Transport stakeholder meeting

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  • Transport and Health JSNAStakeholder workshopAngelique MavrodarisEmmeline WatkinsIain Green

    Public Health19/11/2014



  • Joint Strategic Needs Assessment (JSNA)Commissioners & LA jointly describe health, care & wellbeing needs & service deliveryFocus on:OutcomesPartnership workingConsultationDrives commissioning process

  • The Local Government and Public Involvement in Health Act (2007) required upper tier LAs to produce a JSNAs - Health & Social Care Act 2012 gave this duty to Health & Wellbeing Boards, with an additional statutory duty to prepare a joint health & wellbeing strategy to identify the needs identified in the JSNAStatutory Background

  • A summary table of the duties and powers introduced by the Health and Social Care Act 2012 relevant to JSNAs and JHWSs

    Key - X* duty must be discharged via HWB

    LOCAL DEMOCRATIC LEGITMACY POWERS AND DUTIESCCGsLocal AuthorityNHS CBLocal HealthwatchHealth and Wellbeing BoardFunctions of health and wellbeing boardDuty to prepare assessment of needs (JSNA) in relation to LA area and have regard to guidance from Secretary of StateX*X*X (to participate)XDuty to prepare JHWSs for meeting needs included in JSNA in relation to LA area and to have regard to guidance from Secretary of StateX*X*X (to participate)XDuty to involve third parties in preparation of JSNAs:Local HealthwatchPeople living or working in the areaFor County Councils each relevant DCX*X*XPower to consult any persons it thinks appropriate in preparation of JSNAsX*X*XDuty to have regard to the NHS Commissioning Board mandate in developing the JSNA and JHWSX*X*XDuty to publish JSNAsX*XImpact of duties on other associated functionsDuty to have regard to relevant JSNAs and JHWSs in the exercise of relevant functionsX [in exercising any functions]X [in exercising any functions]X [in exercising any relevant commissioning functions

  • JSNA ImpactProvide clearer idea of what is neededDeliver what people wantEvidence decisions enable stakeholders to but into changeIdentify best interventionsEnsure range of interventions available & accessibleInform more effective & economic configuration of services


  • Background and context The purpose of this JSNA is to support HWB Priority 5, focus areas 1&3: Create a sustainable environment in which communities can flourish:Develop and maintain effective, accessible and affordable transport links and networks, within and between communities, which ensure access to services and amenities and reduce road traffic accidents; Encourage the use of green open spaces including public rights of way, and activities such as walking and cycling. The JSNA will also gather information on long distance transport to specialist hospital services Linking to other counties (e.g. NCC) and PHE to ensure a regional approach where appropriate

  • Transport and Health JSNA priority areasAccess and health: An evaluation of transport and social/geographical isolation in Cambridgeshire and the impact on health; directly or due to barriers in accessing specialist and every day care.Active transport: Evaluation of transport strategies and initiatives that promote physical activity such as utilitarian walking and cycling and impact on healthAir pollution: An evaluation of Cambridgeshire air quality, hot spots and their impact on long-term conditions such as asthma and COPD and their life course

  • For each topic Evidence review Assessment of local status and needLocal access and transport dataOverlaid with information on health, deprivation and demandIdentification of inequalities, gaps and opportunities

  • Transport Policy impacts health outcomes

  • Missing appointmentsDelays in careBurden on relativesNo regular source of careLinks with car ownershipInequalities, vulnerable groupsLower prescription fill ratesE.g. Hospital admissions for diabetic ketoacidosis 67% related to stopping insulin50% cited lack of money or transport issuesAccess and health

  • What can we find out locally? Access issuesAvailability, eligibility, awareness, use of various transport types Travel time to key health services in rural and urban areas in Cambridgeshire Impact of current transport arrangements on patient and carer quality of lifeAssessment of need for long-distance transport

    What the JSNA adds:Transport data will be overlaid with potential impact on healthE.g. mapping of health demand, vulnerable groups, inequalities, high disease prevalence areas with access issues

  • Active transport and health NICE local government briefing: walking and cycling (Jan 2013)ensuring there is a network of paths for walking and cycling between places locallyreducing road danger and perception of dangerensuring local strategy, policy and planning support walking and cyclingusing local data, communication and evaluation to develop programmesincluding practical support, information about options focus on key settingsrecognising the health benefitsModels to show health impact of walking/cycling initiatives

  • What can we find out locally? Assessment of current active transport in CambridgeshireRates of walking and cycling Identification of local gaps, inequalities and opportunities RTAs covered by C&P Road Safety PartnershipPotential for building on this by analysis ofVulnerable users e.g. pedestrian, >75 yearsSlight injuries

  • Air pollution influenceslung function across the life coursePHE estimates that there are 257 deaths attributable to air pollution in CambridgeshireBased on PM 2.5, local population and 2010 mortality dataLikely to contribute a small amount to deaths of a larger number of exposedImpacts Lung function, Asthma/COPD exacerbationsHospital admissions for respiratory and cardiovascular conditionsMortalityShort and long-term consequences

    Ben-Shlomo 2002

  • What can we find out locally?Assessment of current and future hot spots in Cambridgeshire and their potential health impact on nearby developmentNew growthRoad changesTimeline for Air Quality Strategy for City, South and Hunts has been delayed to allow for JSNA evidenceIdentification of vulnerable groups and potential health impact


  • Where could you use transport and health data? Create a timeline showing activities in the next 2 years where you could use transport and health evidenceWhat sort of information would be useful?What are the deadlines for this work?

    Flip charts and post-its available for timelines

  • Feedback on timelines


  • Wendy OtterFenland District Council

  • Overview Fenland DistrictAround 20,000 people live in villages or more sparsely populated areas in Fenland22% of residents are of retirement age, higher than the national averageAround 20% of households within the district do not own a carPublic transport availability varies across Fenland but for many of our smaller communities is limited.

  • Transport & Health IssuesPeople cant get to medical appointments, especially hospital appointments. Cost of transportReliance on family and friendsOlder people often have more complex health needs but also complex travel needs A lack of transport InformationA lack of useable transport informationHealth problems can often be sudden - A change in circumstances for transport

  • Addressing the Barriers 1How did we set about addressing the transport and health issues in Fenland & Why? Evidence:to address a situation you have to fully understand what the problem actually isMapping addresses of concessionary fare pass holders, bus stops and bus routes, and locations no more than 400metres from a bus stop2011 research to understand the access to healthcare needs of patients in Fenland2013 Audits of car and cycle parking. Assessment of surgeries in relation to bus stops & services

  • Addressing the Barriers 2

    Stakeholders Understanding who needed to be involved. Working with colleagues to build relationships with our GP surgeries and the 2 community hospitals. Just under 1500 questionnaires were returned in 2011A lack of transport Information Where do I find out about transport?A lack of useable transport information new ways to present information:Fenland Transport DirectoryGetting from A to B Case Studies

  • Addressing the Barriers 3

    Making information available - Where do people go to access information? - Different people access information in different ways - Information therefore has to be available in many ways

  • Current Issues

    Early and late appointments are an issue due to a lack of public and community transportHospital appointments especially those further away from Fenland e.g. Cambridge & NorwichEligibility for NHS Patient Transport many people are no longer able to access patient transportAffordabilityOpportunities to link NHS transport and public transport

  • Any Questions?

  • Transport, isolation and health What are the key transport barriers to accessing services from your viewpoint? How do these impact on health?

    Post-its and flip charts provided

  • Prioritise Have a look at the issues/barriers that all tables have identified

    Which are the most important issuesYou have 5 sticky dots to put against topics you feel are most importantDistribute, or put all dots on one topic


  • Feedback on access

  • Solutions Each table has been given a key barrier to accessing servicesHow could this be addressed?What works/doesn