Community engagement key to Enfield's JSNA strategy


The London Borough of Enfield has teamed up with the local primary care trust (PCT), NHS Enfield. They have placed community engagement at the heart of their joint strategic needs assessment (JSNA).

Community leaders have described the wide-ranging exercise as “as good as you will find anywhere”. It has resulted in a JSNA which will help transform services and, in turn, improve the health and wellbeing of the local population.

Key learnings for other councils

  • Include seldom-heard groups in the consultation process
  • Consult on how you are going to carry out the consultation
  • Make sure you involve people who can work on the JSNA in an unbiased way
  • Create a full-time position to lead the programme on a day-to-day basis, it is too time-consuming to do part-time
  • Aim to get consistent data and then be prepared to improve information in the future.


The Local Government and Public Involvement in Health Act 2007 specified that councils and PCTs produce a JSNA of the health and wellbeing of their local community.

This involves pulling together all the information on the needs of residents into one place. In Enfield's case, that meant collecting data on more than 285,000 people. The borough, the most northern in London, is the sixth largest of the 32 in the capital.

Who was involved?

Such a thorough and detailed approach has, of course, required teamwork. The Steering Group, composed of representatives from the council, PCT, mental health trust, voluntary sector and community, has met on a monthly basis to oversee the process. The partners have also been helped by consultancy support from the IDeA.

However, to drive the JSNA forward on a day-to-day basis and coordinate the consultation a Project Leader, Peter Feldon, was appointed. Meanwhile public health specialists from the PCT were heavily involved in collating the health data and statistics.

Says Feldon:

“It is important to bring everyone in. You need consensus in this process because if people don't feel they have contributed, it is more difficult to get them to accept the priorities that have been identified.”

What was done?

The partners in Enfield were clear from the start that they wanted to carry out a thorough and detailed consultation.

Work on the JSNA started in early 2008. The final report is due to be published in the second half of 2009.

It identifies priority areas including:

  • poverty
  • health inequalities
  • obesity
  • infant mortality
  • mental health
  • healthy lifestyles
  • feeling safe
  • access to health and wellbeing information.

The report set out a wealth of data on the health of the local population. This included everything from average income and unemployment to binge drinking and teenage conceptions.

The consultation phase of the process took place in the first half of 2009 - after almost a year of data collection and analysis.

The partnership identified seven groups whose voices are seldom heard and carried out individual events with them. This was done with the help of the Enfield Community Empowerment Network, which represents community, voluntary and faith organisations across the borough.

A general survey of residents was also held, while easy-to-read questionnaires were handed out to people with learning difficulties. On top of this, more than 400 responses were received from the Citizen's Panel.

Interestingly, the most significant factor identified by residents was fear of crime - although Enfield has relatively low crime rates.

Bindi Nagra, the council's Assistant Director - Strategy and Resources for Health and Adult Social Care chaired the JSNA Steering Group. He believes such feedback was extremely important. He says:

“We know what people are dying of, but before the consultation we did not know what they felt was affecting their health and wellbeing. And that is very important when it comes to accessing services, establishing the underlying causes of the problems and developing evidence-based responses.”

Outcomes and impact

The hard work put into the consultation has paid off. Those involved in the programme and the wider Enfield community are pleased with the result. They believe it provides the building blocks for better services and projects.

Tony Watts, of the Enfield Community Empowerment Network, describes the consultation “as good as any you will find anywhere.” Watts says:

“They did a really good job in reaching out to different parts of the community and I think it shows in what has been pulled together.

“At the heart of this is the good working relationship that exists. The voluntary sector has really felt part of this effort and that will stand Enfield in good stead for tackling these problems in the future.”

Nagra agrees. He believes the JSNA sets a challenge to the local partners when it comes time to refresh the Sustainable Community strategy, local area agreement (LAA) and other commissioning strategies and intentions. He also has a clear message for commissioners.

“I want to see them looking at the priorities, thinking what they can do about them and reporting back on how they intend to tackle them in future.”

But perhaps the lasting legacy of the process will be the improved integration between the partners.

Nagra says:

“We have created a partnership that did not exist before. It brought us around the table and, I think, has led to a greater understanding of each other.”

Next steps

The JSNA may have just been published, but rather than marking the end of the journey, the council and PCT are seeing it as just the beginning.

Nagra says:

“I don't see it as a one-off process, it has to evolve,” he says. “We effectively start again.”

Indeed, he believes it could be refreshed perhaps every 18 months to two years by engaging the public about their health and wellbeing, reassessing the core data and filling in gaps in information.

But this is a challenge that is being passed on to a new Steering Group Chair, Dr Shahed Ahmad, NHS Enfield's Director of Public Health. He agrees the JSNA must keep moving forward.

"We now have a really good overview and breadth of information, which we have not had before.

"I think the challenge now, as well as filling in the gaps in information, is to put the interventions in place to improve the statistics. The onus is going to be on the service providers to deliver and bend services to tackle the problems highlighted.

"For example, we now have really good data on life expectancy and health inequalities. So by working with practitioners we can maybe look at statin prescribing and hypertension to improve outcomes."

Further information

Bindi Nagra
telephone: 020 8379 4512

Pete Feldon
telephone: 020379 3957

11 November 2009

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