What are Joint Strategic Needs Assessments?

JSNAs are local assessments of current and future health and social care needs that could be met by the local authority, CCGs, or the NHS Commissioning Board. They are produced by health and wellbeing boards, and are unique to each local area.

Who is responsible for JSNAs and JHWSs?

Local authorities and clinical commissioning groups (CCGs) have an equal and joint duty to prepare JSNAs and JHWSs, through the health and wellbeing board. The responsibility falls on the health and wellbeing board as a whole.

Homelessness is a HealthCare Issue - Editorial Report by UCH Homeless Team, University College Hospital.

The Forum considers it essential that client service users must be involved and interviewed as part of the assessment. We propose a Service User Forum is set up by the County Council in liaison with the VCS and providers as recomended in the Forum's Review, Executive Summary as follows:

'Executive Summary.  
From analysis of documents reviewed there are unequivocal statements of negative impact.   
The HHT is a critical element in the provision of medical services to the homeless.  
There is a concern that two groups covered by legislation, the disabled, and the mentally ill, have suffered as a result of the closure of the Day Centre.  
Further research/surveys should be carried out into the impact of the closure on the client group themselves. This should include Service User Interviews as there has been no consultation with the client group who use(d) the HHT and Day Centre or any feedback from them. Option of undertaking interviews at Faith Groups outreach is available.  
A Service User Forum should be considered as the ‘voice’ of the client group.  
The split in commissioning is seen as presenting a real risk of a lack of coordination of provision of homeless health care. The level of risk needs to be assessed'.  


Gloucestershire Health & Wellbeing Board Tuesday 19 July 2016 at 10.00 am Cabinet Suite - Shire Hall, Gloucester. Minutes of meeting. St Mungo's Homeless Health Matters Charter approved. We are told approval will trigger the Homeless Health JSNA.

We have been asked by the County Council if the Forum could help work with them in the production of their strategic homeless health JSNA; the Forum considered it to be a very important ommision in the County Strategy. Adoption of the Homeless Healthcare Charter by the HWBB was really good news and we were told would trigger the JSNA. We have not yet heard how the Charter will be implemented and how the JSNA process or plan will work as of January 2017.  We hope the following will help to understand JSNA's etc....


"Understanding Gloucestershire" - A Joint Strategic Needs Assessment (JSNA).

For a helpful introduction form Dorcas Binns and Helen Miller.

Inform Gloucestershire holds some key documents which should relate to homelessness. JSNA's should identify the health needs of homeless people, including single homeless people, the gaps in current services, etc. St Mungo's Broadway have found nationally that a number of JSNA's do not. 

The following are extracts, references, documents, etc., to help with continuing discusion, understanding, awareness, etc:-

The Joint Strategic Needs Assessment (JSNA) should provide a comprehensive picture of the current and future health and wellbeing needs of the population and informs commissioning in order to achieve better outcomes and reduce inequalities. It is jointly produced by the Clinical Commissioning Group (CCG) and Gloucestershire County Council on behalf of the Gloucestershire Health and Wellbeing Board whose members decide the strategic direction of public agency commissioning in Gloucestershire. The production of the report is overseen by the Understanding Gloucestershire JSNA Information and Analysis Group  whose membership includes all the relevant partners and stakeholders; feedback is encouraged.

UG JSNA - Understanding Gloucestershire Executive Summary

UG JSNA - Understanding Gloucestershire Full Report

JSNA - Understanding Districts.

JSNA - Gloucester

Gloucestershire Health & Wellbeing Board.

Archive. Annual Report of the Director of Public Health Gloucestershire County Council 2013-14.

Department of Health Statutory Guidance on JSNA and Joint Health & Wellbeing Strategies.


What are Joint Health and Wellbeing Strategies (JHWSs)?

JHWSs are strategies for meeting the needs identified in JSNAs. As with JSNAs, they are produced by health and wellbeing boards, and are unique to each local area. They should explain what health and wellbeing priorities the health and wellbeing board has set in order to tackle the needs identified in their JSNAs. This is not about taking action on everything at once, but about setting priorities for joint action and making a real impact on people’s lives.


Department of Health - Commisioning Inclusive Health Services. 

JSNA Briefing. A Briefing for Health & Wellbeing Boards produced by Homeless Link and St Mungo's Broadway. Following the Health and Social Care Act 2012, Joint Strategic Needs Assessments (JSNAs) should underpin each local area’s strategy for meeting the health and wellbeing needs of their population.  This short briefing outlines why including and addressing the needs of single homeless people should be a core part of every JSNA so that Health and Wellbeing Boards, and local commissioners, can achieve their goals of improving the health of people in the area, and reducing health inequalities.  It gives Health and Wellbeing Boards some practical examples of how this can be done in partnership with local agencies and service users. (See also our pages on Homeless Health)

St Mungo's JSNA Draft Guidance Sept 2012.

NPS PHE - Toolkit for Commisioners.

Case Sudies. Whats Good/Best Practice? Cambridge County Council JSNA - Homeless and at Risk of Homelessness.

Devon County Council JSNA, HomelessnessPublic Health have been working in partnership with key stakeholders to better coordinate a range of services for people with complex needs using the MEAM (Making Every Adult Matter) Approach.

Devon Homeless Health Needs Assessment.


Relevant extract from the Forums Homeless Health Review, Recomendation 4 on page 3, as follows:

There have been queries as to who has responsibility for health inequality’s and the health of the homeless. NHS England (commission function for Primary Care), CCG’s (commission secondary care), County Councils commission public  health and social care. Directors of Public Health have a key role in providing  leadership.  The Gloucestershire Health & Wellbeing Board (H&WB) has an important duty re the homeless, planning for health provision and leadership in addressing homeless health and holding their Director of Public Health to account for homeless health.  
The Health & Social Care Act 2012 include a welcome increased focus on health inequality’s and integration but the split in commissioning presents a real concern about the risk of a lack of coordination. (‘A Future. Now – Homeless Health Matters: the case for change Oct 2014’, a report by St Mungo’s Broadway refers. www.mungosbroadway.org.uk/documents/5390/5390.pdf).  CCG’s have a duty to provide services for all patients in their locality whether registered with a GP or NOT, including services for the homeless, (Report ‘Healthcare for the Homeless…’ - Consultants Deloitte, Centre for Health Solutions).
This should identify the health needs of homeless people, including single homeless people, and the gaps in current services. It is understood to be a statutory responsibility of the Director of Public Health GCC.

Recommendation: The Gloucestershire Joint Strategic Needs Assessment (JSNA) document to be reviewed.

The County Council JSNA documents have been reviewed and healthcare of the Homeless has NOT been included. On asking the County Council we were told that this was not a priority as yet. June 2016.

Click here for the subsequent Briefing Paper for the Forums meeting on the 15th June, Agenda Item 4.

Is Homeless an afterthought for some health planners in the UK? We hoped that homeless healthcare was not just an after thought of health planners here in Gloucestershire as reported by St Mungo's for other authorities.

If so, use your own data to inform your local JSNA. Decide as a local partnership what you can do. Developing an Action Plan.

Homeless Link From Data into Action using your health needs audit.

Homeless Link Homeless Health Needs Audit.

Homeless Health Needs Audit - Printable version of the survey.

Homeless Link have designed the Homeless Health Needs Audit as a framework for gathering and using information about the health needs of people experiencing homelessness in your area.

Why conduct an audit?

With the right partners involved and the right approach, a Health Needs Audit will help you:

  • Increase the evidence available about the health needs of people who are homeless and the wider determinants of their health.
  • Bring statutory and voluntary services together to develop responses to local priorities and address gaps in services.
  • Give people experiencing homelessness a stronger voice in local commissioning processes.
  • Help commissioners understand the effectiveness of their services.

Who should use it?

The audit and the accompanying guidance can be used by anyone with an interest in homeless health. Given the scope of the issues concerned, we recommend that the audit and its wider resources be used in partnership by representatives from the local authority, voluntary sector and health services.


Pilot example: in Leeds, lead partners fed back the results via the Leeds Homelessness forum, and held a separate half day workshop with local agencies, the PCT and Leeds City Council. They used this workshop to identify possible follow up which could be taken by providers, local health commissioners and the local authority. The resulting action plan was the result of joint input and planning which made it far more effective. - See more at: http://www.homeless.org.uk/our-work/resources/health-needs-audit-toolkit/from-data-into-action-using-your-health-needs-audit#sthash.ADV6HuQN.dpuf

This document is designed to provide you with: 1. An overview of what a JSNA is and its aims 2. How the information gathered in your health needs audit could be used in your local JSNA.


Homeless Population.

The greatest challenge with this client group is that despite having a multifarious mix of needs, quite often each need in isolation does not meet the criteria for anyone service, therefore there is no statutory duty upon district councils or executive authorities to help them. The risk in the current economic climate with cuts to public spending is that services for homeless people will be viewed as superfluous; ‘not core business’ and some of the most vulnerable people in society risk being further marginalised, their needs ignored until their health needs or behaviour requires emergency/acute/costly interventions.

'Inclusion Health' recommends a greater focus upon members of the population that are socially excluded. Arguably the homeless population contains within it some of the most excluded individuals in society, therefore they are chronically excluded. 

The Department of Health / Cabinet office paper 'Inclusion Health' uses a framework to highlight key areas where changes can be made or services enhanced to ensure a greater equity of access to health services, a better understanding of the needs of this groups and better treatment outcomes. 

To read about 'Inclusion Health' click on following sub page -