Joint Strategic Needs Assessment (JSNA) Review 2023

Health and wellbeing boards continue to be responsible for the development of Joint Strategic Needs Assessments (JSNA).

About the JSNA

The JSNA is made up of a collection of products including:

• Community Insight - an online resource providing a wide range of data and services, mapped at small area level
• needs assessments on a specific theme or population group
• reports and surveys - including the JSNA executive summary, data snapshots and survey briefings

JSNA review aims

The JSNA review aims to:

• inform the development of the JSNA programme to ensure it meets the needs of stakeholders (groups and organisations that use or are impacted by the JSNA)
• explore opportunities to collaborate across Sussex
• maximise the influence of the JSNA to inform commissioning (buying) and delivery of services across Brighton & Hove
• raise awareness of the JSNA across stakeholders
• ensure that stakeholders can contribute to the development of the JSNA

JSNA review summary

Stakeholders were engaged through on-line surveys (a stakeholder and a separate public survey) and workshops (in-person and an evening on-line workshops).

A total number of 116 survey responses were received and 49 people attended the workshops.

A full summary of stakeholder feedback is provided through this document.

To summarise:

• half of the survey respondents were current users of the JSNA and were generally positive about the current products including the use of infographics, however wanted more timely updates
• responders suggested Community Insight mapping tool could be improved with ‘how to’ videos and better use of benchmarking, user/patient voice and asset mapping
• those that hadn’t used the JSNA before said that “knowing about it” and “awareness of its use and its benefits” would encourage use in the future
• workshop feedback highlighted the importance of developing the JSNA, including improving the promotion of the JSNA and stakeholder involvement  

We wanted to hear stakeholders views about the JSNA, so we undertook surveys and workshops to enable them to contribute in different ways.

Stakeholder activities in 2023

Stakeholder survey

January to February (6 weeks) - 108 responses

Public survey

January to February (6 weeks) - 8 responses

In person workshop

1 March - 32 attendees

Online workshop

9 March - 17 attendees

Stakeholder respresentation

Our stakeholders include the:

• public
• community and voluntary sector
• NHS
• Brighton & Hove City Council

How stakeholders were represented in our activities

We asked for feedback on:

• Community Insight
• needs asseements
• reports and surveys

About our surveys

Our survey method included online surveys developed using Smart Survey.

The JSNA review survey was promoted through a plan developed with the council's communications team.

The survey was estimated to tak 10 to 15 minutes to complete.

All survey questions were about JSNA products.

What we asked in our surveys

We asked:

• are the JSNA products easy to use?
• are the JSNA products useful?
• What do you like about the JSNA products?
• What can be improved about the JSNA products?

Feedback from JSNA users

Around half were current users of the JSNA (56 users out of 108).

80% who used the JSNA in the last 12 months found each product very or fairly useful.

At least 70% found each product very or fairly easy to use.

100% found the JSNA executive summary and in depth needs assessment very or fairly useful.

What could be improved

Our JSNA users wanted:

• better use of:
  • benchmarking
  • user/patient voice
  • asset mapping
• improved Community Insights mapping toolds
• 'how to' training videos

Feedback from non JSNA users

We asked 'What would encourage you to use the JSNA/Local Intelligence?'

Non JSNA user responses

Non users wanted:

• to know about it
• have an awareness of its use and benefits
• to understand the information provided and how it was relevant to them

We held a half day workshop at Hove Town Hall, attended by a range of stakeholders.

We also held an early evening online workshop lasting 1 and a half hours. This was attended by those who couldn’t make the daytime event.

We asked the same 5 questions at each workshop.

In person half day workshop

The in person workshop included:

• key note speakers
• presentations
• table group discussions of the 5 questions

Watch the presentations from the in person workshop.

The workshop agenda

1. Opening - presented by Councillor Sarah Nield - Lead Member for Adult Social Care, Brighton & Hove City Council
2. Set the scene, reflecting on the improtance of JSNA and how it's being used - presented by Rob Persey - Director of Health and Adult Social Care, Brighton & Hove City Council
3. The future challenges across Sussex intergrated care systems and what is required from the JSNA to support us in meeting these challenges - presented by Lola Banjoko - Executive Managing Director for Brighton & Hove, NHS Sussex
4. The value of the JSNA for the voluntary and community sector - presented by Maria Antoniou - Partnerships and Development Manager, Community Works
5. Stakeholder survey feedback - prestented by Kate Gilchrist - Head of Public Health Intelligence, Brighton & Hove City Council

Online evening workshop

This workshop included rapid feedback on the 5 questions asked, building on the themes from the in person workshop.

We asked:

What do stakeholders across the city need from the JSNA to maximise the influence of the JSNA to inform commissioning and delivery of services?

Stakeholder feedback

Stakeholders said to consider:

• production
• setting context
• content
• maximising use
• structure and style
• promotion

Feedback on production

Stakeholders said:

• involve stakeholders including comissioners and Community and Voluntary Sector (CVS)
• embed digital accessibility
• timeframes are important

Feedback on setting context

Stakeholders said:

• it is important to include information on:
  • social determinants such as financial wellbeing and quality of housing
  • wider determinates such as crime and disorder
  • access to city assets and physical/psychological barriers to accessing them
  • climate change

Feedback on content

Stakeholders said:

• target information on questions that need answering for effective service provision
• include information:
  • from a wide range of sources, for example frontline workers, schools and CVS
  • for people with no records in the city
• include prevention and long term impact on life expectancy, health life expectancy and inequalities
• include disaggregated data to inform providers
• recommendations need to be realistic in the context of financial restraints
• balance information between quantitative and qualitative elements across JSNA products

Feedback on maximising use

Stakeholders said:

• understand and address barriers towards use
• understand and demonstrate where it has been put to use
• make it easy to use and train people to access information for themselves
• take an asset based approach to engage communities and residents
• engage with businesses to contribute but also to improve the wellbeing of staff

Feedback on structure and style

Stakeholders said:

• use symbols to help people see and search for content at a glance – overarching index
• liven up the content with case studies and quotes
• provide one page summaries of protected characteristics 
• create a webform for ongoing feedback in needs, assets and experiences
• view data for different geographies data in Brighton & Hove

Feedback on promotion

• create a press/media strategy - the term JSNA is off-putting
• find opportunities to make reference to the JSNA, for example in the Walking Festival
• proactively engage with other partners and link across to their information resources
• implement community focussed communication plans

We asked:

What do stakeholders need from the JSNA across geographies and organisational boundaries?

Stakeholder feedback

Stakeholders said:

• consider alignment and standardisation across geographies
• recognising that organisations work across different boundaries, for example there is a need to view maps and areas through different lenses
• consider that there may be gaps and overlaps in data that need to be reflected
• consider different comparisons, for example national, core cities, coastal cities and housing areas
• include green and blue spaces and services, and consider:
  • how to access spaces and services, for example walking, public transport, topography, time, cost and accessibility
  • distribution of garden space, unused green spaces around buildings
• ensure Climate Risk and vulnerability are considered, including:
  • mental health and climate anxiety
  • flood risk

We asked:

How do we best capture evidence of the needs and assets from communities and neighbourhoods across Brighton & Hove?

Stakeholder feedback

Stakeholders said:

• consider system-thinking and strategic approaches to joint working - this will contribute to the JSNA being built into:
  • key strategies
  • job roles
  • service users and lived experience
  • patient groups
• map existing data – consider gathering and storing data from partners in one place and allow resource for this
• use different kinds of data and evaluating data – include the role or weight of stories and anecdotal evidence alongside quantitative data
• develop more co-production – have consistency between partners, design for involvement and 'closing the loop' feedback (what actions have been taken based on the feedback we have given)

The engagement ladder

There are 5 levels in the engagement ladder.

This information is an extract from the "Commissioners’ Guide to engaging Service Users, Carers & the Public 2018" Health & Adult Social Care Brighton & Hove City Council and NHS Brighton & Hove clinical commisioning groups (CCG).

Informing

Providing balanced information to individuals and communities to help them understand:

• processes
• problems
• alternatives
• opportunities
• solutions

Consulting

Obtaining feedback on analysis, decisions and alternatives, for example surveys and focus groups.

Involving

Working directly with patients and communities to ensure concerns and aspirations are understood and considered.

Collaborating

Working in partnership in each aspect of the decision, for example co-design.

Empowering

Decision making placed in the hands of the community or individual, for example personal health budgets.

We asked:

How do we best capture evidence of the needs and assets from communities and neighbourhoods across Brighton & Hove?

Stakeholder feedback

Understanding the JSNA

Stakeholders said:

• improve the use of language
• ensure the JSNA is not digital excluding
• ensure recommendations are presented in a way that is understood and meaningful
• support people with the parts they don’t understand

Ways of involvement

Stakeholders said:

• have lots of different ways to involve people, using many different methods to reach different groups of people.
• find fun ways of gathering evidence for example:
  • in pubs
  • at football matches
  • at places where young people go
  • at food banks
• carefully think and plan for involving people we never hear from and be aware of confirmation bias

Meaningful feedback

Stakeholders said:

• support stakeholders with ongoing involvement throughout the process
• give stakeholders meaningful feedback from their input
• share feedback with people who have contributed and let them evaluate the data and make use of it. 

We asked:

What framework should be used for the JSNA, option 1 or option 2?

About the framework options

There were 2 options of how information could be presented under heading sections on our webiste.

Option 1 - adapted form the current framework

• People - population and vunerable groups
• Healthy places - building blocks of health and wider determinants
• Starting well
• Living well
• Aging well
• Dying well

Option 2 - health index framework

• Population
• Healthy people - difficulties in daily life, mental health, mortality, wellbeing, physical health conditions
• Healthy lives - behavioural risk factors, chlidren and young people, physiological risk factors, protective measures
• Healthy places - access to green spaces, access to services, crime and safety, economic and working conditions, living conditions

Stakeholder feedback

There were mixed views on which option is best. However, more people were in favour of adopting a Health Index framework.

There was general support for ‘Four wells’ to be incorporated into which ever framework is chosen.

It was acknowledged that user preference will depend on users' circumstances.

We asked:

What principles should we use to prioritise needs assessments?

1. Reflects national priorities
2. Aligned with local priorities 
3. High potential for needs assessment to increase evidence base
4. Timely for updating an historic or older needs assessment
5. Acceptable opportunity cost of conducting the needs assessment
6. High potential for needs assessment to support cost saving
7. There is a high prevalence/incidence of condition in the local population
8. The issue has a high impact on the population affected
9. High potential to support reducing inequalities  
10. Optimal timing, for example, to inform commissioning of services or strategy development
11. High potential for needs assessment to benefit multiple topic areas or services
12. High ability to act-on and implement recommendations
13. Adequate resource and workforce capacity to undertake the needs assessment
14. Potential for increased opportunities for collaboration
15. Potential to support a funding bid
16. Other principle 

Stakeholder feedback

Survey results

All 15 principles suggested were important to consider - more than 50% felt each principle was important

There were 5 principles that felt the most important - with more than 90% feeling that these were important or very important. These same 5 principles were in the top 5 across sectors and were:

1. Aligned with local priorities
2. There is a high level of inequalities
3. The issue has a high impact on the population affected
4. There is a high prevalence/incidence of condition in the local population
5. There is a substantial gap in evidence that can be filled

Workshop feedback

From the feedback we were able to establish the top 6 principles

1. Aligned with local priorities
2. There is a high level of inequalities
3. The issue has a high impact on the population affected
4. There is a high prevalence/incidence of condition in the local population
5. There is a substantial gap in evidence that can be filled
6. Optimal timing - for example, to inform commissioning of services or strategy development

Stakeholders said:

• use these top 6 principles, other principles are inherent in the process
• when reviewing needs assessment topics consider principle 2 as highest importance
• don't use a numerical scoring system, as this may mask importance
• start with a list of proposed priority topic areas based on local strategies

We asked for stakeholder feedback and ideas to inform the development of our JSNA to best meet your needs.

What stakeholders fed back

Stakeholder told us your thoughts about:

• the JSNA framework and products
• how to maximise JSNA impact
• stakeholder needs around data and geographies within the city and across Sussex
• how to best capture evidence from communities
• what principles to use to prioritise needs assessments

What happens next

We will use all survey and workshop feedback and ideas to propose:

• recommended actions to develop our JSNA
• a programme of needs assessments over the next 3 years

This will be agreed by our Health and Wellbeing Board in July 2023

We will make this publicly available the Brighton & Hove City website.