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Commissioning

Bury

Developing a joint Strategic Needs Assessment

Bury Metropolitan Borough Council were keen to become an "early implementer" of joint strategic needs assessments (JSNA), not just to comply with statutory requirements, but also to realise the significant benefits of conducting such an exercise as early as possible.

By drawing together disparate pieces of analysis into a single strategic view of the issues being faced within Bury, agencies and the people of Bury would be assisted in making step changes in the outcomes being worked towards. This development complemented the Health Needs Assessments already carried out within the PCT's Public Health section, which suggested that there are complex, multi-layered influencing factors with an impact on the health and well-being of individuals.

In order to carry out a thorough assessment of need, it was decided that a "whole systems" approach should be adopted which, given the history of statutory agencies carrying out assessment and planning activities in relative isolation, would be no easy task. One service user's statement which featured in the Better Outcomes for Older People Framework reflects this well:

"It seemed like quite a few people had pieces of the jigsaw but no-one had the picture on the box".

By bringing this together, it was hoped that a better understanding of individual and community need, as well as how best to deliver services to gain the required outcomes, would be achieved.

What prompted the organisation to develop this approach?

An increasing drive to conduct periodic borough-wide JSNA's to inform service provision. Historically, assessments have only occurred within an individual organisation and have not linked with partner organisations to give a rounded and holistic view of need, and the issues that create need.
Conducting a needs assessment is no longer seen merely as 'good practice', but as a statutory requirement within the health, public health and adult social care domains outlined in Our Health, Our Care, Our Say and the Commissioning Framework for Health and Well-being.

What has the work involved?

A project management approach was adopted from the outset and, as such, a formal project structure, consisting of a Project Board, Project Manager and Virtual Workgroups was established. The Board consisted of commissioner, provider and third sector representatives from across the well-being sector (including the likes of libraries, leisure, culture etc). Significant investment in terms of time and effort was made in the planning state to try to overcome capacity issues at all levels.

There were three main project phases:

Audit phase - information sources and community intelligence on resource usage and need were collated, which involved consultation with the community.
Community Needs Assessment phase - development of a detailed understanding of need over a 10 to 15 year period, patterns and trends, dependencies and other influencing factors.
Strategy Derivation phase - based upon the needs assessment, evaluation of what and how services should be planned and commissioned to meet future needs, or re-designed to meet current need.

External project support was engaged from a public sector consultancy organisation and the project was delivered over a 10 month period. A detailed project initiation document/project plan can be downloaded here.

How have things changed for the better?

Creation of an agreed and shared view of the issues in Bury, and some of the challenges faced by each agency in addressing these issues.
Recognition and understanding of the issues faced by agencies supporting the older adult population, and articulation of the likely short to medium term scale of change.
The third sector has wanted this type of information for years to inform their strategic direction - they have been part of the board that have helped to shape the outputs.
Development of a super output level data tool that allows analysis of any of the data collected against any other variable at the lowest possible level. This facilitates identification of a correlation between particular variables on a small area basis, which can be used to form hypotheses and intervention strategies.

What have been the major challenges/drawbacks?

Its bigger than you think! When people first think about the JSNA process, they think it is simply a case of putting a 'little bit of this information' with a 'little bit of that information'. In actual fact you need to go back to basics, reanalyse and draw new conclusions.
Whilst the local authority has the statutory duty to undertake a JSNA, it doesn't necessarily have the skills, knowledge and understanding of issues to be able to analyse them properly or to unlock solutions. Bury quickly realised they didn't have the right skills in the right quantities available at the right times which led to engagement of external support.
A lack of capacity at Board level. Demands on individuals to complete tasks and meet deadlines in addition to undertaking their operational day jobs proved problematic.
By undertaking the project with a limited range of partners it was difficult to develop a comprehensive picture of the issues of the borough.

What lessons have been learnt?

A formal project structure and strict project management methodology are absolutely crucial.
Communication at all levels is vital. Rather than assuming that communication will automatically happen, a centrally controlled communication function should be established.
As this can be a difficult concept to grasp, the messages have to be carefully tailored and managed over a long period of time before the penny finally drops in some areas.
It's not simply about capture and analysis. It is also about the impact on the population of the borough. Whilst the JSNA should provide intelligence about particular issues faced by your population, it will not tell you what to do about it!
It is important to maintain focus. This may seem very obvious but undertaking JSNA is very hard work and takes a long time. It tends to throw up more questions than answers which often means going over old ground.
Before the project begins it is important to define what areas you want to look at to avoid eating up resources at an extremely fast rate, and decide whether a strategic or operational level view of intelligence is going to be taken.
Dont' assume that data is complete and available. Even through Bury had a data sharing protocol in place between the major agencies, they found it easier to share it through the firm of consultants engaged to assist with this as they signed an honorary contract with the PCT.
It is very important to share similar sets of intelligence on similar service groups and to draw conclusions from the combination of them.

How might this work affect commissioning in the longer-term?

JSNA is being fitted into Bury's business planning cycle. The reason this project was completed by October 2007 was so that it would feed into the partners' business planning processes as a source of intelligence.
JSNA is being used to drive commissioning strategies and to set the agenda for the next 3 to 5 years.
Bury is modelling what impact JSNA might have on budgets based on the commissioning and business planning decisions that are made.
It will be used to help inform market management activities, talking to providers to reshape services and drawing investment into the borough.
It is a key data source that has informed the priority setting for the local area agreement.