SOMERSET JOINT STRATEGIC NEEDS ASSESSMENT October 2008 SOMERSET PRIMARY CARE TRUST AND SOMERSET COUNTY COUNCIL JOINT STRATEGIC NEEDS ASSESSMENT TABLE OF CONTENTS PREFACE Page 1. INTRODUCTION ......................................................................................1 Background and Somerset’s Approach 2. DEMOGRAPHY OVERVIEW ...................................................................7 3. SOCIAL AND ENVIRONMENTAL CONTEXT .........................................9 4. CURRENT HEALTH STATUS .................................................................33 What the situation is like now How are we doing? What is working? Where are the gaps? 5. CURRENT MET NEED.............................................................................119 6. “SOMERSET VOICE” ..............................................................................133 Community Engagement Patient and Public Involvement 7. ANALYSIS OF HEALTH INEQUALITIES ................................................147 8. GOING FORWARD FOR SOMERSET ....................................................169 Summary of key issues Recommendations for Action 9. USEFUL LINKS AND RESOURCES .......................................................173 Web information Somerset Local Area Agreement 2008-2011 National Indicators chosen Access and Feedback Index STATISTICAL COMPENDIUM (separate file electronically – ‘JSNA for Somerset - Core Data Set’) October 2008 Welcome to the first Joint Strategic Needs Assessment (JSNA) for Somerset. It is built on strong partnership working, already present in Somerset, and is underpinned by the Somerset Health and Social Needs Analysis data, which has been regularly updated since 1998 (latest publication HSNAG 2007). The scope of our JSNA provides a firm foundation for commissioning to improve health and social care services and reduce health inequalities. It enables stronger partnerships between communities, local government and the NHS. The document structure sets out a picture of Somerset that encompasses the county’s environmental attributes and challenges, the social context of our populations, our health status, how current needs are met, the ‘Voice’ of Somerset stakeholders and communities and where the health inequalities and gaps are to be found. By its very nature, the JSNA is not a static document; it will change and develop to adapt to the needs of Somerset people and be a crucial tool in ensuring the services we provide are based on sound evidence and are value for money. We would welcome any comments you make wish to make on its content. Signposts for how to do this are included toward the end of the document. Chapter 4 (‘Current Health Status’) highlights the current situation concerning children and young people, teenage pregnancy, sexual health, substance misuse, mental health, learning disabilities, obesity, smoking, diabetes, coronary heart disease and stroke, cancer and older people. At the end of each of these sections is a summary and an identification of gaps. A separate ‘Health Inequalities’ section (Chapter 7) goes into more detail about these gaps and where further work could be undertaken. The JSNA is a large document; there have been over 45 contributors (many on behalf of multi-agency teams) bringing together their knowledge and expertise in specialist areas from Somerset County Council and Somerset Primary Care Trust. I would like to thank them all for the enthusiasm and rigour with which they approached the requirements of the JSNA. There is much to be proud of in the work undertaken to help Somerset people stay healthy, enjoy their lives, be supported and informed; and looked after across the health and social care sectors when needs require. We also think the Somerset JSNA is an interesting document in its own right. This has been an opportunity not just to look at how health and social care works together and to influence commissioning decisions but to share information with a host of organisations, communities and individuals who want to make a difference to the future of this vibrant and forward-looking county. Joint Director of Public Corporate Director Corporate Director for Health Community Children’s Services CHAPTER 1 - BACKGROUND The Department of Health’s Draft Commissioning Framework for Health and Wellbeing (March 2007) proposed to establish a duty on upper tier Local Authorities and Primary Care Trusts (PCTs) to produce a Joint Strategic Needs Assessment (JSNA). The duty to undertake a JSNA was also described in Section 166 of the Local Government and Public Involvement Act (2007) and set out in the draft statutory guidance, Creating Strong, Safe and Prosperous Communities. The duty commenced on 1 April 2008. What is a Joint Strategic Needs Assessment1 (JSNA)? This is an ongoing process by which Somerset County Council and Somerset Primary Care Trust (SPCT) will describe the future health, care and wellbeing needs of our local population (over the short term – three to five years and long term - five to ten years) to inform the commissioning of services, the Local Area Agreement (LAA) and Sustainable Community Strategy. It will be delivered by collaborative partnership working, including the involvement of District Councils, Local Strategic Partnerships (LSPs), patients, the public and voluntary sector. It will address evidence of effectiveness, identifying not only what works well, but highlight gaps in information where further work is required. This is why each JSNA will be unique; it will reflect local circumstances and what is really required to meet the needs of the Somerset population. How does the JSNA add value to existing needs assessment? The JSNA is a driver for change2. In creating an evidence base for the local populations of Somerset, it informs key levers for change in outcomes for health and wellbeing – public demand, partnership working, seamless provision and local commissioning. On one level, it is a tool, a methodology for strategic analysis of an area and an important one precisely because of its scope. On another, it captures the change of culture across health and social care. To do this, the JSNA needs to bring together diverse and often competing interests within both professional and public interest groups to shape local outcomes for health and wellbeing. JSNA and the commissioning cycle – how does it work? The Department of Health describes effective commissioning in terms of eight steps: 1. Putting people at the centre of commissioning 2. Understanding the needs of populations and individuals 3. Sharing and using information more effectively 4. Assuring high quality providers for all services 5. Recognising the interdependence of work, health and wellbeing 6. Developing incentives for commissioning for health and wellbeing 7. Making it happen: local accountability 8. Making it happen: capability and leadership 1 DoH JSNA Guidance document, February 2008 2 London CSIP Commissioning Learning Event 3 – 8th January 2008 1 CHAPTER 1 - BACKGROUND 3 The Local Government and Public Involvement Act (2007) places the duty of JSNA on upper-tier local authorities and PCTs. In practice, the Director of Public Health, Corporate Director - Community and the Director of Children’s Services jointly undertake the JSNA, working closely with Commissioning and Finance to help set strategic priorities and make evidence based investment. A jointly appointed Director of Public Health, as we have in Somerset, can facilitate the process by working across health and local government. For PCTs, the World Class Commissioning assurance model will ensure PCT Boards take an active interest in the JSNA and that it is used and understood at senior governance level. Our approach to developing the JSNA for Somerset A steering group was established to drive the development of the JSNA. The group is made up of the Joint Director of Public Health, the Corporate Director – Community, Director of Children’s Services, Head of Environment and Regeneration for Somerset County Council and commissioners from the PCT, the Director of Primary Care Development and Director of Secondary Care Development. There is representation from the PCT Professional Executive Committee and a finance representative, as appropriate. 3 JSNA presentation – Renu Bindra (Public Health Development) DoH 2 CHAPTER 1 - BACKGROUND The function of the JSNA steering group is to: agree and finalise the JSNA process and timeframe ensure involvement of key stakeholders in the JSNA working group and subgroups provide strategic support and advice ensure partner and public views are considered within the ongoing JSNA process agree content of the final document identify, highlight and explore key local health inequalities make recommendations through the JSNA and the Health and Wellbeing Group with regard to changes in commissioning and delivery of children’s and adult services A technical working group was established to progress the data collation needed to support the written evidence in the JSNA and provide supplementary local level information to the core data set. At the first meeting of the JSNA steering group a commissioner commented, “I welcome the JSNA, it will drive the health agenda and take commissioning further on. It will encourage joined-up working, tackling inequalities and improving the delivery of services”. Figure 2 3 CHAPTER 1 - BACKGROUND The Local Area Agreement (LAA) and Sustainable Community Strategy (SCS) What is an LAA? Local Area Agreements4 set out the priorities for a local area agreed between