1. JOINT STRATEGIC NEEDS ASSESSMENT Linda de Caestecker Director of Public Health NHSGGC Carol Tannahill Director GCPH

2. Joint strategic planning requires both Health Needs Assessment Evaluation of Services

3. What is a health needs assessment? Health needs assessment is a systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities It is a valuable tool for informing the planning process by identifying the priorities for professional and service development that will improve the health of the target population and reduce inequalities Can provide an opportunity to engage with specific populations and enable them to contribute to targeted service planning and resource allocation Can provide an opportunity for cross-sectoral partnership working and developing creative and effective interventions

4. Health Needs Assessment Assess the level of need for health and social care services –Develop a demographic profile of the population of interest –current and future composition by age, gender, geographic location, urban-rural location, household composition specific population subgroups, such as ethnic group. dependency ratio household tenure etc. –Gather information on indicators of need in the population of interest including life circumstances, health status, risk factors, data gaps, likely future levels of need –Crucial element of strategic needs analysis is to identify needs of more specific groups within populations and understanding that Sometimes services have to be provided differently or with greater intensity to ensure that equitable access and outcomes can be achieved Describe the current pattern and level of supply of these services Identify the extent of the gap between need and supply. - Integrating and making sense of information - Setting priorities

5. Reasons not to undertake a HNA Tick-boxing exercise as a front-piece to a report If there is no sign-up to acting on the results of the HNA Because it has never been done before in that area Stalling tactic To legitimise the role of public health departments

6. HNA must….. Assess differential impacts of policies and strategies and understand: –The population groups and individuals furthest from good health and from service provision –The wider population, that is, including those who do not currently use supports or services –Population groups currently well but at risk of developing poor health and well-being –Carers networks, support groups and other people-based assets –The mechanisms for self-care and collaborative or co- produced care

7. Defining ‘Need’ Bradshaw (1972): Perceived/Felt need: need perceived by the individual Expressed need: felt need turned into action (help seeking) Normative need: defined by experts (may not be felt) Relative need: gap between the level of service between similar communities Matthew (1971): A need for medical care exists when an individual has an illness or disability for which there is effective and acceptable treatment or care, i.e. need as ‘capacity to benefit’ Stevens, Raftery, Mant: Need as ‘population’s capacity to benefit from health care’ i.e. if potential for health gain = zero, then need = zero.

8. Change in Population Need Changes in incidence and prevalence of disease e.g. epidemiological or demographic change Changes in population capacity to benefit from treatment e.g. new treatments, new organisation of care Changes in identification methods, treatment thresholds, referral pathways etc Changes in public and professional expectations

9. Deaths from Coronary Heart Disease in < 75 years, 2004-2010 ICD 10th Revision, (I20 - I25)

10. Secular decline in Mortality because of Ischaemic Heart Disease Three possibilities: Issues re data Reduction in incidence (Changing profile of risk factors) Reduction in case-fatality and resulting change in prevalence

11. Real health care system Need Demand Outcomes Clinical decision - by patient Clinical decision - by clinician (together with patient?) Variation in effectiveness Resources used: also can be considered as service capacity Activity Patient pathway

12. Defining Need, Supply & Demand Need - what people benefit from Demand - what people ask for Supply - what is provided Need Demand Supply

13. Need, Demand & Supply Demand Need Supply d = supply that is needed but not demanded, e.g. BP checks a = demand that is neither needed nor supplied e.g. baldness cure. b = supply that is demanded but not needed, e.g. some Caesarean Sections, e.g., 27.8% in Scotland e = need that is neither supplied nor demanded, e.g., brain transplant (some people!) f = need that is demanded but not supplied, e.g. homeopathy ab c fd e c = supply that is neither needed nor demanded, e.g. Independent Sector Treatment Centres – private companies providing NHS care in England & Wales

14. Aim of Needs Assessment Need Demand Supply Need Demand Supply

15. Three main approaches to HNA Epidemiological –Defining the condition to be examined –incidence and prevalence –effectiveness and cost-effectiveness –existing services Comparative –contrast services received by one population with other populations and with standards Corporate –seeks views, demands, wishes and alternative perspectives of stakeholders (public, professionals, politicians, users, carers, other interested parties)

16. Developing Workforce Planning Capability in Scotland Epidemiological approach to Needs Assessment Incidence/prevalence of disease - prevalence of risk factors Ability to benefit - need only exists if potential for benefit - evidence-based medicine Assessment of unmet need Health care -primary and secondary prevention, diagnosis, acute care, terminal care etc.

17. 1. Information about local health situation (health status & current services) 2. Interventions that work and are affordable that would address the local health situation? 3. What does this mean for how existing local “health” services should be organised?

18. Comparative Approach Contrasts the services received by the population in one area with those elsewhere May comprise entire methodology for needs assessment Absolute level of need not known/defined Based on comparison of levels of services Analysis of variations Referral rates, surgical rates, admission rates Use of ‘norms’

19. Variations Coding and diagnosis Illness behaviour Demography, - age, sex, deprivation, ethnicity Supply factors -numbers of beds, consultants, out-patient services Medical behaviour -consultation rate - referral rates - admission criteria Need

20. Corporate Approach to Needs Involves the systematic collection of the knowledge and views of informants on healthcare services and needs. Stakeholders contribute corporate view of local needs, and what should be changed Stevens and Gillam 1998, BMJ 316, 1448-1452

21. Assessment Corporate View Opinion Leaders PurchaserProviders Professionals Politicians General Practitioners Press Patients / service users

22. Non NHS sources of Information Physical environment Crime Housing and homelessness Social services Socio-economic environment including employment Lifestyle Education Leisure and culture Transport Accidents

23. High levels of ADHDHigh levels of drug and alcohol use High unemployment Poor educational attainment Smoking related heart disease respiratory difficulties High Morbidity Anti Social Behaviour Gender Inequality Poor housing/environmental issues Racial tension / hate crimes High crime rates. Significant fear among older people Obesity across the life course Classic Needs Map © Cormac Russell ABCD Institute, 2013

24. © Cormac Russell ABCD Institute, 2013

25. Beyond the assessment of needs The wider context of Public Service Reform –Outcome-focussed planning and delivery –The challenges of Christie –Asset-based working, co-production and improvement science

26. What might this mean for measures and approaches? Quality of experience; Capabilities; Opportunities; System-based; Equity-focused Productivity, efficiency, cost- effectiveness; Outcome-focused; Condition-specific

27. This implies Expanding beyond a traditional evidence-base as the foundation for planning Sharing learning about measures and approaches – how to go beyond our current administrative data –Adopting collaborative approaches –Valuing qualitative alongside quantitative measures

28. Building on past experience Existing resources (see www.scotpho.org.uk)www.scotpho.org.uk –Profiles and indicators –Toolkits (eg health inequalities toolkit) –Survey data (eg SHeS, SHS, GUS etc) –Evidence (eg Marmot review on tackling health inequalities) Local and national data sources

29. But also barriers to use Individual: data confidence; conflicting evidence; skills and confidence Currency and relevance of the information in a partnership context Context: time available; volume of information; clarity of purpose

30. Conclusions There is a lot of experience on which to build A strategic approach is needed (including clear purpose; attention to workforce development) Underpinned by a learning mindset and associated structures to develop measures and approaches that are fit for purpose