What are they?
Joint Strategic Needs Assessments (JSNAs) bring together all the relevant information about a community, including population data, levels of smoking, housing quality – along with the views of residents – to help plan future commissioning and ensure that the community has the health and social care services it needs.
First introduced in 2007, JSNAs were the responsibility of primary care trusts until the current wave of health reforms placed GPs at the helm of local commissioning. Local authorities and CCGs will have a statutory duty to produce JSNAs annually from April 2013.
What is the rationale behind them?
The Health and Social Care Act 2011 proposed an ‘enhanced’ role for JSNAs to ensure that local authorities and CCGs work closely together in health and wellbeing boards, analysing the current and future health and social care needs of their populations. In practical terms, JSNAs will provide population-level data for GPs, help with priority setting and keeping track of spending.
Another part of the rationale is to ensure GP involvement in drawing up the plans. Previously, under PCTs, quality of JSNAs was highly variable – some of them little more than data collection exercises. The renewed focus on JSNAs is intended to raise the bar across the board by bringing GPs’ knowledge of their patient populations to the table.
JSNAs are also intended to keep decisions about action, investment – and disinvestment – genuinely local rather than a reflection of national priorities. And it could be argued, distancing ministers from disputes over rationing and hospital closures, in the process.
Where are they in terms of development?
Work by shadow health and wellbeing boards on refreshing existing JSNAs began in January, feeding into the JSNAs sister plans, JHWSs -Joint Health and Wellbeing Strategies, which in turn feed into CCGs´ commissioning plans.
A consultation on draft statutory guidance for health and wellbeing boards on producing JSNAs and JHWSs was launched by the Department of Health in the summer and closed in September.
What are going to be the tricky bits to digest/get agreement on?
The plans themselves: JSNAs and JHWSs will be used to gauge CCG performance – and quality premiums – so CCGs have to be sure they are as accurate and representative as possible.
However, the BMA and others have voiced concerns over the political independence of health and wellbeing boards given that they are committees of local authorities. There are also fears over local councillors exercising undue influence over the decisions of the boards in relation to JSNAs. The worry is that health and wellbeing boards could become political battlegrounds and that tussles over JSNAs could undermine GPs´ commissioning clout.
Critics are also concerned about whether the involvement of health and wellbeing boards in drawing up JSNAs will mean excessive scrutiny of CCGs´ commissioning plans. ‘It will be important that this scrutiny function respects the clinical expertise of the clinicians responsible for the CCG commissioning plan,’ is the BMA´s line.
Alisdair Stirling is a freelance journalist