PUBLIC HEALTH
Walsall
Joint Strategic Needs Assessment:
Briefing Paper
Public Health Report No: PH0004-SL0802
Author: Dr Sue Laverty and Rachel Robinson
Issued: 1st February 2006
Public Health Directorate
Walsall Teaching Primary Care Trust
Jubilee House
Bloxwich Lane
Walsall
WS2 7JL
Telephone: 01922 618388
Facsimile: 01922 618360
www.walsall.nhs.uk
1
Walsall Joint Strategic Needs Assessment
Briefing Paper
1. Purpose
This briefing paper discusses the new duty conferred on local authorities and PCTs to
develop Joint Strategic Needs Assessments (JSNA), the implications for
commissioning and service planning in Walsall and suggests how this important area of
work may be progressed locally. It has been produced for the Director of Public Health,
Director of Social Care and Inclusion, Associate Director for Adults Services and the
Director of Children’s Services.
2. Background
The Local Public Involvement in Health Act (October 2007) signals a new direction for
local government. In the context of developing further effective, accountable local
government it seeks to:
 Strengthen strategic leadership and partnership approaches
 Empower local citizens and communities
 Focus commissioning on outcomes
 Simplify the performance framework and move to a light touch approach in
terms of inspection
At the same time the NHS is in the midst of significant reform. There is a synergy
between the approach outlined above and the NHS systems reform agenda. JSNA is
seen as a crucial part of this agenda. There is increasing recognition that
commissioning has focused on volume and price, rather than outcomes. There is an
over emphasis on providing care in institutional and acute settings. Our focus has been
on treating illness rather than preventing them and progress in tackling health
inequalities has been slow. Whilst, the challenge of providing choice, placing patients
at the centre and importantly giving them a real say in service development remains.
Proposed in a Commissioning Framework for Health and Well-being (2007) and
Creating Strong, Safe and Prosperous Communities (2007), the JSNA is seen as an
important tool in addressing some of these issues.
2. What is a JSNA?
A JSNA aims to inform commissioning strategies designed to improve health and wellbeing and reduce inequalities. It should inform health and social service planning
decisions and delivery of priorities through the Local Area Agreement, in both the
medium and longer term. In addition the JSNA should be used to inform and link to a
range of other plans and strategies including, Sustainable Community Strategy, PCT
local delivery plans, PBC business plans, Children and Young People’s plan to name
but a few.
JSNA is a continuous process underpinned by three key principles:
 Partnership working
 Community engagement
 Evidence of effectiveness
It is a core element in the commissioning cycle (see diagram 1) and it is envisaged that
a range of outputs might derive from this process (see diagram 2).
The findings from the assessment will need to be shared with a range of stakeholders
in order to inform commissioning decision across the health and local authority sector.
2
Diagram 1: The commissioning cycle
Needs
Priorities
Review Outcomes
(what are the gaps and
how do we fill the gaps)
Deliver plan
Decide action
Get resources
This part of the cycle is where the outcomes are measured
Diagram 2: JSNA
3
3. Why do a JSNA?
Undertaking a JSNA is a statutory requirement but the real value of the JSNA process
is in providing a framework for enhanced partnership working and community
involvement around the commissioning agenda. JSNAs provide the opportunity to look
ahead 3-15 years and support and direct change so that local services:
 Are shaped by the views of local people
 Reduce health inequalities
 Increase social inclusion
 Are delivered effectively and efficiently.
A good JSNA will:
 Define achievable improvements in health and social care outcomes for local
people
 Inform commissioning cycles
 Aid better decision making
 Underpin the Local Area Agreement and the PCT’s prospectus
 Send signals to existing and potential providers of services about potential
service change
4. Implementing JSNA in Walsall
Whilst health needs assessment are not new the JSNA offers the opportunity to
systematise our approach and undertake assessments jointly across health and local
government sectors. This approach does raise important issues which are now
discussed in turn
4.1 JSNA – local vision
Considerable latitude has been given to how localities define and utilise JSNAs. JSNA
is not an end in itself. The value of this approach depends on local agreement re its
value and the role it will play in informing local commissioning cycles across the health
economy.
There needs to be local ownership and agreement about what success looks like. How
will we know if JSNA has been worthwhile? How close are we in Walsall to agreeing
this vision and the criterion for success? What do we need to do next to achieve it?
(see section 4)
4.2 Refining the question
There is no dearth of data to collate nor of information to present and herein lies a
danger. Whilst it might seem appealing to want to collect data on every conceivable
determinant of health and wellbeing, the reality is that without focus a needs
assessment can easily loose its way. Data collation becomes an end in itself.
It is more useful for a needs assessment to be question-led and allow this to refine your
approach. What are the specific questions that commissioners want answers to? How
prepared are they to act on a plausible range of answers? What is their commitment?
Focusing the line of enquiry is more likely to result in an effective JSNA which informs
change. To this end implementing JSNA locally will require engaging with key
commissioning and planning groups across the health and partnership sector.
Initial discussions regarding the focus of JSNA in Walsall have suggested that tackling
health inequalities offers a good option. Given that it has been prioritised in Walsall
tPCT’s strategy and a prime focus of Walsall MBC as a spearhead authority.
Focusing the JSNA on this issue would tie in with the development of a local Health
Inequalities Strategy and also build on existing needs assessments filling any gaps
from an inequalities perspective.
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4.3 Data collation
It is clear that a good JSNA relies on sound data. A national minimum core dataset is
being developed, which takes into account the DOH’s key outcomes and the Local
Government National Indicator set. There is an expectation that locally relevant data
sets will be added. See appendix 1 for the dataset as it currently stands with comments
about availability and collation of the information across Walsall. In addition, work has
begun in Walsall assembling other relevant documents and data.
Agreeing, populating and maintaining this dataset poses challenges and begs the
question of whether Walsall has the infrastructure, in terms of information databases,
analyst’s ands resources to support this work and the additional work proposed locally.
Currently, both within and between organisations different information systems and
teams collect information and produce intelligence derived from the data. These
systems are not necessarily compatible and interpretation of the data requires a good
working knowledge and experience of the organisation/sector.
There are resource implications for implementing this process which need to be
considered. In terms of capacity analyst support will be required for the collation,
verification and interpretation of the data. This may require a dedicated officer/team
across organisations to co-ordinate the work. An attempt was made to develop a
pooled intelligence resource across Walsall. The Shared Partnership Information
Resource (SPIR) had a vision to be pro-active, action driven by shared strategies and
pooled intelligence resource. The resource was to inform local decision making and
the development of strategies to reflect common objectives. A data warehouse was
developed and hosted at Black Country Observatory (BCO) containing shared socioeconomic information. Whilst the features and the benefits of the SPIR were
recognised across the Borough sustaining the system proved difficult for a number of
reasons. The JSNA may provide an opportunity to revisit this principle.
5. Next steps in Walsall
It has been shown that JSNAs will allow us to build on existing expertise and
knowledge in needs analysis and further strengthen partnership approaches locally.
The change required to deliver effective JSNAs is in degree rather than kind. It will
require:
 Agreeing a vision for JSNA, defining criterion for success and ensuring
ownership across the partnership
 Stronger partnership working across the commissioning agenda and
rationalisation of the process and structures which support it
 Shared data collation and analysis and consideration of the infrastructure
required to ensure timely delivery
 An explicit reporting pathway, a clearly identifiable line of accountability and
performance monitoring framework
A suggested way forward is to:
 Agree an overall steering group comprising the Directors of Public Health,
Adults Social Services, Director of Children’s services and the Director of
Walsall Borough Strategic partnership.
 Establish a working group to address the key issues outlined above with initial
priorities to include, agreeing a vision and local ownership of JSNA, developing
the minimum data set and framework for collation and completing an initial
draft by October 2008.
 It has to be acknowledged that this is an interitive process which will be refined
over the next 12-14 months.
5
Appendix 1 – Data Required for JSNA
Local Availability
v7a
Domain
Table 1: PRIMARY DATA NEEDED FOR A STRATEGIC NEEDS ASSESSMENT
Sub-domain
Population
numbers
Sub-subdomain
Data/Indicator
Available
Source
Estimates
5 year age bands and gender
Y
ONS
Projections
Population 3-5 years ahead
Y
ONS
Current
Current births
Y
ONS or
PCT
Lead
Agency/
Officer
LA or
PCT
LA or
PCT
PCT
Frequency
Reported
Lowest
Geography
Covered
Annual
Borough
Annual
Borough
Quarterly
Postcode
Demography
Births
Projections
Projected births
Y
PCT
PCT
Annual
Borough
Estimates
Numbers and percentages by age
band
Y
ONS
LA or
PCT
Annual
Borough
Projections
3-5 years ahead
N
Limiting Long-Term Illness
Y
ONS,
Census
Y
ONS
Y
Y
Ethnicity
Disability
Social &
Environmental
Context
Migration
Misc proxy
indicators
Deprivation
Living
arrangements
Housing
Bold red = National Indicators
Italic grey = optional indicators
See www.auditcommission.gov.uk/migrantworkers/d
ata for available indicators
Index of Multiple Deprivation (IMD)
Proportion of children in poverty
(NI 116)
1. Housing tenure
2. Overcrowding
Older People
1. Living alone
2. Central heating
LA or
PCT
Borough
LA or
PCT
Every 10
yrs
SOA
ODPM
LA or
PCT
Every 3
years
SOA
ONS,
Census
LA or
PCT
Every 10
yrs
SOA
Comments
Not currently available
but could be estimated
from historic data and
local intelligence
A joint working group led
by Tim Ferguson, could
look at
developing/scrutinising
local demographic
estimates and projections
More detailed description
of data is available
Work in progress. Indicators are liable
to be added, removed or amended.
Appendix 1 – Data Required for JSNA
Local Availability
Domain
v7a
Sub-domain
Sub-subdomain
Data/Indicator
Available
Source
Adults with learning disabilities in
settled accommodation (NI 145)
Adults in contact with secondary
mental health services in settled
accommodation (NI 149)
Economic
Environment
Transport
Access to car or van, etc
Employmen
t
1. Overall employment rate (NI
151)
2. Working age people on out-ofwork benefits (NI 152)
3. Working age people claiming
out-of-work benefits in the
worst performing
neighbourhoods (NI 153)
Vulnerable People
1. Adults with learning disabilities
in employment (NI 146)
2. Adults in contact with
secondary mental health
services in employment (NI
150)
Other Employment Indicators– e.g.:
Unemployment rate,
Claimant count, etc
Other
Average incomes
Isolation
Rural or urban location
Access to services (e.g. from Indices
of Deprivation)
Voice
Bold red = National Indicators
Italic grey = optional indicators
Satisfaction of people over 65 with
home and neighbourhood (NI 138)
Lead
Agency/
Officer
Frequency
Reported
Lowest
Geography
Covered
Every 10
yrs
SOA
Comments
LA
Y
ONS,
Census
LA or
PCT
LA
Y
ONS
PCT or
LA
Annual
Borough
Y
ODPM
LA or
PCT
Every 3
years
SOA
More detailed description
of data is available
LA
Work in progress. Indicators are liable
to be added, removed or amended.
Appendix 1 – Data Required for JSNA
Local Availability
Lifestyle/Risk factors
Domain
v7a
Sub-domain
Burde
n of illhealth
an
disabili
ty
Frequency
Reported
PCT
PCT
Jo
Robinson
Annual
Quarterly
Annual
Borough
PCT
PHIT and
Caroline
Mansell
Annual
Postcode
Manor
PCT
PHIT
Annual
Postcode
Smoking
1. Modelled and/or recorded
prevalence
2. Quit rates
3. Deaths due to smoking
Y
Y
N
Eating
habits
Modelled and/or recorded eating
behaviour
Prevalence of breast-feeding at 6-8
weeks from birth (NI 53)
N
Y
PCT
Y
Alcohol
Alcohol-harm related hospital
admission rates (NI 39)
Modelled and/or recorded drinking
behaviour
Lowest
Geography
Covered
E.g. from Active People Survey
Y
Sports
England
PCT
Paul
Wicker
Every 2
years
Ward?
Sexual
Behaviour
Under 18 conceptions (NI 112)
Under 16 conceptions
Y
ONS
PCT
Diane
Osborne
Annual
Some ward
data is
available
Hypertension
Modelled and/or recorded prevalence
Y
Doncaster
Model
PCT
PHIT
Annual
Practice
N
Obesity
Modelled and/or recorded prevalence
: adults
Obesity among primary school age
children in Reception Year (NI 55)
Obesity among primary school age
children in Year 6 (NI 56)
Y
NCMP
PCT
PHIT
Annual
Postcode
Y
NCHOD
ONS
PCT
PHIT
Annual
Borough
(some LE
calculations
at ward)
All Causes
Bold red = National Indicators
Italic grey = optional indicators
All-Age All-Cause Mortality (NI 120)
Life Expectancy
Comments
Some data is available
routinely, data on deaths
would need to be
estimated fro evidence
and death extracts
Data on feeding at 6-8
weeks is available, but
coverage is around 80%.
Coverage for Initiation
rates are higher
N
Physical
Activity
Other
Misc
Lead
Agency/
Officer
Data/Indicator
Behaviours
Available
Source
Sub-subdomain
A separate local report
and action plan was
produced by Paul
This data is always 2
years out of date, local
proxy measures are
being developed by the
PCT
See comment below
Work in progress. Indicators are liable
to be added, removed or amended.
Appendix 1 – Data Required for JSNA
Local Availability
Domain
v7a
Sub-domain
Sub-subdomain
Frequency
Reported
Lowest
Geography
Covered
Annual
Ward
Annual
Ward
PCT
PHIT
Annual
Borough
ONS
PCT
PHIT
Annual
Borough
PBS
Diabetes
Population
Prevalence
Model
PCT
PHIT
Annual
Practice
Data/Indicator
Available
Source
Infant Mortality
Y
ONS
Main causes of death
Y
ONS
Y
Manor
Dr Foster
or NHS
Comparator
Y
Y
Hospital admissions – top 10 causes
Lead
Agency/
Officer
PCT
PHIT
PCT
PHIT
Comments
Self-reported measure of overall
health and wellbeing (NI 119)
Healthy life expectancy at age 65
(NI 137)
Causes
considered
amenable
to
healthcare
Mortality
Modelled v. recorded prevalence
Diabetes
General
General
Circulatory
Implications – e.g. Life
Expectancy/Quality-Adjusted Life
Expectancy/Costs from UKPDS
Mortality rate from all circulatory
diseases under 75 (NI 121)
N
Y
NCHOD
Annual
Borough
Mortality
Y
NCHOD
PCT
PHIT
Annual
Generally,
Borough but
Postcode
from PHMF
via PHIT
Modelled v. recorded prevalence
Y
Doncaster
Model
PCT
PHIT
Annual
Practice
CHD
Bold red = National Indicators
Italic grey = optional indicators
PCT
PHIT
Diabetes, hypertension,
cancer, respiratory
disease, and circulatory
disease are also reported
in the recent Public
Health Report on Long
Term Conditions
Work in progress. Indicators are liable
to be added, removed or amended.
Appendix 1 – Data Required for JSNA
Local Availability
Domain
v7a
Sub-domain
Sub-subdomain
Data/Indicator
Hospital admission rate for MI (proxy
for incidence)
Stroke
Available
Source
Lead
Agency/
Officer
Frequency
Reported
Lowest
Geography
Covered
Y
Dr Foster
or NHS
Comparator
PCT
PHIT
Annual
Borough
Quarterly
Trust
Annual
Postcode
Annual
Trust
Admissions for cardiac
revascularisation
Y
WMSHA
Mortality
Y
NCHOD
Y
Dr Foster,
NHS
Comparato
r
Hospital admission rate for Stroke
(proxy for incidence)
General
Mortality rate from all cancers
under age 75 (NI 122)
By site
Cancer registrations
WMSHA
Andrea
Price or
PCT,
PHIT
PCT
PHIT
PCT
PHIT
NCHOD
PCT
PHIT
Annual
Generally,
Borough but
Postcode
from PHMF
via PHIT
WMCIU,
CIU or
NCHOD
PCT
PHIT
Annual
Ward
Annual
Generally,
Borough but
Postcode
from PHMF
via PHIT
Annual
Practice
Annual
Borough
Annual
Borough
Cancer
Respiratory
Infectious
STIs
Bold red = National Indicators
Italic grey = optional indicators
Y
COPD Mortality
Y
NCHOD or
ONS data
PCT
PHIT
COPD modelled v. recorded
prevalence
Y
Doncaster
Model
TB notifications
Y
HPA
KC60 GUM STI data, particularly
gonorrhoea
Y
HPA or
GUM
PCT
PHIT
Regional
Surveillan
ce Unit
RSU or
Manor
Work in progress. Indicators are liable
to be added, removed or amended.
Comments
Appendix 1 – Data Required for JSNA
Local Availability
Domain
v7a
Sub-domain
Sub-subdomain
Source
Lead
Agency/
Officer
Frequency
Reported
Lowest
Geography
Covered
New diagnoses of HIV/Aids
Chlamydia in under-25s
Late diagnosis of HIV
Y
HPA or
GUM
RSU or
Manor
Annual
Borough
Annual
Borough
PCT
PHIT
PCT
Sue
Laverty
Dental
Decay
% DMFT in 5-year olds
Y
NCHOD
Mental
Dementia
e.g. Predictions from POPPI
Y?
PCT
Falls
Hospital admissions for Fractured
Neck of Femur (proxy for incidence)
Y
NCHOD
PCT
PHIT
Annual
Borough
Y?
ONS
PCT
PHIT
Annual
Borough
Y?
ONS
PCT
PHIT
Annual
Borough
Borough
Trauma
Road
accidents
Injuries
Services
Available
Data/Indicator
People killed or seriously injured on
roads
Children killed or seriously injured
on roads (NI 48)
Hospital admissions caused by
unintentional and deliberate
injuries to children and young
people (NI 70)
Borough
Musculoskeletal
Arthritis
Admissions for hip and knee
replacement
Y
NCHOD
PCT
PHIT
Annual
Disability
General
Long-term limiting illness
Y
ONS,
Census
PCT or
LA
Every 10
yrs
Numbers
Physical disability, frailty and sensory
impairment Older and Vulnerable
People
1. Number of clients
2. Number receiving services in
community
Social Services
Bold red = National Indicators
Italic grey = optional indicators
Work in progress. Indicators are liable
to be added, removed or amended.
Comments
Appendix 1 – Data Required for JSNA
Local Availability
Domain
v7a
Sub-domain
Sub-subdomain
Data/Indicator
Available
Source
Lead
Agency/
Officer
Frequency
Reported
Lowest
Geography
Covered
Y
PCT
PCT
PHIT
Annual
Practice,
Ward
Learning disability Older and
Vulnerable People
1. Number of clients
2. Number receiving services in
community
Mental health and Older and
Vulnerable People
1. Number of clients
2. Number receiving services in
community
Substance misuse Older and
Vulnerable People
1. Number of clients
2. Number receiving services in
community
Other vulnerable people
1. Number of clients
Number receiving services in
community
Timeliness of social care
assessment (NI 132)
Standard of
Service
Preventative
Bold red = National Indicators
Italic grey = optional indicators
People supported to live
independently through social
services (NI 136)
Carers receiving needs
assessment or review and a
specific carer’s service, or advice
and information (NI 135)
Uptake rates for Flu jab, etc
Uptake rates for MMR, etc
Work in progress. Indicators are liable
to be added, removed or amended.
Comments
Appendix 1 – Data Required for JSNA
Local Availability
Domain
v7a
Sub-domain
Sub-subdomain
Data/Indicator
Offer of an appointment at a GUM
service within 48 hours
Long acting reversible contraception
methods as a percentage of all
contraception
Sexual Health
Services
Access to NHS funded abortions
before 10 weeks gestation
Access to NHS funded abortions
before 10 weeks gestation (CYP)
User
perspective
on social
care
Voice
User
perspective
on health
care
Bold red = National Indicators
Italic grey = optional indicators
Available
Source
Lead
Agency/
Officer
Frequency
Reported
Lowest
Geography
Covered
Y
UNFIY and
WMSHA
PCT
PHIT
Monthly
Borough
Y?
PCT
PCT
Barat
Patel
?
Practice
PCT
PHIT
Annual
and some
quarterly
Borough
(PCT data
Postcoded)
Y
ONS and
PCT
Comments
Annually from ONS but
locally PCT has
developed a system to
monitor trends more
frequently
The extent to which older people
receive the support they need to
live independently at home (NI 139)
Self-reported experience of social
care users (NI 127)
National Patients Survey Programme
findings for local institutions. Available
from
http://www.healthcarecommission.org.
uk/healthcareproviders/yourlocalhealt
hservices.cfm
Work in progress. Indicators are liable
to be added, removed or amended.