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Title:
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Joint Strategic Needs Assessment review and 3 year programme of needs assessments |
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Date of Meeting:
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18/07/2023 |
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Report of:
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Director of Public Health, Alistair Hill |
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Contact:
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Head of Public Health Intelligence, Kate Gilchrist and Louise Knight, Senior Public Health Intelligence Specialist |
Tel: 01273 296580 |
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Email:
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Kate.gilchrist@brighton-hove.gov.uk and Louise.knight@brighton-hove.gov.uk |
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Wards Affected:
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All |
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FOR GENERAL RELEASE |
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Executive Summary
Since April 2013, local authorities and NHS Clinical Commissioning Groups (now Integrated Care Boards) have had equal and explicit statutory obligations to prepare a Joint Strategic Needs Assessment (JSNA). The JSNA provides a comprehensive analysis of the current and future needs of local people and is used to inform commissioning of services that will improve health outcomes and reduce inequalities. Their outputs are used to help to determine what actions the Council, the local NHS and other partners need to take to meet health and social care needs, and to address the wider determinants that impact on health and wellbeing. The JSNA informed the development and delivery of our Joint Health and Wellbeing Strategy
This duty is discharged by the Health & Wellbeing Board and overseen by the city-wide Joint Strategic Needs Assessment Steering Group.
In July 2022 the Board agreed that the Steering Group should review the JSNA structure and propose a three year programme of needs assessments.
This paper summarises the review and sets out recommendations for the development of the JSNA for the Board to approve. This paper also proposes a three year programme of needs assessments (2023/24 to 2025/26) for the Board to approve. |
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Glossary of terms · JSNA products refers to the public health intelligence products held on the JSNA website, including in-depth and summary needs assessments, data profiles and summaries, reports and briefings, and the Community Insight data mapping platform.
· JSNA stakeholders refer to users including, the Community and Voluntary Sector (CVS), NHS Sussex, the local authority, the general public, and other partners.
· ‘Core20Plus5’ populations refers to a focus on the 20% most deprived populations ‘PLUS’ ICS-determined groups experiencing poorer than average access, experience or outcomes from healthcare and ‘5’ clinical focus areas with the greatest opportunities to narrow the current gap in life expectancy due to health inequalities.
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1. Decisions, recommendations and any options
1.1 That the Board approves the proposed recommendations for JSNA development over the next three years (Section 5.1 and Appendix 3).
1.2 That the Board approves the proposed three year JSNA programme of needs assessments for 2023/24 to 2025/26 (Sections 6.4-6.5 and Appendix 5).
2. Relevant information
2.1 The current JSNA comprises a suite of products and resources held on the BH Connected Local Intelligence website (LOCAL INTELLIGENCE | BH Connected) including:
· Resources and outputs: Including the JSNA executive summary, data snapshots, survey briefings and Annual Reports of the Director of Public Health
· A programme of in-depth needs assessments on a specific theme or population group, approved by the Health and Wellbeing Board. Due to the resource requirements and partnership working involved, there are usually two in-depth needs assessments per year
· Summary needs assessments which take the form of a range of products including data summaries, updated topic information, Census briefings, data profiles, and signposting to existing resources
· Community Insight, an online resource providing a wide range of data mapped at small area level across the city as well as up to date reports for these areas.
2.2 In-depth needs assessments provide a comprehensive analysis for a specific topic of the current and future needs of local people to inform commissioners and providers how they can improve health outcomes and reduce inequalities. They also ensure that health strategies are based on high quality evidence and are a valuable resource for community and voluntary sector organisations.
2.3 Evidence for the needs assessments usually includes: local demographic and service data; evidence from the public, patients, carers, service users and professionals; national research; and best practice. These elements are brought together to identify need, current services, service gaps and under-provision, unmet need, inequalities, and over-provision of services.
2.4 The JSNA informs the key Brighton & Hove and Sussex health and wellbeing strategies including:
· the Brighton & Hove Joint Health and Wellbeing Strategy, published in 2019, which sets out the vision of the Health and Wellbeing Board to improve the health and wellbeing of local people and reduce health inequalities, and
· the Sussex Health and Care Partnership strategy ‘Improving Lives Together’, published in 2023, which sets out sets out the ambition across health and care in Sussex over the next five years.
2.5 The JSNA is delivered by a partnership led by the Brighton & Hove City Council Public Health Team. The programme is overseen by the City-wide Joint Strategic Needs Assessment Steering Group which includes representatives from the council’s Public Health, Adult Social Care, Families, Children and Learning, Housing, Sustainability, Policy, and Communities Equality & Third Sector teams; NHS Sussex; University Hospitals Sussex Foundation Trust; Healthwatch; Community Works; Sussex Police; and the two universities.
2.6 Due to the development of new integrated working arrangements including the Sussex Health and Care Partnership and new Place structures (Brighton & Hove) a JSNA review was proposed to ensure it is sustainable and continues to meet the needs of the city and stakeholders.
2.7 At its July 2022 meeting the Brighton & Hove Health and Wellbeing Board (HWB) agreed that a review of the JSNA should be undertaken.
3.0 The JSNA review
3.1 The aims of the review were:
· To inform the development of the JSNA structure and products to ensure it meets the needs of stakeholders including the Community and Voluntary Sector (CVS), NHS Sussex, the local authority, the general public, and other partners
· To explore opportunities to collaborate with East and West Sussex and the possibilities for alignment and ‘read across’ between the JSNAs
· To maximise the influence of the JSNA to inform commissioning (including prevention and public health promotion) and delivery of services across Brighton & Hove
· To raise awareness of the JSNA across stakeholders
· To ensure that stakeholders can contribute to the development of the JSNA
· To provide recommendations for JSNA development resulting from the review and propose a three year programme of needs assessments and products.
3.2 The Steering Group was reconvened (it had not met since early 2020 due to the Covid 19 pandemic), and the Terms of Reference and membership was reviewed and agreed (See Appendix 1). The Steering Group signed off the review plan and met regularly over the review period to provide oversight. A task and finish group was formed to specifically advise on the stakeholder engagement methods.
3.3 Stakeholders were engaged through on-line surveys (a stakeholder and a separate public survey) and workshops (in-person and an evening on-line workshops).
3.4 Stakeholder feedback, JSNA document review, and a review of other local authorities’ JSNA websites, and Steering Group discussion were used to inform the proposed recommendations.
4.0 Stakeholder feedback
4.1 A total number of 116 survey responses were received and 49 people attended the workshops. A summary of stakeholder feedback is provided in Appendix 2.
4.2 Half of the survey respondents were current users of the JSNA and were generally positive about the current products including the use of infographics, however wanted more timely updates.
4.3 Responders suggested Community Insight mapping tool could be improved with ‘how to’ videos and better use of benchmarking, user/patient voice and asset mapping.
4.4 Those that hadn’t used the JSNA before said that “knowing about it” and “awareness of its use and its benefits” would encourage use in the future.
4.3 Workshop feedback highlighted the importance of developing the JSNA, including improving the promotion of the JSNA and stakeholder involvement.
4.4 Stakeholders tended to support the following revised structure:
· Healthy places (Community assets and the social and environmental building blocks of health)
· Healthy people (Physical and mental health conditions, learning disability and neurodiversity)
· Healthy lives (Risk and protective factors for health and wellbeing)
with the ‘four wells’ incorporated across these heading (starting well, living well, ageing well and dying well).
5.0 Proposed recommendations for JSNA development
5.1 The proposed recommendations for approval are provided in Appendix 3. In summary, the review findings recommend the following 10 key areas where the JSNA programme can be strengthened:
1. Joint Strategic Needs Assessment (JSNA) governance: Ensuring oversight and assurance of the JSNA programme.
2. Working with East and West Sussex: exploring opportunities for read across Sussex to support the aims of the ICS and avoid duplication.
3. Engagement, involvement and co-production: Developing an inclusive engagement and involvement plan, building on good practice in in depth needs assessments across the JSNA programme, inclusion of intersectional equalities, and ensuring reporting back to communities.
4. JSNA production: refine tools, templates and processes.
5. JSNA framework and products: introduce the new framework for the JSNA with life course running throughout. Review of Community Insight.
6. Website and JSNA webpages: Redesign and webpages and move to Brighton & Hove City Council website.
7. Accessibility of the JSNA website and products: ensuring JSNA content meet accessibility standards, or accessible versions available.
8. Promotion, communication and maximising use of the JSNA: Rebrand and rename the JSNA; How to guides and videos and JSNA communication plan.
9. Explore potential for additional resources to produce the JSNA: with a focus on qualitative research, coproduction, mixed research methods and community-led research.
10. JSNA needs assessments prioritisation process: Development of 3-year work programme agreed by the Health and Wellbeing Board with an annual review and update to the Board.
6.0 JSNA programme prioritisation process and proposed 3 year programme (2023/24 - 2025/26)
6.1 Stakeholders were asked to explore the principles to consider when prioritising health and wellbeing topics to review. Feedback resulted in the six principles listed below (See Appendix 2 for more detail):
1. Aligned with local priorities
2. A high level of inequalities
3. A high impact on the population affected
4. A high prevalence/incidence of condition in the local population
5. A substantial gap in evidence that can be filled
6. Optimal timing, e.g., to inform commissioning or strategy and benefit across Sussex and organisations.
6.2 The Steering Group agreed the principles and process to prioritise topics (see Appendix 4).
6.3 The Steering Group agreed the proposed three year programme of needs assessments, including in-depth and summary products, detailed in Appendix 5 for approval by the Board. The topics are summarised in 6.4 and 6.5 below.
6.4 In-depth needs assessments topics, by year:
2023/24:
1. Special Educational Needs and Disabilities (SEND), neurodiversity, and learning disabilities (children and young people aged 0-25)
2024/25:
1. Neurodiversity and learning disabilities (adults aged 18 and over)
2. To be agreed: The steering group received suggestions to explore a range of topics associated with women’s health, including menopause, menstrual health, and period poverty, and wider fertility issues including pregnancy, pregnancy loss, and considered bringing these together. However, to avoid duplication and to be meaningful, the scope of this proposal will need to be considered further in line with the wider Sussex Women’s Health Strategy work that is underway.
2025/26:
1. Young people transitioning between children’s and adults' services (aged 16-25)
2. Pharmaceutical Needs Assessment (a statutory duty of the Health and Wellbeing Board that is published every 3 years)
In addition to the 2023/24 needs assessment highlighted above, the Health Counts survey, a large survey of the health and wellbeing of adults in Brighton & Hove, will take place in spring 2024. This survey is conducted locally approximately every 10 years and is an important resource in describing our local health and wellbeing needs.
6.5 Summary product topics, by year:
2023/24: Childhood immunisations; Chronic respiratory disease; Equalities: Population groups facing social and cultural exclusion; Healthy places; Hypertension; Sensory impairments; Sexual health; UK armed forces current and past personnel and their families.
2024/25 and 2025/26: Draft topics are listed below; these will be further reviewed by the JSNA Steering Group in 2024 to consider timeliness and alignment with local service need and capacity and brought to the Board for final approval.
2024/25: Ageing well; Carers; Globally displaced communities; Sex workers; Healthy lives; Healthy people.
2025/26: Asthma (Children and young people); Children in Care and those who are Care Experienced; Diabetes (Children and young people); Epilepsy (Children and young people)
7.0 Important considerations and implications
7.1 Legal: The Health and Social Care Act 2012 (s196) requires the function of preparing a JSNA to be discharged by the Health and Wellbeing Board. Specifically, from April 2013, local authorities and Clinical Commissioning Groups (now Integrated Care Boards) have equal and explicit obligations to prepare a Joint Strategic Needs Assessment (JSNA) which provides a comprehensive analysis of current and future needs of local people to inform commissioning of services that will improve outcomes and reduce inequalities. The Health and Care Act 2022 replaces CCGs with Integrated Care Boards. S26 of the 2022 Act inserts new provisions into the 2012 Act requiring the formation of an integrated care partnership [comprising the Local Authority and Integrated Care Board] and for that partnership to develop and review its own integrated care strategy in light of local needs assessments, including the JSNA.
Lawyer consulted: Sandra O’Brien 23/06/2023
7.2 Finance: The resources required to support the production of the JSNA are funded by public health ring-fenced grant. The JSNA provides a comprehensive analysis of current and future needs of local people to inform commissioning of services that will improve outcomes and reduce inequalities. Future commissioning plans and delivery plans have to reflect these needs. Any subsequent reports and plans will need to individually assess their financial implications, the impact on the needs of the city and the intended outcomes.
Finance Officer consulted: Sophie Warburton 23/06/2023
7.3 Equalities: Needs assessments consider specific needs of groups with protected characteristics. The JSNA is a key data source to inform action to improve outcomes in all groups and meet the public sector equality duty (including Equality Impact Assessments).
7.4 Sustainability: No implications: Sustainability related issues are important determinants of health and wellbeing, and these are integrated in the summary. The JSNA will support commissioners to consider sustainability issues.
7.5 Health, social care, children’s services and public health: The JSNA summary sets out the key health and wellbeing and inequalities issues for the city and so supports commissioners across the city in considering these issues in policy, commissioning & delivering services.
Supporting documents and information
Appendix 1: City-wide JSNA Steering Group Terms of Reference
Appendix 2: JSNA review stakeholder feedback
Appendix 3: Proposed recommendations
Appendix 4: Summary prioritisation process for JSNA programme
Appendix 5: Proposed JSNA 3 year programme of needs assessments
Appendix 1 City-wide JSNA Steering Group Terms of Reference
1. PURPOSE
1.1. To meet the current statutory duty of Brighton Hove and Brighton & Hove City Council (BHCC) and NHS Sussex to produce a Joint Strategic Needs Assessment (JSNA) and follow the draft national guidance on JSNA (2012).
1.2. To develop and propose a programme of JSNA outputs for the next 3 years.
1.3. To provide oversight and assurance of the JSNA programme.
2. Responsibilities
2.1. To produce and monitor a rolling programme of topic-based needs assessments informed by the priorities of the city, agreed by the Health and Wellbeing Board, ensuring an intersectional, accessibility and race-lens informed approach.
2.2. To approve the project initiation plans for topic-based needs assessments to ensure they meet locally agreed quality standards e.g. includes intersectional equalities and public and patient voice evidence, with a targeted focus on under-represented group voice and nuanced and intersectional lived experience/ qualitative insights
2.3. To reference protected characteristics and intersectionality in assessing the City-wide JSNA programme.
2.4. To assure the quality and accessibility of methodologies, quality standards and technical resources used.
2.5. To identify the training needs of commissioners and other partners involved in producing inclusive, accessible, and quality needs assessments.
2.6. To ensure the inclusive and accessible dissemination, support, and leadership of the City-wide JSNA programme.
2.7. To ensure consistency and congruence across partners and alignment of strategic aims to be reflected in the JSNA.
2.8. To provide expertise and feedback on specific perspectives, taking an intentional race-led and intersectional view considering differential layer of impacts, data, and experiences.
3. GOVERNANCE
3.1. The City-wide JSNA Steering Group will report on JSNA outputs to the Health and Wellbeing Board by means of an annual report.
3.2. The Health and Wellbeing Board will be asked to review and approve the JSNA planned rolling programme.
3.3. Governance arrangements will be reviewed annually, along with the TOR.
4. MEMBERSHIP
4.1. The steering group will comprise representatives from the following organisations. Members will nominate a deputy if unable to attend.
Brighton & Hove City Council (BHCC)
· Public Health
· Adult Social Care
· Families, Children and Learning
· Communities and Equalities
· Policy & Partnerships
· Communications
· Housing
· Sustainability – added April 2023
NHS
· Integrated Care Board Brighton & Hove (Performance and Intelligence; Community and Primary Care)
· Sussex Health and Care Partnership
CVS organisations
· Healthwatch
· Community Works
Universities
· Brighton and Sussex Medical School/University of Sussex
· University of Brighton
Other Organisation
· Sussex Police
5. MEETING FREQUENCY AND QUORACY
5.1. The steering group will meet approximately every six weeks until the review and 2023 programme planning is complete (approx. Q1 2023/24), and will meet quarterly after that.
5.2. The Chair may call additional meetings if deemed necessary.
5.3 Meetings will be quorate if the following are present:
o The Chair, or delegate
o Representation from the public health intelligence team and at least two other representatives from BHCC
o Representation from at least three other partner organisations
o Administrative support
6. Attendance
· Members are required to send apologies, and delegate representation if unable to attend meetings.
· If members are unable to attend meetings they should provide a written update for the Steering Group where relevant.
· Apologies for meetings, requests for information and any papers necessary for the Steering Group meetings should be made to the Steering Group administrative support contact.
7. Resources
· The Steering group will be administered by BHCC public health team.
Date agreed: 16/01/2023
Date of review: January 2024
Appendix 2 JSNA review Stakeholder feedback
Please see link here: JSNA review stakeholder feedback