STRATEGIC NEEDS ASSESSMENT Version 1 Strategic Needs Assessment l Dundee Health and Social Care Partnership l 1 2 l Dundee Health and Social Care Partnership l Strategic Needs Assessment CONTENTS Page No. 1.0 CONTEXT 5 1.1 Health and Social Care Integration 5 1.2 Strategic and Commissioning Plan 5 1.3 Strategic and Commissioning Process 5 1.4 Strategic Needs Assessment (SNA) 5 1.5 Strategic Needs Assessment at Care Group Level 6 1.6 The Case for Change 7 1.7 Strategic Priorities, Shifts and Actions 8 1.8 Outcomes and Performance Monitoring 8 1.9 Commissioning of Services 8 2.0 STRATEGIC NEEDS ASSESSMENT IN DUNDEE 10 2.1 Profile of Dundee 10 2.2 Key Findings from the Strategic Needs Assessment 10 3.0 DEMOGRAPHICS 11 3.1 Population of Dundee 11 3.2 Ethnicity 12 3.3 Life Expectancy 13 4.0 DEPRIVATION 16 4.1 Scottish Index of Multiple Deprivation 16 4.2 Benefit Claims and Income Deprivation 17 4.3 Employment Support Service 19 4.4 Health, Wellbeing and Lifestyle Factors 19 4.5 Smoking 19 4.6 Obesity 20 4.7 Drug Misuse 20 4.8 Alcohol Misuse 24 4.9 Sexual and Reproductive Health and Wellbeing and Blood Borne Virus 26 4.10 Teenage Pregnancies 27 5.0 LONG TERM HEALTH CONDITIONS 29 5.1 Prevalence of Long Term Health Conditions 29 5.2 Prevalence of Multi-Morbidities at a Younger Age 32 5.3 Community Pharmacy Data 35 6.0 PUBLIC PROTECTION 37 6.1 Child Protection 37 6.2 Adult Support and Protection 37 6.3 Violence Against Women (VAW) and Domestic Abuse 39 6.4 Levels of Crime and Supervision of Offenders 39 Strategic Needs Assessment l Dundee Health and Social Care Partnership l 3 7.0 HOUSING AND HOMELESSNESS 46 7.1 Housing Tenure in Dundee 46 7.2 Homelessness in Dundee 47 8.0 SHIFTING THE BALANCE OF CARE 50 8.1 Unscheduled Care 50 8.2 Variation in Unscheduled Care Rates Between LCPP Areas 51 8.3 Variation in Unscheduled Care Rates Within LCPP Areas 55 8.4 Homecare Services 57 8.5 Care Homes 60 8.6 Falls 62 9.0 PERSONALISED SERVICES 66 9.1 Self Directed Support 66 10.0 CARERS 67 10.1 Carers in Dundee 67 10.2 Known Carers by LCPP Area 68 10.3 Inequalities for Carers in Dundee 70 10.4 Older Carers Aged 65+ Years 71 10.5 Respite Care 73 11.0 CHILDREN AND YOUNG PEOPLE 74 11.1 Care Leavers 74 11.2 Children with Disabilities 75 12.0 STRATEGIC PLANNING GROUP CARE GROUPS 77 12.1 Older People 77 12.2 Dementia 80 12.3 Physical Disabilities 80 12.4 Sensory Impairment 83 12.5 Learning Disabilities 88 12.6 Mental Health 91 12.7 Mental Health Officer Services 94 12.8 Cancer 96 13.0 END OF LIFE CARE 101 13.1 Location at Death 101 13.2 Time Spent at Home or Community Setting in Last 6 Months of Life 102 14.0 STRATEGIC NEEDS ASSESSMENT IN DUNDEE: NEXT STEPS 104 4 l Dundee Health and Social Care Partnership l Strategic Needs Assessment CONTEXT 1.0 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. Strategic Needs Assessment l Dundee Health and Social Care Partnership l 5 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 All of these SPGs are in the process of preparing Strategic and Commissioning Statements which set out the strategic direction for each Care Group in Dundee for the next five years, in line with the ‘direction of travel’ and timeframe laid out for the Plan. Each of these Statements will have an accompanying needs assessment describing the specific health and social care needs presented by each of the Care Groups at a service level. The Care Group needs assessments build on the population and demographic profiling of needs in the city and will feed into the overarching strategic needs assessment being further developed at a city wide, and locality level. It is anticipated that these Care Group Statements will be completed and published during the financial year 2016 – 2017. 6 l Dundee Health and Social Care Partnership l Strategic Needs Assessment 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 is presented in this document, Version I of the SNA. 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.