Learning Objectives

1. Applied Methodologies in Public Health Information: Health Needs Assessment (HNA) and Joint Strategic Needs Assessment (JSNA)Day 4 Session 3 Sarah Jane Flaherty EMPHOJames Hollinshead EMPHO6thth July 2010

2. Learning Objectives • Understand the principles of a health needs assessment • Work through an example of a health needs assessment • Introduction to JSNA

3. HNA: Key Resources • Health Needs Assessment: A Practical Guide June 2005 http://www.nice.org.uk/aboutnice/whoweare/aboutthehda/hdapublications/hda_publications.jsp?o=705 • Clarifying approaches to: HEA, HIA, Integrated impact assessment, HEA and race equality impact assessment http://www.nice.org.uk/aboutnice/whoweare/aboutthehda/hdapublications/p101.jsp

4. What is a Health Needs Assessment? • At your tables • Discuss how you would define a Health Needs Assessment • Feedback with some key words that would be in this definition

5. HNA: definitions • The epidemiological approach to needs assessment • Prevalence and incidence • Services available and their costs • Effectiveness and cost-effectiveness of services • Quantified models of care and recommendations • Outcome measures, audit methods and targets • Information and research requirements • http://hcna.radcliffe-oxford.com/ 1994 & 1997 The systematic method of identifying unmet health and healthcare needs of a population and making changes to meet those unmet needs. Wright J, Williams R & Wilkinson J. BMJ 1998; 316: 1310-3. A systematic review of the health issues facing a population leading to agreed priorities and resource allocation that will improve health and reduce inequalities. Health Needs Assessment: A Practical Guide (NICE 2005)

6. Put simply! • Systematic process • Identify health problems • Identify services required • Supports priority setting • Leads to action

7. HNA: different models/common ground • a disease • a service • a community or social experience

8. Who has undertaken a HNA? Why?

9. Why undertake HNA? • Provide evidence about a population on which to plan services and address health inequalities • Opportunity to engage with specific populations • Enable them to contribute to targeted service planning and resource allocation • Opportunity for cross-sectoral partnership working • Develop creative and effective interventions

10. Why undertake HNA? NHS Planning Guidance 2005-2008 • Undertake needs assessment in conjunction with partners • PCTS need to demonstrate the use of needs assessment in their planning Health care commission PCT core standards 2007/08: Core standard C23 • The PCT assesses the health needs of its local population, including analysis of its demography, health status, health and social care use and patient and public views. • The PCT’s commissioning decisions and local target setting are informed by its assessment of health needs .... • The PCT commissions or provides targeted programmes and services .... based on the needs of its local population. *NB The Healthcare Commission are an Independent regulator of health and social care in England

11. Why undertake HNA? World Class Commissioning (2008) • WCC competency 5 to manage knowledge and assess needs: • 'Manage knowledge and undertake robust and regular needs assessments that establish a full understanding of current and future local health needs....’ • Commissioning decisions should be based on sound knowledge and evidence. By identifying current needs and anticipating future trends, PCTs will be able to ensure that current and future commissioned services address and respond to the needs of the whole population, especially those whose needs are greatest.

12. Questions?

13. Cycle of health needs assessment 1 What population? ... and who to involve? 2 Identifying problems and challenges 5 Review measuring impact learning population profiling perceptions of needs IMPLEMENTING ACTION 4 Action planning for change 3 Prioritisation which issue(s) to tackle? what are effective and acceptable interventions?

14. Cycle of health needs assessment 1 What population? ... and who to involve? 2 Identifying problems and challenges 5 Review measuring impact learning population profiling perceptions of needs IMPLEMENTING ACTION 4 Action planning for change 3 Prioritisation which issue(s) to tackle? what are effective and acceptable interventions?

15. Cycle of health needs assessment 1 What population? ... and who to involve? 2 Identifying problems and challenges 5 Review measuring impact learning population profiling perceptions of needs IMPLEMENTINGACTION 4 Action planning for change 3 Prioritisation which issue(s) to tackle? what are effective and acceptable interventions?

16. Key steps • Define population • Population profile - demographics • What are the health problems? • What services are currently in place? • What services should we have in place to address these health problems? • Identify service gaps • Identify priorities – lead to action

17. Define the population • Geographic location e.g. living in deprived neighbourhoods or housing estates • Settings e.g. schools, prisons, workplaces • Social experience e.g. asylum seekers, specific age groups, ethnicity, sexuality, homelessness • Experience of a particular medical condition e.g. mental illness, diabetes, respiratory disorders

18. Population profile • Demographics: • Age • Sex • Ethnicity • Different population subgroups experience differing health needs • Profiling can be a good way to identify inequalities

19. What are the health problems? • Collecting + interpreting various sources of data • How to measure health problems? • Depends on defined population • Disease frequency vs risk factors vs social wider determinants of health • National vs local epidemiological data • Comparative data

20. How to measure health problems? • Measure disease frequency? Incidence vs prevalence? • Describe: • Time - time trend • Person – age / sex/ ethnic groups • Risk factors • Wider determinants of health (deprivation) • Morbidity / mortality

21. What are the health problems? • Take into account range of stakeholder viewpoints • Perceptions and expectations of the profiled population (public, patients, carers) • Perceptions of professionals providing the services • Perceptions of managers of commissioner/provider organisations • Relevant national, regional or local priorities • Qualitative data – surveys/interviews/focus groups

22. What are the health problems? • Provide evidence about a population on which to plan services and address health inequalities • An opportunity to engage with specific populations and enable them to contribute to targeted service planning and resource allocation • Provides an opportunity for partnership working and developing creative and effective services

23. Routine surveillance systems • Mortality data (ONS available on NCHOD) • Morbidity data: e.g. Service use • Primary care – QOF data (NHS Information Centre) – Secondary care – HES data (NCHOD/EMPHO) • Sexual health e.g. Chlamydia – KC60 returns • Cancer registry • Lifestyle data (surveys, NHS Information Centre) • Literature search – primary research studies • Always be aware of limitations of data sources

24. Cycle of health needs assessment 1 What population? ... and who to involve? 2 Identifying problems and challenges 5 Review measuring impact learning population profiling perceptions of needs IMPLEMENTING ACTION 4 Action planning for change 3 Prioritisation which issue(s) to tackle? what are effective and acceptable interventions?

25. Exercise: Planning a Health Needs Assessment 1 What population? ... and who to involve? 2 Identifying problems and challenges 5 Review measuring impact learning population profiling perceptions of needs IMPLEMENTING ACTION 4 Action planning for change 3 Prioritisation which issue(s) to tackle? what are effective and acceptable interventions?

26. Applied Methodologies in PHI: JSNA

27. http://www.dh.gov.uk/en/Publicationsandstatistics/Public • ations/PublicationsPolicyAndGuidance/DH_081097 • "Joint Strategic Needs Assessment describes a process that identifies current and future health and wellbeing needs in light of existing services, and informs future service planning taking into account evidence of effectiveness.“ • "Joint Strategic Needs Assessment identifies 'the big picture' in terms of the health and wellbeing needs and inequalities of a local population."

28. The duty to produce a Joint Strategic Needs Assessment • Section 116 of Local Government & Public Involvement in Health Act (2007) set out a new statutory requirement for PCTs and responsible local authorities (from April 1st 2008) to produce a JSNA of the current and future health and social care needs of their local community. • Applies to unitary or upper tier local authorities (upper tier authorities to consult with district councils within their geographical area). • To be carried out jointly by the Director of Public Health, the Director of Adult Social Services and the Director of Children’s Services. • The JSNA will inform: • the Sustainable Community Strategy • priorities and targets in the Local Area Agreement • commissioning priorities

29. Joint strategic needs assessment • JSNA is a development of HNA - bigger and better! • Key features: • - Jointness! • - Big picture • - Whole population • - Includes focus on future needs • - Well-being as well as health • - Social care as well as health care • - Maintains the focus on inequalities • - Engagement with local communities

30. Joint strategic needs assessment • A good JSNA will: • Provide analyses of data to show the health and well-being status of local communities • Concentrate on current and future health and wellbeing needs of the population (short term (3-5 years) to inform Local Area Agreements, and the longer term future (5-10 years) to inform strategic planning • Define where inequities exist • Inform the commissioning of services and interventions to achieve better health and wellbeing outcomes and reduce inequalities • Use local community views and evidence of effectiveness of interventions to shape the future investment and disinvestment in services

31. Joint strategic needs assessment • What information should a good JSNA include: • - Which groups are getting a raw deal? • - How many children are living in poverty? • - What are people dying of? • - Which of our communities dies youngest? • - Roughly when do people die? • - How many people are there over 75? • - Are we spending our money on the right things? • - What illnesses are people living with? • - What are people living with that makes their lives difficult? • - What help do the groups who are getting a raw deal want and need? • - Where do the groups getting a raw deal live?

32. JSNA cycle

33. The Benefits of JSNA • Improve need assessment and commissioning information • make our decision making more evidence based • doing it jointly makes the information more robust, and access to a wider set of data sources • think about how we store information and update it • Focuses our minds on the longer term–5, 10, 20 years • help us to check out if our priorities are the right ones • identifies gaps in our knowledge–where we don’t know what we need to know! • developed jointly leads to joint ownership • [Source: Kirklees PCT]

34. Useful JSNA resources • APHO resource pack http://www.apho.org.uk/resource/view.aspx?RID=53885 • Introducing the Core Dataset • Statistical validity • Projection methods for use in JSNA • Data sharing for JSNA – principles and examples • Measuring health Inequalities • The NHS Information Centre JSNA web pages http://www.ic.nhs.uk/services/in-development/joint-strategic-needs-assessment-jsna • DH JSNA pages http://www.dh.gov.uk/en/Managingyourorganisation/JointStrategicNeedsAssessment/index.htm • EMPHO JSNA webpages http://www.empho.org.uk/methodologies/jsna/jsna1.aspx

35. The Department of Health JSNA web pages http://www.dh.gov.uk/en/Managingyourorganisation/JointStrategicNeedsAssessment/index.htm

36. APHO Resource Pack http://www.apho.org.uk/resource/view.aspx?RID=53885

37. NHS Information Centre for Health and Social Care http://www.ic.nhs.uk/services/in-development/joint-strategic-needs-assessment-jsna

38. Local Case Study: Nottinghamshire County http://www.nottinghamshire.gov.uk/factsaboutnotts.htm • Formation of multi agency JSNA groups (steering group and workgroup) • Review of the JSNA guidance (and the updates) • Agreement on three themes • Older people, Children and Young People, Vulnerable Groups and Adults • Collection of all the information and evidence • Consultation with stakeholders • Prioritisation and interpretation by the PH and LA teams

39. Nottingham City PCT JSNA http://www.nottinghaminsight.org.uk/insight/jsna/jsna-home.aspx • Interactive document • Chapters; demography, life expectancy, Behavioural factors, children young people and families, adults • Small subsections e.g. LTC within chapter. ‘bite sized chunks for commissioners’ • Template for each subsection (consistent format)

40. Future of JSNA • Broad vs focussed • Static vs interactive • Finances and disinvestment • Future of health and social care integration • New structures for commissioning teams (GP consortia)

41. Summary • Understand the principles of a health needs assessment • HNA definitions • HNA resources • HNA policy context • HNA cycle • Work through an example of a health needs assessment • Introduction to JSNA

42. Any questions? If there are any comments please email: james.hollinshead@empho.nhs.uk sarah.flaherty@empho.nhs.uk