The foundation of effective strategic commissioning is a picture of the local community and its health and wellbeing needs. The White Paper Our health, our care, our say outlined the proposed requirement for local authorities and PCTs to undertake regular joint strategic needs assessments (JSNA) to enable them to forward plan, 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. The aim of JSNA is to ensure that PCTs and local authorities have a better understanding of their local populations and the challenges they face in tackling health inequalities. PCT Directors of Commissioning should work together with the Director of Public Health, the Director of Adult Social Services and the Director of Children's Services to lead the process across commissioner and provider organisations in order to collate and pool knowledge. This will require analysis and interpretation of data held by many agencies to establish a baseline of population needs.

JSNA will be a cornerstone for implementing the Commissioning framework for health and wellbeing and the NHS framework for World class commissioning. It should drive the commissioning process, highlighting areas of concern that need further investigation and identifying priorities.

The Local Government and Public Involvement in Health Act 2007 places a new duty on PCTs and upper tier local authorities to jointly deliver a JSNA from April 2008. A JSNA is based on a joint analysis of current and predicted health and wellbeing outcomes, an account of what people in the local community want from their services, and a view of the future, predicting and anticipating potential new or unmet need. It should incorporate views of the local population, not just existing users of services, and include and be informed by equality impact assessments.

JSNA is a continuous process that indentifies the 'big picture' in terms of the health and wellbeing needs and inequalities of a local population. The issues identified by JSNA should inform the priorities and targets set by the Local Area Agreement and consequent commissioning strategies, and influence other strategies and plans e.g. PCT Local Delivery Plans, Children and Young People's Plans, PBC commissioning plans, Supporting People strategies, and Community Safety Strategies. JSNA should have an impact on commissioner priorities and actions, including practice-based commissioners, and government will look for evidence that commissioning decisions have been informed by the JSNA.

JSNA will provide a framework to examine all the factors that impact on health and wellbeing of local communities, including employment, education, housing, and environmental factors. A national core data set for JSNA, published here, signposts a range of existing data sources that can assist the JSNA process. Local authorities and PCTs will be expected to supplement the core data set with additional, locally relevant information to add depth and insight into the needs of their populations, having locally agreed standards on data quality for inclusion. A 'minimum' data set for JSNA would include the following:

Guidance states that the JSNA process will be underpinned by:

• partnership working - PCTs and local authorities are jointly responsible for including statutory partners in the Local Strategic Partnership, providers from the public, private and third sectors and members of the local community;
• community engagement - actively engaging with local communities, patients, service users, carers and providers - including the third and private sectors - to develop a full understanding of needs is a key facet of JSNA. Communities should be involved in all stages of JSNA from planning to delivering and evaluating, rather than being restricted to commenting on final drafts;
• evidence of effectiveness - by identifying relevant best practice, innovation and research to inform how needs will best be met.

Click here for further information about population needs methodology.

Assessing the needs of children and young people

The Children Act 2004 requires local authorities to prepare and publish an overarching plan setting out their strategy for discharging their functions in relation to children and young people. The Children and Young People's Plan (CYPP) is prepared by local authorities and their partners, feeding into and informed by the Sustainable Communities Strategy. A key element of the CYPP is the requirement to carry out a comprehensive needs assessment, in partnership with all those involved in the planning process, and to review it on a regular basis. The needs assessment is based on the requirement to improve the five Every Child Matters (ECM) outcomes for children, young people and their families. The scope of the CYPP therefore extends to all services affecting children in the locality, not just those provided by the local authority. With its focus on outcomes, partnership working and consultation, the CYPP process is fully consistent with that of JSNA, with JSNA taking the needs of the full age range of the local population into account.

Strategic alignment of the CYPP and JSNA process, using consistent and identical datasets, is therefore needed. The data to inform the health and wellbeing aspects of the five ECM outcomes will eventually be contained within the core dataset for JSNA, together with a wider range of information that can be used to support the CYPP.

Sources of further help - external links

The National Adult Social Care Intelligence Service (NASCIS) is a suite of analytical tools and information resources allowing for analysis of Social Care data to support activities such as planning, performance management and service improvement. Analytical tools include NASCIS interactive Online Analytical Processing Tool and Standard Reports. Also included are links to POPPI, PANSI and FLoSC tools developed by the Care Services Efficiency Delivery Programme (CSED)

Commissioning Services out of Joint Strategic Needs Assessment - A Discussion Paper reports the findings of a small-scale survey undertaken in the North West in order to
determine the priorities for Regional JSNA development activity in 2009/10. 

Joint Strategic Needs Assessment is a publication from the Improvement and Development Agency's (IDeA's) Healthy Communities Programme. It highlights the variety of approaches taken across the country and what has been achieved. It also states that much more needs to be done to ensure all areas use the joint strategic needs assessment process effectively to improve the health and well-being of their population and reduce inequalities.

A web site dedicated to Joint Strategic Needs Assessment has been launched by the Department of Health. It gives background information on JSNA, pulls together existing information and documents and provides access to tools and resources to support the implementation of JSNA.

Joint Strategic Needs Assessment, Health Inequalities and Commissioning - Next Steps in the North West, 1st July 2008 at the Reebok Stadium, Bolton

Following up on two successful workshops held last year around the subject of Joint Strategic Needs Assessment, the Care Services Improvement Partnership, working with a partnership of regional organisations, including: the Regional Public Health Group, Government Office North West, NHS North West and ADASS, organised this event to bring people up to date with progress on JSNAs so far, both nationally and regionally, review the links to LAAs and community plans and share good practice.

 Please click here to access the full programme with web links to background documents, or click on the links given below to download the individual presentations given during the day:

• Health inequalities: progress and next steps: A North West perspective.
• How JSNAs fit within the new Comprehensive Area Assessment Framework.
• From JSNA to commissioning.
• Pulling it all together: can the JSNA jigsaw deliver wellbeing?
• Implementing Joint Strategic Needs Assessment: launching the North West project.

 For further information please contact philip.jones@csip.org.uk.

A JSNA podcast is one of a series to help commissioners understand the changing landscape of health and local authority commissioning to meet local population needs. Seamus Breen, a commissioner in Yorkshire/Humberside, explores the statutory requirement of Joint Strategic Needs Assessment with author of the guidance, Dr Renu Bindra, National DH Policy Lead on JSNA.

The JSNA Readiness Tool provides a relatively simple and cost-effective way of assessing the readiness of local systems to ensure a Joint Strategic Needs Assessment of their population is undertaken and completed. It enables a rapid appraisal of a system’s readiness and progress in delivering a JSNA and identifies areas of difficulty, thereby enabling a focus upon remedial action commensurate with the significance of the problems.

Guidance on Joint Strategic Needs Assessment was produced in December 2007, which provides tools for local partners undertaking JSNA. It describes the stages of the process, including stakeholder involvement, engaging with communities and recommendations on timing and linking with other strategic plans. It also contains a core dataset, guidance on using JSNA to inform local commissioning and provides signposts to tools and resources to support JSNA.

The Care Services Efficiency Delivery (CSED) programme has developed an online demand forecasting and capacity planning system www.poppi.org.uk. The Projecting Older People Population Information (POPPI) system explores the impact that demography and certain conditions may have on populations aged 65 and over. It provides population projections to district level with characteristics and prevalence assumptions from research. The information can be used as a starting point for Joint Strategic Needs Assessment and the system will deliver a consistent baseline.

The North West Public Health Observatory at http://www.nwph.net/nwpho offers a range of local public health intelligence and links to national datasets. NWPHO holds datasets of hospital episode, mortality and birth statistics as well as geographic and demographic information, and makes them available via interactive web-based tools. Local health profiles are available for any postcode in the North West. NWPHO provide training, support and advice on methods such as HEA, HNA, lifestyle surveys and health scrutiny. Downloadable articles and regular reports are also produced such as sexual health bulletin, birth trends, hospital admissions, and 'Where wealth means health' (Justin Wood, Tom Hennell, Alyson Jones et al. January 2006) which discusses health inequalities.

The Association of Public Health Observatories www.apho.org.uk provides models for estimating the prevalence of hypertension, diabetes, coronary heart disease and chronic obstructive pulmonary disease, with further models in development.

Health needs assessment (HNA) is a systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities. The Health Development Agency published Health Needs Assessment - a practical guide in 2005, it can be downloaded from the NICE website at http://www.nice.org.uk/aboutnice/whoweare/aboutthehda/hdapublications/ health_needs_assessment_a_practical_guide.jsp. The BMJ has published a series of six articles describing approaches to and topics for health needs assessment, and how the results can be used effectively www.bmj.com/cgi/content/full/316/7142/1448.

Health impact assessment (HIA) helps to identify the potential health consequences of a proposal on a given population, and recommend ways to maximise the positive health benefits and minimise potential adverse effects on health and inequalities of the proposal. www.hiagateway.org.uk provides further information about HIA and links to reports, completed HIA case studies, HIA toolkits, training courses, and contact details. The King's Fund have a health impact assessment reading list.

Health equity audit (HEA) identifies how fairly services or other resources are distributed in relation to the health needs of different groups and areas, and the priority action to provide services relative to need. Policy and guidance on health inequalities can be found at www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/HealthInequalities/fs/en and the Department of Health published Health Equity Audit - a guide for the NHS in 2003.

The Health Poverty index visualisation tool www.hpi.org.uk/index.php gives a high-level overview of each local authority area showing its 'health poverty' - a combination of the present state of health, the root causes and intervening factors. It includes some data enabling comparison across ethnic groups.

The Local Basket of Indicators and the interactive Health Inequalities Intervention Tool can both be accessed via the London Health Observatory web site. The local basket of indicators provides a menu of indicators to examine health inequalities across a range of dimensions. The intervention tool pulls together key information on disease and life expectancy.

The Index of Multiple Deprivation 2007 combines a number of indicators, covering a rnage of economic, social and housing issues, into a single deprivation score for each small area in England. This allows each area to be ranked relative to one another according to their level of deprivation, which will be useful for commissioners when undertaking strategic needs assessments.

The Department for Education and Skills (DfES) published Data sources for commissioners for children, young people and maternity services in 2006. This document bring together many sources of data for needs assessment, writing Children and Young People's Plans, comparing against statistical neighbours, and performance management so that commissioners can base decisions on evidence.

The Child and Maternal Health Intelligence Unit (CHIMAT) www.chimat.org.uk is a new national resource providing access to information and knowledge related to child and maternal health. It is currently developing a specific needs assessment tool for children, based around the requirements of the CYPP and with clear linkage to the JSNA core data set.

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