Policy and Governance
Policy
policies addressing continuity and mechanisms to overcome barriers at the interfaces between social and health care

LAND / ORT: United Kingdom
Keywords: England, governance, needs assessment, joint working

Joint Strategic Needs Assessment (JSNA)

Summary

The Joint Strategic Needs Assessment came from the Social Care Green Paper 'Independence, wellbeing and choice' (2005). It was reinforced in the Health White Paper, 'Our health, Our Care, Our say' (2006) and subsequent to the change of government in the Health White Paper ‘Equity and excellence: Liberating the NHS’ (2010).

The Local Government and Public Involvement in Health Act (2007) specifies that local authorities with responsibility for social care and local health authorities produce a Joint Strategic Needs Assessment (JSNA) of the health and wellbeing of the local community.

The JSNA was designed to strengthen local partnerships and align the objectives and work of key social care and health organisations at a local level. The shared framework of JSNA is thought to improve knowledge and communication between the local populations and their health and social care commissioners and providers. This integrated approach to needs assessment provides a solid foundation for service commissioning that can improve delivery, better target the needs of particular user groups (including older people with LTC needs) and reduce inequalities.

This example considers the effectiveness, impact and sustainability of JSNA in England.

What is the main benefit for people in need of care and/or carers?

Local partners have a shared assessment, plan and vision to target the needs of populations, including older people with LTC needs. This approach is thought to highlight any gaps in provision addressing unmet need.

What is the main message for practice and/or policy in relation to this sub-theme?

The legal dimension of JSNA has led to much stronger relations between health and social care in England.

Warum wurde diese Initiative implementiert?

A JSNA is carried out in all localities in England as it has been a legal requirement since April 2008. The ‘joint’ aspect of the needs assessment is key to its design and intended outcomes. The process of assessing population needs should involve the local health authority (currently in the process of being transferred to GP consortia), local authorities with responsibility for social care, and other organisations which contribute to planning and provision. It should also involve a high level of stakeholder engagement with local communities. In this way the JSNA’s rationale is to improve the interfaces between local commissioning and provider organisations and members of the local population.

By sharing a standardised format and undertaking one single needs assessment it is hoped that all actors can share the same vision and objectives. The JSNA is designed to address the broad health and social welfare needs of entire local populations. However, there are indicators specifically about older people, as well as the general population and children and younger people. Key demographic information is also collected and cross tabulated by age group with the aim of highlighting any inequalities and gaps in provision.

Beschreibung

The Local Government and Public Involvement in Health Act (2007) places the responsibility to undertake the JSNA with local authorites and health authorities, thus ensuring that directors in both health and social care work together closely and have a shared understanding of local needs. The JSNA is integrated into government strategy via health and social care White Papers (Department of Health, 2005, 2006, 2010 ). There is also more specific statutory guidance around how to undertake and use the JSNA, including standardised tools (Department of Health 2007, HM Government 2008).

The specific functions of the JSNA are:

To steer commissioning decisions
To provide a holistic assessment of the health and welfare needs, incorporating wider social factors as well as direct health and social care provision e.g. housing, employment, transport, environment
To map existing services and who uses them
To identify local priority areas
To highlight inequalities and gaps of unmet need in provision
To provide an evidence base to direct funding to the areas of greatest need

The process of developing a JSNA locally necessitates work in partnership with a wide range of stakeholders including providers from the public, private and voluntary sectors, community groups and members of the local community. All actors are involved in all stages, from design and delivery, to evaluation and feedback.

Delivery consists of the collection of information, based on a standard core dataset. The dataset is made up of indicators of need, many of which are specifically related to older people e.g. older people’s perceptions of their neighbourhoods, prevalence of dementia, hospital admissions for falls and extent to which older people are supported to live in the community.

JSNAs are ongoing and data is continually refreshed to fill in gaps in information and build strategies for service improvement.

Welche Effekte wurden erzielt?

Introducing JSNA as a legal obligation had a significant impact on the amount of high level joint working in English health and social care. In this way the legislation can be seen as a real success in terms of stimulating inter-organisational co-operation.

Different outcomes have been recorded locally, many of which are positive for older people and their carers. For instance, the JSNA for the area of Gateshead highlighted older people living in their own homes as an area that needs greater consideration.

Conducting a single assessment and operational plan for strategic improvement shared by several local organisations has positive implications towards cost-effectiveness. This is enhanced by the centrality of cost-effectiveness in the whole JSNA process. That is, the JSNA identifies where services are needed and guides commissioners towards cost-effective investments. Although, it has also been highlighted that communication of JSNA findings to relevant commissioners is an important area where there is often room for improvement.

Having been mainstreamed in 2008 it is widely viewed as too early to tell whether this local activity is more likely to improve health outcomes than previous attempts. Early evidence looks positive as there is a sense of rigour about the use of information that was often seen to be missing from previous joint planning. Despite the scale and complexity of the exercise and the amount of work needed to set up the new process, evidence suggests that the task has been met by enthusiasm and commitment by staff involved in co-ordination.

The new government has confirmed JSNA as part of a much reformed health system. A gradual scaling down of local health trusts and shift of commissioning responsibility to GP consortia means that a slightly different mixture of actors may be involved in future. Overall the JSNA can be viewed as highly sustainable, demonstrating the ability to remain even within a rapidly changing political and organisational context.

Worin bestehen die Stärken und Schwächen der Initiative?

A key strength of the JSNA is the high level joint working between health and social care organisations it has brought about. JSNAs have also led to the consolidation of local community data in one place. This increases ease of access and safeguards against the inefficiency of different organisations duplicating the same information.

Monitoring and evaluation are ongoing and a series of challenges remain. A key weakness or concern is that the learning from the assessment filters through into service commissioning and user outcomes. Within this the link to informing commissioners is vital, especially in a national environment where this commissioning function is being redeveloped.

Maintaining the buy in from all actors involved is another key challenge as England enters period of system reform. Diverse providers as well as new commissioners should be fully informed and incentivised to support the JSNA.