Joint Stategic Needs Assessment

In 2007, section 116 of the Local Government and Involvement in Health Act
introduced a duty for local authorities and PCTs to undertake a Joint Strategic Needs Assessment (JSNA) of the health and social care needs of the area. Subsequent statutory guidance (currently in draft form) described JSNA as “the means by which they [local partners] will describe the future health and social care needs of the population” (HM Government, 2007, para.3.28). This is expected to be carried out jointly by the Director of Public Health, the Director of Adult Social Services and the Director of Children’s Services, with the new duty set to commence on 1st April 2008. This was later reinforced in best practice guidance published in December 2007, which sets out expectations with regards to (Department of Health, 2007):

• The various stages of JSNA
• Stakeholder and community involvement and engagement
• Timing and duration
• Links to other strategic plans

In particular, JSNA is defined as “a systematic method for reviewing the health and wellbeing needs of a population, leading to agreed commissioning priorities that will improve the health and wellbeing outcomes and reduce inequalities” (Department of Health, 2007, p.7). Conceived as a continuous process, JSNA should be underpinned by effective partnership working, community engagement and evidence of effectiveness, with each JSNA reflecting unique local circumstances. Focusing on current and future needs (over at least 3 to 5 years, but also including a longer term assessment), JSNA should align with three-yearly Local Area Agreements (LAAs) and should link to a range of additional local authority and PCT strategies and plans (with 12 examples listed on p.12 of the guidance). Given that The Children Act 2004
requires local authorities to produce a separate Children and Young People’s Plan (based on a comprehensive needs assessment), further work is being undertaken to develop a specific needs assessment tool for children (and this explains the subsequent focus of this report on adult health and social care – see below for further discussion).

In addition, the best practice guidance contained an appendix signposting users to a range of existing data sources to assist the JSNA process. While work is ongoing on this core dataset, the guidance was also clear that such sources should be supplemented by “information gained through active dialogue with local people, service users and their carers” (p.13), with communities involved at all stages of the JSNA process. As part of this, “ensuring the engagement of particularly vulnerable and hard to reach groups, those with complex medical and social care needs and those experiencing exclusion” was recognised as “one of the significant challenges of JSNA” (p.14).

Once needs have been identified via JSNA, the guidance emphasises the role of the Local Strategic Partnership (LSP) in identifying shared targets to meet these needs through the Sustainable Community Strategy and the LAA. In order to identify priorities for commissioning, an outcomes-based approach will be required.

Against this background, the Integrated Care Network and the Department of Health have commissioned the Health Services Management Centre at the University of Birmingham to conduct a national survey to explore preparations underway locally for implementing JSNA, key barriers and enablers, and the potential implications for the delivery of the NHS and Local Government White Papers (Department of Health, 2006; Department for Communities and Local Government, 2006). In addition to the main report, three standalone appendices seek to summarise learning from related and other fields (regeneration and economic development, health care needs assessment and broader local government) in order to identify any transferable lessons and to
avoid ‘reinventing the wheel’.

In particular, HSMC’s focus has been on JSNA as a potential mechanism for
developing and strengthening existing inter-agency relationships. In principle, JSNA could be ‘the glue’ that holds current and future health and social care partnerships together, enabling both organisations to fully understand the needs of the local area and begin to design future services together. Equally, without an underlying commitment to joint working, to involving local people in planning services and to understanding the future together, JSNA runs the potential risk of becoming yet another ‘tick box exercise’ and not a genuine lever for change at all. Commissioned at exactly the time when the new duty of JSNA comes into force, we hope that this report is a timely contribution to this process.