Applied Methodologies in Public Health Information: Health Needs Assessment and

Joint Strategic Needs Assessment

Day 4 Session 2Kate Saffin PHRU

May 2009

Based on material developed by Dave Jenner EMPHO

James Hollinshead EMPHO

Learning Objectives

1. To understand what is meant by HNA and JSNA

2. To increase awareness, through case studies, of how HNA and JSNA are applied in practice

Starting understandings

HNA… JSNA… HIA… HEA… EqIA… EIA… SEA… SA… IIA

HNA: Key Resources

• Health Needs Assessment: A Practical Guide June 2005

http://www.nice.org.uk/aboutnice/whoweare/aboutthehda/hdapublications/hda_publications.jsp?o=705

• HDA. Clarifying approaches to: HEA, HIA, Integrated impact assessment, HEA and race equality impact assessment http://www.nice.org.uk/aboutnice/whoweare/aboutthehda/hdapublications/p101.jsp

HNA: definitions

A systematic review of the health issues facing a population leading to agreed priorities and resource allocation that will improve health and reduce inequalities.

Health Needs Assessment: A Practical Guide (NICE 2005)

The epidemiological approach to needs assessment• Prevalence and incidence• Services available and their costs• Effectiveness and cost-effectiveness of services• Quantified models of care and recommendations• Outcome measures, audit methods and targets• Information and research requirements

http://hcna.radcliffe-oxford.com/ 1994 & 1997

The systematic method of identifying unmet health and healthcare needs of a population and making changes to meet those unmet needs.

Wright J, Williams R & Wilkinson J. BMJ 1998; 316: 1310-3.

An HNA:• Is SYTEMATIC i.e. there is a process or method

behind it• IDENTFIES NEED or REVIEWS HEALTH ISSUES

(element of looking at information or talking to communities to find out how they can benefit)

• Supports MAKING CHANGE as a result of these assessments (i.e. they should result in a change to address need)

• Contributes to AGREEING priorities/resource allocation. It implies involvement of others, partners, communities etc.

BMJ 1998;316:1310-1313Development and importance of health needs assessment

John Wright, Rhys Williams, John R Wilkinson

HNA terminology

HNA: different models/common ground

• a disease

• a service

• a community or social experience

Why undertake HNA?

• provide evidence about a population on which to plan services and address health inequalities

• provide an opportunity to engage with specific populations and enable them to contribute to targeted service planning and resource allocation

• an opportunity for cross-sectoral partnership working and developing creative and effective interventions

Drivers for HNA

NHS Planning Guidance 2005-2008

PCTs and their partners will need to consider the particular needs of their population, taking into account different needs and priorities within each community.

PCTs should demonstrate that, as well as using epidemiological data and general survey data to identify the differing needs of their populations, they have listened to the views of patients and the public and in particular have taken account of the results of patient and user surveys ....

Drivers for HNA

Core Standard C23

The PCT collects, analyses and shares data about its patients/service users and services, including where relevant data on ethnicity, gender, age, disability and socio-economic factors, including with its commissioners, to influence health needs assessments

and strategic planning to improve the health of the community served.

Drivers for HNA

World Class Commissioning (2008)

By identifying current needs and anticipating future trends, PCTs will be able to ensure that current and future commissioned services address and respond to the needs of the whole population, especially those whose needs are greatest.

PCTs should .... undertake robust and regular needs assessments that establish a full understanding of current and future local health needs and requirements

Cycle of health needs assessment1

What population?

3Prioritisation

4Action planning

for change

5Review

2Identifying problems

and challenges

... and who to involve?

population profilingperceptions of needs

which issue(s) to tackle?what are effective and acceptable interventions?

IMPLEMENTING ACTION

measuring impactlearning

Cycle of health needs assessment1

What population?

3Prioritisation

4Action planning

for change

5Review

2Identifying problems

and challenges

... and who to involve?

population profilingperceptions of needs

which issue(s) to tackle?what are effective and acceptable interventions?

IMPLEMENTING ACTION

measuring impactlearning

Step 2: Identifying Problems and Challenges• Not only .... Population profiling

• But also .... How does the population perceive its needs?

– workshops or focus groups - representatives from the local population and local service providers

– interviews of key people– consider a survey of those concerned– consider how to reach individuals/groups who might otherwise

be excluded

Cycle of health needs assessment1

What population?

3Prioritisation

4Action planning

for change

5Review

2Identifying problems

and challenges

... and who to involve?

population profilingperceptions of needs

which issue(s) to tackle?what are effective and acceptable interventions?

IMPLEMENTING ACTION

measuring impactlearning

Cycle of health needs assessment1

What population?

3Prioritisation

4Action planning

for change

5Review

2Identifying problems

and challenges

... and who to involve?

population profilingperceptions of needs

which issue(s) to tackle?what are effective and acceptable interventions?

IMPLEMENTING ACTION

measuring impactlearning

Case Studies

• examples from Health Needs Assessment: A Practical Guide (NICE 2005).– a secondary school population– residents of Greenwich and Bexley at risk of self-harm and

suicide

• local case study– Bullingdon prison, Oxfordshire

National case study: secondary school pupils in Newcastle• 3 schools in Newcastle• Aim to ascertain health issues to target Health Promotion

initiatives• Involved health, education, CAHMS- high level buy in Chief

Executive PCT and Director of Education• Survey of all year 9 pupils• Issues: sexual health, drugs, smoking• Health drop in centres formed (sexual health and lifestyle issues)• Well implemented

• Main learning: involve young people in the development of the HNA

National case study: people at risk of self harm and suicide Bexley• To examine the scope for preventing suicide and self

harm in Bexley• Group involved Directors of A&E, voluntary agencies

and coroner, representatives of the Mental Health Trust

• Reviewed mortality data and case notes• Found high suicide rates in young deprived males• Plan to target at risk people in A&E• Action plan formulated but only partially implemented

• Main message: HNA may not be effective if local decision makers not involved

Prison HNA

• Main health and wellbeing issues?

• Information sources?

Case Study: Bullingdon Community Prison• Describe prison - e.g. type and number of prisoners, turnover• Collect data on prisoners’ health - collate existing data • Collect perceptions of major health and health care issues -

staff/prisoner views, across the whole prison• Describe prison services– gap analysis• Identify options for addressing need - use evidence on effective

interventions • The PCT then went on to:

– Develop and implement plan for change - set achievable standards and targets, implement changes

– Monitor progress

based on ...• Toolkit for health care needs assessment in prisons, University

of Birmingham, February 2000.

Applied Methodologies in PHI: JSNA

“Strong leadership for health andwellbeing is key. This will be providedby Directors of Adult Social Services,and Directors of Public Health (jointlyappointed across health and localgovernment), working alongsideDirectors of Children's Services.Together they will lead local strategicneeds assessments, then plan forthe delivery of more effective healthand wellbeing outcomes, alongsidereductions in local health inequalities”.

• Part of “Our Health Our Care Our Say” implementation.

• Focus on:– keeping people healthy and

independent– bringing together health and

social care– joint working across NHS

and local authorities

• First detailed description of JSNA

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_072604

http://www.dh.gov.uk/en/Publicationsandstatistics/Public

ations/PublicationsPolicyAndGuidance/DH_081097

The duty to produce a Joint Strategic Needs Assessment• A new statutory requirement for PCTs and responsible local

authorities (from April 1st 2008) to produce a JSNA of the current and future health and social care needs of their local community.

• Applies to unitary or upper tier local authorities (upper tier authorities to consult with district councils within their geographical area).

• To be carried out jointly by the Director of Public Health, the Director of Adult Social Services and the Director of Children’s Services.

• The JSNA will inform:

– the Sustainable Community Strategy

– priorities and targets in the Local Area Agreement

– commissioning priorities

JSNAs are about ...

• ... understanding the current and future health and wellbeing needs of the population ...

– over both the short term (three to five years) to inform Local Area Agreements, and

– the longer term future (five to ten years) to inform strategic planning

• ... in order to inform the commissioning of services and interventions that will achieve better health and wellbeing outcomes and reduce inequalities

• ... addressing outcomes described in both the National Indicator Set for local authorities and local authority partnerships, and the “vital signs” referred to in The Operating Framework for 2008/09

JSNAcycle

JSNAcore dataset

APHO JSNA resources (work in progress)

• APHO have been commissioned by DH to input into the JSNA process.

AIMS:• Recommendation of core dataset• Development of JSNA data tool• Guidance on inequalities analysis• Guidance on data sharing protocols• Methods of forecasting and projections• Guidance on statistical validity

Local Case Study: Nottinghamshire County

• Formation of multi agency JSNA groups (steering group and workgroup)

• Review of the JSNA guidance (and the updates)

• Agreement on three themes

• Older people, Children and Young People, Vulnerable Groups and Adults

• Collection of all the information and evidence

• Consultation with stakeholders

• Focussed by the Steering Groups

• Prioritisation and interpretation by the PH and LA teams

Summary

• HNA definitions• HNA resources• HNA policy context• HNA cycle• Examples of HNA• Introduction to JSNA