Health needs assessment: A practical guide

1 AcknowledgementsThe authors of this publication gratefully acknowledge the contribution of Judith Hooper andPhil Longworth, the authors of the HDA Health needs assessment workbook (2002), for developing the framework and some of the original material on which this guide is based. Othercontributors to this guide include the participants of the HDA regional scoping, learning andexpert workshops 2002/04, and internal and external colleagues who have supplied advice, casestudies and other material. Particular thanks are due to: Andrew Beckingham Peter Brambleby Ruth Chiddle Nick Doyle Janet Flanagan Robert Glendenning Julia Pallant Mary Pigott Maggie Rae Susan Rautenberg Dawn Scott Paul Scott Helen Thornton-Jones Shahla Wright Tricia YoungerHDA Regional Associate Directors and Practice Development OfficersFrom 1 April 2005, the functions of the Health Development Agency transferred to the NationalInstitute for Clinical new organisation is the National Institute for Health and Clinical Excellence (to be known asNICE).

2 It is the independent organisation responsible for providing national guidance on the promotion of good Health and the prevention and treatment of ill web address from 1 April 2005 is and compiled by Sue Cavanagh and Keith ChadwickHEALTH DEVELOPMENT AGENCYH ealth needs assessmentContentsSummary: Health needs assessment at a glance2 Section1. Introduction6 How does HNA support national priorities?7 Benefits and challenges7 Resources required to start an HNA92. Common language123. The five steps of Health needs assessment20 Step 1 getting started22 Step 2 Identifying Health priorities25 Step 3 Assessing a Health priority for action36 Step 4 Action planning for change42 Step 5 Moving on/project review464. HNA skills required and tools available505. Case studies541 Geographic populations at different levels, eg regional, PCT/local authority catchment area or Acomb Health needs assessment , Selby and York GP practice population rural Mid-Hampshire602 Settings populations eg schools, workplaces, prisons, Secondary school population Young People s Health Prison populations in three prisons in Durham683 Shared social experience populations eg homelessness, refugee, ethnicity, culture, age, Children under four and their families Newcastle upon Tyne Sure Start Black and minority ethnic children Leeds774 Specific Health experience populations eg diseases, chronic illness, mental Health , Cardiac service requirements of a black and minority ethnic population in Suicide and self-harm residents at risk in Greenwich and Bexley866.

3 Bibliography and references91 References cited in the text92 Useful resources947. National and regional contacts97 National98 Regional98 Health DEVELOPMENT AGENCYH ealth needs assessmentCONTENTSS ummary: Health needs assessment at a glance2onetwothreefourfiveStep 2 Identifying Health prioritiesPopulation profilingGathering dataPerceptions of needsIdentifying and assessing healthconditions and determinant factorsStep 5 Moving on/reviewLearning from the projectMeasuring impactChoosing the next priorityStep 4 Planning for changeClarifying aims of interventionAction planningMonitoring and evaluation strategyRisk-management strategyStep 3 Assessing a Health priorityfor actionChoosing Health conditionsand determinant factorswith the most significantsize and severity impactDetermining effective andacceptable interventionsand actionsStep 1 getting startedWhat population?What are you trying to achieve?

4 Who needs to be involved?What resources are required?What are the risks?StepStepStepFigure 1: The five steps of Health needs assessmentStepStepSummary: Health needs assessmentat a glanceHEALTH DEVELOPMENT AGENCYH ealth needs assessmentSUMMARY3 What is Health needs assessment ? Health needs assessment is a systematic method for reviewing the Health issues facing apopulation, leading to agreed priorities and resource allocation that will improve Health andreduce undertake HNA? HNA is a recommended public Health tool to provide evidence about a population on which to plan services and address Health inequalities HNA provides an opportunity to engage with specific populations and enable them tocontribute to targeted service planning and resource allocation HNA provides an opportunity for cross-sectoral partnership working and developing creativeand effective interventionsHow does HNA support national and local priorities?

5 The government is committed to reducing Health inequalities within the population. It has set apublic service agreement to: REDUCE Health INEQUALITIES BY 10% BY 2010 ASMEASURED BY INFANT MORTALITY AND LIFE EXPECTANCY AT BIRTH provides a vital tool to meet this objective, and is recommended in various policydocuments to inform regional and local strategic are the benefits of HNA?Benefits from undertaking HNAs can include: Strengthened community involvement in decision making Improved team and partnership working Professional development of skills and experience Improved communication with other agencies and the public Better use of are the challenges of HNA? Working across professional boundaries that prevent power-or information-sharing Developing a shared language between sectors (see Section 2) Obtaining commitment from the top Accessing relevant data Accessing the target population Maintaining team impetus and commitment Translating findings into effective needs assessment (HNA) is asystematic method for reviewingthe Health issues facing apopulation, leading to agreedpriorities and resource allocationthat will improve Health and purpose of this guide is to provide practicalassistance to everyone engaged in undertakingHNA, including strategic managers at regionaland local levels, facilitators, and practitioners inprimary care trusts, local government and thevoluntary and community guide has been developed from the originalHealth needs assessment workbook(Hooperand Longworth, 2002), published by the HealthDevelopment Agency (HDA)

6 This revised editionhas been produced to: Present HNA within the current political andprofessional context Provide additional practical resources Highlight the important contribution HNA canmake as part of HDA s Evidence into Practiceapproach to tackling Health Department of Health (DH) charged theHDA to support the Evidence into Practiceapproach to improving Health outcomes, basedon integrating evidence, learning and locallyderived practitioner knowledge and localimprovement systematic process usedin HNA provides ideal opportunities forengaging with specific communities, gatheringevidence from and about them, and utilising anevidence-based approach to effect servicechanges and improvements with their tools and guides have been producedby individuals and organisations in recent yearsto assist practitioners undertaking HNAs. Manyare listed in Section 6, Bibliography andreferences.

7 Some are based on the approachoutlined in the original HNA workbook (Hooperand Longworth, 2002), but offer more detailedassistance with particular types of HNA, or aredesigned for certain practitioner project leads should acquaintthemselves with the various HNA tools andguides that have been produced, using the coreprocess in this guide will ensure a consistentand robust process is followed and enableeasier comparison between HNAs. Thesystematic process promoted in this guide hasbeen well tried, tested and refined over severalyears by practitioners, many of whom haveactively informed this guide outlines five steps that will enable asimple but robust process to be process is flexible, but the steps should beadequately covered to ensure a quality process eg Health profiling alone is not HNA, nor isundertaking a rapid appraisal exercise, but bothcan contribute. An HNA should always lead topositive action, and implementation anddissemination strategies are an essential part ofthe process.

8 This guide attempts to keep thecore information to a minimum, but signpoststo additional resources are included for clarity the process is describedas linear, in reality frequent cross-checkingand revision across steps will be required. The case studies provided in this publicationare examples of HNAs undertaken with arange of populations. They are intended tobe illustrative, and experiences may differwhen undertaking similar DEVELOPMENT AGENCYH ealth needs assessment1. INTRODUCTION7 How does HNAsupport nationalpriorities?The aim of the government s healthinequalities strategy is to narrow the gap inhealth between different social and economicgroups and areas. It has set a national publicservice agreement target to: REDUCE Health INEQUALITIES BY10% BY 2010 AS MEASURED BYINFANT MORTALITY AND LIFEEXPECTANCY AT BIRTH provides a vital tool in helping to meetthis objective through targeting populationsmost in need of improved support linked with commissioning has been anintegral task of Health authorities since lives: our healthier nation(DH, 1999)stresses the importance of the community srole in identification of Health needs andpriorities; and Shifting the balance of powerwithin the NHS: securing delivery(DH, 2001)gave specific responsibility to primary caretrusts.

9 The Wanless report Securing goodhealth for the whole population(Wanless et al., 2004) also emphasises the importanceof high levels of public engagement in orderto achieve optimum gains in Health outcomesand a reduction of Health expenditure in thelong term. The HNA approach provides anideal opportunity for different agencies tobuild trust with communities to ensuregenuine partnership involvement inreconfiguring can usefully inform: Health equity audits (see Section 2, page 17) Local delivery plans Community strategies Specialised services commissioning Health and social care joint planning and commissioning General practice strategic development are sometimes conducted by voluntary,community and charitable organisations tocollect information about their targetcommunities for funding and project planningpurposes. When public sector agencies areconducting HNAs, they should check withvoluntary and community organisations to seewhat information they have collected and,where appropriate, to involve them in projectteams or stakeholder andchallengesBenefits from undertaking an HNA caninclude: Strengthening community involvement indecision making Improved public patient participation Improved team and partnership working Professional development of skills andexperience Improved patient care Improved communication with otheragencies and the public Better use of value of HNA to general practice and theGeneral Medical Services contract lies in thecontribution it can make to improving dataquality, which is important to meeting quality8indicators; developing chronic disease registers.

10 And providing information for an evidence baseof need which can support funding applicationsto provide enhanced services. It also supportsthe clinical governance agenda and informationrequired for National Service Framework are a requirement of professionalcompetency for the UK voluntary register ofpublic Health specialists and for Part 2 Faculty ofPublic Health examinations, but they mustdemonstrate a robust process involving soundepidemiological and social sciencemethodologies (see Section 3, page 27 andSection 4, pages 52-53).Challenges that may be encountered whenundertaking an HNA can include: Working across professional boundaries tackling territorial attitudes preventing poweror information sharing:-develop positive working relationships withcolleagues within other sectors-develop an understanding of organisationalstructures/priorities/obje ctives-ensure others are clear about the benefitsto their organisation/profession ofconducting HNA.