Background to a Joint Strategic Needs Assessment of Health and Wellbeing of the Norfolk population

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1 Background to a Joint Strategic Needs Assessment of Health and Wellbeing of the Norfolk population 1. Policy Context The Department of Health White Paper Our health, our care, our say (2006) identified the need for Directors of Adult Social Services and Children s Services and Directors of Public Health to undertake regular strategic needs assessments of the health and wellbeing status of their populations Later in 2006, the Local Government White Paper, Strong and Prosperous Communities outlined a vision of responsive services where communities are empowered to influence local health and social care systems. The Local Government and Public Involvement in Health Act (2007) placed a duty upon upper-tier local authorities and Primary Care Trusts to work together to produce a Joint Strategic Needs Assessment for their local population (for Norfolk this is Norfolk County Council, NHS Norfolk and Great Yarmouth and Waveney Primary Care Trust). The statutory guidance Creating Strong, Safe and Prosperous Communities accompanying the Local Government and Public Involvement in Health Act (2007) positions Joint Strategic Needs Assessment as underpinning the Sustainable Community Strategy and in turn, Local Area Agreements. 2. What is Needs Assessment? A Needs Assessment is a systematic method for reviewing the issues facing a population, leading to agreed priorities and resource allocation that will improve health and wellbeing and reduce inequalities. Norfolk s Joint Strategic Needs Assessment (JSNA) will build a high-level, definitive evidence-base of health and wellbeing need. The JSNA will help to highlight what need exists, where needs are greatest, which services are used the most and where there are gaps. It will help to show those groups and communities in Norfolk who do not experience the same positive health and wellbeing outcomes, who do not have the same access to services as others and where inequalities, or unfair differences are happening. A JSNA should not be viewed as a large technical document. A JSNA is a structured process with both a short-term focus (3-5 years) and long-term (5-20 years). This is the first JSNA undertaken for Norfolk and it is regarded as a learning experience with the potential for ongoing development and refinement.

2 There is guidance available to help with the needs assessment process. A Guidance document on JSNA suitable for partners can be accessed at: A practical guide to health needs assessment can be accessed at: 3. The JSNA process The guidance suggests the JSNA should align with the three-yearly Local Area Agreement planning cycle(see the document Norfolk JSNA Process ). The JSNA process has several stages:- What are the aims? Who needs to be involved? What resources are required? What population? Undertaking JSNA Feeding back JSNA Were communities involved in decision making? Publishing JSNA in widely accessible formats Gathering data and creating profiles Turning data into intelligence about current and future health and wellbeing needs Content of JSNA Using JSNA Agreeing on expressed outcomes Using existing local systems to agree on who, what and where the local priorities are The JSNA process is a substantial programme of work which relies on an integrated approach between health and social care. For Norfolk, the overall governance of the JSNA process lies with the Norfolk County Strategic Partnership Management Group). The Executive Responsible Officers are the Director(s) of Adult Social Services, Children s Services and Public Health for the County of Norfolk (please see the document Governance of Norfolk s JSNA ). Engagement with Local Involvement Networks (LINks) will be an important part of the JSNA process. In future the JSNA will be steered and overseen by the Health and Wellbeing Partnership which sits within Norfolk s County Strategic Partnership and has representation from the County and District Councils, NHS Norfolk and Great Yarmouth and Waveney Primary Care Trust. The Health and Wellbeing Partnership

3 provides the oversight of the Healthy and Well theme within Norfolk Ambition and performance manages health and wellbeing Local Area Agreement targets. Norfolk s JSNA will support the County Strategic Partnership in its thinking around health and wellbeing priorities and inform target-setting in the Local Area Agreement. 4. Stakeholders There is a wide range of stakeholders in the JSNA process including statutory partners in the Local Strategic Partnership, providers in the public, private and third sectors and members of the local community (including patients and service users and their carers). Stakeholders can help to shape the JSNA process, facilitate exchanges with local communities and identify groups who may not have the capacity to make themselves known to local services. 5. Activity so far A JSNA Project Manager and Delivery Group are tasked with data collection, analysis, publishing and communicating datasets and summaries (see the document Terms of Reference for JSNA Delivery Group ). The JSNA process started in December The JSNA Delivery Group talk to stakeholders and identify, source and request data, in addition to working up the detail with partners on a collection of Appendices. Timescales Dec 2007 Jan 2008 Feb March April May June-Aug Aug December 2008 Activity Planning Project Initiation Documentation Work programme agreed by Directors JSNA framework and boundaries set and agreed by Directors Scope and detail of JSNA informed by stakeholders Creating and convening a JSNA Delivery Group Working up detail of qualitative and quantitative information Identification, sourcing, requesting, collection and analysis of data Exploring and testing appropriate format for JSNA end product Production of summaries Launch of the JSNA live on Norfolk Insight Launch of the JSNA Summary, linking to LAA local priorities Further refinement of and addition to JSNA profile Development of Norfolk s JSNA process by the County Health and Wellbeing Partnership

4 6. The JSNA product Whitehead and Dahlgren s Model of Health (1991) Some of the data for the JSNA is called core data and must be included. Norfolk s JSNA will also include information on a wider range of issues which influence health and wellbeing of people living in the county (see social model of health, above). The JSNA will reflect these determinants with indicators, for example, of; deprivation, housing need, homelessness, educational attainment income, worklessness, antisocial behaviour, violent crime and domestic violence. What the JSNA product will contain: JSNA Summary JSNA main profile Key Headlines Demography of Norfolk Health and Wellbeing Status Wider determinants of Health and Wellbeing Public Voice JSNA Outcomes JSNA Appendices (also profiles) Children and Young People Adults and Older People Mental Health Long Term Conditions End-Of-Life Care Substance Misuse Sexual Health Vulnerable People

5 7. Norfolk Joint Strategic Needs Assessment Live The data and documents which comprise Norfolk s Joint Strategic Needs Assessment (JSNA) can be accessed live at the Norfolk JSNA homepage on Norfolk Insight: 8. Potential benefits to be realised through the Joint Strategic Needs Assessment process and product Additional health and social care datasets, at small area level, accessible on Norfolk Insight, covering a range of health and wellbeing indicators Having data at the smallest area level will facilitate new geographical hierarchies such as children s and adult s commissioning localities, the Waveney locality and complement existing District and Safer Neighbourhood profiles The data sets behind the JSNA can be refreshed and updated when new data is available

6 Local profiles of needs and inequalities can better inform Sustainable Community Strategies but also disaggregation of Local Area Agreement targets to locality/district level 9. Expressed Outcomes The Department of Health guidance for JSNA strongly suggests that a JSNA should generate a collection of expressed outcomes or desired changes for health and wellbeing improvement and the reduction of inequalities. It is fully anticipated that Norfolk s JSNA will generate a number of expressed outcomes. Also, the JSNA will highlight gaps in our knowledge and areas which need further attention. Joint health and social care commissioning groups may decide to commission further needs assessment. This may be where the JSNA process has identified a gap in knowledge around the health and wellbeing needs of a specific group or community, or inequity of service provision. Using JSNA Expressed Outcomes Outcomes might be expressed at various levels (high level or policy and performance e.g. a vital sign, second level e.g. service level investment or improved service outcomes and third level e.g. communities of interest such as rural communities or children with a disability). Examples of outcomes might be used to inform targeting setting i.e an increase in the percentage of teenage parents (from X in 2008 to Y in 2009) in Norfolk who are using family support services on a weekly basis or in priorities for service direction and delivery such as adult males living in our 10% most deprived communities must be constituting 60% of our Stop Smoking Service users and 4- week quits in and so on. Outcomes can be used as they are; for example given to service providers to build services designed to meet the outcome or they can become a JSNA priority measure. Prioritisation of JSNA Outcomes Expressed outcomes do not automatically become JSNA priorities. Expressed outcomes should be reviewed by our Local Involvement Networks (LINks) and enter our joint (i.e. Local Area Agreement) and respective commissioning prioritisation processes (for example through existing joint health and social care commissioning groups) in order for these outcomes to be made the subject of a JSNA priority measure.