Ed Harding and Michelle Kane of HK Consulting give an overview on how the JSNA process works and why GP commissioners need to lead from the front in reviewing the JSNA for their area
What is a Joint Strategic Needs Assessment and Joint Health and Wellbeing strategy?
Joint Strategic Needs Assessments (JSNA) and Joint Health and Wellbeing Strategies (JHWS) aim to help the NHS and local authorities work together to make cost effective interventions and tackle high level problems such as health inequalities
JSNAs are a process that builds a robust evidence base for local commissioning plans and identifies and analyses the nature of priority issues, establishing a mutually agreed ‘big picture' of a local population, and JHWS (a new duty introduced in the Health and Social Care Bill) constitute an agreed, formal response to these issues by clinical commissioning groups (CCGs), local authorities and other key partners, providing a strategic framework for all local commissioning.
Where JSNAs and JHWSs are working well, they should provide CCGs with essential intelligence on local populations, and help align wider services to support health and wellbeing outcomes, for example social care, pharmacies, domiciliary care markets, housing adaptations and renovations, planning, schools, family services and the voluntary and private sector in driving improvements.
JSNA and JHWS are core business for Clinical Commissioning Groups
Your local JSNA and JHWS will have a central role in CCG performance management and quality premiums.
Joint Strategic Needs Assessments (JSNA) and Joint Health and Wellbeing Strategies (JHWS) are now core business for CCGs for several reasons. Broadly, the Government has changed its position to bolster the influence of health and wellbeing boards over NHS commissioning, opening up a stronger three-way relationship between local boards, the national NHS Commissioning Board (NHS CB) and CCGs. CCGs continue to be statutory members of the health and wellbeing board, obliged to participate in the local duties of promoting integrated working, producing JSNA and JHWS and commissioning with regard to both.
Health and wellbeing boards will now be consulted by the NHS Commissioning Board in several key processes, including the authorisation of CCGs and the sign off and review of CCG commissioning plans, for which they are certain to look to the JSNA and JHWS to guide their opinion. The NHSCB annual review of CCG performance must now include an assessment of ‘participation in and alignment with' the health and wellbeing board and JHWS, and the NHSCB must consult with local boards in doing so. There is also a clear indication that the Government intends a strong role for JSNA and JHWS in the proposed CCG quality premium, which will measure performance against reduced inequalities in healthcare outcomes.
GP leadership will be crucial to building JSNA and JHWS good practice
The quality of JSNAs to date has been inconsistent. GP skills and expertise will be crucial in leading a new generation of JSNA and JHWS.
Although JSNA has been a mandatory requirement on local government and the NHS since 2008, many are yet to develop a high quality contribution to local leadership and commissioning. However, some leading areas have successfully used the process to drive an evidence-based challenge to local service provision and have achieved demonstrable improved outcomes and cost savings as result. For example, Gateshead has pioneered an early intervention cost modelling approach to COPD, Devon commissioned an early intervention service for older peoples' accommodation and support and Waltham Forest made headway against childhood obesity by using the JSNA to influence planning and licensing decisions.
GP expertise will be crucial in raising standards for JSNA and JHWS more consistently across the country. To date, many JSNAs have focussed on data collation and publishing, and have lacked the necessary skills to lead investment / disinvestment decisions. GPs will recognise the importance of skills and capacities such as care pathway analysis, cost modelling, evidence of effectiveness, and will bring valuable experience of business planning and priority negotiation. The community-level perspective and front-line experience of GPs will also be an invaluable perspective on local needs and the key drivers behind service usage and outcomes.
Make sure to state your needs of JSNA and JHWS and ensure a high quality process
Demand a clear, shared specification for JSNA and JHWS, clarifying overall remit, activities, roles, intelligence products and timelines. Be ready to state your needs and expectations of the process.
According to the recent research, two-thirds of local authorities will have created shadow health and wellbeing boards by September 2011. Many will have started to develop their plans for JSNA and JHWS. Others, possibly those who do not grasp the detail of new policy or the potential of the process, may be tempted to delegate leadership of the process to the operational level. Meanwhile, much of the necessary skills base for quality JSNA may already be leaving the PCT unchallenged – a recent survey revealed a ‘brain drain' is underway in senior PCT staff and commissioning roles. Overall, poorly resourced JSNA and JHWS processes operating ‘under the radar' of the core members of the health and wellbeing board place CCGs at a significant disadvantage; a simplistic or unilateral priority setting process may exacerbate different perspectives and lead to conflict, and leave it difficult for CCGs to ensure the design, specification and ‘mission statement' of the process is of sufficient quality.
CCGs can use their place at the health and wellbeing board to play a vital role in ensuring JSNA and JHWS are clearly established from the start as high level, authoritative processes run in genuine partnership. Existing best practice guidelines can be used as leverage to demand a full review of the existing process, and will help guide new, joint specification that adequately reflects the demands placed on the new processes and secures the skills, expertise and capacity needed for the task at hand.
Be ready to compromise, and be ready for the long haul
Building quality JSNA and JHWS will take time. Be ready to consider other perspectives and reach compromises.
CCGs are strongly advised to frame their approach to JSNA and JHWS as part of a much wider, longer undertaking of trust building and a shared endeavour with other local leaders for health and wellbeing. The basic functions of both processes may be self-evident, but experience shows that complexities and different perspectives will inevitably surface as partners build a process intended to drive high-level priorities and decision-making. Recognise the different pressures that different agencies face and build realistic frameworks than cope with them.
As new leaders, CCG's have a valuable role in managing local expectations for process – inevitably, quality JSNA processes are unlikely to spring up overnight and will need long-term engagement of the health and wellbeing board, the JSNA operational team, and other audiences to work. New leaders, systems and processes take time to settle. Ask that the health and wellbeing board evaluates your JSNA at regular intervals as part of an ongoing learning process. Either way, challenging conversations are probably an indication you are on the right track.
HKC are a specialist consultancy focusing on health and wellbeing. www.hkconsulting.co.uk