1. Day 4: Health Needs Assessment and Joint Strategic Needs Assessments Helen Yeo Senior Public Health Intelligence Analyst, North Somerset Local Authority

2. Aims of the session 1.To understand what is meant by a Health Needs Assessment (HNA) and Joint Strategic Needs Assessment (JSNA) 2.To increase awareness of how HNA and JSNA are undertaken in practice

3. Health Needs Assessments (HNA)

4. What is a Health Needs Assessment? Definitions Health needs assessment (HNA) is an essential tool to inform commissioning and service planning, and can be defined as a systematic method of identifying the unmet health and healthcare needs of a population, and making changes to meet those unmet needs (Health Knowledge). A systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve the health and reduce inequalities Health needs assessment a practical guide, 2005) The systematic method of identifying unmet health and healthcare needs of a population and making changes to meet those unmet needs Wright J, Williams j BMJ 1998:316 1310-3

5. Need for healthcare Need - population's ability to benefit from health care interventions Demand – felt need, i.e. the services that people ask for. Supply - measured in different ways Service-based activity Population-based activity 'the availability of good medical care tends to vary inversely with the need for it in the population served” Inverse care Law – Tudor Hart, 1971)

6. Cycle of health needs assessment 1 What population? 3 Prioritisation 4 Action planning for change 5 Review 2 Identifying problems and challenges

7. Example of Health Needs Assessment from North Somerset Stop Smoking Service HNA

8. 1. What is the population? Estimated number of smokers between 24,179 and 30,943 Smoking prevalence in North Somerset ad England, April 2011-March 2012 Service saw 9% of smokers in a year, 6% London

9. 2. Identifying problems and challenges

10. Where are the highest rates of smoking?

11. How does access compare to what you would expect from spread of smokers in the population? Need versus access

12. Customer feedback – 24% response rate Overall satisfaction high 100%, would recommend the service None Given % (n) Very Helpful % (n) Helpful % (n) Unsure % (n) Unhelpful % (n) Very unhelpful % (n) How helpful was the information and advice that staff gave to you during your appointment / group session? - 78% (98/125) 15% (19/125) - 1% (1/125) 6% (7/125) How helpful was the written information that staff gave to you? 8% (10/125) 51% (64/125) 28% (35/125) 4% (5/125) 1% (1/125) 8% (10/125) Use these high levels of satisfaction to recruit others?

13. 3. Prioritisation Customer satisfaction when people entered the service was high so focus on other areas of concern Namely –Wider access for men –Access for younger people

14. 4. Actions Improve access rates to the Local Stop Smoking Service (LSSS) for men Ensure work/focus in deprived areas is maintained. Increase access to the LSSS by those aged 16-19, 20-24 & over 60

15. 5. Review Demographic group Access ratesOutcomes Worse than expectedChanges since previous HEA Better than average Worse than averageChanges since previous HEA SexMalesSimilarSame Slightly worse (not sig) Age16-19 years 60+ years Improvements for those aged 20-24 years 60+ yearsUnder 20 yearsUnder 20 years (not sig) slightly worse PregnancyNaImprovements for pregnant women Same Pregnant women (not sig) worse Occupation-New analysisManagerial/ Professional Intermediate Never worked/long term unemployed New analysis Deprivation-Increase from those from the most deprived quintile 2nd least deprived quintile Most deprived quintileMost deprived quintile worse (not sig) 2nd quintile improved WardCongresbury Backwell Increase for those living in WsM Central Blagdon and Churchill Winford WsM Central WsM South Yatton Successful quit rates in Backwell, in Gordano and Pill have improved Quit rates have got worse in WsM Central and South Table E1: Summary of access and outcomes by different demographic characteristics

16. Exercise – design your own health needs assessment Scenario: Planning consent has just been granted for a new permanent pitch for a gypsy and traveller site in ‘Somewheresville’. The Director of Public Health has requested that a health needs assessment be undertaken to understand the health needs of the population with a particular emphasis on their experience of accessing health services and behaviours. Exercise: Split into two groups and plan how you would undertake a health needs assessment focusing on the first two stages – what is the population and identifying any potential problems. Think about what data you would wish to analyse and whether you need to collect any new data. Nominate someone to feedback.

17. Joint Strategic Needs Assessments

18. JSNA’s – a history First detailed description in 2007 http://webarchive.nationalarchives.gov.u k/+/www.dh.gov.uk/en/Consultations/Clo sedconsultations/DH_072622 Shortly followed by guidance – Dec 2007 http://www.rbkc.gov.uk/pdf/jsna_guidanc e.pdf With the NHS reorganisation came further guidance for LA’s - March 2013 https://www.gov.uk/government/consult ations/health-and-wellbeing-board- duties

19. Joint Strategic Needs Assessments JSNA is a development of the HNA approach. Key features Integral part of commissioning cycles Jointness Big picture Focus on future health needs Well being as well as health Social and health care Engagement with local community Drives the focus of the Joint Health and Well Being Strategies – locally determined

20. How does it work in North Somerset 3 year rolling timetable – continuous process Each year the JSNA board identifies new areas to be included within the JSNA The board delegates the writing of needs assessments to lead officers within the council and NHS www.n-somerset.gov.uk/jsna

21. Key resources Health Needs Assessment: A practical Guide (2005) http://www.nice.org.uk/aboutnice/whoweare/aboutthehda/hdapublic ations/health_needs_assessment_a_practical_guide.jsp Statutory Guidance on Joint Strategic Needs Assessments and Joint Health and Wellbeing strategies (2013): https://www.gov.uk/government/consultations/health-and- wellbeing-board-duties Small Area Indicators for Joint Strategic Needs Assessment http://www.apho.org.uk/jsna