This assessment examines the needs of all residents of Merton as opposed to individual residents to identify those groups that experience poor outcomes and access to services. This will provide evidence for these groups to be able to participate as equal partners, along with LBM, Merton CCG, Healthwatch Merton (HWM) and other stakeholders, in negotiations to establish priorities and to inform service planning and commissioning.
Our objective is to close the gap in health experience between the most and least disadvantaged residents of Merton.
Within this objective, we aim to:
- develop a profile of health and social needs in Merton
- identify gaps in services either arising from differences in existing services and need or national standards/frameworks
- establish priorities that are aligned with best practice as set out in the evidence provided in this assessment.
- develop services along a pathway that starts with the influences on health and prevention and continues through secondary prevention, early diagnosis, treatment and improved quality of life for those living with chronic conditions.
A needs assessment provides opportunities to:
- increase effectiveness of interventions by ensuring they respond to identified needs
- address health inequalities, targeting resources to those most in need
- involve partners in shared decision making, including communities, patients, service users, carers and both public and private providers
- reflect community views.
This report reflects our commitment to improve the lives of Merton residents by strengthening our commissioning competencies to target scarce government resources to meet health and social care needs better. The results of the JSNA will contribute towards improving the outcomes for all Merton residents across the life course, with particular emphasis on early years. This includes improved health and wellbeing, improved quality of life, making a positive contribution, increased choice and control, freedom from discrimination, economic wellbeing, and maintaining personal dignity and respect.
For the 2013-14 JSNA:
- We met with our partners in the statutory and voluntary sectors to understand their views of health and disadvantage in Merton.
- We are sharing the data with our commissioning partners across Merton to agree opportunities to refocus interventions to match community needs, where appropriate.
- We built on the Annual Residents Survey questionnaire conducted in 2012-13 and included additional questions on health and wellbeing in the 2013 Merton Annual Residents Survey.
We are working to identify inequalities between ethnic groups, gender, age, and deprived communities so that we can better target services to meet their needs. Success will however be limited by the availability of data. All public bodies have had a legal obligation to ensure there is no racial discrimination since the Race Relations Amendment Act was passed in 2000. Collection of ethnicity data is one way of ensuring this. According to a report1by the Parliamentary Office of Science and Technology: ‘the patchy ethnicity data in primary care undermines the planning and evaluation of policy and precludes the monitoring of changes over time.’ The JSNA offers an opportunity to show which groups of residents have the greatest needs for services, and the barriers they face to improve their health, so that our commissioning can take into account those barriers. Without this feedback, we are in danger of commissioning and planning services that don’t benefit the most disadvantaged people.
We are aligning the JSNA with the way the local authority organises its services around adults and children. The JSNA delivery group agreed that the JSNA is an ongoing effort and a work in progress.
An evolving approach
We are adopting a new approach this year, one that continues to rely on quantitative analysis of health and disease outcomes but that expands discussion of the influences on health. Until recently, health research tended to concentrate on NHS interventions, such as surgery, medicines, and smoking cessation. This is beginning to change as more research becomes available in areas that enable us to predict what could happen to life expectancy in a borough, for example, if we make changes to the number of years that young people stay in school, or if we reduce unemployment by a certain amount.
The effects of social and economic policy on life expectancy are now beginning to become measureable and predictable. Research from organisations such as the Government’s Social Exclusion Unit, the WHO Expert Group on Social Determinants, and the Joseph Rowntree Foundation brought to national awareness the impact on health in terms of likely numbers of deaths due to poverty and poverty-reducing measures. A Danish study revealed that it is not too difficult to show how lifestyle risk factors and number of years in education affect life expectancy.2Because Denmark has a similar life expectancy to the UK, the effects of risk factors on health will be used in the section of this report.
From this year forward, we will combine current research showing the specific impact of selected risk factors that affect health with this emerging research on the influences on health to estimate the possible impacts of specific interventions on life expectancy in the borough. We will begin to highlight joint initiatives that in combination have the largest impact on reducing life expectancy inequalities in the borough.
We will combine this with efforts to improve identification of specific groups in Merton that suffer inequalities in health outcomes and access to health care.
The rationale for a Joint Strategic Needs Assessment
WHO defines health as:
A state of complete physical, mental, and social well-being and not merely the absence of disease, or infirmity.
Health is a cumulative state that involves the capacity, perceived or actual, of individuals to thrive in their social and physical environment and to function and cope with specific illnesses and life in general.3
Health is therefore influenced by a wide range of factors. An adaptation of the Dahlgren and Whitehead’s model
Lifestyle risk factors4 (below) proposes that genetic predisposition interacts with environmental influences and individual lifestyle behaviours to produce health or ill health, which is then mediated by health care services to restore health where required.
Influences on health
Source: Barton and Grant 2005 based on Dahlgren and Whitehead 1991
Worldwide evidence has shown that living standards and levels of education have the greatest influence on health. While current work in the NHS focuses on curative healthcare – fixing people once they become unwell – the local authority delivers services that influence health promotion and prevent people from getting ill in the first place. Working in partnership thus increases our chances of reducing inequalities in health. In addition, both LBM and Merton CCG provide services to the same populations that would be more effective if coordinated. More can and should be done to enable effective local leadership and partnerships to flourish in meeting the Government’s vision for an integrated approach to improving people’s health and wellbeing. These strategies set out a requirement to align systems supporting frontline local delivery, governance arrangements, commissioning, access to information, workforce development and action to drive improvements in quality and outcomes.
Process to develop the 2013-14 JSNA
In Merton the JSNA has been developed to inform commissioners and gives an overview of the population's health and social care needs across the borough. The way in which the JSNA process fits into the commissioning cycle is described in the diagram below.
JSNA process and commissioning cycle
The 2013-14 refresh of the JSNA core dataset builds on the previous JSNA and latest guidance. The last JSNA was used to inform priorities set out in the current Merton Health and Wellbeing Strategy.
The JSNA delivery group met in late August 2013 and agreed that the work would be led by the Director of Public Health and the Merton Public Health Team, supported by Merton's council departments, the Merton CCG, HWM and Merton Voluntary Service Council (MVSC).
To complement the quantitative analysis, qualitative feedback was sought in various ways e.g. through the insight work commissioned by Public Health Merton, the specific quantitative work under way on different health areas by Public Health Merton and a culminating community consultation event held in September 2013 – please see
Merton voice: what our communities are saying for details. Results of these will be interspersed throughout the themes where relevant in the Merton Voice section in each topic area.
Organisation of this report
This edition of the JSNA is structured to follow a life-course approach. It is divided into 10 themes:
This report uses data to describe the health and social care needs of residents of Merton, using the JSNA core dataset as a start. Further exploration and more in-depth work were commissioned on health inequalities by Public Health Merton, and the findings are described in the health inequalities theme and in other themes where relevant. Additional detailed work is reflected in different themes.
Some work is ongoing and will have a bearing on the findings in this edition e.g. the ongoing Merton Mental Health Review. Once the review findings are finalised these will be used to update the relevant sections of the JSNA and the same applies for other work being undertaken by Public Health Merton. The JSNA is thus a living document in many ways.
^Ethnicity and Health. January 2007. Parliamentary Office of Science and Technology postnote. Number 276..
2.^ Juel, K. et al. (2008). Risk factors and public health in Denmark.
Scandinavian Journal of Public Health. 36 (Supplement 1):227
^ World Health Organization (WHO) (1999).
Men, Ageing and Health. Achieving Health Across the Lifespan
4.^ Dahlgren, G. and Whitehead, M. (1991). Policies and strategies to promote social equity in health. Stockholm: Stockholm Institute for Future Studies.