A Public Health Approach to Social Care and Wellbeing Services

Tony McGinty

Joint Assistant Director for Public Health

Lincolnshire County Council and NHS Lincolnshire 

The Approach

Understand Your Population

Understand Triggers

Evidence Based Modelling

Procure and Manage

• Joint Strategic Needs Assessment (JSNA)

• Evidence based demand forecasting

• Wellbeing Support Service model

Areas for discussion

• Establish JSNA as a continuous process;

• Improve level and quality of engagement;

• Produce a succinct annual JSNA report;

• Focus report on the health inequalities

Objectives for JSNA 2011

JSNA Objectives

• 35 topic areas identified based on the data.

• Each topic has an identified ‘Owner’.

• ‘Owner’ issued with a template upon which to provide commentary.

• Commentaries underwent a ‘peer review’ process

JSNA Approach

JSNA Approach (2)

What do we know?

• Indicator details

• Data, trends, profiles

• Targets and performance data

• Local views and engagement

• National and local strategies

• Current commissioned activity and services

• Key inequalities and equality impact

• What are the knowledge gaps?

• How are these impacting on effective service commissioning/delivery?

• What are the risks of us not delivering?

• What is coming on the horizon and what should we be doing next?

What is this telling us?

• New JSNA Website

• Joined up approach (IMD, Economic Assessment, etc)

• Additional ways of viewing the JSNA

• Brief Overview Report

Presentation of JSNA

Presentation of JSNA (2)

Presentation of JSNA (3)

• Promoting healthy lifestyles

• Improving health and wellbeing for older people

• Delivering high quality systematic care for major causes of ill health

• Improving health and reducing health inequalities for children

• Reducing Worklessness

Identified Priorities from JSNA

JSNA Priority/Marmot Objectives

Marmot Objective

Priority

Give every child the best start in life

Enable all children, young people and adults to maximise their capabilities

Create fair employment and good work for all

Ensure healthy standard of living for all

Create and develop healthy and sustainable place and communities

Strengthen the role and impact of ill health prevention

Promoting healthy lifestyles Improving health and wellbeing for older people Delivering high quality systematic care for major causes of ill health Improving health and reducing health inequalities for children Reducing Worklessness

• Linked to JSNA priorities

• Developed in consultation with stakeholders (e.g. via Excellent Ageing)

• Focused on triggers which:

– place people at risk of requiring more costly services; and/or

– Indicate people may need some support, advice or assistance

Evidence based demand forecasting

Areas of focus for demand forecasting:

Evidence based demand forecasting

• In receipt of supporting housing

• Long term health conditions (Stroke, CHD, COPD, Dementia)

• Out of work benefits

• Fuel Poverty

• House re-possessions

• Estimated unclaimed disability benefits

• Adult social care (people assessed as not eligible combined with people exiting reablement services with no further services)

• Frail Older Peoples Project

Evidence based demand forecasting

Category of NeedNumber

(2010)

People in receipt of Supporting People services 12,521

People with long term health conditions 70,926

Worklessness 48,170

Housing Need - Fuel Poverty 71,600

Housing Need - Repossessions 1,000

Unclaimed benefit claimants 97,420

Adult Social Care 4,045

Frail Older People Project 7,078

TOTAL 312,760

Limitations of the model:

Evidence based demand forecasting

• Some people will appear in more than one area

• Reliability/consistency when projecting and forecasting into future

• Other areas need to be forecast as well (Problem drug users, Smoking, Obesity, etc)

• Not all people will require the same level of support

Engagement

• A Little Bit of Help Please!

• Stay in touch with me

• Over lapping boundaries

• Accessible

• Acceptable

Next steps for the model:

Evidence based demand forecasting

• Delphi approach to obtaining consensus with regards the forecasting

• Development of a model of support which recognises the differing levels of support people require

• Agree with colleagues in other services (social care) overlaps, hand off processes, risk/benefit sharing, etc

Tier of Support

Level 1 - Local Advice Network

Level 2 – Brief Intervention

Level 3 – Ongoing Support

Example Interventions

Adapted from ‘Improving Care and Saving Money’, DH (2010)

Signposting & information

General Advice (1)

Specialist Advice

Supported Employment

DAAT Services

SmokeFreeLincs

Phoenix weight management

Health Trainers

General Advice (2)

Exercise Referral

Food for Life Play for Life

Fit KidsCommunity

Walks

Benefit Advice

Debt Advice

Form completion

Advocacy

Practical Support

Housing Support

Life skills

Emotional Support

Domestic Help

Telecare

Self care support

Community Equipment

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v.2 July 2011

Num

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Community

Support Acute

Time

Wellbeing Support

Managed Advice Networks

Stay in touch please

The Approach

Understand Your Population

Understand Triggers

Evidence Based Modelling

Procure and Manage