1. Joint Strategic Needs Assessment
(How does this link to research)?
December 2012
Pat Diskett (Deputy DPH, NHS Bristol)

2. Background Requirement since end of 2007 (2008)
Joint = PCT (DPH) + LA (HSC/CYP)
National Best Practice Guidance
Strengthened Influence – has to inform new statutory Health and Wellbeing Strategy (plus CCG + NHS commissioning plans)

3. Overview of the JSNA
Identifies Health and Wellbeing needs, now and into the future (predicts changing needs/trends) – on-going process
Informs local (joint) priority setting and has local engagement: to improve health outcomes and reduce inequalities – and informs H&WB Strategy development
Strategic to inform commissioning and planning decisions and help shape services/provision (use of resources):
Commission or deliver differently in the future?
Helps shape both current and future services

4. Joint Process - > JSNA Outputs
Strategic Analysis + Prioritisation
Broad baseline report -
minimum dataset
Info + data sharing -> intelligence +
dissemination
Workforce development and training
Web based portal, data sharing,
profiling tools
Needs analysis; Evidence;
Equity Audits
Pointers, address gaps –>
work programme
Service review design and redesign
Shape of the JSNA – bottom up:
Initially a broad baseline report – short timescale, bringing info. together on what we already know and turning data into strategic intelligence
Pointers to reflect and include locally identified priorities for improvement e.g. include BME/migrants, aging population, service capacity e.g. ageing work force, few male care workers.
Leading to a work programme made up of varied projects (of all shapes and sizes) – e.g. to fill gaps, enhance knowledge, better use knowledge and ensure local engagement.
Process, project managed to fit in with planning cycles
Leading to strategic opportunities for re-positioning resources
Some evidence that this has occurred (e.g. CYPS strategies “proofed” against the JSNA and findings also have contributed to JSNA development)
Horizon scanning 4

5. JSNA 2012 2012 JSNA - Transitional new Baseline
2011 New structure / new guidance / new stakeholders (inc CCG Localities)
Evidence base for Health and Wellbeing Strategy
Potential to use JSNA to help shape/inform research questions?
Third year of 3 year cycle
Using buidlng block approach shown in the pyramid, should be truly strageic thus need to add in an economic compnent challenging resource allocations

6. From JSNA to Health and Wellbeing Strategy?
Secondary Care and Specialist Services
Primary Care and Interface services
Prevention, Risk Assessment and Targeted Interventions
Health and Wellbeing Board
Children
and
Young People
Adult Health and
Social Care
People and Patients,Health Watch, Carers, Communities and Services (inc. Acute, VCS etc)
CCG Functions
NHS CB Functions
Public Health Commissioning
Wider Determinants
of Health
JSNA is one tool that will inform Strategy development (alongside national outcomes frameworks, local priorities, policies etc).
It is clearly and important tool and is integral to the work of the Board and all the functions of the Board (see the span of responsibility of the Board in the above diagram).
Key points of Diagram:
Leadership of the whole health and wellbeing system across the whole life course (adults, older people, children, young people – all with varied/diverse needs) and across all aspects of care ranging from primary prevention (green) to highly specialist services (red).
At the heart is the need to improve and protect health and wellbeing for patients, their carers, local residents, communities and the population of Bristol, and ensure the delivery of appropriate, efficient, and effective quality services that are fit for purpose both now and in the future.
Next stage for the Board is in considering how best to use the JSNA to help define local priorities and to develop a Health and Wellbeing Strategy for Bristol.
Health and Wellbeing Strategy and JSNA
From JSNA to Health and Wellbeing Strategy?

7. Taking the JSNA forward
Joint Health & Wellbeing
Strategy
Taking the JSNA forward
Horizon
scanning
Horizon
ows
gap analysis
JSR
Joint Service Reviews
JSNA
Joint Strategic
Needs Assess-ment
Know- ledge
gap +
analysis
Need to be clear about what is in the JSNA and what is elsewhere but clear feeds in (iterative and heuristic process)
Not sure we are doing enough horizon scanning (but is a challenge as often is opinion based and completing priorities – needs to tie back to evidence which as yet is over the horizon….)
Baseline report 7

8. What Next: How can we make the JSNA “Truly Strategic”?
Programme Budgeting/Economic Analysis?
New Tools/Techniques/Academic Support?
Evidence into practice e.g. opportunities for better alignment of academic research and NHS/LA knowledge/evidence gaps?
Role of CCGs? GP Data?
H&WB Strategy?
RISKS -> Increased problems of partnership working? Shake up of partners priorities.
Loss of progress made in last 3- 4 years whilst everybody finds their feet in the new world.
Getting GPs interested?
Up-skill all participants in the process on economic analysis or accept that external help is required (costs of that/out-sourcing/role of CSUs?)

9. To build in an economic component, needed a conceptual Model that commissioners/all stakeholders could easily understand and identify with – to provide a Framework for potentially difficult (resource allocation) discussions
Full explanation of the Model and suggestions how to use it are in the 2010 JSNA

10. Final Thoughts
Good Intelligence and High Level Strategic (Economic) Analysis is ….
still no guarantee of effective decision-making……………
How many decisions are purely evidence based?
Political priorities usually take precedence over epidemiological and other objective evidence. Evidence itself can be manipulated for political ends/expediency
The same can be said of short term financial priorities which also usually take precedence over epidemiological and other objective evidence that has a longer term focus)?
How many decisions will be evidence-based n the future? How will the health and well-being Board (and the JSNA) be able to hold others to account. Will the role of the JSNA adapt sufficiently to support this? (Note that, unlike the DPH report, it is not “independent” but is “owned” .

11. 2012 Strategic Summary- Bristol
Population Change
Economic Outlook
Children and Young People
Adults and Older People
Health Inequalities
Lifestyles and Health Improvement
Healthy City (inc wider determinants of health)
Service Landscape, Service Utilisation and Needs
Challenges for commissioners & planners over 3-5 yrs