Joint Strategic Needs Assessment
Bristol Case Study:
Health Economics of Health
Improvement?
March 2012
Pat Diskett (Deputy DPH)
Nick Smith (JSNA Project Manager)
Overview of the JSNA
 JSNA is ongoing process to identify Bristol’s health and
well-being needs - now & in the future
 Jointly produced - City Council (Children Services and
Adult Social Care ) and NHS Bristol, with input from LINk
 Purpose is to help shape services, and inform future
commissioning/development plans (resources)
 Strengthened influence - new statutory Health and
Wellbeing Strategy (plus CCG + NHS commissioning plans)
Bristol JSNA - Background
 Joint Process – Council / NHS / partners /participatory
 To improve health outcomes - now & in the future (priorities + reposition resources to meet changing needs) -> Strategic focus
 Steering Group + “embedding” Strategy (as a Commissioning Tool)
 2008 – 2010: 3-year cycle
 2008 Baseline -> 2009 + 2010 Updates/refresh + gap filling
 All JSNA Reports are at: www.bristol.gov.uk/JSNA
[or email: [email protected]]
Joint Process - > JSNA Outputs
Strategic Analysis + Prioritisation
Workforce
development
and training
Service review
design and
redesign
Web based portal, data sharing,
profiling tools
Pointers, address gaps –>
work programme
Horizon scanning
Broad baseline report minimum dataset
Info + data
sharing ->
intelligence +
dissemination
Needs
analysis;
Evidence;
Equity
Audits
JSNA 2010 and Economics
 National policy changes + Recession
 Difficult choices and efficiencies
NHS = QIPP
BCC = Re-Design
(Quality Improvement, Productivity, Prevention)
 Health Improvement versus Services?
 Shift resources around the system?
 Transparency and evidence?
 Everything to everybody?
JSNA 2010
 2010 Update is end product
of 3-year cycle, building on JSNA
Baseline and Atlas tool.
 Strategic and economic
elements to support
Commissioning + Planning
BUT need for worked local examples
and a Conceptual Commissioning Model
for Health and Wellbeing
The Approach (1)
 Q 1: What are we spending now?
(Benchmarks, Quality, Gaps, Outcomes)?
 Q 2: Why are we doing this/What savings
or efficiencies might be possible by doing
things differently or investing differently?
(Evidence + Assumptions + Outcomes
-> Timeframe = “real” Efficiencies?)
The Approach (2)
 Q.3 What might we need to spend in the
future (what to include/exclude)?
(Changing Needs, Trends, Projections,
Evidence, new Technologies, Best
Practice)?
 Q.4 What if we do nothing?
The Approach (3)
 Quick Wins (savings in year possible?)
 Strategic Priorities – alignment
……………..a Pragmatic Approach
 How good is good enough?
Economic Case Studies
 Started with several (6-8 case studies)
e.g. alcohol; smoking/cancer; diabetes;
obesity/physical activity; dementia, children with
disabling conditions and others (e.g. ageing and
adapted housing)
 How/Who:
Volunteer Health Economist (Joe Ariyan)
PH team (Consultants, ADsPH, PHIU, R&D,
Clinical Effectiveness lead)
BCC and PCT colleagues, Academic help
JSNA 2011: App’x 3– Lifestyles &
Health Improvement
 Rising trend in Bristol alcohol-attributable hospital
admissions - indication of alcohol misuse in local pop’n:
Rate of Alcohol Attributable Admissions per 100,000
2500
2252
2000
1845
1899
1934
2005/06
2006/07
2007/08
2351
1711
1500
1354
1233
1000
500
0
2002/03
2003/04
2004/05
2008/09
2009/10
Alcohol (1) Costs
 April 2009 April 2010 = 3,278 admissions
(Bristol hospitals) directly specific to
/attributable to alcohol consumption (e.g.
cirrhosis of the liver).
 Each spell cost us on average £1,375 – a total
bill for the year of about £4.5 million.
 If able to prevent only 1 in 10 of these spells,
this could still save us an estimated £0.5
million per annum at current costs.
Alcohol (2) Costs
 ? Hospital spells partially due to excess alcohol
consumption (e.g. a trip or a fall when drunk)
 2009/10 = 6,966 spells in Bristol hospitals
 Each spell cost on average £1,749 = total > £12.2
million
 Programmes to reduce the level of drinking +
prevent 1 in 10 of these spells could save an
estimated £1.2 million of these costs.
Alcohol (3): But what if we do
nothing?
 Total NHS costs in Bristol attributable to
alcohol admissions in 2009/10 = £16.7
million.
 Projected costs in just 10 years’ time
based on an analysis of recent trends
and population changes are in the
region of £22 - £33 million
Alcohol QIPP: Did it Work?
 Impact on Commissioning Decisions and
Resource Allocations?
 A&E/Hospital based programme
 Wet Clinic
 Evaluation/Developing the Evidence-base
Alcohol related Harm (4): But what if
we do nothing?
 What about the total cost of health care
of alcohol harm in Bristol, not just
hospital stays?
 It is estimated that this is £31 – £51
million in 2010, and, if we do nothing, it
could rise to £43 – £97 million by 2020.
Obesity
 Methodological Challenges
 Modelling
 Outcome/Results
 Wider impact?
Dementia
 Modelling – Scenario Generator
 Care Pathway Issues
 Programme Budgeting?
Challenges
 Data and intelligence (Apples and Pears)?
 Financial Information (NHS and LA)
 Evidence of Effectiveness?
 Tools, Benchmarking, Modelling and Assumptions
 National Data Sets/Timeframes/Advice
 Skills, Expertise, Methodological challenges (Obesity ->
Academic Approach) and Version control
So how are we doing (1)?
 JSNA Outputs and Outcomes - Fit for Purpose?
 Do commissioning priorities reflect the JSNA?
[evidence of effectiveness]
 How to better integrate JSNA in current and new
commissioning processes e.g. ? CCGs/GPs “wants”?
 How can commissioners better contribute to JSNA
(and economic analysis)?
How are we doing (2)?
 Commissioning needs met?
- What areas of need are priority for more
economic information/Intelligence?
- What intelligence would better support decommissioning and re-commissioning?
What Next: How can we make the
JSNA “Truly Strategic”?
 Programme Budgeting?
 New Tools/Techniques/Academic Support?
 Role of CCGs? GP Data?
 Role of Local Authority? PHE?
 H&WB Strategy?
Taking the JSNA forward
Joint Health & Wellbeing
Strategy
Horizon
ows
Horizon
scanning
JSR
Joint
Service
Reviews
Knowledge
gap
+
gap
gap
analysis
analysis
JSNA
Joint
Strategic
Needs
Assessment
Baseline report
Final Thoughts
 Good Intelligence and High Level
Strategic (Economic) Analysis is ….
still no guarantee of effective decisionmaking……………