Marion Usher, Health and Wellbeing Development Manager, NHS NE

1. Draft statutory guidance on Joint Strategic Needs Assessments (JSNAs) and joint health and wellbeing strategies Marion Usher, Health and Wellbeing Development Manager, NHS NE

2. Role of JSNAs, joint health and wellbeing strategies and health and wellbeing boards in the future • The Government has set out a new vision for the leadership and delivery of health and care services. This includes building upon progress with establishing Joint Strategic Needs Assessments (JSNAs) as a fundamental part of the planning and commissioning cycle at a local level. • Central to this vision is that decisions about services should be made as locally as possible, involving people who use them and communities to the maximum degree – HWBs are a key part of this. • To achieve improved health and wellbeing outcomes for local communities, there needs to be increased joint working between the NHS and local authorities, with high quality local leadership from the health and wellbeing board and relationships being an essential foundation. • Health and wellbeing boards will have a role in improving joint working by bringing together key commissioners across the local system and through their function of encouraging integrated working in relation to commissioning. • Health and wellbeing boards provide leadership across the local authority (including Public Health, Adult Social Care, Children’s Services, and elected members), the local NHS (by CCGs and where needed the local arm of the NHS CB); and the local community facilitated by Healthwatch. • The ambition is for health and wellbeing boards to go further than analysis of common problems and to develop deep and productive partnerships that provide solutions to those commissioning challenges, rather than just commenting on what those problems and challenges are. This is the essence of what Joint Strategic Needs Assessments and joint health and wellbeing strategies are there to do.

3. Key challenges for emerging health and wellbeing boards Not being “talking shops” or over-bureaucratic committees – focused on action Avoid becoming the “Christmas tree” for every difficult issue Managing expectations – genuinely integrated working takes time, often years How to engage the wider public, not just the interested few Building support for the need for transformational change Maintaining enthusiasm – quick wins as well as strategic transformation 3

4. How can we learn together, the national contribution The National Learning Network : Learning community which includes: 11 Learning sets based around themes of common interest (95 HWB are members) Associates: all members of HWBs, experts, policy leads and key stakeholders An on-line “Community of Practice” to facilitate learning and sharing between network members and the learning community National events to stimulate new thinking and share learning Development support to individual HWBs (provided by the LGA) Leadership development programme for HWB members Aligning HWB development with other change programmes (Public Health transition, CCG development, establishing Local Healthwatch) 4 4

5. Learning set themes Improving services through more effective joint working - including a specific focus on Children & Young People Improving the health of the population Bringing collaborative leadership to major service reconfiguration Creating effective governance arrangements How do we “hard-wire” public engagement into the work of HWBs? “Raising the bar on Joint Strategic Needs Assessment and joint health and wellbeing strategies Making the best use of collective resources 5 5

6. Current hot topics CCG authorisation How can the process support CCG development and furtherdevelopstrong relationshipswithin HWBs? How can CCGs provide evidence of engagement in HWBs and JSNA and JHWS processes Widening the scope of JSNA to develop a “picture of place” Agreeing a “first-cut” joint health and wellbeing strategy by July 2012 Using the strategy to shape individual commissioning plans for 2013/14 How can Boards best support the development of Local Healthwatch? Developing strong relationships while HWB membership is still in transition 6

7. Learning from the experience of JSNAs so far • JSNAs have been required by local authorities and PCTs since 2007. It is reported that progress since has been good, but there are still too many poor quality JSNAs • Most JSNAs to date have focused on a “deficit” approach based on mortality and illness. Relatively few have been balanced by an assessment of the assets, strengths and capacities of local communities. • Experience also suggests that to date, community engagement in JSNAs has been variable. • Health and wellbeing boards provide an opportunity to refresh and support good JSNAs within the context of true partnership working across agencies. • The new joint health and wellbeing strategy provides the link to commissioning decisions and can encourage integrated and joint commissioning.

8. JSNAs and joint health and wellbeing strategies – tools for shared leadership What services do we need to commission (or de-commission), provide and shape; both separately and jointly? – commissioning plans So what are our priorities for collective action, and how will we achieve them together? – the JHWS Explicit link from evidence to service planning What are we doing now, how well is it working and how efficient is it? - a analysis on our progress So what does that mean they need, now and in the future and what assets do we have? – a narrative on the evidence - the JSNA What does our population & place look like? –evidence and collective insight Engagement with users and the public HEALTH & WELLBEING BOARD

9. Feedback from health and wellbeing boards so far • There needs to be an understanding of JSNAs and joint health and wellbeing strategies as part of an ongoing process, not a “shopping list” • Local leaders are best placed to understand the broad range of groups in their community and any central attempt to comprehensively list all groups will always lead to inadvertently prioritising or missing one group or another • An emphasis on assessing the full needs of the whole local population, across the life course, and also thinking about assets than can be used • Need for leadership from the health and wellbeing board – joint responsibility to input into and act upon JSNAs and joint health and wellbeing strategies • Opportunity to tackle inequalities and wider determinants through joint working across agencies and also with local partners and their strategies • Thinking about a wide evidence base – qualitative and quantitative from a number of sources and service areas • Making the link to commissioning – JSNA and joint health and wellbeing strategy not an end in itself, but a process to get to the services that meet the need of the local population

10. Development of statutory guidance • Statutory guidance on JSNAs and joint health and wellbeing strategies has been developed and was published in January in draft for feedback • It is high level – focus on the principles and processes of good JSNAs and joint health and wellbeing strategies • Has been informed by early implementer health and wellbeing boards • We sought wider feedback from the health and care system, and stakeholders on this draft during January and February – this has now closed • We are now refining the draft ahead of a short public consultation in the Spring • Our aims in publishing the draft guidance were twofold: • To support emerging shadow health and wellbeing boards in refreshing their JSNAs and developing joint health and wellbeing strategies ready to inform commissioning plans in for 2013/14 (in preparation from autumn 2012) • To gain feedback to ensure the final version of the guidance is fit for purpose and builds on the experiences of emerging HWBs • We plan to develop wider suite of resources to support health and wellbeing boards, co-produced with partners and sector leaders • Aim to provide support to health and wellbeing boards and their partners where they want it – about delving into specific challenges • Could be a number of tools and a range of formats for various audiences

11. Key points in the draft guidance (1/2) • JSNAs look at a range of evidence on the local area to identify what is needed to improve the health and wellbeing of the local population now and in the future, and possibly what assets can be used to meet these needs • narrative on the data and should provide the trail from impartial evidence to decisions made, providing a clear rationale • Joint health and wellbeing strategies are where health and wellbeing board members agree their top priorities to focus on together as a basis for (but not the totality of) their commissioning plans and decisions • prioritise the greatest needs and not try to take action on everything all at once • Commissioning plans to be informed by the priorities identified in the joint health and wellbeing strategy, involving the health and wellbeing board in their development • flexibilities in commissioning – find best way to meet the needs, including joint action • Cover the whole population and life course – including children & young people, older people, hard to reach / chronically excluded groups; looking at a range of types of need – including health, wellbeing, care and wider influences

12. Key points in the draft guidance (2/2) • Cover the upper-tier local authority area, consulting districts / borough councils, and involving the NHS Commissioning Board - unique to the area • Undertaken by the whole health and wellbeing board – equal responsibility • Are links with other responsibilities health and wellbeing board members have (e.g. addressing health inequalities) • Involve other local partners and the community, considering accessibility and Public Sector Equality Duty, with Local Healthwatch as a facilitator or conduit • Use expertise of other partners to understand and address the needs of different groups, especially the excluded and vulnerable • Are continuous and iterative processes, building on and informing other assessments and strategies • They are not ends in themselves • Can use agreed priorities to influence wider commissioning and action at a local level – encourage partners to adopt the outcomes and all contribute • Strategic tools to understand and taking action on local inequalities • Are integral part of commissioning cycles so should be timed to align • JSNAs can drive improved evidence in areas where it has been poor in the past (e.g. homelessness)

13. Some good practice on JSNAs • Torbay has a dynamic and interactive online dataset for GPs that allows them to look at linear growth models for the local area, and compare ward or GP practice-level data. • Portsmouth use a prioritisation sheet format for partners to submit needs assessment requests. Workshops, made up of a wide group of stakeholders, are then asked to score the requests. A score greater than 12 identifies the topic as a high priority. • Newcastle has a shared online information and data analysis resource spanning health and wellbeing for everyone who commissions or uses health, social and children`s services in the city. • Currently, Gateshead`s Overview and Scrutiny Committee is reviewing its JSNA with an emphasis on ensuring that the JSNA informs other strategies and commissioning intentions. The review includes a peer review of the current JSNA.

14. Some good practice on H&WB strategies • There is little limited good practice to share at this stage. • The North West transition alliance has produced a report entitled “Principles, Processes and Production” of a joint H&WB strategy. Ideas include: • Gaining agreement to the process to consider influences and evidence, from which it derives priorities and builds the H&WBS. • Identifying the most pressing needs, inequalities, gaps an patterns of future need. • Using a decision making or weighting toolkit to help agree priorities • Determining the number of priorities- will it be 3, 6 12 or more? • Alignment with other strategies • Communication and implementation of the strategy. www.transitionalliance.co.uk

15. More good ideas for H&WB strategies • Birmingham have produced a guide to a joint H&WB strategy. This suggests making it an ongoing process, linking it to the life course framework and outcomes, as shown below.

16. Voluntary and Community Sector Contribution to JSNAs VONNE suggest the following-: • V&CS Contributions could include: • Data and information about service user needs • Engage people who lack visibility • Knowledge about local services and gaps • Map of local provision and inform future service planning • How to engage: • Find out who leads the JSNA process locally and ask how they engage the VCS • Demonstrate how your group or organisation can contribute to the JSNA and H&WBS and how your service impacts on local outcomes • Make sure your evidence is clear- how will you quantify outcomes and value? • Develop links with other organisations ( eg VONNE network)

17. Forward direction • Emerging shadow health and wellbeing boards and stakeholders engaged on the draft guidance • DH held a short public consultation of between 4 and 8 weeks, based on the feedback. • The guidance will then be refined the draft before publishing the final statutory guidance after Royal Assent, before Summer Recess 2012. • Statutory guidance is just part of the work to support JSNAs and joint health and wellbeing strategies • it is the core that will inform many other resources • informed and driven by the National Learning Network and links with stakeholders • As discussions take place, topics and themes for the “suite” will surface • Contact: JSNAandJHWS@dh.gsi.gov.uk