JSNA Case Studies:
Case study examples of voluntary and community sector engagement in the JSNA process.
1. Age Concern/Lancashire JSNA – Better commissioning of Services for Older People
Age Concern Lancashire has worked positively with the JSNA Team in a number of ways and continues to have an active ongoing working relationship with them.
Initially, Age Concern Lancashire offered the JSNA Team training in putting the ‘story’ to the data they held on older people from a health and social care perspective. A Big Lottery research report called ‘Linking Communities’ was also used as evidence to inform the JSNA process. The report provided information following a consultation with local older people, which discussed and raised a wide range of concerns, issues and needs of older people and looked at how communities can best support those needs.
As a result:
- The Head of Intelligence in the LA used the Report to train Assistant Heads and Community Engagement Staff – cascading the findings internally to people working on JSNA to inform their work.
- The Report has also been shared with relevant leads in the PCT and LA.
This led to:
- The Big Lottery awarding the full amount of funding for a 3year research project based on the ‘Linking Communities’ report - to examine older people’s quality of life. AC Lancashire knows that JSNA Team assistance was pivotal to gaining the funding.
- The Report focuses on a social return on investment with support & information being supplied within the JSNA Team.
- The work is now part of the JSNA work programme scoping strategic needs assessment and is one of three pieces of bespoke analysis looking at wider determinants of health.
- An Older Persons group being set up as a direct result of the collaboration with the JSNA team. The group considers issues facing older people and is facilitated by the Chief Executive of Age Concern Lancashire and involves other colleagues from the CVS and statutory sector.
This will assist in advising on commissioning intentions and improved service provision.
For further detailed information contact – Helen Ramsbottom – Helen.email@example.com
2. Bristol JSNA: Royal National Institute Blind (RNIB) Using JSNA’s to improve services for blind and partially sighted people
Following the publication of the Bristol JSNA baseline report, the Royal National Institute of the Blind (RNIB) presented new evidence to suggest significant increases in Bristol’s blind and partially sighted population.
Whilst the Local Authority held details of those registered blind or partially sighted, it was suspected that those with sight loss are significantly undercounted because of the stigma attached to being on a ‘register’, the lack of a single trigger or referral system that signposts the population to the register.
Other local sources of data supported the growth cited in the national research, including the number of outpatient appointments at United Bristol Healthcare NHS Trust, admission rates to Bristol Eye Hospital, and the number of outpatient appointments at the eye clinic at Tyndall’s Park Children’s Centre over a two year period.
RNIB worked closely with Bristol PCT and the local authority, providing up-to-date epidemiological evidence on the prevalence and the most cost effective interventions for reducing blindness. Whilst it is still too early to evaluate the impact, RNIB believe the improved section on sight impairment supported the case for the new patient support service in Bristol eye hospital.
For further detailed information contact – Andrew.firstname.lastname@example.org
3. Bristol JSNA – Improving and reducing hazards that lead to hip fractures in older people, early deaths from heart disease and stroke and poor health in children under 15 years.
The Bristol JSNA cross-referenced hazards identified through Housing Health and Safety Rating System (HHSRS) statistics with PCT health profiles and local authority statistics and 2007 House Condition Survey.
Findings revealed higher than national average hip fractures amongst older people, early deaths from heart disease and stroke, fear of crime and children under 15 years “not in good health”.
Priorities generated by the JSNA included:
- Lower cost or free loft/cavity wall insulation for those with chronic pulmonary disease referred by the PCT
- Subsidised loans for homeowners to improve properties to meet Decent Homes Standard
- Home adaptations, making use of the Disabled Facilities Grant, to plug gap in suitable housing provision for ageing population
The Chartered Institute of Environmental Health’s (CIEH) cost calculator found that the total cost of dealing with expected occurrences of excess cold would be £2.2 pounds which equates to an annual NHS saving of £7.4 million.
4. Devon JSNA – Preventing Hospital Admissions and Health Interventions Through Supported Housing
Devon JSNA assessed detailed ‘accommodation and support needs’ of user groups within its communities using a consistent framework and methodology which complements and develops health and social care JSNA for:
- Older people,
- People with Mental Health needs
- People with Learning Difficulties
JSNA found over 13,000 people in need of a face to face supportive housing. Set against health profiles and older people’s aspirations, the agreed evidence base led to joint commissioning of Rapid Response and Early Intervention services for older people to prevent hospital and health interventions. It has been estimated that the projected savings have been estimated as follows:
- Initial investment of £572,000 over 53 weeks
- Local evidence suggests a cost saving of £211,000
For further detailed information contact – email@example.com
5. Cambridgeshire’s - JSNA for the Homeless and those at risk of Homelessness
Cambridgeshire’s JSNA process uses a client group approach of separate client groups as part of the gathering of data for JSNA’s which then feed into the combined JSNA for Cambridgeshire.
The Homeless JSNA was developed by a steering group of statutory and voluntary agencies in 2009.
The JSNA process in Cambridgeshire involves strategic county wide buy-in and clear accountability for delivery of the recommendations. The JSNA becomes the first step in planning and commissioning cycles for the homeless population.
The JSNA process is enabling better Voluntary and Service-user engagement through the:
- Working Together for Change;
- using person centred reviews for commissioning approach
- co-production of commissioning of homeless services,
- using care plan reviews with multi-agency and user workshops to plan and commission for better outcomes for homeless people and appropriate development of provider services
This is a process that will be lead by Cambridgeshire’s Voluntary sector although in partnership with other public sector organisations.
For further detailed information contact - Dr Fay Haffenden, Consultant in Public Health Children & Health Inequalities, NHS Cambridgeshire, email: firstname.lastname@example.org
6. Liverpool JSNA– Healthy Homes Programme: Reducing premature deaths and hospital admissions by removing exposure to health hazards
Liverpool Primary Care Trust (PCT) commissioned in conjunction with Liverpool City Council the Healthy Homes Programme (HHP) in 2008/2009 following the development of the 2008 JSNA which provided evidence on health inequalities in Private Sector Housing across Liverpool.
The HHP’s overall aim was to reduce premature deaths by up to 100 per year and to reduce GP consultations and hospital admissions by over 1000 cases per year, through the removal of exposure to health hazards.
The programme assessed the health and wellbeing needs of the occupants of 15,000 properties, using a single assessment process, which enabled referrals to be made to a wide range of agencies for assistance. It also prioritised the worst 2,750 properties for inspection by the Environmental Health Team and, where appropriate, action was taken to remove category 1 hazards.
A wide range of partners who provide housing, health and wellbeing services were involved in the programme from the start - CAB, Churches Together Liverpool, Age Concern, Merseyside Fire and Rescue Service, Next Steps (free careers service to over 18 year olds) etc
The community in deprived areas of Liverpool will see improvements to their housing, health and wellbeing as a direct outcome of the HHP. Not only will the needs of vulnerable residents be identified and services provided to meet them, but also data will be available to assist future JSNA’s and service planning. It is too early to say if the programme has successfully reached its target in reducing premature deaths by 100 per year but Liverpool CC are keen to carry out a comprehensive evaluation of the HHP focussing on outcomes and evidence that can be used to show the value of the work they are doing. They will achieve this through:
- Commissioning a University, jointly with the PCT, to conduct an evaluation of the HHP, as part of a wider evaluation of the outcomes achieved through a number of health programmes taking place in the area.
- Commissioning the BRE to model financial savings to the NHS by home improvement works to eliminate hazards (this is subject to confirmation).
- Carrying out a survey of self-reported changes in health and well-being following interventions initiated through the programme.
- Collating information from agencies detailing the outcomes of referrals they received e.g. the number of people who have stopped smoking.
For further detailed information contact – Ian Watson – email@example.com
7. Wiltshire JSNA – Prisoner Health Trainers Programme
Within Wiltshire the JSNA team identified prisoners as a group that had higher risk of poorer health outcomes relating to specific health and social care needs and wider determinants.
Erlestoke Prison is an adult male, category ‘C' closed training prison and is the only prison in Wiltshire. Erlestoke receives adult male prisoners from much of England and Wales, as well as from local prisons in South Wales and Bristol. In Erlestoke prison, the ethnic minority population is higher than the ethnic population of Wiltshire. 23% of the prison population is non-white, compared to just 3% of Wiltshire’s population. 41% of prisoners are under 30 years of age.
Prisoners have a range of health and social care needs both in prison and following release. In 2009, a Health Needs Assessment was carried out for HMP Erlestoke Prison. Specific health needs were identified for this group including: sexual health, infectious diseases, mental health and substance misuse.
Wiltshire PCT commissioned a health trainer service in 2009 following the findings of the JSNA and the health needs assessment. The service is delivered by ex offenders who undertook City and Guild training at level 3. This enabled them to work with prisoners to support behaviour change.
The work includes promoting healthy eating and reducing obesity; stops smoking providing additional support to the stop smoking team; increased exercise programme and substance misuse advice and guidance and access to therapeutic services to increase positive self esteem and mental and emotional well being. Health Trainer service in Prisons can impact on four of the resettlement pathways in the National Reducing Re-offending Action Plan. These include skills and employment, health, drugs and alcohol and attitudes, thinking and behaviour. The schemes success relies on good partnership working across the statutory, voluntary, charity and community sector across Wiltshire.
For further detailed information contact – Maggie Rae, Director Public Health, Wiltshire PCT and County council Tele: 01380 728899
8. Wiltshire JSNA - commissioning services for the armed forces and NHS dentistry
The JSNA in Wiltshire has helped partners to identify new areas of need including the health and social care needs of members of the armed forces (Wiltshire has a high concentration of members of the armed forces and their families).The interrelationship of alcohol related crime and antisocial behaviour and alcohol related ill health. It has also identified lack of NHS dentistry provision and has since influenced a £1.4 million new allocation of spend to increase improved services and dentistry provision. It was agreed that further JSNA developments should present a picture that discusses the real need of local communities.
For further detailed information contact – Maggie Rae, Director Public Health, Wiltshire PCT and County council Tele: 01380 728899
9. Waltham Forest JSNA – Childhood Obesity
The JSNA highlighted childhood obesity was more evident in year 6 pupils in over 21 local schools. The findings influenced a whole system approach towards addressing the underlying issues of child hood obesity and the following actions were taken:
- School Sports Partnership targeted schools with physical activity schemes
- Local Authority refused planning permission for new takeaways within a 400 yard radius of schools, leisure centres, or parks
- Healthier school dinners were encouraged whilst also ensuring school takeaways were also healthier.
Benefits to date include:
- 2.2% drop in obesity levels from 2007/8 to 2008/9
- Fast food outlets reduced from 253 to 241 over same period
Waltham Forest hope that longer term outcomes from the actions they have taken will include overall health improvement for pupils, improved behaviour and concentration in the classroom along with a reduction in litter in targeted areas.
Case study supplied by JSNA Development Manager
10. Staffordshire JSNA – End of Life Care
The JSNA for Staffordshire – the story so far, records the impact the JSNA has had developing new services and new approaches in Staffordshire. Areas reviewed include adult mental health, alcohol, offender health, end of life care and older people’s mental health services
The JSNA identified issues in the older population for the growing numbers of over 65s and the increased demand this will have on local services. It was identified through the JSNA that access to end of life care services was poorer for those people who were most in need. Three quarter of deaths were attributable to circulatory or respiratory disease although dementia is often not stated as the prime cause of death and therefore masks service need.
The place of death does not always indicate this as a person’s preferred choice and over 50% of patients who die in hospital do so within the first week of admittance. It is estimated that if hospital admissions were reduced by half over £4.8 million would be released and spent on other service needs.
As a result of the Staffordshire JSNA the data gathered was used to translate the strategy recommendations into funding proposals as part of South Staffordshire PCT Local Delivery Plan. This resulted in funding to support hospice care and end of life care facilitators aligned to health and social care teams. A service improvement programme was initiated in over a third of nursing homes.
South Staffordshire PCT has now adopted end of life care as one of its World Class Commissioning outcomes and is monitoring progress against the proportion of people who choose to die at home.
11. Derby JSNA– Financial Exclusion
“The acid test of the success of our JSNA is the impact it has on the way that services are subsequently commissioned and provided.” Derbyshire County Council
The JSNA for Derbyshire was used to develop a PCT and other partner’s strategic framework to reduce inequalities in health. The JSNA highlighted that over a period of five years there had been 13.000 premature deaths in Derbyshire and it was evident that over 1,000 of these could have been prevented if additional resources were targeted towards the 20% most deprived wards.
These findings led the PCT to extend the Citizens Advice Bureau (CAB) sessions into its GP practices and offer a regular CAB service in 90% of practices by the end of March 2010.
In 2008/2009 an extra £2.4 million income was secured for families in Derbyshire as a direct outcome of the CAB project, which also helped manage an additional £2.7 million of debt.
The PCT and partners are further targeting a reduction in financial exclusion and are currently investigating the development of a credit union for Derbyshire
12. Suffolk JSNA – Residential Dementia Care Home
Suffolk’s Joint Strategic Needs Assessment for 2008-2011 states there is a strong relationship between the projected growth in the elderly population and the rise in dementia.
A private housing organisation identified the need for residential dementia housing within Suffolk following the evidence they were provided with through the JSNA report. Following discussions and partnership working with the local JSNA panel and Suffolk County Council and Primary Care Trust the housing organisation built a residential home for sufferers of dementia.
For further detailed information contact – Alicia Giles-Stewart, Joint Commissioning Manager -Tel: 01284 35220.
13. Wirral JSNA – Patient Advice and Liaison Service (PCAL)
Following the publication in 2008 of Wirral’s JSNA there was evidence that mental health recovery was a key priority for NHS Wirral and the Local Authority. GPs also reported on their patients presenting to them with mild to moderate mental health issues, which they believed was impacted upon due to wider health and social care determinants such as poor housing, debt, environmental, unemployment etc. Some GPs were already providing a CAB service within their practices yet this was not equitable for all patients in Wirral who may have wished to access this service. The PCT agreed the service needed to be commissioned across all GP practices and worked in partnership with Wirral CAB and Wirral Advocacy services and commissioned a collaborative voluntary sector Primary Care Advice and Liaison Service (PCAL) in April 2009.
The PCAL service provides an advice, information and support service to people, aged sixteen and above with no upper age limit ,with common mental health problems. The service is provided by Wirral Citizens Advice Bureau and Advocacy in Wirral, drawing upon the expertise and knowledge of both organisations in a unique partnership. The pathway to the service is via GP referral, with Advocacy in Wirral providing an expert dimension for more complex cases.
PCAL was awarded a three year DH contract with an annual value of £392, 650 totalling £1’177.950 for a period of three years. A full evaluation of the project is underway and to date following case study reviews feedback suggests this service is exceeding its predicted outcomes and support the development of effective preventative strategies through social and community based interventions addressing the broad social determinants of health and well-being
For further detailed information contact Tricia Moroney, Programme Manager, NHS Wirral – email firstname.lastname@example.org
14. Suffolk JSNA - Suffolk Carers’ Centre
The Carers Centre reported on an excellent partnership approach to the JSNA process and document. There is a comprehensive overview of carers’ information which is also broken down into specific categories of carers, including young carers. The information is complemented by useful policy background on carers’ issues and what is expected of local authorities in relation to carers.
The Carers’ Centre felt that this successful engagement was achieved through being part of the area’s Family Carers Partnership Board and having good relations and individual meetings with officers. They felt the engagement was real and that their contribution was valued and impacted the JSNA process.
For further detailed information contact – Alicia Giles-Stewart, Joint Commissioning Manager -Tel: 01284 352201
15. Islington JSNA and Voluntary Sector
Islington refreshed their local JSNA by conducting a qualitative approach towards developing local evidence of need within the voluntary and community sector. Islington JSNA team have developed and progressed greater awareness and understanding of the JSNA in the voluntary and community sector.
Stronger relationships have also developed with other key stakeholders – LINks, police etc and the call for information from the voluntary and community sector has supported PCTs, LA and LSPs to understand the structure and capacity of the sector. Future strategies will also be shaped and informed by the voluntary and community sector that will also influence the development of service provision.
For further detailed information please contact Rachel Maan Email: Rachel.email@example.com.
16. Harrow JSNA – New Services
The voluntary and community sector for Harrow report that their understanding of the JSNA process has enabled them to understand local needs and demographics. Through a range of different engagement and involvement activities the sectors awareness of the JSNA process has increased and supported them in applying for funding to deliver key services across Harrow.
The JSNA has also been used to inform various strategy documents:
- PCT Strategic
- Commissioning Plan
- Joint Analytical Group’s Strategic Report
- Local Authority’s Housing Strategy for Older People
- Community Safety Plan
- Integrated Commissioning Strategy.
The JSNA has led to more partnership working between statutory and voluntary sector and has supported joint working between the Somali community and police to enhance crime awareness and also held an event within the Somali community for young people. Somali women have also held a mental health awareness event in partnership with Harrow PCT.
The JSNA has also led to the development of new services and initiatives. Examples include:
- Domestic violence support
- Employment pathways for drug users following treatments
- Posts to support carer and user engagement and service development
- Shop4Support, and community equipment retail model
- Development of Older people’s services (e.g. matrons for long-term conditions, reablement, intermediate care pathways
- Information and screening events to highlight prevention of strokes and high blood pressure
- Events and training sessions by MIND on religion, culture and BME women
Case study examples of voluntary and community sector involvement in influencing commissioning of public sector services.
17. Hull Local Involvement Network (LINk) -Improving Mental Health Services for Young People
As part of the JSNA process people involved in Hull local LINk network identified mental health services for younger people as an issue, which LINk then investigated to identify some of the underlying problems and put forward opportunities to address this. A small task and finish group was formed to explore the issue. The group researched local services and asked young people, and voluntary and community groups that support them, for their views.
LINk identified that for many young people problems were experienced during the process of transition from children’s to adults’ mental health services, leaving them feeling distressed and without adequate support. Young people stated the need for a wider range of services that improve mental health by improving their confidences and self-esteem. Some young people discussed their concern towards not being able to access services out of hours and at weekends.
A report was written up which highlighted key recommendations for service improvements based on the feedback received during the LINks investigation. The report was submitted to Hull local NHS Trust under the power to make recommendations, which services are legally obliged to respond to. In response, Humber Foundation Trust (provider of mental health services) agreed that managers of the single point of access services would formalise protocols regarding transition between services. NHS Hull, the city’s PCT responsible for commissioning services, responded to the recommendations and presented these to the children and adolescents group of the Humber contract architecture. The report will be presented to the World Class Commissioning Mental Health Goal Group and the Humber Foundation Trust board meeting which will provide opportunities to exert influence on delivering improved services.
For further detailed information contact – Jonathan Appleton - firstname.lastname@example.org