Wakefield District have pioneered a new collaborative model for building an enhanced Joint Strategic Needs Assessment. Liz Blenkinsop explains.

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It will have escaped few people that expectations on JSNAs have been significantly raised in recent months. We wanted to design a process that would not just help all partners make better sense of the bigger health and wellbeing issues we faced in our community, but be robust in going further through into setting local priorities, following up actions and talking more clearly about the money. This meant a fundamental overhaul - starting from first principles.

We were clear that the process would only work if it was seen as a new start, co-produced with the community. Our first step was to hold a series bespoke workshops for different stakeholder groups – elected members, CCG representatives, local government and NHS officers, and the voluntary and community sector – to explore their views on health and wellbeing issues and the potential role and remit of the JSNA and JHWS in Wakefield.  

Starting with separate groups encouraged people to get things off their chest and speak their minds. It soon became clear that while the groups didn’t agree about everything, everyone recognised that we needed each other; we all shared the same bottom line about what we were doing, and why.  

Feedback from the first workshops was brought together to create an early draft mission statement that captured partners’ understanding of health and wellbeing issues and formed a common basis for taking the development process forward for wider comment and consultation.

A sense of fairness was essential; we wanted everyone to feel their contribution was valuable, that no one was being railroaded, and that there were clear opportunities to feedback and help shape our new process.

The second step in the Wakefield process brought together champions from each group to look in more detail at how the JSNA and JHWS could help us work together better.

Dr Andrew Furber, director of public health for Wakefield District believes: “this was the ideal opportunity to ask the tough questions. The process cannot be all things to all people.  We need to know who to prioritise, and how and to what extent the process will influence strategic decision-making.”

Exploring the detail was not easy; as one participant put candidly, it is easy to  sign-up to a partnership when you’re talking about someone else’s money, and a lot harder when you’re talking about your own.  

This phase encouraged lively debate around trickier issues such as the actual level of the influence of JSNA and JHWS should have in decision-making, and where partners should be ready to surrender a degree of sovereignty and move toward more integrated and partnership approaches.

“This is where the early engagement and the mission statement really proved its worth,” says Dr Furber. “It kept the debate in the realm of ‘how do we make this work’, not ‘why should we?’”

We were encouraged to see that partners were starting to see the JSNA and JHWS as a high level catalyst for change as much as a platform for developing and disseminating intelligence.  As one colleague said “everyone has to realise that doing things differently might mean you doing things differently. If we’re not all ready to see it through, it’s meaningless”. 

We felt that having agreed some of key issues around JSNA function, we were able to move on to look at the form. We agreed a menu of resources and JSNA support services so everyone knows what to expect. Wakefield partners also made progress on agreeing standard definitions for quality intelligence and templates for in-depth analysis which gives our JSNA analysts a better idea of what people really want to know. 

Dr Linda Harris, clinical director of Spectrum CIC believes “the most complex and contentious issues will need to look at more than just data; the JSNA must host  an investigative approach to problem solving, with clear phases of identification, analysis, innovation, decision-making, delivery and communication, and ultimately review. Just as with the whole JSNA process overall, setting out a clear template for each step along the way is crucial to transparency and local confidence, and will allow all partners to engage more effectively”.

Governance was the final issue we touched on: having laid out the aims, objectives and products of the JSNA, we wanted colleagues to focus clearly on how we go beyond aspirations and actually to make it happen. 

Michelle Kane of HK Consulting, who worked with Wakefield to design and deliver the programme, believes governance is one of the most important aspects of the JSNA process; “to paraphrase Mervyn King, good governance is about intellectual honesty, not just sticking to the rules and regulations. In tough times, clear roles and responsibilities can only help encourage debate to achieve the best outcomes for the community”.   

After exploring a range of ideas, Wakefield partners proposed three separate but interconnected tiers for our JSNA: an executive led by the health and wellbeing board; a strategic group; and an operational group. Existing groups will be adapted to fulfil these new roles.

Dr Furber agrees with the common sense approach of Wakefield partners; “it’s not always a question of re-inventing the wheel but rather auditing what you already have and making best use of existing skills, expertise and capacity that lies across the whole health and wellbeing system.”

All partners at Wakefield are the first to point out that redesigning our JSNA and JHWS process doesn’t stop here – any process that aims to drive change will also need to be reviewed and adapted over time. However, we are now clear about what we want to achieve and who we need to work with to realise our aspiration. 

Our key message to other areas is that all areas have to learn to work together better. The JSNA is an excellent place to build this relationship on a combination of evidence, sound process and the shared bottom line: our communities. Leave what you think you know at the door and be prepared to listen; you’ll be surprised how much partners agree.

The shadow Health and Wellbeing Board has now agreed the mission statement, governance arrangements, content and priorities of the JSNA. The board will look in detail at the priority areas at future meetings. This will provide the strategic direction and mandate to commissioners on the changes that need to be made to make the biggest difference on outcomes.