Rutland JSNA Executive summary Aim of the JSNA This Joint Strategic Needs assessment is the means by which Leicestershire County and Rutland PCT and Rutland County Council will describe the current and future health, care and well being needs of local populations and the strategic direction of service delivery to meet those needs. The JSNA will provide analyses of data to show the health and well being status of local communities define where inequalities exist uses local community views and evidence of effectiveness of interventions so in the future, investment can be better targeted at services that work and have greatest impact. The JSNA gives a strategic assessment of health and social care needs and will inform service development and planning in the areas in which it is likely to have the greatest impact. The JSNA will link with the areas of health and social care services where there is the greatest need for change and highest strategic priority. How the Rutland JSNA was developed Many information sources have been used to compile this needs assessment. The document outlines the key population characteristics of the locality, social and environmental factors, life expectancy, poor health, health behaviours and risk factors for disease, how social care and health services are used and the views of local people. The strategic assessment of health and well-being needs was developed in three phases, A summary of the primary data sources An analysis of the joint impact across health and social care and A detailed analysis in key areas informed by consultation An initial action plan
Key Findings Generally, findings suggest Rutland is an affluent area with positive health outcomes. The county suffers from barriers to accessing housing and services, particularly in rural areas. This is a particular issue for people who are vulnerable as it can lead to further isolation. We can expect the overall demand for primary, community and secondary care services to increase significantly due to the predicted population increase, both as a result of an increase in life expectancy and migration. As the population ages there will be more people in Rutland with common long-term conditions, depression, falls and stoke. Overall the health of the population of Rutland is better than average however, there are gaps in health status between the best off and the worst off in our populations and these gaps are widening. There are considerable inequities in access to health care services in our poorest communities, with considerable inequalities in health outcome and access to healthcare services particularly for minority groups. The relative gap in access to acute health services between most deprived and least deprived areas in the PCT area indicates that people in deprived areas have emergency admission rates 20-40% times higher than those for the affluent population. The biggest gap is seen in children and young adults. The key health issues to reduce inequity in health and improve life expectancy for our poorest communities are linked to coronary heart disease, cancer, chronic respiratory disease and pneumonia. The Rutland population reflects national lifestyle trends in levels of smoking, alcohol use, overweight and obesity, teenage pregnancy and HIV. Recommendations Rutland is changing All partner organizations need to ensure that they are planning for the expected population growth for the area, and acknowledging the key demographic changes behind this, an increased aging population and migration.
Tackling Health inequalities To sustain continued improvement of health outcomes across Rutland it is necessary for the county to target interventions to those areas and population groups where the health improvements will have most impact. The PCT and the wider partnership also need to explore the inequalities in health outcomes that the (in Rutland small numbers) of disadvantaged people face and develop solutions to improve health in these areas. Some of these may have very specific and specialist health requirements which might require individual solutions and flexible service delivery. This will have a greater impact on the health and wellbeing of the overall population rather than just focusing on improving health outcomes across the county. More work needs to be undertaken to understand the needs of ethnic minorities within our population, including economic migrants. Coronary heart disease (CHD) has been identified as a major contributor to the areas with poorer life expectancy experienced in the Primary Care Trust. Future investment and service development should be directed to the primary, secondary and tertiary prevention of CHD, stroke and diabetes in the local population as a priority. Rutland is part of this overall PCT population who will require this service development. Targeting our resources to achieve equity for our communities The health and social care needs of the population in Rutland are directly linked to its economic well being. Economic development should be encouraged to reduce the levels of deprivation and its associated consequences within Rutland. There are specific concerns about the availability of affordable housing in Rutland for young people and people on low incomes. To adapt commissioning processes to allow services to be more sensitive to population health need, and use targeted investment as an approach to address inequity in access to services. Establish whether current activity reflects local population need, including elective and out-patient activity especially in priority areas such as CHD care.
To make changes to allow the local population to have informed choice about the services they receive. Use the practice based commissioning process to enable improved services, choice and access. Investment in, development and reconfiguration of services needs to be considered with reference to current activity and population need. The PCT should proactively review its programme budgeting investment levels to identify areas for increased investment and for efficiency targeting. Ensuring the best treatment for all In order to meet the needs of the aging population, services to treat common long-term conditions should be made more accessible and be provided in the community wherever possible. Access to GP surgeries should be improved, with enhanced opening hours, and more effective use of Rutland Memorial Hospital to serve local community needs. Ensure that residents of Rutland have access to local NHS dentistry and adequate ambulance response times. Improving our health and reducing preventable deaths Refocus commissioning priorities to increase investment in public health and health improvement, in order to fully support and implement national guidelines and recommendations on key preventative health priority areas (Wanless, Darzi). Fully implement local Darzi Staying Healthy recommendations around tobacco control, physical activity, alcohol and food and health. Deaths and injuries on the roads need to be reduced in Rutland
PCT and relevant stakeholder organisations to fully implement NICE guidance and national strategic recommendations wherever possible, to deliver key evidence based priority areas of health improvement in Rutland. The current identified priorities in Rutland are: o Alcohol o Obesity & Physical activity o Substance Misuse o Tobacco Control & Smoking Cessation These are particularly pertinent to the younger population within Rutland.
and Rutland County Council Joint Strategic Needs Assessment ACTION PLAN APRIL 2008 STRATEGIC NEEDS IDENTIFIED LOCAL SERVICES ACCESS CURRENT ACTION FUTURE DEVELOPMENT RESPONSIBILITY TIMESCALE Discussions are taking place in respect of Rutland Memorial Hospital as part of the lcr PCT Community Hospital review. Provisional service model involves an expanded range of services available at RMH including an enhanced MIU Enhanced opening hours for GP surgeries to be negotiated by the PCT RCC to review information quality and availability and enhance web site RCC to review service access including the introduction of more mobile and localised service delivery RCC RCC cross departmental group Formal Consultation begins April 08 During 08/09 During 08/09 DARZI review of NHS services - incorporating care closer to home to report nationally and influence local service availability DH/ Summer 08
AGEING POPULATION WITH ASSOCIATED HEALTH PROBLEMS Rural Community Council project (funded by SP) to identify and engage isolated and vulnerable older people via Parish network - linking got services Long term conditions and promoting independence will be part of the revised Rutland LAA targets (NI 142,124 and 130) and therefore prioritise funding within RCC and RCC - Caring for all group - including 08 onwards AGEING POPULATION WITH ASSOCIATED HEALTH PROBLEMS (cont d) PUBLIC HEALTH ISSUES, SMOKING, OBESITY, ALCOHOL where appropriate RCC provides a range of carers assessment and support services Specific smoking cessation programmes in place across area Development and expansion of Community Matrons and specialist teams for people with long term conditions Carers Support - strategy to be produced to inform enhanced local carer services Specific Rutland focus on the following: Schools, Smoking in Pregnancy Smoke Free Homes, the local prisons, test purchasing and RCC staff; RCC/ DASS, Environmental health and 09/10 Summer 08 08 onwards Production of Rutland Alcohol strategy and associated action plan Public health issues will be part of the revised Rutland LAA targets (Ni 123, NI39, NI56) and therefore prioritise funding within RCC and Head of DAAT and Community Safety RCC RCC - Caring for all group - including April 08 08 onwards
SPECIFIC ISSUES Participation The has established a patient consultation policy and RCC has embarked on contracting a host organisation for a Rutland LINks Economic deprivation CAB - grant funded by RCC have undertaken welfare benefits campaign work in both Oakham and Uppingham. They also provide ongoing debt advice support to Rutland residents It is hoped to further develop benefit take up work to village areas - subject to resource availability and development of the wider RCC access policy RCC During 08/09 Accidents. RCC have instigated a subsidised 'pass Plus' scheme for younger drivers in an attempt to reduce road fatalities amongst younger drivers RCC C has a wider and ongoing strategic brief to address speeding on Rutland roads - including better signage, speed control humps and - subject to relevant partnership agreement the consideration of additional speed cameras. RCC Ongoing
SPECIFIC ISSUES (cont d) KSI (Killed and seriously injured) targets will also be part of revised LAA (NI47) and therefore prioritise funding within RCC and RCC 08 onwards LPT/LA's review of Services in the Community to ensure integrated working and ensure good appropriate health advice and access to mainstream health services LCC/RCC/LPT End of 08 for proposed model Learning Disability OTHER GAPS IDENTIFIED VIA CONSULTATION Health Action plans in place for the majority of Rutland residents with learning disability Report of MH/LD works stream for DARZI review and Valuing People re-launch RCC/LPT Autumn 2008 Palliative Care/Cancer Care Flexible Services to deal with small numbers RCC commissions specialist service requirements from neighbouring authorities Need to establish prevalence figures to sustain any local commissioning of specialist social care services. to confirm service availability across specialist areas for Rutland RCC/ ongoing
FURTHER ANALYSIS AND INFORMATION FOR FUTURE ASSESSMENTS Initial data analysis - in accordance with national guidance has been completed as part of this JSNA This now needs to be followed up with further detailed analysis specifically considering: Changes in demand and patterns following new service models Enhanced demographic population prediction models POPPI Incorporation of SP and enhanced children's data Greater involvement of data provided by third sector organisations and SP 08 onwards