Context
Joint strategic needs assessments (JSNAs) provide a foundation for effective strategic commissioning, offering an accurate picture of the local community and its health and wellbeing needs. The requirement for local authorities and PCTs to undertake regular joint strategic needs assessments (JSNA) to enable them to plan was outlined in the 2006 White Paper ‘Our health, our care, our say’. JSNAs are used to support the development of the wider health and social care market, including services for those who have the ability to pay for social care services themselves. The Local Government and Public Involvement in Health Act 2007 placed a duty on PCTs and upper-tier local authorities to jointly deliver a JSNA from April 2008.
The coalition government has confirmed the importance of JSNAs as the foundation of priority setting and a mechanism for encouraging greater involvement of local voluntary and community organisations. The government’s 2010 green paper, Modernising Commissioning, notes that it will be important that as local areas develop new partnership arrangements around Health and Wellbeing, local HealthWatch and their approach to the JSNA, they draw on civil society organisations both as a source of expertise and as a voice of less heard groups in local communities. The proposed local Health and Wellbeing Boards will bring together GP Consortia, the Local Authority, Healthwatch and civil society organizations,
The Department of Health has asked Local Government Improvement and Development (LGID), to produce a best practice guide on JSNAs which will include a section on civil society organisation engagement. This guide is expected to be produced in 2011.
JSNAs will help local people to hold providers and commissioners to account, agree local priorities and inform a range of commissioning strategies and plans. This will be underpinned through new statutory duties for local councils and GP consortia to work together to promote the health and well-being of their local population. JSNAs will continue to be central to local service planning and market development under new arrangements for social care and health.
The planned introduction of GP commissioning will require local authorities to coordinate JSNAs with GP consortia as they take on the commissioning role of PCTs by April 2013. The JSNA will continue to inform the commissioning of health and care services in localities. Local authorities and GP consortia will have an equal obligation to develop the JSNA, led by local authorities.
What is a JSNA?
JSNAs are a cornerstone of social care commissioning. They should drive the commissioning process, highlighting areas of concern for review and identifying priorities. JSNAs ensure that health organisations and local authorities have a better understanding of their local populations and the challenges they face in tackling health inequalities.
A JSNA is based on a joint analysis of current and predicted health and wellbeing outcomes, an account of what people in the local community want from their services and a view of the future, predicting and anticipating potential new or unmet need. It should incorporate the views of the local population, not just existing users of services and it should include and be informed by equality impact assessments.
A JSNA is a continuous process which indentifies the 'big picture' in terms of the health and wellbeing needs and inequalities of a local population. The issues identified in JSNAs should inform the priorities and targets set by local authorities and other commissioners. JSNAs should have an impact on commissioner priorities and actions and they will provide a framework to examine all the factors which impact on the health and wellbeing of local communities, including employment, education, housing and environmental factors.
The JSNA national core data set signposts a range of existing data sources to assist the JSNA process. Local authorities and health organisations are expected to supplement the core data set with additional, locally relevant information to add depth and insight into the needs of their populations, having locally agreed standards on data quality for inclusion. A 'minimum' data set for a JSNA would include the following:
| Domain | Examples |
| Demography | Population, migration, births, ethnicity |
| Social and environmental context | Rural/urban and other characteristics, deprivation, employment and benefits, living arrangements |
| Current known health status | Behaviours and lifestyle (smoking, alcohol, obesity, physical activity, sexual behaviour), teenage conceptions, illness, disability and mortality |
| Current met needs | Number of social care clients, standards of service, primary care uptake |
| Service user | Social care (user surveys), primary and community care (GPAQ, PALS, complaints), hospital (self-reported health outcomes, satisfaction surveys) |
| Public demands | Local Authority (Annual Residents Surveys, Health Scrutiny Reports), NHS (petitions), National Patients Survey programme, LINKs, Citizen's Panels |
Guidance states that the JSNA process will be underpinned by:
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partnership working - PCTs and local authorities are jointly responsible for including statutory partners in the Local Strategic Partnership, providers from the public, private and third sectors and members of the local community;
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community engagement - actively engaging with local communities, patients, service users, carers and providers - including the third and private sectors - to develop a full understanding of needs is a key facet of JSNA. Communities should be involved in all stages of JSNA from planning to delivering and evaluating, rather than being restricted to commenting on final drafts;
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evidence of effectiveness - by identifying relevant best practice, innovation and research to inform how needs will best be met.
Click here for further information about population needs methodology.
Sources of further help - external links
Joint Strategic Commissioning Learning Development Framework. November 2012 (Institute of Public Care for the Scottish Government and the Joint Improvement Team Scotland). The joint commissioning of older people’s services is a key focus of the support that the Joint Improvement Team provides to Community Health and Social Care Partnerships and their partners - local authorities, NHS boards, third and independent sectors. Developing a coherent joint commissioning strategy is fundamental to delivering on the Scottish Government’s key policy objective of re-shaping care for older people. At a time of substantially increasing numbers of older people, coupled with reducing resources, it represents an important tool that can provide rigour and transparency to the decisions taken by commissioners, and confidence to a public who otherwise see changes taking place that they do not understand. In order to assist those responsible for improving joint commissioning skills and capacity across health and social care partnerships, the Scottish Government and the Joint Improvement Team Scotland commissioned the Institute of Public Care to produce a Learning Development Framework focusing on joint commissioning.
The National Adult Social Care Intelligence Service (NASCIS) is a suite of analytical tools and information resources allowing for analysis of Social Care data to support activities such as planning, performance management and service improvement. Analytical tools include NASCIS interactive Online Analytical Processing Tool and Standard Reports. Also included are links to POPPI, PANSI and FLoSC tools developed by the Care Services Efficiency Delivery Programme (CSED)
Joint Strategic Needs Assessment is a publication from the Local Government Improvement and Development (formerly IDeA) Healthy Communities Programme. It highlights the variety of approaches taken across the country and what has been achieved. It also states that much more needs to be done to ensure that all areas use the joint strategic needs assessment process effectively to improve the health and well-being of their population and reduce inequalities.
A web site dedicated to Joint Strategic Needs Assessment has been launched by the Department of Health which gives background information on JSNA, pulls together existing information and documents and provides access to tools and resources to support the implementation of JSNA.
The JSNA Readiness Tool provides a relatively simple and cost-effective way of assessing the readiness of local systems to ensure a Joint Strategic Needs Assessment of their population is undertaken and completed. It enables a rapid appraisal of a system’s readiness and progress in delivering a JSNA and identifies areas of difficulty, thereby enabling a focus upon remedial action commensurate with the significance of the problems.
Joint Strategic Needs Assessment and joint health and wellbeing strategies explained - Commissioning for populations. December 2011 (Department of Health). The purpose of this document is to support emerging health and wellbeing boards as they engage with the Joint Strategic Needs Assessments and develop their preparatory joint health and wellbeing strategy. It also describes what support the Department of Health will provide, including what resources will be available and when, and how we will build in learning from early implementer health and wellbeing boards in this.
Guidance on Joint Strategic Needs Assessment, produced in December 2007, provides tools for local partners preparing a JSNA. It describes the stages of the process, including stakeholder involvement, engaging with communities and recommendations on timing and linking with other strategic plans. It also contains a core dataset, guidance on using JSNAs to inform local commissioning and it provides signposts to tools and resources to support JSNAs.
An online demand forecasting and capacity planning system www.poppi.org.uk has been developed by the Institute of Public Care (IPC) for the Care Services Efficiency Delivery Programme (CSED). The Projecting Older People Population Information (POPPI) system explores the impact that demography and certain conditions may have on populations aged 65 and over. It provides population projections to district level with characteristics and prevalence assumptions from research. The information can be used as a starting point for Joint Strategic Needs Assessment and the system will deliver a consistent baseline.
Getting started: prospects for Health and Wellbeing Boards. December 2012 (the Smith Institute). The new Health and Wellbeing Boards are an important part of the NHS reforms and central to the push for greater integration of health and social care. This report offers a timely insight into how the boards operate and what challenges lie ahead. The fact that they have widespread support and explicitly seek to strengthen partnership working between councils and healthcare commissioning groups bodes well.
The Yorkshire and Humber Public Health Observatory offers a range of local public health intelligence and links to national datasets, as well as geographic and demographic information, and makes them available via interactive web-based tools.
The Association of Public Health Observatories provides models for estimating the prevalence of hypertension, diabetes, coronary heart disease and chronic obstructive pulmonary disease, with further models in development.
Health needs assessment (HNA) is a systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities. The Health Development Agency published Health Needs Assessment - a practical guide in 2005.
The BMJ has published a series of six articles describing approaches to and topics for health needs assessment: Health needs assessment: from theory to practice, and how the results can be used effectively (non subscribers to BMJ have free access to the article but must complete the registration form).
Health impact assessment (HIA) gateway helps to identify the potential health consequences of a proposal on a given population, and recommend ways to maximise the positive health benefits and minimise potential adverse effects on health and inequalities of the proposal. The site provides further information about HIA and links to reports, completed HIA case studies, HIA toolkits, training courses, and contact details.
Health inequalities highlights policy and guidance on health inequalities and identifies how fairly services or other resources are distributed in relation to the health needs of different groups and areas, and the priority action to provide services relative to need. The Department of Health published Health Equity Audit - a guide for the NHS in 2003.
The Health Poverty index visualisation tool gives a high-level overview of each local authority area showing its 'health poverty' - a combination of the present state of health, the root causes and intervening factors. It includes some data enabling comparison across ethnic groups.
The local Basket of Indicators and the interactive Health Inequalities Intervention Tool can both be accessed via the London Health Observatory web site. The local basket of indicators provides a menu of indicators to examine health inequalities across a range of dimensions. The intervention tool pulls together key information on disease and life expectancy.
The Index of Multiple Deprivation 2007 combines a number of indicators, covering a range of economic, social and housing issues, into a single deprivation score for each small area in England. This allows each area to be ranked relative to one another according to their level of deprivation, which will be useful for commissioners when undertaking strategic needs assessments. The Economic Deprivation Index (EDI) has also been developed. The Tracking Neighbourhoods Report provides further information of the type of analyses that can be undertaken using the EDI.
