Working with the local voluntary sector to tackle Inequality and Exclusion – a better JSNA
This is a story about some work I have been doing for the last year or so to improve the way the expertise of grass roots organisations is heard by local commissioners.
The problem
There’s nothing inherently wrong with the Joint Strategic Needs Assessment (JSNA) and the Joint Health and Wellbeing Strategy (JHWS) but the way they have been developed means that they are:
- read by few,
- provide a very high level view of need that is largely based on a set of standard national measures
- struggle to bend system priorities to complex, small and pressing issues that too often slip below the radar.
It is often the case that it is these small, complex ‘wicked’ issues that grass roots organisations are tackling on a day to day basis – and they feel frustrated that the problems they are addressing do not seem to be understood at a JSNA or JHWS level. This of course is one of the reasons why commissioning continues to favour big statutory and private organisations.
I think that one of the reasons this happens is because we fall into the trap of thinking that the JSNA process is primarily a linear one – gather up all the data, put it all in one place – a web site or a report and then analyse it.
I am not arguing against this process – its good to have a population level view – but it is not sufficient if we want a genuinely responsive, inclusive and integrated approach to local commissioning, specifically one that is able to bring issues forward that:
- Affect small populations
- Are complex – multi-causal
- Have poor incomplete data sets
- Are about power, exclusion and inequality
Many of the organisations that work in this area are voluntary and community sector ones. If you work in areas that are easily ignored with people who are unpopular with policy makers then you are likely to struggle to be heard too. Witness the Trussell Trusts exclusion by Ian Duncan Smith.
So, we need a more asset based approach. One that gives voice to these organisations, playing to their strengths and allowing them to share their analysis of the issues they are tackling. This means providing opportunities for the expertise of these organisations to play in and for the voice of the people they serve to be heard.
It also means making it worthwhile for these very pressured organisations to contribute to the process.
Rapid Intelligence Review
About a year ago I started a project to try to come up with a rapid way of trying to address this problem – this is not rocket science. Working in partnership with Involve Yorkshire and Humber and funded by what was then the Yorkshire and Humber Public Health Observatory (now Public Health England Knowledge and Intelligence Team) we devised a model based on the following principles:
- It had to make little demand on the voluntary and community sector in terms of time or resource
- It needed to be led by a VCS view of what issues we should focus on
- It had to capture a more complete story – so a mixture of qualitative and quantitative data
- It had to be cheap
- It needed to make some recommendations
The VCS in two areas (NOVA in Wakefield and Voluntary Action Sheffield) with their respective local authorities worked through the process with us. In Sheffield they identified food banks and specifically the people who use them as the priority area and in Wakefield they identified Pressured Parents.
The Wakefield Report is available here
The Sheffield Report (which I referred to in an earlier blog) is available here
Jake Abbas (Interim Director, PHE Northern, Knowledge and Intelligence Team) and I have written an overview report on the process which has now been published by Public Health England. This is titled:
Implications
The experience of doing the two reviews has led me to the following conclusions:
- the JSNA process cannot just be about putting all the data into one place – it must also include a continuous process of small reviews that focus on “wicked issues” and the process for determining these should be jointly agreed with local civil society organisations.
- it is important to have actions and recommendations – but for a number of these issues just using the review to create a debate at a place level is a step forward.
- we need a more inclusive view of evidence – lack of population level data or RCT evidence is not a good reason for failing to investigate a topic – its actually an abrogation of responsibility.
What do you think?
Footnotes
Jake and I shared this work at the 2014 Local Area Research and Intelligence Association Conference in 2014
By the end of 2014 Sheffield City Council had taken note of the recommendations in the Rapid Review and agreed to invest a further £400k in Foodbank and associated welfare rights support
Thanks Mark, good work here. I can see how the Rapid Review process was effective for the relatively recent phenomenon of food-banks, how might it work with other areas where we want to collect meaningful but equally qualitative information?
Seems to me that providers of services more mainstream might not welcome this kind of scrutiny. Can it only work for voluntary sector and is only positive evidence useful? I know of many ‘traditional’ services which the users do not rate highly but which continue to drain resources. Some of this is hard to break down but needs illumination as much as the good non-traditional activities.
Ted
Thanks Ted – yes a fair point – the organisations who took part did so on a voluntary basis – so would need to think how to bring more challenge into this work. Having said that I think some of the elements are there already – for example – using an independent external agency, the involvement of the CVS and so on. I think the approach (albeit considerably smaller) actually has some similarities with the Fairness Commission methodolgy which was was fairly successfuly in Sheffield. I suppose the key bit for me is that this sort of process is not THE answer just part of the solution.