1. Quality payments will be linked to the health and wellbeing strategy
The Government's response to the Future Forum report says the assessment of quality and outcomes will include looking at how much a commissioning group has contributed to the outcomes prioritised in joint health and wellbeing strategies.(HWS)
The HWS build on Joint Strategic Needs Assessments (JSNA) which were introduced in 2007 when it became a statutory duty for local authorities and PCTs to produce one.
A JSNA provides a comprehensive analysis of local current and future needs of adults and children. Until now however JSNAs have often failed to engage commissioners.
Michelle Kane of HK Consulting says there have been a number of reasons for this: 'Where they've not connected it's been a case of they've been dominated by one party, say social services or public health and so there's been no real ownership of the other stakeholders including commissioners because people are still working in their silos.'
2. Your existing JSNA might not be very good
There is a spectrum of JSNA's out there.
The good ones have resulted in challenging conversations, moved money around the system, exposed unmet need and highlighted inequalities.
The bad ones have just told everyone what they already knew and become an end in itself.
Michelle Kane, who previously worked for the DH on its JSNA development programme says roughly a third of JSNAs are good at the moment.
Good JSNAs can create very innovative working and achieve real savings. In Devon for example the JSNA looked at older people and found over 50 percent of 13,000 people in need of a service had no face to face help. Health, social care and housing jointly commissioned a £570,000 mobile response and early intervention services. In its first year it produced £211,000 in cost savings.
3. Realise you have to make a start somewhere
There are so many stakeholders with competing pressures, views on local needs and a mass of data, that if not careful your JSNA/HWS will be trying to be all things to all people. The point of a JSNA is to prioritise and focus people's minds so there can be joint working on finding solutions. Miss Kane says: 'There's no right or wrong answer on where to start. Some areas take a client approach - they know there is a particular sort of person who get passed round the system often costing lots of money in the process. Others work on particular areas, say the most deprived estates, while others decide to focus on particular diseases.'
4. Think about how your HWS will be resourced
The successful areas with JSNAs are the ones that have had a dedicated resource devoted to them rather than adding it on to people's day jobs. Some areas have a full time JSNA programme manager. How such work and staff will be funded will need to be one of your earliest conversations.
5. Realise you won't please everyone
'Not everyone can be everyone's priority' says Ms Kane. There will be conflict and perceptions will be challenged.
'A JSNA and HWS is about taking on a huge range of different views and opinions and being ready for compromise. Everyone has pressures they have to meet, whether it's outcomes, frameworks, safeguards' says Ms Kane 'The Health and Wellbeing Board will have to understand the pressures partners are under and create a compromise.'
Further information www.rsph.org.uk/jsna and www.idea.gov.uk/idk/core
