Sandie Keene, Director of Leeds Adult Social Services, gives an insight into the demography of Leeds and shares her experiences of establishing a Joint Strategic Needs Assessment (JSNA) for the needs of the local population.

1. LEEDS JSNA
A whole system approach to assess
the current and future needs of the
local population

2. Lessons from our journey so far…..
• Ownership
• Integration – into the health and social care
system
• Community involvement
• Analysis – intelligence not information
• Qualitative and quantitative
• Localism – localities are key

3. This is Leeds – population 787,700 ( at present!) –
rising to over 1million by 2033

4. Index of Multiple Deprivation 2010 – 150,00 living in
the most deprived SOAs nationally

5. 2001-2009 components of change
18.0 Live B irths
Deaths
16.0
Net migratio n & Other change
14.0 To tal change
12.0
10.0
8.0
6.0
4.0
2.0
0.0
M id 2001-02 M id 2002-03 M id 2003-04 M id 2004-05 M id 2005-06 M id 2006-07 M id 2007-08 M id 2008-09

6. Understanding the geography
• 33 electoral wards
• 8 Parliamentary constituencies (with one extending beyond the
Leeds MD boundary)
• 3 Management Areas
• 10 Area Committees
• 108 Middle Super Output Areas
• 476 Lower Super Output Areas
• 3 Police Divisions
• 17 Neighbourhood Policing Teams
• 3 ALMOs and 1 TMO
• 28 Extended Services Clusters (school based)
• 38 Neighbourhood Networks (Adult Social Care)
• GP consortia

7. Ownership across all required!

8. A picture of Leeds – 2008/9 JSNA
It gave clear priorities for partners:
• Responding effectively to demographic change
- Over 75s and children and young people
• Responding effectively to specific health and wellbeing
challenges
- Obesity, alcohol, drugs and smoking
• Counteracting widening inequalities between
neighbourhoods and key vulnerable groups
- Fragmentation across neighbourhoods and communities

9. Key actions from the JSNA 2008/9
• Embed the governance and accountability into wider partnership
arrangements (through Healthy Leeds, Joint Strategic
Commissioning Board)
• Closer alignment of planning and commissioning cycles (LCC and
PCT)
• Process in place – Joint Information Group and Strategic
involvement group for a continuous process/review of HNA and
HNA template agreed for improved quality
• Populate data gaps (e.g. equalities and mental health data in
particular) and improve projections and predictive modelling
• Locality profiling : Development of 108 neighbourhood profiles
at MSOA level

10. Locality profile – example Little London
Neighbourhood Indexes were developed for each middle level SOA, these are
now being revised to include more detailed data

11. Example of Impact – Area Committees
• Joint Health Improvement Managers
• Locality Partnerships
• Prioritisation and Investment
• Actions
– Alcohol
– Multi-Agency Referral Scheme (MARS)
– COPD
– Smoking Cessation

12. Reducing Infant Mortality rates – a locality
approach
Mortality under 1 year per 1,000 live births
30.00
rate per 1,000 live births
25.00
2003-2005
20.00
2004-2006
15.00
2005-2007
10.00
2006-2008
5.00
2007-2009
0.00
Chapeltown Beeston Hill Leeds
source: NHS Leeds Cluster Information Service
Target to Reduce the IM rate in ‘deprived Leeds’ to 7 per 1000 live births by
2013. (Leeds average 5.8; deprived Leeds – 8)
Two demonstration sites – Chapeltown and Beeston - multi agency response

13. Impact of housing on health
Report commissioned from Sheffield Hallam and York
University
• Investing in Leeds’ housing stock will enhance the health of
residents
• Improving the energy efficiency of the Leeds housing stock
will reduce fuel poverty
• There should be an integrated programme of investment in
home safety measures and home adaptations to maintain the
independence of older residents
• Leeds Council should invest in home security measures as
part of an integrated package to improve health by reducing
crime and fear of crime

14. Leeds Housing Strategy
Built on the Leeds JSNA: 3 priorities
- Increasing the supply of affordable housing
- Improving housing quality
- promoting independent living
Research is now leading to:
- an assessment of impact across partners – e.g. police and
burglary reduction due to safety in homes
- An invest to save model now produced to enable LCC to
estimate saving from investments in the housing stock e.g.
energy efficiency and saving on health care for chronic
conditions

15. Financial Inclusion
• Leeds city council led multi-agency financial
inclusion steering – 3 priorities with key initiatives =
affordable credit, debt/money advice, financial
literacy
• Engagement with the voluntary sector – working
with CAB to establish how voluntary sector
information on their clients and areas of need can
add value to the JSNA with a focus on debt.

16. Key challenges going forward –
Qualitative data
• 2009 JSNA acknowledged this as a gap – gathered
surveys on City Council portal; established SIG
• 2010 – Analysis of common themes – using grounded
theory (Nvivo 9 software) – 105 sources gathered
• Aim – to develop a comprehensive consultation library of
qualitative information, analyse the information and
establish themes and recommendations to feed into the
refreshed JSNA

17. Emerging themes
• Children/Young people
• Mental Health
• Transport
• Older People
• Access to Services
• Healthy Lifestyles

18. Analysis – intelligence not information
Review of all Health Needs Assessments completed since 2008
with the aims of:
• To undertake a content review of recently completed needs
assessment, against the priorities and data gaps identified by
the JSNA
• To identify the main themes and priorities arising from needs
assessments
• To develop a proforma for locally produced needs
assessments to lead to quality intelligence

19. Embedding within the commissioning
process
• In 2009 NHS Leeds was recognised for its work on the JSNA
within the WCC process
• The JSNA was taken through both Executive within Leeds City
Council and Scrutiny Committee – embedded in strategies (e.g
the Housing strategy)
• Programme of work used the JSNA analysis in their
commissioning process – maternity services
• However there remains the challenge to embed it through all
commissioning in the city to ensure services are delivered in
relation to needs – the new Health and Wellbeing Board and
Clinical Commissioning groups are an opportunity to revisit this

20. Where are we now?
• Refreshing quantitative data set and analysis of qualitative data to feed
into shadow Health and Wellbeing Board in September and LCC State of
the City report
• Two joint workshops held to consider quantitative and qualitative data and
add ‘the story behind the data’
• Wider workshop planned for all partners in September to consider the 7
quality themes identified by Local Government Improvement and
Development to ensure ownership
• Shadow Health and Wellbeing Board first meeting to explore their role in
relation to the governance of the Leeds JSNA to ensure a whole system
approach to assessing need and agreeing priorities for Leeds for now and
the future.

21. Future governance