JSNAs have suddenly been thrust into the limelight. But why are they so important?
Key account managers and other commercial team members in pharmaceutical companies should already be well aware of joint strategic needs assessments (JSNA). JSNAs were initially introduced in 2008. Since then local authorities and Primary Care Trusts have been under a statutory duty to produce assessments to outline operational plans for health services to meet the needs of the local population.
However, since the introduction of the Health and Social Care Act the importance of JSNAs has increased tenfold, with them being recognised as a key driver of improvement. JSNAs are now a fundamental part of the planning and commissioning cycle at a local level. Under the reformed health system there is a greater emphasis placed on the process and outputs of JSNAs than had previously been attributed – and there is a clear expectation regarding their influence on commissioning plans.
From April 2013 onwards, local authorities and clinical commissioning groups (CCGs) will have an equal and explicit obligation to devise the needs assessment document.
Local leaders and commissioners will be tasked with identifying the health needs and requirements of the local population and addressing these either through the services they commission, through the introduction of new initiatives, or through joint working and collective action with local providers. In doing so, local authorities and CCGs will be able to plan and commission services in an integrated fashion to allow health and care services to efficiently and effectively meet the needs of all members of the community.
In turn, JSNAs will be used by regional health and wellbeing boards to understand and take action to tackle local challenges. The assessments will also play a fundamental role and heavily shape the design of joint health and wellbeing strategies to set and measure outcomes; and also align these with local priorities established in the NHS Outcomes Framework – plus similar public health and adult social care frameworks.
‘Picture of a place’
Assessments must consider all of the current and future health and social care needs in relation to the area a local authority and CCG are responsible for. It must include requirements which report authors believe are achievable and which can be affected to a significant extent by the actions of the local authority, CCG or NHS Commissioning Board.
The Health Act has a clear expectation that JSNAs – and the strategies which are created as a result – will provide the basis for all local health and social care commissioning. JSNAs are a treasure map for pharmaceutical companies and their Key Account Managers. The documents, which must be published, provide a framework to examine factors that impact on the health and wellbeing of communities. Although these range from employment and education to housing and environmental factors, it is the overall impact of these on the physical and mental wellbeing of local residents that pharma should be targeting.
The DH says that JSNAs need to “articulate and address the unique ‘picture of a place’ in every region. In doing so, these valuable documents inform not only local commissioners, but their partners in delivering health services to provide a framework of objectives.
PCTs and local authorities have used JSNAs to establish the current and future health and social care needs of residents. Within the assessments there needs to be a focus over the short and medium term on taking into account anticipated changes in the demographic and infrastructure.
Captured data, information and intelligence underpin JSNAs. This evidence will also be published, giving pharma an insight into local priorities in areas where they can influence and target. But the assessments are far more than just a collection of evidence. They provide an analysis and narrative on the background of the region they cover. They process extracts while analysing evidence and allowing Health and Wellbeing Boards to develop a plan on the basis of these, using data to drive strategy and commissioning. They are a must read for a KAM to gain invaluable background information on local trends and targets.
JSNAs do not have to be completed on an annual basis. In fact, it is only in recent months that a number of PCTs have updated their initial JSNA. However, the DH states that assessments should build on and align with similar needs assessments in local areas to avoid duplication and to develop a “comprehensive local assessment” to inform integrated services. The aim for local authorities and commissioners is to create a single, consistent story on any given issue and to remove duplication whilst contributing across the local system.
‘Putting localism in action’
In the 2011 DH document Joint Strategic Needs Assessment and join health and wellbeing strategies explained – commissioning for populations Paul Burstow, then the Minister for Care Services, highlighted the importance of JSNAs and resulting strategies, saying they are “key to putting localism into action.”
In the foreword of the document he commented: “The strengthened role of JSNAs and joint health and wellbeing strategies will enable the local health and care system to go further than ever before. For the first time, decisions about health and care will be made on the basis of clinical expertise, evidence from the JSNA, and the valuable input of locally elected councillors and the public, via local HealthWatch and wider engagement with the community. This means decisions about action, investment and disinvestment can be genuinely local, rather than a reflection of national priorities.”
Burstow added that he was “clear” the assessments will not have a “galvanising effect on their own”. But when in combination with health and wellbeing strategies and aligned commissioning plans JSNAs have the “potential to be transformational in improving health, care, and wider services for people in our communities.”
The NHS Confederation agreed about the importance of JSNAs but warned about the quality of these assessments. It pointed out that a “good quality” assessment has the “potential to drive improvements, highlight health inequalities and closely inform commissioning.” But a “weak” JSNA is “disconnected from key decision-makers and commissioning and, therefore, removed from local communities.”
“Relatively few have been balanced by an assessment of the assets, strengths and capacities of local communities, which is clearly more desirable,” the Confederation said. “We believe that JSNAs have not yet reached their full potential for commissioning in local authority areas. The reform proposals provide a welcome opportunity to extend JSNAs to include health and voluntary partners.
“If the JSNA remains focused on health services, public health and social care alone, it may require fewer resources but will provide a limited analysis of the needs and assets of the community and may not engage or inform key partners, which is surely one of the key benefits.”
JSNAs are and will be a valuable tool for pharmaceutical companies to identify the local health and wellbeing needs of specific regions across England. Although these documents contain important information on how pharma can drive improvements through system redesigns, pharma still needs to devise innovative care pathways to drive outcomes which will be financially attractive to commissioners.
A quick search of the internet reveals that no two JSNAs look the same – some are 14 pages long, others 114. The DH sees JSNAs as a means to outcomes “not just within single years, but over time.” Key Account Managers, using joint strategic needs assessments and the data available to them, must ensure they have an in-depth insight into the local challenges commissioners face and provide solutions now and in the future to create lasting relationships.