Health & Social Care Integration: Joint Strategic Needs Assessment (JSNA) Annandale & Eskdale George Noakes Senior Health Intelligence Analyst Health Intelligence Unit, NHS D&G gnoakes@nhs.net
What is the JSNA? Statutory document for integration Working within a suite of integration documents (Strategic Plan; Finance etc.) A broad sweep across all services included in integration Quantitative data Epidemiology, Comparisons (benchmarking), Qualitative data A compendium from which to source information to inform the locality plans
Quick Locality Statistics 38,100 people in Annandale & Eskdale 6,825 (17.9%) aged 65-79 2,241 (5.9%) aged 80+ On average 338 births and 440 deaths per year 4,210 people income deprived 2,290 people employment deprived 374 (1.0%) people from Black and Minority Ethnic Groups (inc. Gypsy Travellers) 3,786 (10%) Carers (Census 2011) 576 new referrals in 2013/14 for Annandale & Eskdale residents to the Community Mental Health Team
Themes
Isolation The challenges (and advantages) of serving a rural area Social isolation and social capital Public Transport issues People not having enough time for themselves Loneliness
Isolation Adults aged 75+ living alone likely to double by 2037 D&G: From 6,400 to 11,700 Annandale & Eskdale: From 1,475 to 2,575 Across D&G there are nearly 15,000 carers, 29% (4,300) provide 50+ hours/wk In Annandale & Eskdale there are nearly 3,800 carers, estimated that 1,100 will be providing 50+ hours/wk Across D&G approx. 125 per 1000 people aged 75+ have a community alarm or other tele-health; lower than national average (approx. 190 per 1000 people aged 75+)
Isolation I am not just disabled as I am part of the LGBT community. Having both mental health and physical health I often feel left out of any community. (Community Survey 2011) Rural transport in D&G is ill thought out and seems almost deliberately planned to prevent you from using it. (Community Survey 2011) Nearly every new resident that now arrives in my care home suffers from some degree of social isolation. The rise of dementia sufferers combined with the fact that people are staying at home longer means that having 1 or 2 short visits each day from care at home is not sufficient to alleviate loneliness in many cases. (Care Home Manager, 2014)
Increasing Complexity More people with multiple illnesses, drugs, other challenges Longer survival of those with complex needs Share of care across many settings and how it is all coordinated Social changes
Increasing Complexity Across D&G 12,500 people on SPARRA have 2+ chronic illnesses (growing ~300/year) 12,123 (31%) have one or more long term conditions in Annandale & Eskdale (Census 2011) Annandale & Eskdale 3,100 people have 2+ chronic illnesses (SPARRA) Healthy life expectancy : Scotland in 2012 women were estimated to have 18.8 years of ill health, and men 17.5 years care at home clients classed as intensive (10+ hours) consistently above national average Annandale & Eskdale 500 people receive care at home, 210 (42%) receive intensive care at home
Increasing Complexity Across D&G approx. 2,950 people with dementia In 5 years there will be 3,430 (+16%) In 10 years there will be 4,000 (+35) In 2037 there will be 5,925 (+100%) I am at my wits end struggling to get the support that [I] need and deserve. It was difficult to find out where and who to go to. Everything that was needed was in all different departments. Support should be [accessible] in one place instead of going from pillar to post.
Personal Resilience Keeping people healthy and independent for as long as possible Anticipatory care and prevention work Re-ablement to return people to previous independence Housing/adaptations to stay in your own home
Personal Resilience Keep Well: Proportion of carers who indicated poor mental health & wellbeing vs. the general population Source: Keep Well Database; NHS Dumfries & Galloway
Organisational Resilience Ageing workforce; recruitment challenges Diminishing resource Valuing our staff and maintaining high quality service through training and professionalism Health of the workforce, stress and sickness absence
Organisational Resilience Only 61% of NHS and Council staff meeting basic physical activity guidelines NHS Vacancies at Sept 2014: 20 consultant posts (8.2% of workforce), 66.5 nursing and midwifery posts (3.9%) and 11.7 Allied health profession posts (4.5%) What about when the country is back up and running and shops can pay 7.50 hourly rate of pay. Do you work 9-5, go home, put your feet up? Or do you want to work for less money and you might get a phone call saying can you quickly nip to the pharmacy, this person s meds need changed. Someone is not well can you stay there until the GP comes? Interview with Private Care Company, 18 September 2013.
Getting the Balance Right How we provide care across NHS/council/partners and from acute/intensive to community/ongoing care Priorities around fitting into new hospital, delayed discharges, multiple handovers, complex pathways Developing community resilience (social capital) to make the best of our assets
Getting the Balance Right Across D&G delayed discharges have increased from 3,042 Bed Days in 2011/12 12,835 in 2014/15 In Annandale & Eskdale, in 2013/14 there were 1,778 Bed Days occupied by delayed discharges, 648 Bed Days (36%) 6+ weeks Emergency admissions double of electives (14,800 vs. 6,400)
Getting the Balance Right Older people are often admitted to hospital due to lack of adequate alternative services in the community. Dumfries & Galloway is developing an Intermediate Care model that both supports the reduction of avoidable admissions and facilitates timely discharge from acute settings. The development of multidisciplinary and multi agency teams across primary and secondary care, working together to bridge the gap, will ensure that the patient s journey is safe and effective. Full Business Case. A New District General Hospital for Dumfries & Galloway.
Person Centred Care Being able to choose; self directed support The value of being listened to (supportive conversations); every contact should add value End of life planning Rising emergency admissions indicates lack of planned care
Person Centred Care People who died in 2012/13 spent on average 9% (16 days) of their last six months in the DGRI In Annandale & Eskdale 50% people died at home (domicillary, residential care, palliative care) There is a standstill on building - we need housing suitable for elderly/ less mobile people - not just council backed but private development of bungalows and apartments. Community Survey 2011, Over 61 Annandale& Eskdale Sometimes I need to see the GP but can t get an appointment; they say I should phone at 8am, but I need someone to help me phone, and my support workers are not here at that time in the morning. Dumfries and Nithsdale Community Consultation on Health and Social Care.
Addressing Inequalities People at the bottom still have worse outcomes across most measures The impact of poverty, deprivation & protected characteristics Social capital when your face doesn t fit Different definitions of vulnerability across services/organisations
Addressing Inequalities In Annandale & Eskdale 4,320 residents in the 20% most deprived areas by local quintiles (SIMD 2012) 1100 (4%) working age people unemployed, 969 have never worked or are long term unemployed (Census 2011) 1 in 5 households have no car or van Across Dumfries & Galloway 6,200 young women 16-34 have low level or no qualifications 1,500 residents speak English not well/not at all
Addressing Inequalities I had no job, no house. I drank to excess, I beat my wife; we are no longer in touch. So now I have no family. I am not proud of it and I am working through it. I had no understanding then of what was happening. (Now has diagnosis of PTSD). Veterans in Dumfries & Galloway: A Health Needs Assessment I am not from the UK originally and I always have a sense of being second class in this country. Community Survey 2011, ethnic minority
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