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Local authorities and health, through the Clinical Commissioning Groups (CCG's) have a duty to prepare a Joint Strategic Needs Assessment (JSNA) to inform the way in which decisions about health, wellbeing and social care services are planned and arranged.

The JSNA is the collection and collation of information and intelligence about the health and wellbeing needs of the local community. This includes information about what are referred to as the ‘wider determinants’ of health, like housing, income, employment, social and recreational needs and provision.

The figure below illustrates the complexity of the key determinants of health and wellbeing.

The Main Determinants of Health
Enlarge the The Main Determinants of Health diagram.

The Marmot Review and Recommendations

In November 2008, Professor Sir Michael Marmot was asked by the then Secretary of State for Health to chair an independent review to propose the most effective evidence-based strategies for reducing health inequalities in England from 2010.

The final report 'Fair Society, Healthy Lives was published in February 2010, and concluded that reducing health inequalities would require action on six policy objectives:

1. Give every child the best start in life

2. Enable all children, young people and adults to maximise their capabilities and have control over their lives

3. Create fair employment and good work for all

4. Ensure healthy standard of living for all

5. Create and develop healthy and sustainable places and communities

6. Strengthen the role and impact of ill-health prevention.

The JSNA is informed by the Marmot Review.

Enfield People and Enfield Place include information about the wider determinants of health and wellbeing and describe Enfield as a place to be born, grow up and get older in, as well as a wide range of detail about the characteristics of the people of Enfield.

Enfield Resources, is an important part of the JSNA and is a consideration of the resources or ‘assets’ that the community as a whole can bring to bear on meeting the identified needs. This is only in part about money – although of course very substantial amounts of money are involved in the provision of health services locally and in the services provided or arranged through the local authority.

It provides a set of information about what is spent locally including in support of the diverse voluntary sector and includes other considerations, for example the substantial contribution made by unpaid family carers. However, over time this information will increasingly be developed to include consideration of the extent to which the local authority and the clinical commissioning group are able to influence individual behaviours and attitudes and to build ‘resilience’ within the community – resilience as illustrated by the strength of the systems of mutual support that enable communities to cope with challenges and in particular to cope with change. This section has clear links to the Enfield Strategic Partnership Community Cohesion Strategy.

The sections children and young people and their families and then of adults, include reporting on health indicators that affect the whole population. The critical importance of early intervention in the lives of children, in particular the needs of especially vulnerable children such as children with disabilities, mental health problems, looked after children and young carers, if health outcomes are to be improved is the focus of section 4. The section on adults takes as its theme the prevention of premature death, ill health and long term conditions in people aged 18 – 64 as well as the support needed by adults and their carers who are particularly vulnerable due to physical or mental ill health or learning disability.

The section of our JSNA termed here as ‘older people’ is a focus on the health and wellbeing of people over 65 years. The consideration of older people separately facilitates a focus on the provision of social care, including the contribution of unpaid family carers and the progress being made in helping older people to retain their independence despite increasing frailty, and at planning for the impact of the substantial increase in older people living with health problems and disabilities, including older people with learning difficulties.


Introduction

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