The Role of the DPH and Joint Strategic Needs Assessment

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The Role of the DPH and Joint Strategic Needs
Assessment
PUBLIC HEALTH IN THE NEW COMMISSIONING WORLD

• George Leahy
• Head of Public Health Development
• Department of Health

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Purpose

• To discuss the new Commissioning Framework, and
  in particular JSNA
• To outline potential challenges for DsPH
• To explore what support you need, and how to get
  it

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The Commissioning Framework Summary

• Launched March 2007 consultation ends 29th May
• Key development in system reform agenda
• Focus on promoting health and well-being,
  including prevention of ill-health
• Stronger focus on commissioning for outcomes to
  reduce inequalities
• Emphasises importance of strong partnerships
• Recognises potential role of third sector

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The Commissioning Framework Aims

• A shift towards services that are personal,
  sensitive to the needs of the individual and
  focused on maintaining independence
• 2. A reorientation towards promoting health and
  well being, and proactive prevention of ill
  health
• 3. A stronger focus on commissioning for
  outcomes, across health and local government,
  working together to reduce health inequalities
  promote equality

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Where we are now

• Health reform and investment has changed the NHS
• Clinical outcomes have improved
• Increasing effectiveness of joint working across
  health social care
• More choice among services, which are delivered
  closer to home

• Commissioning for volume and price - not quality
  and outcomes
• Too much care in institutional settings
• Health inequalities remain
• Focus on treating illness
• Limited diversity of providers
• Individual choices still limited, local voices
  sometimes unheard

BUT
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Eight steps to more effective commissioning

• Putting people at the centre of commissioning
• Understanding the needs of populations and
  individuals
• Sharing and using information more effectively
• Assuring high quality providers for all services
• Recognising the interdependence of work, health
  and well-being
• Developing incentives for commissioning for
  health and well-being
• Making it happen local accountability
• Making it happen capability and leadership

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Understanding the needs of populations and
individuals JSNA

• Key building block of commissioning process
• Duty of local authority and PCT
• LAA and local targets based on the JSNA
• Must be focussed on outcomes
• Must be focussed on the future
• 3-5 years improvements in outcomes/reductions in
  health inequalities
• 5-15 years for major infrastructure
  planning(transport, housing, healthcare
  facilities)
• 1 year contractual changes at frontline / PBC
  level

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JSNAWhat it isnt, what it can do

• Need to define scope
• Not the whole commissioning process
• Not the plan to deliver changes in service
  delivery
• It is a process and a document
• (DsPH must be involved in whole commissioning
  process)

• It is the information evidence to support other
  parts of the commissioning process medium
  short term
• Includes Patient and Public voice
• PCT Prospectus Sustainable Community Strategy
• Signals to the market that changes in provision
  expected
• Services as they are currently delivered could be
  decommissioned

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JSNA and the Commissioning Cycle
OUTPUTS (The link to other stages of
commissioning)
INPUTS (Data/information needed)
Joint Strategic Needs Assessment the desired
health and well being outcomes in 3 5 years
time for your population
Demography
Programme of systematic service reviews (NHS /
Social Care)
Social environmental context
Current known health status of populations
Prioritisation framework for annual contracting
procurement
Current met needs of the population
Medium-term market development capacity to
deliver desired service configuration (Local
Government and NHS)
Patient/Service User voice
Public demands
What decisions will be made by whom?

• Analysis of inequalities
• Outcomes
• Service Access

PCT Prospectus outcome metrics chosen
PCT
Primary Care Investment Commissioning decisions
(NHS)
Evidence of effectiveness
SCS, LAA and Outcome indicators (35/200)
LSP
Capital Investment Plans (local / regional
government and NHS)
Programme budgets and outcomes
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Interpersonal Relationships

• Statutory guidance
• Duty on the DPH/DASS/DCS to work together

• Poor relationships could undermine JSNA and
  commissioning
• Do you require support in developing, e.g.
  negotiation and relationship management skills?

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Prioritisation Leadership

• JSNA focuses on outcomes
• Over the short to medium term
• Aligned with SCS LAA cycles

• What will prevent an agreement on outcomes?
• How will priorities be set?
• Will there be any political/power imbalances?

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Prioritisation Leadership Decommissioning

• What part will you play?
• How could JSNA support you?
• How will you maintain PH as a priority?

• JSNA is backdrop supports prioritisation
• annual contracting
• More importantly
• Longer time periods
• Provides defensible process for decisions on
  priorities
• This includes building local support for
  decommissioning(patient/public/political voices)

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Which Model Suits You?