Presentation on theme: "Joint Strategic Needs Assessment: What is it, who’s it for, how can you use it, how can you influence it? VSNW, 8 th May, King’s House, Manchester."— Presentation transcript:
Joint Strategic Needs Assessment: What is it, who’s it for, how can you use it, how can you influence it? VSNW, 8 th May, King’s House, Manchester
Original Requirement 2007 LA and PCT requirement to produce a Joint Strategic Needs Assessment – ‘to identify the health and social care needs of the whole population’ – part of the aim to work jointly. From 2008 was perceived by many to be all about data. – Most JSNAs were led by Public Health. – Local data collections were undeveloped – Inclusion of feedback from local people was absent
The data available was largely either ‘activity’ (flow through, numbers benefitting) or ‘performance’ (how many, how fast, coverage). Not much was predictive or based on community assets, or based on the views and opinions of local people. Also the data available was overwhelmingly about the big killers and the NHS response to them: cancer, heart disease, stroke, A&E waits, ambulance response times, waiting lists. Health Needs Assessments (HNAs) were sophisticated but narrowly focussed. And ‘data’ was often thought to be ‘intelligence’ (the number of points a football team has tell you much – but what about goal difference and games in hand? Even the simplest data has to be turned into intelligence) So many JSNAs were old style health data documents; historical and ‘dead’.
Just a bureaucratic chore? Most JSNAs were big documents – ‘Shelfies’ : the result of a one off exercise, heavily reliant on nationally available data. Useful for general understanding of the area but not offering much new. Also commissioners did not use the JSNAs much as they were generally not seen as precisely relevant to their needs – communication between JSNA people and commissioners was limited in many places. And JSNAs were not valued as they did not add value: – Public Health Observatories – ONS data – DH (now PHE) Area Health Data Sets – GP QOF data – HES data (Hospital Episodes)
‘just let us have the data on X, yes by 4 o’clock this afternoon - we need it to justify our commissioning strategy’. PH and LA intelligence tended to have little understanding of the commissioning process Commissioners did not understand what data was available, how long it took to collect it, it’s reliability, the difference between data and intelligence, that there is no ‘answer’, that all intelligence has to be interpreted. Also ‘intelligence’ can only take you so far; decision making may have rationality at it’s core - but that core may be tiny (euthanasia, public sector/private sector, HS2, Michelin Man)
2011 – all change? 2012 Health and Social Care Act transferred the responsibility to Health and Wellbeing Boards (i.e. CCG, Local Authority (DAS, DCS, DPH). Guidance: – JSNA should be produced by a genuine partnership – JSNA underpins the Joint Health and Wellbeing Strategy – and has to be referenced in the priority decisions made – required ‘assets approach’. – Implies that JSNA should be regularly updated and not ‘a document’.
2011 saw new impetus All NW JSNAs were reviewed and many included stronger more precise relationships with commissioners and the vol sector. Many became web based and more frequently updated Many introduced ‘deep dives’
What should be assessed? – breadth, depth, geography, conclusions, recommendations?
Coverage? Breadth: birth, morbidity, economy, longevity, populations…what else, what balance? Depth: old people, diabetes, people with muscular dystrophy, meningitis, housing stock shortfalls, immunization coverage, five a day attainment, FGM prevalence…. Inequalities: emphasise populations and conditions showing the greatest internal and/or external inequalities. Sources: National/local current – new local collections? Geography: The borough, a ward, Super Output Areas, particular populations, GP registers? Conclusions: how concrete should ‘conclusions’ be? Recommendations: Wigan 2011 JSNA has 31 recommendations, others do not stray into that territory.
Some Approaches Resources and Responsibilities: who leads, governance, who does the work? (Data submission delegated to operational leads?) ‘Life Course’ approach or ‘domains’, or ‘health inequalities’ following Marmot Review of Web based with different chapters updated individually Three or six monthly updates, newsletters Turning Data into Intelligence… …Boundary between data/ intelligence/ conclusion/recommendation Cheshire East has ‘data on a page’ for each issue. Relationship with Joint Health and Wellbeing Strategy
Approaches and developments More comprehensive ambitions ‘Deep Dives’ Three or four annual priorities and… …’JSNAs’ on specific subjects (Sponsor, Specific Teams, Reference Groups…) ‘Calls for Evidence’ Standing Vol Sector/Community representative group Encompassing a broader range of evidence (i.e CCG surveys and LA surveys)
Some Problems: Prioritization HWB Board derives priorities from intelligence. – Mortality Rates/Morbidity levels? – Vulnerable or numerous populations? – The ‘recency effect’, – Social/political/media pressure, – Vested interests? 2011 ONS estimate 8,748 deaths related to alcohol, 2010 ONS estimate 81,400 deaths related to smoking. Alcohol is a top priority in about 16 NW HWB Boards. Smoking is much less prevalent, almost absent as an HWB Board priority in the NW.
There may be other negative factors associated with alcohol, not associated with smoking: hospital admissions, street disorder and anti social behaviour, loss of days at work, susceptibility to multiple morbidities. Feeling that smoking is ‘conquered’ because lung cancer deaths are coming down and percentage of people smoking is coming down, access is limited and getting more limited (while access and cost of alcohol makes it attractive). Alcohol harm is more ‘public’ and although alcohol related deaths are not rising, liver disease and diabetes is. Is there a bandwagon?
Prioritization Criteria: Liverpool’s – Scale of the issue affecting the population – Severity of the impact the issue has on the affected population – Health inequalities – are some groups affected disproportionately – Current outcomes – Links to other issues – Evidence that the issue can be addressed by local action – Feasibility of actions to address the issue
Other Problems Leadership/Governance Relationship with Commissioners (focus, commissioning cycle, ‘warm handover’) The ‘bucket syndrome’ – ‘your JSNA will tell you…’ (Pharmaceutical Needs Assessment, SEN…) External Demands including: – guidance from PHE and others who have no status with local JSNAs, – Single Issue Organisation Criticisms (Alcohol Concern), – FOIs. Outcome focus, predictive modelling.
Some Opportunities for You Who leads on JSNA in your area? What are the governance arrangements? What are this year’s priorities? Teach a man to fish: It might take some digging around to find data or intelligence which meets your needs. (titling, old data, obscure links) – try different routes in, seek help in finding it. But make sure you can use it – do not just ask for the material. But if you cannot find it, ask where it is and/or why it is not there.
Submitting your own intelligence Many areas now operate a ‘call for information’ (Wirral, Manchester, Liverpool…) seeking proposals for issues to be investigated. Potential contributions might involve: – Submitting the pattern of work you do with your client group and resultant views of needs and gaps – Offering them your own reports and results of surveys, consultation etc – Offering people to comment on issues or give their opinions – Alerting the JSNA team to important national reports/developments – Offering time to serve on reference groups or standing JSNA committees – Banding together with other voluntary organisations to raise issues – Questioning prioritisation decisions underpinning the JHWS or commissioning strategies