Joint Strategic Needs Assessment for Kirklees Summary of findings, 2008 Mark Greaves, Head of Adult Services, Dr Judith Hooper, Director of Public Health and Alison O’Sullivan, Director for Children and Young People
Introduction and background: why and how we undertook the JSNA Every local authority and PCT has a new statutory duty to undertake a joint strategic needs assessment (JSNA) of their local population. The Directors of Adult Social Services, Public Health and Children and Young People’s Services have to work together to develop the JSNA and it should form the basis for planning service development and is seen as a key building block of the commissioning process. It provides an opportunity to look to the future - over the next 5, 10, 15 and 20 years - so that we can plan now for likely changes in needs. It is one of the major influences in directing our commissioning priorities. This document summarises the outcomes from the first phase of our JSNA work here in Kirklees and highlights the key messages and some of the implications for future commissioning and planning. For the first stage of the JSNA we have focused on refining, improving and
bringing together the information we have available that highlights overall population needs. This information is from national and local sources and includes a wealth of information we have collected directly from children, young people and adults across Kirklees through a range of large scale surveys. We have used this initial work to take a longer term view of population trends and the likely impact on demand for support over the next years and decades. Alongside this quantitative information we have looked at the commissioning knowledge we already have in order to identify what these figures and trends mean for services locally and to highlight priority areas for work. In order to deliver this first stage of our JSNA we have used a number of different information sources. The quality of sources varies and some population, condition and trends information is more
robust and well researched than others. Needs assessment, and in particular trend forecasting, is not an exact science - predictions tend to be more accurate at a general, larger population level and because of this we have aimed to keep key messages very strategic at this stage. This is a summary of the full report, which includes locality information, see back page for contact details.
What influences our local priority setting? Available resources
National and local priorities
Views of local people
Joint Strategic Needs Assessment
Overall messages about needs and our changing populations Between 2007 and 2025 the population of Kirklees is predicted to increase by 10%. This increase ranges from only 1% in the number of 0 – 20 year olds to an increase of 45% in over 65s. By 2025 1 in 4 people will be under 20, more than 1 in 2 will be 20 – 64 and nearly 1 in 5 will be over 65. Overall the numbers of births are currently static, but are increasing among families of South Asian origin. Overall 22% of young people under 19 are now of South Asian origin, whilst 86% of the total population are white. Life expectancy for both men and women is continuing to rise steadily, but Kirklees still lags behind the England
average. This improvement is partly explained by the reduction in premature deaths from our major killers – heart disease and cancer over the last 10 years, but again rates in Kirklees are higher than nationally. The Index of Deprivation (ID) 2007 identifies Kirklees as one of the most deprived 50 districts in England for both the Income and Employment Domains, as was the
2 Kirklees Primary Care Trust and Kirklees Council
case in the ID 2004. More than 70,000 people are now classed as income deprived, and Kirklees ranks worse than in 2004, going from 21st worst to 12th worst in England.
Key issues and findings Specific populations Older people Projections suggest a significant and substantial increase in the numbers of older people between 2007 and 2025 in Kirklees, reflecting national and regional trends. The number of over 65s is projected to rise by almost 45%. The largest growth of almost 58% will be seen in potentially the most frail and dependent group of over 85s with key implications for planning future service provision for this group.
Carers Carers are increasingly providing a significant proportion of community care as services target provision on those with the highest needs. There are approximately 40,000 carers in Kirklees and one in five provide care for over 50 hours per week. Research by the Equal Opportunities Commission suggests that caring can have a detrimental impact on health and employment. One in five carers give up work or are unable to take a job because of caring responsibilities. 21% of those caring for 50 hours or more per week are not in good health. This reinforces the message that we need to continue to provide appropriate support to our carers in Kirklees.
People with physical/sensory impairments
shortage of housing options for disabled adults. Support for disabled parents could be improved as it will avoid the need for young people to take on too great a caring role.
People with learning disabilities Mild and moderate levels of learning disability affect around 2.5% of the population; this equates to approximately 10,000 people in Kirklees. There are 1,860 adults with severe learning disabilities known to services in Kirklees. The number of people with learning disabilities is increasing - there has been an increase of 3% in the number of people supported by Adult Services each year over the past few years. This compares with a 1% rise nationally. Increasingly there are a high proportion of younger adults with learning disabilities within our ethnic minority communities, especially South Asian communities. A high proportion of younger adults with learning disabilities also have profound and complex physical and mental support needs. The number of older people with learning disabilities is increasing and we are seeing an
increase in the occurrence of early onset dementia. Adults with learning disabilities have poorer general health than the wider population and can struggle to access mainstream health services. Few adults with learning disabilities are in paid employment and there are limited supported living options for people to choose from.
Women of child-bearing age Women as potential or actual mothers are key in family dynamics. Their health during pregnancy impacts on the health of their child and determines future patterns, such as eating behaviours, in families. Maternal malnutrition, whether due to poor diet, obesity or smoking, is the most significant factor in infant deaths locally, and the rate of infant deaths in North Kirklees is twice the national rate. Locally, 15% of women of child-bearing age are obese, 27% overweight, 1 in 4 smoke and 1 in 5 were still smoking at the birth of their child. Therefore programmes around stopping smoking (particularly before and during pregnancy), increasing levels of physical activity and developing healthier eating habits, are a priority and they can also impact on the whole family.
1 in 5 people over 16 years have at least one dimension of disability and 1 in 5 people over 18 years need help with at least one task of daily living i.e. 50,000 people in Kirklees. There is no evidence to suggest dramatic increases in the number of adults aged 16-64 with physical/sensory impairments. However later onset conditions such as Parkinson’s disease, sensory impairment, arthritis etc will rise as the over 45 population grows. Disabilities linked to diabetes and obesity are also set to increase as the prevalence of these conditions rises. Only 1 in 2 people with complex impairments remain in their jobs even though employment is critical to enabling people to remain independent. There is a serious
Joint Strategic Needs Assessment for Kirklees, 2008 3
Conditions Mental health and emotional well-being 1 in 4 adults experience mental health problems at some point in their life and 1 in 6 adults are experiencing mental health problems at any one time. Depression, anxiety and phobias are the most common. Carers are twice as likely to have mental health problems. 1 in 4 older people have symptoms of depression that are severe enough to warrant intervention. However this is not limited to adults amongst 14 year olds locally; 1 in 4 are not happy with themselves as a person, and this increases to 1 in 3 girls; 1 in 3 do not feel happy at school and a similar proportion say they did not get on with staff at school; more than half are worried about tests and exams and 1 in 3 worry about school work. Severe mental health issues such as schizophrenia are relatively rare with approximately 1,200 working age adults in Kirklees being affected, but the lifelong impact of these conditions on individuals and their families is substantial. Emotional well-being is a concern for all public services and we should be focusing on preserving it. Improving young people’s relationships, self-image, self-esteem and levels of worry, which all impact on emotional wellbeing will give young people the ability to cope with life. Supporting adults to remain in or return to employment will pay dividends in terms of mental health and we need to improve our performance in this area. Access needs to be improved to talking therapies, physical activity, creative arts and leisure. People with mental health problems also struggle to access a range of supported housing options and this impacts on their chances of recovery.
now and this is likely to rise to 4,340 over the next 18 years. Early diagnosis of, and intervention for, dementia are the keys to delaying admission to long term care and to help people remain independent for longer. Promoting healthy ageing, for example keeping people active and tackling social isolation, is important in delaying the onset of dementia. Accommodation choices for older people with dementia are limited and finding quality residential and nursing care which promotes people’s independence can be difficult.
Obesity Obesity is one of the most significant threats to the long term health of our population as it leads to a wide range of health problems. Nearly 1 in 10 children in Reception year at school and 1 in 6 children in Year 6 are already obese, and this is predicted to rise. Amongst all adults 1 in 5 are obese and this increases to 1 in 3 of 55 – 64 year olds. The rate for all adults is predicted to rise to 1 in 3 by 2010. Parental obesity significantly increases the risk of children becoming obese.
Dementia Dementia is most common in older people with prevalence rising sharply in people over 65 years. It is one of the main causes of disability in later life. As the numbers of older people rise, so will the numbers of people with dementia. There will be a steady increase in numbers of people with dementia over the next 3 years followed by a dramatic rise over the next 15 years. In Kirklees there are an estimated 3,000 people with dementia living in the community
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Pain Pain is a complex experience shaped by multiple factors. It has a severe impact on many people’s lives, accounting for about 25% of all sickness absence from work. Pain has the worst impact on someone’s functioning. Yet as a condition it is poorly managed by services as there is no clear agreed pathway of care. Locally those with pain are 50% more likely to have depression and more likely to be obese or overweight. Those aged under 65 with pain were twice as likely to have heart disease, stroke and diabetes.
Heart disease and stroke Heart disease is the second biggest cause of premature death in Kirklees (after cancer). Locally more people have heart disease (6.8%) than nationally (5.7%) and amongst those under 65 men are 3 times more likely to have it than women. Heart disease causes significant suffering because of coexisting conditions and its impact on health functioning. It is clearly linked to getting older and being poor, but adopting healthy personal behaviours can prevent it worsening. These include not smoking, being physically active and eating a healthy diet. 1 in 5 people locally have high blood pressure which can lead to stroke and heart disease. Healthy behaviours can also help to reduce high blood pressure and reduce the risk of stroke. However, of those with heart disease or stroke, around 1 in 6 still smoke and they are more likely to be physically inactive and obese.
Diabetes The prevalence of diabetes is increasing and currently stands at 5% of adults under 56 and 14% of over 65s. As the older population increases and certain risk factors, especially obesity, continue to grow, more and more people will be affected. It is a very disabling and potentially fatal condition if not well managed. Diabetes increases the risk of other conditions such as heart disease and stroke, and magnifies the ill effects of other risk factors such as smoking, high cholesterol levels and obesity. Men are twice as likely to have diabetes and South Asian people 6 times more likely to have diabetes than white people. The severity of impact of the disease is linked to how soon it is identified and how well managed it is. However 3 in 4 people with diabetes locally are still obese or overweight and twice as likely to be inactive.
Personal behaviours Smoking Smoking is the single greatest killer resulting in avoidable and early death, killing more than 106,000 people in the UK annually; 17% of all deaths. Most die from lung cancer, chronic obstructive lung disease (bronchitis and emphysema) and coronary heart disease. Smoking also causes countless suffering, as it is a cause of a wide range of diseases that do not necessarily result in death. Second hand smoke is a major risk to the health of non-smokers. Locally smoking rates remain high with 1 in 4 adults still smoking and more than 1 in 5 children admit to having smoked a cigarette. A cause for major concern is that 23% of women were still smoking at the birth of their child, varying from 34% in Dewsbury to 7% in Denby Dale.
Alcohol Drinking alcohol to excess is a major cause of disease and injury, increasing the risks of heart disease, cirrhosis and cancer. Heavy drinking has a severe risk of cardiovascular disease as well as addiction. Binge drinking is linked to significantly increased blood pressure. Consuming alcohol in pregnancy increases the risk of foetal abnormality. Alcohol is also strongly related to crime and disorder, particularly domestic violence, antisocial behaviour and drink driving. People do not recognise the harmful effects of their behaviour and there are low levels of awareness of the amounts of alcohol people drink
and the harmful effects. Since 2001 there has been a dramatic increase in consumption amongst adults in Kirklees, in particular, 35% of men and 29% of women drinking over sensible limits. Binge drinking has increased even more, particularly in women, to 36% who had binged in the past week. This was much higher than regionally or nationally. Nearly half of 14 year olds drink every week, compared to less than 1 in 3 in 2005, with those getting drunk every week rising to 1 in 12 from 1 in 50 since 2005. The numbers of young people under 18 who binge drink and drink alone is of particular concern.
Food and nutrition Nutrition with physical activity is second only to smoking tobacco in its influence on a wide range of health issues, not just obesity. As a nation we simply eat too much, and not in the right balance. Locally we know that only 1 in 5 adults and 1 in 5 children report that they eat 5 portions of fruit and vegetables a day. Decaying teeth is another sign of poor nutrition and the rate in Kirklees for 5 year olds is double the national average.
Physical activity Not only does being active reduce the risk of health problems for all ages it also is a key part of treatment and care for people with long term conditions and often an excellent opportunity for social interaction. But only 1 in 4 adults and only 1 in 2 14 year olds are physically active enough to benefit their health and 1 in 10 adults do no physical activity at all.
Joint Strategic Needs Assessment for Kirklees, 2008 5
Wider factors Housing condition and options Decent housing is a pre-requisite for health and has a significant influence on people with many health conditions such as asthma and depression. However 1 in 10 households in Kirklees are living in poor quality or unsuitable homes, most commonly because they are too small, badly in need of repair/improvement or unsuitable due to specific health problems or disability. Nearly 1 in 5 families are living in overcrowded conditions, in some localities this rises to 1 in 4. Fuel poverty is a major issue affecting 1 in 5 of all households. As the population grows and more people are living alone there is significant demand for additional housing. Increasing house prices and already low incomes rising at a much slower rate will combine to make housing affordability a major challenge over the coming years.
Employment Work provides status, purpose, social support, structure to life and income so it is important not just for the working person but also their family. But work can cause ill-health, locally 1 in 5 adults have a health condition caused or made worse by work. Being out of work has a huge negative impact on the health and well-being of the person and their family and is often a consequence of ill-health or disability. Nearly 25,000 working age adults in Kirklees are ‘employment deprived’. Of those over 18,000 are on Incapacity Benefit and nearly half of all those moving onto IB do so because of mental health issues.
Educational attainment
Isolation and social networks
Educational attainment significantly improved across Kirklees at Key Stage 1, 2 and 4 between 2005 and 2007. However, these improvements are not at the right level, given the local social and economic context. Across Kirklees a complex pattern exists of inequalities between different ethnic groups, different communities and different schools.
Isolation has a significant effect on general well-being and increases the risk of a range of health issues such as depression. In Kirklees 1 in 10 adults aged under 65 live alone and 1 in 5 adults aged over 65 live alone. As the older population grows in line with national population projections, the numbers living alone will therefore increase.
Overall students from the largest minority ethnic group, i.e. Pakistani origin, performed below the Kirklees average at KS1, 2 and 3. This persisted up to KS4 where students of Pakistani origin were least likely to achieve the 5 + GCSEs at grade A*-C. Post 16 the picture changes, as those of Pakistani origin narrowed the achievement gap to Level 2. They were also more likely to participate after age 18 and continued to accrue qualifications leading to higher than typical participation in higher education.
Strong social networks are particularly important for vulnerable people. However 1 in 3 older people, disabled people and carers in Kirklees find it difficult to access groups which provide support for people with specific health and social care needs. Social isolation needs to be tackled by all partners across Kirklees to ensure that there are adequate activities and support networks available in local communities. The Voluntary and Community sector can play an increasing role in developing community based activities.
Locally there has been real improvement in the number of schools on special measures (halved over 3 years) but real differences in performance remain between schools of a similar nature.
Inequalities The primary aim of this first JSNA has been to describe the health and well-being needs of the whole population of Kirklees. However, in collating and analysing the data which underpins this assessment it is clear that for some issues certain groups are more likely to be affected. Some of these differences are highlighted above, but because of limited space in this summary these inequalities have not been described in full here. More detail about these differences is set out in the fuller report that accompanies this summary. This includes a detailed analysis for each of the 7 localities. It is crucial that any planning based on this JSNA focuses on ensuring the most important issues for a specific population are tackled and those most in need are targeted by any interventions.
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Using the Strategic Needs Assessment Information from the Joint Strategic Needs Assessment is a major influence in establishing our local commissioning priorities. We are already using this JSNA information to direct our commissioning. For example, information has been fed into the ‘Picture of Kirklees’ Conference,
Kirklees Partnership Board, the Local Public Service Boards for Adults and Healthier Communities and Children and Young People, and the key messages have helped shape the draft of the new Local Area Agreement (LAA). Information from the JSNA is also being
National Dataset
Local people’s views and experiences
Research and trends information
used to inform commissioning intentions and service and locality planning. The following diagram summarises the inputs and potential outputs from the JSNA work:
Public Health Information
Local Commissioning Intelligence
Health & Social Care Prevalence Information
Informing
Joint Strategic Needs Informing
Priority Setting Community Strategy
Local Area Agreement
Influencing
Locality Plans
PCT Business Plan
Children’s/ Young People’s Plan
Client Group Commissioning Plans
Housing/ Supporting People Strategies
(e.g. Mental Health Strategy, Older People’s Strategy, Obesity Plan, etc)
The next steps in developing the Joint Strategic Needs Assessment More detailed information from the JSNA work is now being used by the PCT and the Council to direct our commissioning and planning. Work is underway to develop a range of mechanisms to share this information more widely. The JSNA is not a single, one-off exercise, but is an ongoing piece
of work which will add to our commissioning “intelligence”. As we develop our JSNA, we will be including more information about: • the local market and workforce; • service user and carer views; • service usage information; • locality level information and trends.
Work will continue to: • further develop coherent, consistent and appropriate data sets; • develop the capacity across all partners to generate, analyse and present this information; and • ensure that relevant planning systems make use of the information that the JSNA is producing.
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Further information More detailed information about the JSNA is available on the Council and PCT websites including the full report: www.kirklees.gov.uk www.kirklees-pct.nhs.uk
Or by contacting: Deborah Collis Public Health Directorate Kirklees PCT
Margaret Watt Adult Services Kirklees Council
Matthew Holland Children & Young Peoples Service Kirklees Council
deborah.collis@kirkleespct.nhs.uk
margaret.watt@kirklees.gov.uk
matthew.holland@kirklees.gov.uk
8 Kirklees Primary Care Trust and Kirklees Council