Government reform of commissioning mean now is a good time to take stock of your joint strategic needs assessment. Ed Harding and Michelle Kane outline some key dos and don’t in setting priorities and objectives.
The government has made it clear that joint strategic needs assessment, and the new joint health and wellbeing strategy it is intended to drive, will form the cornerstone of local priority setting and decision making. Both processes will play a central role in strategic commissioning and performance management across health and wellbeing boards, clinical commissioning groups and the NHS Commissioning Board.
Introduced in 2007, the joint strategic needs assessment is a process to identify the current and future health and wellbeing needs of a local population, build stronger partnerships, and lead to agreed commissioning priorities to improve outcomes and reduce health inequalities.
Experience shows the assessment has tended to add the most value when designed as an exercise in shared problem solving, making partners face complex issues and inconvenient truths such as service gaps, socially excluded groups, and inequalities.
Now is a good time to take stock of your local assessment. All areas need to review their process from scratch and ensure the assessment and the new strategy are equipped for a higher stakes game of increased visibility and influence. The following five steps will help in building priority setting.
Take high level ownership
The needs assessment and joint health and wellbeing strategy are sound foundations for the health and wellbeing board’s other leadership duties of integrated working and ensuring value for money.
- Make your assessment and strategy core business of the health and wellbeing board, and designate time for discussion of key points of both processes.
- Expect the board to set a clear, high level vision statement for your assessment and strategy.
- Seize the opportunity for a fresh start with new leaders.
- Confuse strategic leadership of the assessment and strategy, which cannot be delegated with management, and operational activities, which can.
- Let the board farm off leadership of your assessment and strategy as “one less thing to do”. If the board does not set a vision for evidence based leadership, what does it do?
- Allow key partners to disengage. Equal ownership is essential when priority setting comes to influence investment.
Go back to basics
Both the assessment and strategy are duties, but partners may have different views on what the processes should do. How, for example, will the needs assessment balance population-level analysis with the depth needed to drive commissioning and business planning? Build a local vision and design a process that makes sense in your area.
“Remember, the real value of the joint strategic needs assessment is to drive new ways of working,” advises Fay Haffenden, consultant in public health at NHS Cambridgeshire. “The partnership process itself is as important as any reports or analysis the assessment creates.”
- Debate the value of the assessment and strategy as a shared, evidence-based problem-solving process.
- Agree how fundamental the process is to be to decision making. Will it “inform” commissioning, or “drive” it? Be clear from the start.
- Evaluate the strengths and weaknesses of your existing assessment and look at other areas that have made it work.
- Assume your existing process will do.
- Allow the debate to be defined purely around the issue of data – it is an integral part of the process, but not enough in itself.
- Get bogged down in the detail too soon. A solid mission statement will help sort out the detail later on.
Choose your audience
Experience shows that if assessment is to have influence, it must be owned by and tailored to the needs of certain audiences. Think about who they are and try to engage them from the beginning. Geoff Ainsley, programme manager at Minding the Gap in Yorkshire and the Humber, also urges areas to “think about where the levers over social and environmental determinants of health truly lie, and seize the opportunity to go beyond health and care.”
- Think clearly about who will use and contribute to the assessment and strategy.
- Ask commissioners and decision-makers to set out what they need from the process, what do they really want to know, at what time, and in what format?
- Explore opportunities to link strategic priorities for health and wellbeing across agencies and organisations, for example housing, planning, education and the voluntary sector.
- Write off non-traditional partners outside of health and social care without good reason.
- Assume that publishing datasets is the same as providing usable intelligence.
- Try to be all things to all people. Which audiences, decision-makers and commissioners will you prioritise?
Priority setting is political
Expect your partners to arrive at the health and wellbeing board with different professional outlooks and language. Transparency, negotiation and clear procedures have all demonstrated their worth in managing the rocky road to agreed priorities where local opinions and values need to be thrown into the mix.
- Recognise that strategic priority setting will require perspective and compromise.
- Design a robust and transparent process for negotiating priorities that partners can sign up to.
- Find “win-win” and cost-neutral opportunities to avoid the risk that the assessment and strategy become synonymous only with efficiency drives.
- Rush into the details around priority setting until you have agreed the overall value and guiding principles of an assessment-led approach.
- Pass the buck. Effective priority setting processes are led from the top.
- Let disagreement and heated debate put you off. This is inevitable in a disinvestment environment and is a sign your processes have authority.
National guidance is useful to a point. Beyond that, you will need an agreed local specification with working protocols for your assessment and strategy that realise your aspirations.
- Demand a clear specification detailing roles, responsibilities, working arrangements, links with commissioning and evaluation frameworks, just as you would for any other service.
- Agree statements of quality against which to measure the contribution of your assessment and strategy. For example, where do we want to be in five years?
- Ensure your assessment has the capacity and analysis required to be credible.
- Assume agreed priorities will automatically translate into actions – document actions and evaluate progress.
- Forget that the skills and expertise lie across the whole system, not just in public health.
- Assume people can squeeze this in with the day job. The best and most influential processes have had dedicated capacity.
Finally, keep a sense of perspective. Remember that the needs assessment and health and wellbeing strategy are part of a wider programme of integrated working and value for money.
Doncaster Borough Council assistant director of housing Gary Wells advises: “Don’t be afraid to start with services or care groups where there is obvious synergy and overlap. Use this to then move on to proposals that take partners further away from their comfort zones.”
We do not underestimate the scale of the challenge but if you are serious about improving real lives and real communities, this is an opportunity you cannot afford to miss.