Joint Strategic Needs Assessment
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,
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 introduction of GP commissioning requires local authorities to coordinate JSNAs with CCGs from April 2013. The JSNA continues to inform the commissioning of health and care services in localities. Local authorities and CCGs 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:
- partnership working - CCGs 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;
- 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;
- evidence of effectiveness - by identifying relevant best practice, innovation and research to inform how needs will best be met.