The Future of the Joint Strategic Needs Assessment

Wednesday, Week 6: The Future of the Joint Strategic Needs Assessment

The future isn’t looking so bright this week. It could just be the weather. Cloud and fog all around. The sun came out for a little bit when I was discussing our new approach to the Joint Strategic Needs Assessment — or the ‘JSNA’ as it is lovingly referred to. Just kidding, no one lovingly refers to it. In fact, fewer and fewer people refer to it at all anymore.

The sun came out at the right moment — so the “Future of the JSNA” it is for this week!

What is the JSNA?

The Department of Health published two sets of guidance (2011 and 2013) on preparing the JSNA.

“From April 2013, the local authority and the clinical commissioning groups, together with local HealthWatch, will be required to prepare the JSNA through the health and wellbeing board, undertaking a comprehensive analysis of the current and future needs and assets of their area. In the context of the JSNA an asset could be anything that can be used to improve outcomes and impact on the wider determinants of health (DH 2011, p 19).”

My emphasis, above, but this is the key work to be done — “current and future needs”. Big. Important.

And a couple years later, a ‘get out of jail free card’.

“JSNAs and JHWSs [Joint Health and Wellbeing Strategy — for another blog!] are an important locally owned process, through which to achieve this. As such, and with duties that fall upon local parts of the system, each health and wellbeing board is likely approach them according to their own local circumstances. It would not therefore be appropriate for central Government to be prescriptive about the process or to monitor the outputs (DH, 2013, p 4).”

My emphasis, above, but basically each Health and Wellbeing Board is to do what they think appropriate.

I am sure it wasn’t treated as a get out of jail free card by many organisations…and plenty of ‘support’ and ‘advice’ followed to assist organisations to ‘produce the right answers’ — Mental Health JSNA, Alcohol and Drugs JSNA, and dozens of fact sheets from a range of people and organisations, and also local areas shared their knowledge and guidance for a couple years… then crickets.

Where did it go wrong?

It’s my view (that’s what blogs are for… that and disagreeing/debating) that it went a bit wrong almost immediately. Have a good google around, your JSNA might be brilliant, but I haven’t read anything that sets my hair on fire.

Why?

Because in 2011 DH asked all H&WB Boards to prepare “a comprehensive analysis of the current and future needs” as the precursor to strategic planning, which I’ll talk about in a later blog.

But all further advice was about data, information, evidence. So that’s what everyone produced — tables and graphs. Lot’s of them. Some are in reports 500+ pages long that no one will every read; some are in fantastic websites that few will ever use; more importantly, it is all very detached from the purpose of the JSNA.

The ‘comprehensive analyses’ seem to be lacking one thing — identifying where we want to be in the future.

Without that you just have an analysis of where we are at one point in time.

There has been very little attempt to quantify the gap — any gap, between where we are now and where we want to be at some point in the future, which is the point of ‘a strategy’, isn’t it?

What are we doing about it in Dorset?

Our JSNA process will now comprise an ongoing cycle of three activities:

  1. Top-down system insights process: Our Steering Group is responsible for articulating three key pieces of information: (1) what changes we are trying to effect in key areas, (2) what we want the system to look like in the future and (3) what the system looks like currently.
  2. Bottom-up people insights: Qualitative interviewing is being undertaken with our public-facing workforce to surface issues and themes that may be invisible to those not working directly in an area.
  3. Evidencing Knowledge Gaps: Our ‘systems insights’ will describe how we think our system is working and how we want it to work. We’ll calibrate this with ‘people insights’ that might describe opportunities that enable and stresses that inhibit healthy system development. These two processes will be brought together to identify our knowledge gaps, which we will attempt to evidence if required.

We will have a JSNA Webpage up and running later this month, as part of the Public Health Intelligence webpages (Public Health Intelligence). Wish us luck. Check back in later and have a sticky-beak.

Innovation?

Not really. We are borrowing from traditional strategic planning methodologies, a systems thinking approach using soft systems methods and we are employing a credible method of extracting knowledge from our public-facing colleagues.

Only then are we going to start looking at data/information/evidence.

Wasn’t that what we were meant to do?

This futures blog

This blog is about how we create ‘healthy places’ and what our possible ‘futures’ could be given current trends and momentum within society, the economic and political systems, and the environment. I use the plural ‘futures’ intentionally, because our future is not pre-determined (I hope), we can and should work towards the future we want. This blog aims to generate discussion (maybe even some debate) around ‘Healthy places futures’ in the hope that if we all put our minds to it, a collective vision may emerge, which would inform any strategy we might put in place to get us to our preferred future. We’ll be leaning on heavily on futuring tools found on our Shaping Tomorrow hosted website: phd.shapingtomorrow.com.

The future is already here — it’s just not very evenly distributed (William Gibson 1993).

2 Comments
  1. Rachel Jevons, at that time with PHE and now at West Sussex, once gave a really exciting talk (no,really,trust me,it was) on the statutory guidance on JSNAs, and how it meant health economists would actually have to evaluate qualitative data, even if their evaluation was that it was of no value. Unfortunately I don’t think it ever actually happened anywhere.

  2. I enjoyed this – having been working as JSNA lead for my local area for the past 8 years I can relate to much of what you have said. I will be watching where you go next with interest!

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