Joint Strategic Needs Assessment Research Articles

Finding a way towards Population Health Management on the Central Coast, Australia

Background: To improve the health and wellbeing of the community members on the Central Coast, New South Wales, Australia, this project undertook an assessment of readiness for a Population Health Management (PHM) and neighbourhood based initiative. To do so, it focussed on community needs and strengths and weaknesses of local management on the Central Coast. The Central Coast Local Health District (CCLHD) and Hunter New England and Central Coast Primary Health Network (HNECCPHN) commissioned a joint strategic needs assessment (JSNA). During the project local managers, health professionals, and community members were consulted to gain insight in the readiness and needs of the region. 
 Methods: The JSNA carried out a data driven deep-dive of the health and care needs at a neighbourhood-level with the intent to drive a co-designed intensive place-based population health improvement initiative that optimizes health outcomes, improves access to care and care equity, and reduces total costs to the health system. Supported by the PHM Maturity Index (PHM-MI), the capability across the Central Coast to enable the implementation of PHM was mapped. This allowed gaining insight in the readiness of local management for this pro-active approach. 
 Results: This project is still running and aims to be completed in 2023. Preliminary results of the PHM-MI demonstrate an overall low occurrence of items that support the implementation of PHM. Participants recognized the need and voiced the willingness to work collaboratively. However, they confirmed the absence of a guiding coalition and visionary leadership leading to cross domain collaboration. The major weakness of the Central Coast is the high level bureaucracy and political influence in the health system. This hinders top-level collaboration between multiple organizations, and limits the possibilities of financial changes, the building of an integrated data-infrastructure, and the probability for community ideas to become sustainable. The major strengths of the Central Coast are the strong identity of the community members to the region, the willingness of local managers to focus on the community needs and the availability of data. The project shows that the Central Coast is a region with a lot of hidden potential for a neighbourhood based PHM initiative. 
 Discussion: Using the PHM-MI to map the capability of the Central Coast started the conversation about prerequisites that support a neighbourhood based initiative. Bringing several stakeholders together to participate in the project was challenging, but resulted in new connections between organizations. A next step for the Central Coast is to gain an overview of the most prominent processes in organizational governance, payment streams and budgets, involvement and consultation of community members, and availability of datasets. Therefore, inter- and intraorganizational collaboration is important to bring the hidden strengths on the Central Coast together and build a strong enabling environment to support the growth of the health and wellbeing of the community members on the Central Coast.

Taking a public health approach to violence in Tower Hamlets: a needs assessment

BackgroundThe rise in knife crime in London, UK, and Tower Hamlets, London, UK, has led to calls to implement a public health approach to violence reduction, focusing on both prevention and violence as safeguarding and mental health issues. As part of this approach, we aimed to evaluate whether a Joint Strategic Needs Assessment (JSNA) is better for understanding the violence in Tower Hamlets and support the development of local violence reduction strategies. MethodsMultiagency safeguarding meetings and a thematic review of serious youth violence in Tower Hamlets identified two types of violence requiring JSNAs. These were violence in those younger than 25 years outside of the family (among peers, school settings, street-based settings and gangs) and family violence (between parents, siblings, and intergenerational). Alongside standard JSNA methods, these JSNAs analysed anonymised local datasets on violence and safeguarding from the police, National Health Service, and local authority for demographic, time, and location trends and spatially mapped the results. This analysis was used to identify and understand patterns and risk factors for violence. FindingsThere are time trends for violence in those younger than 16 years, with peaks on weekdays related to school closure. Violence occurs later in the evening for young people aged 16–24 years. Higher levels of mental health problems were identified for children under youth justice compared with the general child population (20% vs 10%). Family violence was predominantly due to partners, parents, and siblings, and nearly 40% of victims were younger than 25 years old. The Crime Survey of England and Wales estimates that 38% of violent crime is reported to the police, allowing the under-reporting of violence in Tower Hamlets to be determined. The cost of violence in the borough was estimated to be over £100 million per year. InterpretationViolence is a substantial public health issue. These JSNAs have improved the understanding of patterns of violence, and the importance of safeguarding and mental health in violence prevention. They have influenced the priorities of local services working with families and young people and developed evidenced recommendations for the strategy for young people who are vulnerable to violence. FundingNone.

Mental health coverage in needs assessments and associated opportunities.

Mental disorders account for almost a third of UK disease burden. Cost effective public mental health interventions have broad public health relevant impacts. Since coverage of such interventions is low, assessment of local coverage is important. A total of 23 Joint Strategic Needs Assessments (JSNAs) around London were assessed for different mental health intelligence. Mental health was poorly covered and difficult to locate in JSNAs. Only a minority of JSNAs mentioned most mental disorders while far fewer JSNAs provided local prevalence estimates or numbers receiving treatment. Only 6% JSNAs included local wellbeing levels and any mental wellbeing promotion initiative mentioned included no information about coverage. Most JSNAs provided little information about impact of mental disorder or broader determinants on mental health. No JSNAs included associated economic implications or information about size of mental health unmet need. Lack of mental health representation in JSNAs means local authorities and clinical commissioning groups cannot perform statutory duties to assess local health needs to inform strategic development and commissioning. This perpetuates poor coverage of public mental health interventions. Actions to improve mental health representation in JSNAs are suggested. Improved coverage of such interventions will result in broad public health relevant impacts and associated economic savings.

What do Joint Strategic Needs Assessments tell us about people with learning disabilities in England?

Purpose – Joint Strategic Needs Assessments (JSNAs) are required for every local authority in England, and should contain information to allow for strategic health and wellbeing planning for the local population, including disabled people. A 2013 analysis of JSNAs showed that JSNAs were not routinely including information on the numbers and health needs of people with learning disabilities, particularly children. The purpose of this paper is to compare the information included in 2013 and 2014 JSNAs. Design/methodology/approach – JSNAs for 141 local authorities in England were sought. Local authorities were contacted when JSNAs were not initially found online. All 137 JSNAs found were analysed for mentions and specific sections concerning people with learning disabilities, and content analysed concerning the specific information they contained. Findings – In total, 72 per cent of JSNAs mentioned people with learning disabilities (vs 82 per cent in 2013); 24 per cent mentioned children (vs 39 per cent in 2013) and 72 per cent mentioned adults (vs 81 per cent in 2013). Overall, 13 per cent of JSNAs included a section on children with learning disabilities (vs 9 per cent in 2013), 65 per cent included a section on adults (vs 48 per cent in 2013) and 11 per cent included a section on older adults (vs 8 per cent in the 2013). More JSNAs contained information on current and projected future populations, health needs, social context and service usage concerning adults with learning disabilities compared to children. There was large regional variation in all these indicators. Originality/value – Further work is needed for JSNAs to contain sufficient information on people with learning disabilities to allow for strategic planning, and for JSNAs to be accessible to the public.

Are health and well-being strategies in England fit for purpose? A thematic content analysis.

Since 1 April 2013, local authority (LA) health and well-being boards (HWBs) in England are required to publish a health and well-being strategy (HWS). HWSs should identify how population health needs are to be addressed. The extent to which this has been achieved is not known. We analysed HWSs to assess how LAs have interpreted statutory guidance, how evidence has been used within HWSs and the relationship of HWSs to Joint Strategic Needs Assessments (JSNAs). Qualitative thematic content analysis of a random sample of one-third of upper tier LA HWSs in 2013-14. Fifty out of 152 LAs were sampled and 47 HWSs analysed. Strategies varied in timescale, length and structure. The term 'evidence' was used most commonly referring to local need, rather than evidence of effectiveness. All, except two, referred to JSNAs. HWSs are dominated by evidence of need and could be strengthened by greater use of evidence of effectiveness for public health interventions. Public health agencies and academics can support the development of effective HWSs by improving the accessibility of evidence and conducting research when evidence is absent. To strengthen HWSs' impact, the statutory guidance should clarify the distinction between evidence of need and evidence of effectiveness.

Developing a systematic approach to asset based health and social needs assessment

Background Traditionally health and social needs assessments have been developed from a deficit approach, focusing on community problems and needs. There is growing interest in working in new ways, using community assets to inform commissioning and service delivery. The Institute for Health and Human Development was commissioned by a London borough to support their transition to an asset based Joint Strategic Needs Assessment (JSNA), …

Joining up health and planning: how Joint Strategic Needs Assessment (JSNA) can inform health and wellbeing strategies and spatial planning

There has been a welcome joining up of the rhetoric around health, the environment and land use or spatial planning in both the English public health white paper and the National Planning Policy Framework. However, this paper highlights a real concern that this is not being followed through into practical guidance needed by local authorities (LAs), health bodies and developers about how to deliver this at the local level. The role of Joint Strategic Needs Assessments (JSNAs) and Health and Wellbeing Strategies (HWSs) have the potential to provide a strong basis for integrated local policies for health improvement, to address the wider determinants of health and to reduce inequities. However, the draft JSNA guidance from the Department of Health falls short of providing a robust, comprehensive and practical guide to meeting these very significant challenges. The paper identifies some examples of good practice. It recommends that action should be taken to raise the standards of all JSNAs to meet the new challenges and that HWSs should be aligned spatially and temporally with local plans and other LA strategies. HWSs should also identify spatially targeted interventions that can be delivered through spatial planning or transport planning. Steps need to be taken to ensure that district councils are brought into the process.

Aligning JSNA and EDS: benefits for minority ethnic communities?

Purpose – The purpose of this paper is to explore potential benefits in aligning Joint Strategic Needs Assessments (JSNAs) with implementation of the Equality Delivery System (EDS) to improve commissioning of healthcare for minority ethnic groups.

Benchmarking integrated care for people with long‐term neurological conditions

PurposeThis paper aims to report results from a national survey of primary care trusts (PCTs) that explored the strategic, organisational and practice context of services for people with long‐term neurological conditions (LTNCs). It seeks to provide benchmarks for integrated service provision and to discuss possible reasons for the variability in progress.Design/methodology/approachEarlier phases of the research identified three models of care that promoted continuity of care for people with LTNCs: community interdisciplinary neurological rehabilitation teams, nurse specialists and pro‐active day opportunities. Based on this evidence, a benchmarking questionnaire was developed and a telephone survey of PCTs in England undertaken in 2009.FindingsThe survey found that the prevalence of models of good practice varied widely across and within PCT areas. Strategic support and commissioning arrangements were also variable. A little over half of responding PCTs had completed a joint strategic needs assessment (JSNA) that included a reference to LTNCs and a quarter of PCTs had no joint commissioning arrangements in place for LTNCs. The complex interplay between strategy, organisational structures and models of delivery, in a context of competing priorities, may account for this variation and patchy progress.Originality/valueService provision for people with LTNCs is an under‐researched area, despite having major implications for long‐term care and support. The paper will be valuable to policy makers and commissioners in benchmarking organisational activity and models of good practice for integrated services.

Joined at the Hip? Joint Strategic Needs Assessments, the Voluntary and Community Sector and Lessons in Partnership Working

Andrew Kaye and Tara Melton from Royal National Institute of Blind People look at what Joint Strategic Needs Assessments mean for public health Why have not-for-profit organizations turned to one another to share tips on the most practical routes for influencing Joint Strategic Needs Assessments (JSNA)? Are we beginning to see a growing public interest in JSNA, or at least their potential to highlight and address the diverse health needs of whole populations? Based on recent evidence, that could be the case; the question then is what does this mean for shaping public health? Original guidance on JSNA stated that engagement is an essential element of JSNA...the process, will in itself, have a positive impact on health and wellbeing.1 Unfortunately, four years later effective engagement with the voluntary and community sector remains an aspiration in many areas.2 It is also unclear whether voluntary organizations have the tool sets and resources to engage with JSNA joint health and wellbeing strategies (JHWS) and shadow health and wellbeing boards. Last November the Royal Society for Public Health (RSPH) and Royal National Institute of Blind People (RNIB) came together to host a workshop on influencing JSNA in collaboration with the public health NGO Forum.3 Colleagues from organizations as diverse as Age UK, Action for Blind People, Action on Smoking and Health and the Royal Society for the Prevention of Accidents all took part. What became immediately obvious were the varying levels of confidence in and preparation for engaging with JSNA. The value of JSNA JSNA were originally designed to lead to stronger partnerships between communities, local government and the NHS. Now they have an enhanced role; a critical function of JSNA is building a unique picture of place. A JSNA must make links between determinants of health, through telling a story about a community; its people; its assets; and the health challenges that still exist. Only when a JSNA does all these things can it help inform a decent JHWS and focus on the wider determinants of health. JSNA is not in and of itself a tool for tackling health inequalities or improving health outcomes. Groups that were once neglected but now seek a higher profile for their health and wellbeing priorities nonetheless view JSNA as a useful stepping-stone. JSNA represents an effective vehicle for raising awareness of various groups' health and wellbeing needs. Lessons from the sight loss sector RNIB together with its partners on the UK Vision Strategy4 have positioned ourselves as sector leaders and have started to dedicate more resource to engaging with JSNA. Early results are very promising in terms of increased recognition of eye health and eye care within many local JSNA. However, bringing the needs of people at risk of, and living with sight loss to the attention of JSNA leads, not to mention seeing this data used to then guide investment decisions, was certainly not straightforward. Undoubtedly one of the most useful things RNIB did from the outset was to commission research on the future costs and prevalence of sight loss. It was very well convincing ourselves that tackling avoidable sight loss was a moral imperative, but unless the economics stacked up, it was going to be difficult bridging the voluntary-statutory sector divide. …

Joint strategic needs assessment: reconciling new expectations with reality

Purpose – This paper seeks to provide a critique on the overall readiness of joint strategic needs assessment (JSNA) to respond to the new roles and functions proposed by the Health and Social Care Bill 2011.Design/methodology/approach – Commentary informed by a national survey of Directors of Public Health in early 2011, a 2010 regional survey of JSNA leads in the South East, and other thematic and case study research exercises commissioned by or associated with the 2009‐2011 DH JSNA Development Programme.Findings – Despite significant progress in the quality of JSNA 2008‐2010, raised expectations pose a serious challenge. It is possible to identify a number of key issues that must be directly addressed if the process is to fulfil the new expectations. The paper concludes with a call to action for members of health and wellbeing boards to audit the quality of their existing JSNA around these main challenges.Originality/value – A new perspective on JSNA in light of new policy changes, combining existing r...

Together we are better? Strategic needs assessment as a tool to improve joint working in England

PurposeThis paper seeks to report the results of a national survey to explore preparations under way by local authorities and primary care trusts (PCT) for the duty to conduct a joint strategic needs assessment (JSNA), key barriers and enablers to this, and the implications for future policy. In particular, the study focuses on JSNA in the context of current and future health and social care partnerships.Design/methodology/approachUsing Department of Health e‐mail circulation lists, the authors conducted a national survey of all PCT chief executives, directors of adult social services and public health in England (a total of 459 people). A qualitative survey was e‐mailed in February 2008 at the time when health and social care communities were preparing to implement the new duty. All completed surveys were analysed by both authors using thematic content analysis. A grounded approach was taken whereby the thematic framework emerged from initial familiarisation with the data, to which any further themes emerging during the coding process were incorporated.FindingsAlthough respondents felt that it was very early days, they had a number of aspirations for JSNA and identified a number of potential impacts and implications. First and foremost, respondents felt that JSNA had scope to raise the profile of the importance of jointly agreed approaches to needs assessment and to partnership working more generally. However, as many respondents pointed out, the extent to which JSNA is able to realise this potential depends on it being seen as a means to an end, rather than an end in itself.Originality/valueOverall, the impression from this early survey was of a health and social care system taking the new duty seriously and with aspirations in some areas to make JSNA a future driving force for local service changes.

Increasing response rates to lifestyle surveys: A pragmatic evidence review

Lifestyle surveys are often a key component of a local Joint Strategic Needs Assessment (JSNA), undertaken to inform public health planning. They are usually administered to a large number of people in order to provide a comprehensive profile of population health. However, declining response rates coupled with the under-representation of certain population groups in lifestyle survey data has led to doubts concerning the reliability of findings. In order to inform the design of their own lifestyle survey, NHS Calderdale commissioned an evidence-based review of the methodological literature relating to the administration of lifestyle surveys, with the specific aim of identifying practical and resource-efficient strategies shown to be effective for maximizing whole-population response rates. A pragmatic review of the published literature was undertaken, specifically to explore the most practical and resource-efficient ways to maximize lifestyle survey response rates to the most commonly used methods (postal surveys, face-to-face interviews, telephone interviews and electronic surveys). Electronic databases including MEDLINE, CINAHL, DARE, EMBASE and PsychINFO were searched. Empirical evidence published in the last 10 years was identified and citation tracking performed on all retrieved articles. An internet search for 'grey literature' was also conducted. The postal questionnaire remains an important lifestyle survey tool, but reported response rates have decreased rapidly in recent years. Interviews and telephone surveys are recommended in order to supplement data from postal questionnaires and increase response rates in some population groups, but costs may be prohibitive. Electronic surveys are a cheaper alternative, but the empirical evidence on effectiveness is inconclusive. Careful planning and tailoring of survey design to the characteristics of target populations can increase response rates and representativeness of lifestyle survey data. The results of this pragmatic review could provide a valuable resource for those involved in the design and administration of lifestyle surveys.

Joint strategic needs assessment: a new approach to joint working in public services

On April 2008, the new statutory duty on local authorities and primary care trusts (PCTs) to work together with their local partners to produce a joint strategic needs assessment (JSNA) came into effect. The purpose of these JSNAs is to identify the unmet health and well‐being needs and inequalities of the whole local population, and to provide a sufficiently broad joint evidence base for a locality. This enables increased joint working and co‐operation among all partners leading to improved outcomes for that population. For the first time, commissioners have the opportunity to create a ‘level playing field’ for identifying unmet mental and physical health needs within the same assessment process. This paper lays out why the structure and policy framework underpinning JSNA may offer a stronger prospect of successful implementation than its predecessors. It uses the findings of a quality assurance audit of JSNAs conducted in the east of England as a real‐world reference point.