Joint Strategic Needs Assessment JSNA The Manchester way

1. Joint Strategic Needs Assessment (JSNA) – The Manchester way

2. Starting Point - What is a JSNA? What it is Common baseline to underpin the development of the Community Strategy, Local Area Agreement and Commissioning Strategic Plan (CSP) Tool for use by commissioners within both health and social care A starting point! This is our view of what a JSNA should be. From the outset, we were really clear that the JSNA should be a useful tool for commissioners and this was the main influence on the structure and content of the final document. We also decided to produce something quickly, even if it was imperfect, rather than spending a substantial amount of time trying to produce the ‘perfect’ document. We wanted to have something out there that commissioners could begin to use and then have a process in place for improving the document over time in the light of their comments. So the current document is very much a starting point. Equally, we started off with a very clear view of what we didn’t want the JSNA to be. Over the years we have produced lots of information profiles of the city which haven’t had much influence on commissioning and we were determined not to repeat that mistake. Also, we were clear that the JSNA is a strategic document and we were not in the business of producing people’s commissioning strategies for them. It is up to individual commissioners to take the JSNA and use it to inform their work. Our role was to make it as easy as possible for them to do this. I’ve already said that the JSNA is a working document that will evolve over time to meet the requirements of commissioners. I will talk briefly at the end of this presentation about what we are doing to take the JSNA process further. This is our view of what a JSNA should be. From the outset, we were really clear that the JSNA should be a useful tool for commissioners and this was the main influence on the structure and content of the final document. We also decided to produce something quickly, even if it was imperfect, rather than spending a substantial amount of time trying to produce the ‘perfect’ document. We wanted to have something out there that commissioners could begin to use and then have a process in place for improving the document over time in the light of their comments. So the current document is very much a starting point. Equally, we started off with a very clear view of what we didn’t want the JSNA to be. Over the years we have produced lots of information profiles of the city which haven’t had much influence on commissioning and we were determined not to repeat that mistake. Also, we were clear that the JSNA is a strategic document and we were not in the business of producing people’s commissioning strategies for them. It is up to individual commissioners to take the JSNA and use it to inform their work. Our role was to make it as easy as possible for them to do this. I’ve already said that the JSNA is a working document that will evolve over time to meet the requirements of commissioners. I will talk briefly at the end of this presentation about what we are doing to take the JSNA process further.

3. Process Multi-agency Working Group established Representatives from NHS Manchester (Public Health/Information/Commissioning) Adults Social Care Children’s Services Manchester City Council (Research and Intelligence/Policy Analysis Teams) Local Involvement Network (LINk) Overall project management/co-ordination through Joint Health Unit

4. Ownership and engagement Executive sponsorship by Public Service Board (PSB) Regular feedback to Adults Health and Wellbeing Partnership Board, Children’s Board and PBC Hubs Input from policy leads for relevant topic areas Local community and user engagement Representation from Manchester LINk on Working Group Talking Health Discovery Survey (NHS Manchester) Public summary produced with input from freelance journalist The key stage in the process was to get the Manchester Public Service Board to sponsor the JSNA. This helped to ensure high level buy-in from all members of the LSP – not just health and social care. We also made sure the policy leads for each topic area were fully engaged in the process from the start and had the final say over the recommendations we were making in the document so that there was some consistency of content with existing strategies. We tried to engage with existing public and user involvement processes, such as the Local Involvement Network and the PCT’s Talking Health online public questionnaire. We have also produced a public summary of the JSNA. This was written by a freelance journalist in order to ensure that the language was non-technical and accessible to everyone. The key stage in the process was to get the Manchester Public Service Board to sponsor the JSNA. This helped to ensure high level buy-in from all members of the LSP – not just health and social care. We also made sure the policy leads for each topic area were fully engaged in the process from the start and had the final say over the recommendations we were making in the document so that there was some consistency of content with existing strategies. We tried to engage with existing public and user involvement processes, such as the Local Involvement Network and the PCT’s Talking Health online public questionnaire. We have also produced a public summary of the JSNA. This was written by a freelance journalist in order to ensure that the language was non-technical and accessible to everyone.

5. Methodology Compilation of data from existing information reports, strategy documents and needs assessments Mixture of text, data tables and charts/maps “What do commissioners need to consider?” boxes Common framework for each chapter/sub-section Cross-referenced with existing strategies to ensure consistency of approach and recommendations Analytically speaking, the JSNA is not that advanced and it is primarily a compilation of data and analysis from existing strategies and needs assessment. However, the way we put this material together was new and different from what had been done before. The key elements of the report are the “What do commissioners need to consider?” boxes. Analytically speaking, the JSNA is not that advanced and it is primarily a compilation of data and analysis from existing strategies and needs assessment. However, the way we put this material together was new and different from what had been done before. The key elements of the report are the “What do commissioners need to consider?” boxes.

6. Example – Chronic Obstructive Pulmonary Disease (COPD) Headline statistics National models suggest that there are aprox.16,500 people with COPD in Manchester (5.5% of the population aged 15 and over). The prevalence of COPD in Manchester is higher than the England average but lower than other comparable cities (e.g. Liverpool, Newcastle) Between 2005 and 2007, 146 people presented to Adult Social Care due to COPD. What do commissioners need to consider (examples)? Use of spirometry in schools and community pharmacies to test lung function Investment in social marketing programmes to support public health messages about the links between smoking and COPD Identify models of service provision to support the care needs of people using Individual Budgets Example of how we have attempted to link the information trends with recommendations to commissioners - what we refer to as the ‘so whats’.Example of how we have attempted to link the information trends with recommendations to commissioners - what we refer to as the ‘so whats’.

7. Milestones December 2007 - Project Initiation Document (PID) agreed May 2008 - First draft presented to Manchester Public Service Board (PSB) June/July 2008 - Presentation to PCT Board, Adults Health and Wellbeing Partnership and Children’s Board July/August 2008 – Presentations to PBC Hub Boards October 2008 – Full reference document and public summary signed off November 2008 – Formal launch at IHiM Conference Process of developing the JSNA took nearly a year so we mustn’t underestimate the scale of the task. At each stage of the work, we went back to the PSB and the relevant organisational management structures to keep them up-to-date with progress and make sure that they were continually engaged with the work. The document was launched at a major multi-agency commissioning event last November. Process of developing the JSNA took nearly a year so we mustn’t underestimate the scale of the task. At each stage of the work, we went back to the PSB and the relevant organisational management structures to keep them up-to-date with progress and make sure that they were continually engaged with the work. The document was launched at a major multi-agency commissioning event last November.

8. Next Steps Further analysis Locality JSNAs to support PBC Hubs, Children’s Services and Adult Social Care Districts etc. Application of population impact measures to key areas of JSNA JSNA website (http://www.manchester.gov.uk/jsna) Hub for sharing documents and data Evaluation and self-assessment Feed into the LAA refresh, future community strategies and updated Commissioning Strategic Plan Our current emphasis is on developing a process for producing Locality JSNAs. This reflects the fact that commissioning activity is increasingly being carried out at a very local level. We have established a JSNA webpage linked to the Manchester City Council site. This includes the JSNA itself, together with a range of accompanying material, including a series of Health Factsheets for every ward in the city. The fact that we have secured buy-in from the PSB means that we are well placed to ensure that the JSNA is able to inform the LAA refresh and the development of the next Community Strategy and Commissioning Strategic Plan. Our current emphasis is on developing a process for producing Locality JSNAs. This reflects the fact that commissioning activity is increasingly being carried out at a very local level. We have established a JSNA webpage linked to the Manchester City Council site. This includes the JSNA itself, together with a range of accompanying material, including a series of Health Factsheets for every ward in the city. The fact that we have secured buy-in from the PSB means that we are well placed to ensure that the JSNA is able to inform the LAA refresh and the development of the next Community Strategy and Commissioning Strategic Plan.

9. NW Survey: JSNAs and Commissioning – What Helps? The survey originally included nearly thirty questions covering the following areas of enquiry–Involvement, JSNA and Commissioning Plans, Outcomes-based commissioning, Relationships with Providers, and Inequalities. So as not to duplicate effort or the workload to the field the survey was reduced substantively to 10 questions. The survey was issued in connection with a NW Commissioners Forum event. Commissioners were invited to complete the questionnaire either online within a six-week period, or at the event itself. More than 60 people took part in this exercise representing 18 of the 22 LSPs in the Region. We collected a total of 39 individual responses with further summary comments collated by facilitators who supported discussions at the event. The survey originally included nearly thirty questions covering the following areas of enquiry–Involvement, JSNA and Commissioning Plans, Outcomes-based commissioning, Relationships with Providers, and Inequalities. So as not to duplicate effort or the workload to the field the survey was reduced substantively to 10 questions. The survey was issued in connection with a NW Commissioners Forum event. Commissioners were invited to complete the questionnaire either online within a six-week period, or at the event itself. More than 60 people took part in this exercise representing 18 of the 22 LSPs in the Region. We collected a total of 39 individual responses with further summary comments collated by facilitators who supported discussions at the event.

10. Manchester JSNA Partnership - Self-assessment Participated in regional review of JSNAs being undertaken by NW Public Health Observatory SWOT Analysis undertaken by members of JSNA Working Group Plans to assess views of wider-stakeholders using framework provided by JSNA Readiness Tool/Quality Assurance Toolkit

11. SWOT Analysis - Strengths “Further strengthened existing partnership arrangements” “Represents a collaborative and joined-up approach to needs assessment between sectors” “Strong support and ownership by key players” “Provides a very sound basis for raising challenging questions about the future commissioning of services”

12. SWOT Analysis - Weaknesses “Community Engagement - challenges of getting best bits from Children’s Services, ASC and NHS Manchester and emerging LINk and getting it all to gel together” “Not sure all commissioning staff are aware of/using the information – especially in PbC” “Available data may not fully meet the needs and expectations of commissioners” “Evaluation of impact on commissioning - discussed, but as yet not fully developed”

13. SWOT Analysis - Opportunities “Links to other needs assessment work under umbrella of PSB (e.g. Crime and Disorder) and LAA (review and refresh)” “Development of Joint Commissioning Approach -Manchester Model and better access to and utilisation of expertise in Universities (e.g. predictive modelling)” “To embed intelligent, needs-led commissioning processes across health and social care” “Locality JSNAs offer real and worthwhile opportunities to develop the thrust of the JSNA process and principles”

14. SWOT Analysis - Threats “Lack of consistency of commissioning streams e.g. PbC x3; Children’s services; NHS/MCC shared commissioning not fully developed” “Ensuring that the JSNA is not seen as the answer to everything - rather a crucial part of the intelligence required by a range of services to better understand what provision is required in the future” “Capacity of PBC and district level partners (Children’s and Adults) to take on Locality JSNA development”

15. Impact to date NHS Manchester Commissioning Strategic Plan (CSP) Adult Social Care Change Programme and Prevention Strategy Implementation Plan Manchester City Council Carers Strategy 2008-2011 Drugs and Alcohol Commissioning Strategy North West Strategic Migration Partnership Although the timetables did not match exactly, we were able to produce a draft version of the JSNA in time to feed in to NHS Manchester’s Commissioning Strategic Plan (CSP). The high level priorities contained in the CSP mirror some of the key issues emerging from the JSNA (e.g. under-18 conceptions, alcohol, childhood obesity and personalised care plans). The section of the JSNA looking at the health of migrants has been fed into the recent report on “Health & Migration in the North West of England”, produced by the North West Strategic Migration Partnership. Although the timetables did not match exactly, we were able to produce a draft version of the JSNA in time to feed in to NHS Manchester’s Commissioning Strategic Plan (CSP). The high level priorities contained in the CSP mirror some of the key issues emerging from the JSNA (e.g. under-18 conceptions, alcohol, childhood obesity and personalised care plans). The section of the JSNA looking at the health of migrants has been fed into the recent report on “Health & Migration in the North West of England”, produced by the North West Strategic Migration Partnership.

16. Making JSNAs work for commissioners How do we engage with commissioners across different parts of the system? NHS (PCT and PBC) Adult Social Care Children’s Services Third sector organisations How should we best design and structure the content and outputs of the JSNA to make it useful for commissioners? How might we evaluate the impact of the JSNA on commissioning behaviours and decisions?

17. What can we offer? Experience of making the best use of political structures across the NHS and local government to ensure wider ownership of JSNA beyond commissioning Understanding of joint working arrangements and links between JSNA, Community Strategy, LAA and CYPP Knowledge of ‘soft’ information sources held by local authority departments Links with other local partnerships to identify and access best practice across the North West

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