Joint Strategic Needs Assessment

1. Joint Strategic Needs Assessment • Colin Foster, Director of Adult Social Services, Health and Housing, Rutland County Council. • Chris Packham, Director of Public Health, Nottingham

2. Overview COLIN FOSTER Director of Adult Social Services, Health and Housing, Rutland County Council.

5. Role of Director of Adult Social Services • Accountability for assessing local needs and ensuring availability and delivery of a full range of adult services • Professional Leadership • Leading the implementation of Standards • Managing Cultural change • Promoting local access and ownership and driving partnership working • Delivering an integrated whole systems approach to supporting communities • Promoting social inclusion and wellbeing

6. Our Task… The DASS and the DPH will play key roles, with directors of children’s services, in advising on how local authorities and PCTs will jointly promote the health and well-being of their local communities. • They will need to undertake regular joint reviews of the health and well-being status and needs of their populations. • They will be responsible for a regular strategic needs assessment to enable local services to plan ahead for the next 10 to 15 years, and to support the development of the wider health and social care market, including services for those who have the ability to pay for social care services themselves.” Para 2.60, Our Health, Our Care, Our Say • .

7. Commissioning Framework for Health and Wellbeing - 2007 • An explicit requirement by April 2008 • Expectation from regulatory bodies that work has already started • Period of consultation to follow • More explicit and mandatory guidance to follow?

8. Links to wider needs analysis • Housing Market assessments • Patient user feedback mechanisms – including specialist groups, LD, Mental health, Drug and Alcohol etc. • Tri-annual household surveys • Parish Plan surveys • Voluntary Sector intelligence • Children Needs analysis for Jar etc.

9. Strategic aims of JSNA A shift towards services that are personal, sensitive to the needs of the individual and focused on maintaining independence A reorientation towards promoting health and well being, and proactive prevention of ill health A stronger focus on commissioning for outcomes, across health and local government, working together to reduce health inequalities & promote equality Stronger focus on identifying and reducing inequalities and improving social inclusion Use local community views and evidence of effectiveness of interventions to shape the future investment and disinvestment of services.

10. Practical advantages of strategic needs assessment / demand forecasting? • If we can identify levels of demand far enough in advance we may be able to configure services more effectively or economically. The provision of new housing for example cannot take place overnight. • We may be able to procure services at a better cost if we have a better idea of how much we might need. • If we are going to have to ration demand then we may need to ration more equitably and target more effectively. • Common understanding between local NHS and LA in setting targets • Identifying what people are really asking for and whether current services really deliver that. • To inform the commissioning cycle and underpin the Local Area Agreement

11. Commissioning needs improving: NHS • It seems that needs assessment in NHS commissioning has to ‘move beyond public health’. That is not to say that epidemiological data analysis is not vital …. but it is clearly no longer sufficient as the sole basis for making decisions about how priorities will be set and resources allocated… HPF Making Commissioning Effective in the reformed NHS In England, 2006 • NHS commissioning • Commissioning for volume and price - not quality and outcomes • Too much care in institutional settings • Health inequalities remain • Focus on treating illness, not preventing it • Limited diversity of providers • Individual choices still limited, local voices sometimes unheard • Lack of public health capacity to carry into this mode

12. Local AuthorityCommissioning • LA’s have not always managed the market as effectively as they could • Some providers have driven up prices –especially in high cost low volume areas • LA’s have artificially undervalued mainstream care brought about by banding systems due to financial constraints brought on by poor national settlements and increased demand. • LA’s have predominantly been concerned about their own customers – i.e those who need LA financial support – not the general population • Over concern about price rather than quality • New self directed care agenda yet to be fully reflected in commissioning processes • Target driven commissioning – national not local and not consistent across all stakeholders

13. Current Summary…. • Elements of JSNA exist, but not systematic • Sharing of information to support commissioning often patchy • Commissioners find that providers unwilling/unable to provide new/innovative services they want to secure • When people need a package of care delivered by more than one provider, it often requires front-line practitioners to pull this together • Incentives within commissioning systems do not yet fully support the delivery of better health and well-being • The accountability for partnership working can be weak, leading to misunderstandings and the breakdown of relationships • Capability to commission well is under-developed

14. Where do we want to be.. • “A good strategic needs assessment, which many areas are already doing, is based on a joint analysis of current and predicted health and well-being outcomes, an account of what people in the local community want from their services (those provided by the statutory sector and the wider market) and a view of the future, predicting and anticipating potential new or unmet need.” Commissioning Framework for Health and Well-being DH, March 2007

15. ‘8 steps to better commissioning’ • Putting people at the centre of commissioning • Understanding the needs of populations and individuals • Sharing and using information more effectively • Assuring high quality providers for all services • Recognising the interdependence of work, health and well-being • Developing incentives for commissioning for health and well-being • Making it happen: local accountability • Making it happen: capability and leadership Putting people at the centre of commissioning

16. Challenges • How powerful is the Duty? • Professional / interpersonal relationships • Political interface – elected member ownership and involvement • Commissioner capability • Links to practice Based Commissioning • Pathway from three year outcomes to annual contract volumes • Prioritising outcomes • Data & Information • Systematising ‘Voice’ • How to link in Self Directed Care, Individualised budgets etc.

17. Current draft guidance: the guidance itself • Based too much on assumptions about the relationship between population and the need for provision (probably works better for health than social care) • Guidance weighted towards what to collect rather than what you do with it. • Doesn’t resolve the targeting v whole population issue. • Not enough about wider factors e.g., housing economic wellbeing, etc and the relationships between factors. • Not enough help with how it links back into strategic commissioning and the fit with self directed care. NHS links to the community less systematic than LA links • Need to avoid duplication of existing tasks or requirement

18. Some methodological and technical challenges • Chris Packham, Director of Public Health, Nottingham

19. ‘Minimal information’

20. “Secondary analyses” for JSNA

21. Four dimensions of JSNA • Population needs assessment • Defines the whole population based on assumptions about characteristics • Uses simple population extrapolation • for instance : in 20 years time… • 6,660 additional assessments of older people per annum. • Another 18,000 hours of domiciliary care per annum. • An additional 2,220 places in residential and nursing home care. • An additional 1,500 people receiving day care services in any one year. • 2,715 people aged over 75 providing more than 50 hours care per week to another person.

22. Surveys • Refines and tempers global population extrapolation with national, regional or local intelligence • Eg Need cannot be expressed for services that are not in existence but need and service requirements can be extrapolated and anticipated from desires. Older peoples attitude to accommodation • The challenges of ‘wants’ (personal desires) and ‘needs’ (professionally defined)

23. Service user profiling • Beginning to understand who uses what: • Health Equity Audit • Modelling: not just ‘how many users’ but can we describe the numerical pathway through services and ask critical question at key points on the pathway eg learning disability survival patterns

24. Met but unsatisfied demand • The effectiveness and efficiency of services • Outcome-based commissioning

25. Will produce some tricky questions… • Have we got the balance between our rehabilitation / recovery services, and our care and support services, right? • What are the differences in terms of costs and outcomes of community based interventions compared to hospital based interventions? • What is the impact on older people of referrals to hospital consultants and admissions for observation. • How much does quality of life influence admission into a care home. • What is the impact of waiting for aids and adaptations. Which have to be integrated into our mainstream commissioning processes (including hospitals, residential care etc)

26. Next steps • Have to get our JSNA going • What can be done regionally (EMPHO) • What can be done once (shared target group social marketing exercises) • What needs doing locally…. • Workshops.