f) People report variable experiences of care and health 3 Fiscal Constraints a) Increasing demand/reducing resources b) High costs/reduced budgets c) Sustainability of current models d) Balance of care e) Effectiveness of current models Each area of information and data collated and analysed as part of the SNA process is summarised and presented in the Plan under each of the driver theme(s) to which it relates. All of the data and analysis that has been included in the Plan was presented in Version I of the SNA and this current version (version 2) contains more current data. This document also presents details of the wider sources of information and data gathered and analysed within the SNA process that are not specifically referred to in the Plan. 3 | P a g e Context 1.7 Strategic Priorities, Shifts and Actions In making decisions regarding the changes that are required in the planning, development and delivery of health and social care services, the analysis undertaken of the drivers for change led to the identification of eight strategic priorities for Dundee. These strategic priorities are set out in the Plan as follows: 1 Health Inequalities 5 Building Capacity 2 Early Intervention/Prevention 6 Models of Support/Pathways of Care 3 Person Centred Care/Support 7 Managing Resources Effectively 4 Carers 8Localities and Engaging with Communities The data and information that made a direct contribution towards the identification of these strategic priorities, as well as their related shifts and actions, is included in the Case for Change section of the Plan, and in this document. The ongoing SNA process, together with the proposed outcomes and performance monitoring process, will allow the Partnership to ensure that any need for review of its strategic priorities, shifts or actions is identified and acted upon at an early stage.
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