Health needs assessment: A practical guide

Acknowledgements

The authors of this publication gratefully acknowledge the contribution of Judith Hooper and

Phil 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. Other

contributors to this guide include the participants of the HDA regional scoping, learning and

expert workshops 2002/04, and internal and external colleagues who have supplied advice, case

studies 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 Younger

HDA Regional Associate Directors and Practice Development Officers

From 1 April 2005, the functions of the Health Development Agency transferred to the National

Institute for Clinical Excellence.

The new organisation is the National Institute for Health and Clinical Excellence (to be known as

NICE). It is the independent organisation responsible for providing national

guidance on the promotion of good health and the prevention and treatment of ill health.

The web address from 1 April 2005 is www.nice.org.uk

Written and compiled by Sue Cavanagh and Keith Chadwick

HEALTH DEVELOPMENT AGENCY

Health needs assessment

Contents

Summary: health needs assessment at a glance 2

Section

1. Introduction 6

How does HNA support national priorities? 7

Benefits and challenges 7

Resources required to start an HNA 9

2. Common language 12

3. The five steps of health needs assessment 20

Step 1 – Getting started 22

Step 2 – Identifying health priorities 25

Step 3 – Assessing a health priority for action 36

Step 4 – Action planning for change 42

Step 5 – Moving on/project review 46

4. HNA skills required and tools available 50

5. Case studies 54

1 Geographic populations – at different levels, eg regional, PCT/local authority

catchment area or neighbourhood 56

1.1 Acomb health needs assessment, Selby and York PCT 56

1.2 GP practice population – rural Mid-Hampshire 60

2 Settings populations – eg schools, workplaces, prisons, hospitals 64

2.1 Secondary school population – Young People’s Health Survey 64

2.2 Prison populations in three prisons in Durham 68

3 Shared social experience populations – eg homelessness, refugee, ethnicity,

culture, age, sexuality 72

3.1 Children under four and their families – Newcastle upon Tyne Sure Start project 72

3.2 Black and minority ethnic children – Leeds 77

4 Specific health experience populations – eg diseases, chronic illness, mental health,

disabilities 81

4.1 Cardiac service requirements of a black and minority ethnic population in Newcastle 81

4.2 Suicide and self-harm – residents at risk in Greenwich and Bexley 86

6. Bibliography and references 91

References cited in the text 92

Useful resources 94

7. National and regional contacts 97

National 98

Regional 98

HEALTH DEVELOPMENT AGENCY

Health needs assessment

CONTENTS

Summary:

Health needs assessment

at a glance

one

two

three

four

five

Step 2

Identifying health priorities

Population profiling

Gathering data

Perceptions of needs

Identifying and assessing health

conditions and determinant factors

Step 5

Moving on/review

Learning from the project

Measuring impact

Choosing the next priority

Step 4

Planning for change

Clarifying aims of intervention

Action planning

Monitoring and evaluation strategy

Risk-management strategy

Step 3

Assessing a health priority

for action

Choosing health conditions

and determinant factors

with the most significant

size and severity impact

Determining effective and

acceptable interventions

and actions

Step 1

Getting started

What population?

What are you trying to achieve?

Who needs to be involved?

What resources are required?

What are the risks?

Step

Figure 1:

The five steps of health needs assessment

Step

Summary:

Health needs assessment

at a glance

HEALTH DEVELOPMENT AGENCY

Health needs assessment

SUMMARY

What is 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.

Why 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 to

contribute to targeted service planning and resource allocation

• HNA provides an opportunity for cross-sectoral partnership working and developing creative

and effective interventions

How does HNA support national and local priorities?

The government is committed to reducing health inequalities within the population. It has set a

public service agreement to: ‘REDUCE HEALTH INEQUALITIES BY 10% BY 2010 AS

MEASURED BY INFANT MORTALITY AND LIFE EXPECTANCY AT BIRTH’

www.hm-treasury.gov.uk/media/70320/sr04_psa_ch3.pdf

HNA provides a vital tool to meet this objective, and is recommended in various policy

documents to inform regional and local strategic plans.

What 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 resources.

What 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 action.

1 Introduction

Health needs assessment (HNA) 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.

The purpose of this guide is to provide practical

assistance to everyone engaged in undertaking

HNA, including strategic managers at regional

and local levels, facilitators, and practitioners in

primary care trusts, local government and the

voluntary and community sectors.

This guide has been developed from the original

Health needs assessment workbook (Hooper

and Longworth, 2002), published by the Health

Development Agency (HDA). This revised edition

has been produced to:

•Present HNA within the current political and

professional context

•Provide additional practical resources

•Highlight the important contribution HNA can

make as part of HDA’s Evidence into Practice

approach to tackling health inequalities.

The Department of Health (DH) charged the

HDA to support the Evidence into Practice

approach to improving health outcomes, based

on integrating evidence, learning and locally

derived practitioner knowledge and local

improvement needs.The systematic process used

in HNA provides ideal opportunities for

engaging with specific communities, gathering

evidence from and about them, and utilising an

evidence-based approach to effect service

changes and improvements with their full

involvement.

Various tools and guides have been produced

by individuals and organisations in recent years

to assist practitioners undertaking HNAs. Many

are listed in Section 6, Bibliography and

references. Some are based on the approach

outlined in the original HNA workbook (Hooper

and Longworth, 2002), but offer more detailed

assistance with particular types of HNA, or are

designed for certain practitioner groups.

Although project leads should acquaint

themselves with the various HNA tools and

guides that have been produced, using the core

process in this guide will ensure a consistent

and robust process is followed and enable

easier comparison between HNAs. The

systematic process promoted in this guide has

been well tried, tested and refined over several

years by practitioners, many of whom have

actively informed this edition.

This guide outlines five steps that will enable a

simple but robust process to be undertaken.

This process is flexible, but the steps should be

adequately covered to ensure a quality process

– eg health profiling alone is not HNA, nor is

undertaking a rapid appraisal exercise, but both

can contribute. An HNA should always lead to

positive action, and implementation and

dissemination strategies are an essential part of

the process. This guide attempts to keep the

core information to a minimum, but signposts

to additional resources are included throughout.

Although for clarity the process is described

as linear, in reality frequent cross-checking

and revision across steps will be required.

The case studies provided in this publication

are examples of HNAs undertaken with a

range of populations. They are intended to

be illustrative, and experiences may differ

when undertaking similar HNAs.

1 Introduction

HEALTH DEVELOPMENT AGENCY

Health needs assessment

1. INTRODUCTION

How does HNA

support national

priorities?

The aim of the government’s health

inequalities strategy is to narrow the gap in

health between different social and economic

groups and areas. It has set a national public

service agreement target to:

‘REDUCE HEALTH INEQUALITIES BY

10% BY 2010 AS MEASURED BY

INFANT MORTALITY AND LIFE

EXPECTANCY AT BIRTH’

www.hm-treasury.gov.uk/media/

70320/sr04_psa_ch3.pdf

HNA provides a vital tool in helping to meet

this objective through targeting populations

most in need of improved support and

services.

HNA linked with commissioning has been an

integral task of health authorities since 1989.

Saving lives: our healthier nation (DH, 1999)

stresses the importance of the community’s

role in identification of health needs and

priorities; and Shifting the balance of power

within the NHS: securing delivery (DH, 2001)

gave specific responsibility to primary care

trusts. The Wanless report Securing good

health for the whole population (Wanless

et al., 2004) also emphasises the importance

of high levels of public engagement in order

to achieve optimum gains in health outcomes

and a reduction of health expenditure in the

long term. The HNA approach provides an

ideal opportunity for different agencies to

build trust with communities to ensure

genuine partnership involvement in

reconfiguring services.

HNAs 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 plans.

HNAs are sometimes conducted by voluntary,

community and charitable organisations to

collect information about their target

communities for funding and project planning

purposes. When public sector agencies are

conducting HNAs, they should check with

voluntary and community organisations to see

what information they have collected and,

where appropriate, to involve them in project

teams or stakeholder groups.

Benefits and

challenges

Benefits from undertaking an HNA can

include:

•Strengthening community involvement in

decision making

•Improved public patient participation

•Improved team and partnership working

•Professional development of skills and

experience

•Improved patient care

•Improved communication with other

agencies and the public

• Better use of resources.

The value of HNA to general practice and the

General Medical Services contract lies in the

contribution it can make to improving data

quality, which is important to meeting quality

indicators; developing chronic disease registers;

and providing information for an evidence base

of need which can support funding applications

to provide enhanced services. It also supports

the clinical governance agenda and information

required for National Service Framework targets.

HNAs are a requirement of professional

competency for the UK voluntary register of

public health specialists and for Part 2 Faculty of

Public Health examinations, but they must

demonstrate a robust process involving sound

epidemiological and social science

methodologies (see Section 3, page 27 and

Section 4, pages 52-53).

Challenges that may be encountered when

undertaking an HNA can include:

•Working across professional boundaries –

tackling territorial attitudes preventing power

or information sharing:

- develop positive working relationships with

colleagues within other sectors

- develop an understanding of organisational

structures/priorities/objectives

- ensure others are clear about the benefits

to their organisation/profession of

conducting HNA.

• Lack of a shared language between sectors:

- consider definitions in section 2 of this

guide (see pages 12-17)

- consider ways of jargon busting to keep

communication accessible to all involved

(see Plain English Campaign, Section 4,

page 50)

- consider impact of different language

within sectors and be creative about using

language that relates to the sectors involved

(eg is it possible to undertake a community

needs assessment versus a health needs

assessment if the issue of ‘health’ is viewed

negatively by some sectors?)

- develop dialogue with and between sectors

in the early planning phase (step 1, page 22)

to explore developing a shared language.

• Lack of commitment from the top:

- identify and establish who needs to be in

agreement with the HNA at ‘the top’

- consider ways of communicating the value

and benefits of the HNA to key senior

stakeholders

-promote examples of successful HNA work

in other organisations (see Case studies).

• Difficulties in accessing relevant local data:

- consider trawling professional contacts for

suggestions on accessing relevant data

- explore the national, regional and

subregional data available from health

observatories (see Section 7) and consider

their usefulness/relevance to your project

- consider experiences from Case studies for

different ways of accessing required data.

• Difficulty in accessing the target population:

- consider whether the target population has

been over-assessed, and discuss with key

stakeholders whether information is

available elsewhere

-review intended methodology for accessing

target population and consider if there are

other, more creative ways, of accessing

population (see Tools and resources)

- explore examples of other HNAs that have

accessed similar populations (see Case

studies).

• Difficulty in maintaining team impetus and

commitment:

-review progress and positively reinforce

achievements

- ensure all team members are aware of

achievements and progress; assist members

in breaking down the HNA into bite-sized

chunks in order to build on work

undertaken

- check out team commitment to the task,

and identify solutions as a team to improve

motivation/impetus.

HEALTH DEVELOPMENT AGENCY

Health needs assessment

1. INTRODUCTION

• Difficulty in translating findings into

effective action:

-review findings in line with other known

targets/objectives at national, regional and

subregional levels

- consider findings in terms of short- and

long-term action – clarify what can be

achieved in the short-term and build on

progress towards long-term goals

- explore resource implications, and

whether findings can assist in developing

debate/discussion on resource allocation.

‘Too often in the past we have devoted

too much time and energy to analysing

the problems and not enough to

developing and delivering practical

solutions that connect with real lives.’

(Choosing Health, page 14, DM, 2004)

Resources required

to start an HNA

Before committing to an HNA project and

proceeding beyond step 1, ensure you have

the capacity to meet the challenges and to

employ the resources that may be involved.

A project lead with strong management

skills should be appointed– but the lead

does not have to have all the skills required

for HNA, as other members of the team, or

consultants, can be brought in to assist.

There are also many other sources of help

available – see Section 7.

Health needs assessments are worthwhile

undertaking only if they result in changes

that will benefit the population. It is

therefore essential to be realistic and honest

about what you are capable of achieving.

Check that:

• Clear aims and objectives for the project

have been identified

• There is an established need for the

project (eg a recent assessment has not

already been done)

• The right people are involved – this should

include who knows about the issue; who

cares about the issue; and who can make

change happen

• There is sign-up to the project from senior

managers and policy makers

•A lead coordinator with project

management skills can be appointed

• Access to the target population and their

willingness to engage with the project has

been established

•A committed and skilled project team can

be appointed (see pages 50-53 for

possible skills required)

• Key stakeholders can be identified

• The proposed project team has adequate

resources – time, space, equipment, skills and

funding – to conduct a good quality HNA.

2 Common language

The following terms underpin the

health needs assessment process

described in this publication. It is

important that HNA project teams

and stakeholders adopt a shared

language for key terms at the start

of a project, to ensure there is

agreed understanding of objectives.

Health

Health is defined as a positive concept that

emphasises social and personal resources, as

well as physical capabilities. It involves the

capacity of individuals – and their perceptions

of their ability – to function and to cope with

their social and physical environment, as well as

with specific illnesses and with life in general

(WHO, 1984; Baggott, 1994).

Inequalities in health

All government departments are now

committed to closing the gap between the

most advantaged sections of society and the

least advantaged, as defined by childhood

mortality and life expectancy. HNA can be a

useful tool in this process through targeting

services and support towards the most

disadvantaged groups (DH, 2003a).

2 Common language

Health needs

These can be:

• Perceptions and expectations of the profiled

population (felt and expressed needs)

• Perceptions of professionals providing

the services

• Perceptions of managers of commissioner/

provider organisations, based on available

data about the size and severity of health

issues for a population, and inequalities

compared with other populations

(normative needs)

• Priorities of the organisations commissioning

and managing services for the profiled

population, linked to national, regional or

local priorities (corporate needs).

An HNA should involve comparing and

balancing these different needs when selecting

priorities (see also definitions of need by

Bradshaw, 1994; Stevens and Rafferty, 1994).

The information can then be used as a basis

for bringing about change through negotiation

with stakeholder groups.

HEALTH DEVELOPMENT AGENCY

Health needs assessment

2. COMMON LANGUAGE

Determinants of

health

This is a concept based on the model of

Dahlgren and Whitehead (1991) (see Figure 2

above), which suggests that there are complex,

multi-layered influencing factors with an impact

on the health of individuals. At the centre are

factors including age, gender and genetic

inheritance. In the second layer are behavioural

patterns such as smoking, diet and physical

activity. In a third layer are social position,

economic resources and the material

environment. The fourth layer includes the wider

or underlying determinants, consisting of social

and community networks, work environment,

housing and living conditions, education and

transport. In the outer layer are the economic,

political, cultural and environmental conditions

present in society as a whole.

Tackling health inequalities requires action

within all these layers of influence, and HNA

can be used to identify, assess and prioritise

where effective action should be targeted.

The HNA should therefore involve a multi-

agency team in collecting information about

specific populations, along with cross-sectoral

stakeholders capable of, and committed to,

undertaking a range of actions to improve

health and service delivery.

Age, sex and

constitutional

factors

Living and working

conditions

Work

environment

Education

Agriculture

and food

production

Unemployment

Health

care

services

Housing

Water &

sanitation

Figure 2

Influences on health

[Dahlgren and Whitehead (1991); from Acheson (1998)]

Population

HNA populations can be identified as people

sharing:

• Geographic location – eg living in deprived

neighbourhoods or housing estates

• Settings – eg schools, prisons, workplaces

• Social experience – eg asylum seekers, specific

age groups, ethnicity, sexuality, homelessness

• Experience of a particular medical condition –

eg mental illness, diabetes, respiratory disorders.

Often a target population will be identified

through a combination of main and subcategory

groups, eg older people living in a deprived rural

area and recovering from a stroke.

HNA selection

criteria

HNA is worthwhile undertaking only if it results

in changes that will benefit the population. It is

essential to be realistic and honest about what

you are capable of achieving. Four criteria should

be used in selecting issues for intervention:

• Impact – which health conditions and

determinant factors have the most impact, in

terms of size and severity, on the health

functioning of the population?

• Changeability – can the most significant

health conditions and determinant factors be

changed effectively by those involved in the

assessment?

• Acceptability – what are the most acceptable

changes needed to achieve the maximum impact?

• Resource feasibility – are there adequate

resources available to make the required changes?

Levels of prevention

of ill health

There are three levels at which interventions can

be effective in tackling ill health for individuals

and within populations:

• Occurring – preventing the problem

occurring at all (primary prevention)

• Recurring – preventing the problem

progressing or recurring by detecting and

dealing with it (secondary prevention)

• Consequences – preventing the

consequences or complications of the problem

(tertiary prevention).

Diseases and

health conditions

Diseases and health conditions experienced within

a population are important when they affect

health functioning. Diseases and health conditions

can sometimes be caused or exacerbated by a

determinant factor, such as poor housing or

smoking. In the process of undertaking HNA,

actions or interventions that can reduce disease

and ill health should be considered at all three

levels of prevention (see above)

Health functioning

Health functioning can be defined as the individual’s

or population’s experience in terms of whether the

health condition or determining factor:

• Negatively affects social roles of caring,

partnering, friendship, sexual relationships,

employer/employee

• Negatively affects the population’s level of

mobility (physical ability)

• Causes physical pain

• Contributes to mental illness

• Negatively affects energy levels (vitality).

HEALTH DEVELOPMENT AGENCY

Health needs assessment

2. COMMON LANGUAGE

*Rank 0 = low impact; 10 = high

Note: A high impact score for health functioning indicates a priority for action

Health

functioning

Determinant factors

Health conditions

Total =

*Rank 0-10

(out of 50)

Figure 3

The health triangle

[adapted from the original model used by Hooper and Longworth (2002)]

Health triangle

The health triangle is an analytical tool that

can assist in:

• Identifying potentially important health

issues for the population

• Reviewing the associations between health

conditions, determinant factors and health

functioning (see previous definitions)

•Structuring the collection and presentation

of data to compile a useful profile.

The health triangle should be used with the

target population and all main stakeholders to

achieve consensus about priorities for action.

Role functioning =

Mental health =

Physical ability =

Vitality =

Pain =

Partnership

Local collaboration by statutory, voluntary,

community and private sector organisations in

planning and implementing economic, social

and health programmes. Local strategic

partnerships may commission HNAs.

Stakeholders

The different partners or sectors who should

be involved in decisions about health,

regeneration and other programmes.

Stakeholders for HNA may include

representatives from local business, education,

police, housing, transport, social services and

leisure, as well as from health agencies. Most

importantly, they should include members and

representatives from the target population.

Community

engagement

A general term used in this context to

describe the active participation of local

people in defining priority issues and being

part of the solution-determining process.

HEALTH DEVELOPMENT AGENCY

Health needs assessment

2. COMMON LANGUAGE

HNA and other

assessment tools

HNA is one of several approaches being used

across sectors to help improve health and

reduce health inequalities. Other frequently

used tools include health impact assessment

(HIA), integrated impact assessment (IIA) and

health equity audit (HEA). Although there are

similarities in these approaches, a key

difference is their starting point.

• HNA starts with a population – when the

health needs of that population are known,

proposals are put forward for the

development and delivery of improved

programmes and services.

• HIA starts with a policy or project, and

predicts the impact on the health of the

population.

• IIA starts with a policy or programme, and

predicts the impact on economic, social and

environmental outcomes.

• HEA starts with a defined population, and

is a process whereby local partners

systematically review inequities in the causes

of ill health and in access to effective

services for that population. HNA might be

an action undertaken in response to

inequities identified by HEA; or might be

used to inform HEA about inequities in the

population and how they might best be

addressed.

Each of these approaches involves a variety of

similar research methods, but it is important

to select the assessment tool according to

your aims and objectives. Similarities and

differences between these tools are covered in

more detail by Quigley et al. (2005).

3 The five steps of

health needs assessment

The five-step project planning process outlined

here presents a set of practical activities and

quantitative and qualitative research exercises

that will ensure a robust and systematic

assessment, with tangible outcomes, is

undertaken. The information gained can be used

to inform service delivery and improve health

outcomes for a targeted population, as well as

leading to other potential benefits, as outlined in

Section 1. The process includes some exercises

and models, eg the health triangle (Figure 3,

page 15), to assist the project team in identifying

priority health conditions and underlying factors

affecting the health of the population, and

in reaching a consensus on appropriate

interventions for positive change. This five-step

process is based on the model outlined by

Hooper and Longworth (2002), which provides

further information relating to the steps on

pages 25–89. Additional help with many of the

practical skills and methodologies associated with

the steps are provided in Section 4.

As each project will be unique, and will differ in

complexity, it is difficult to provide time

estimates for the HNA process – a project may

take anything from a couple of weeks to several

years. The time that individual members of the

team can allocate to the project should be

considered at the beginning to ensure the scope

of the project is realistic.

See the five steps diagram opposite.

Although the step approach, as presented in

this publication, may indicate a linear

process, in practice the process requires

cross checking and regular revisions. It is

therefore important to be aware of the

key elements within all the steps from the

start of the project. Some activities, such

as evaluation and risk management

described in step 4, will need to be applied

throughout the whole project, as well as

to the interventions selected to implement

health improvements.

3 The five steps

of health needs

assessment

HEALTH DEVELOPMENT AGENCY

Health needs assessment

3. THE FIVE STEPS OF HEALTH NEEDS ASSESSMENT

one

two

three

four

five

Step 2

Identifying health priorities

Population profiling

Gathering data

Perceptions of needs

Identifying and assessing health

conditions and determinant factors

Step 5

Moving on/review

Learning from the project

Measuring impact

Choosing the next priority

Step 4

Planning for change

Clarifying aims of intervention

Action planning

Monitoring and evaluation strategy

Risk-management strategy

Step 3

Assessing a health priority

for action

Choosing health conditions

and determinant factors

with the most significant

size and severity impact

Determining effective and

acceptable interventions

and actions

Step 1

Getting started

What population?

What are you trying to achieve?

Who needs to be involved?

What resources are required?

What are the risks?

Step

The five steps of

health needs assessment

Step

To undertake this first step, you should

assemble a group of people who are interested

in the project to consider the following

questions. Ensure that you record your decisions

for future referral, report writing and evaluation

purposes. Invest some time in making sure

people have a shared understanding of the

common language (see Section 2) – this will

avoid a lot of potential confusion later on.

By the end of this step you should:

• Have a clear definition of the population you

are going to assess

• Have a clear rationale for the assessment and

its boundaries

• Know who needs to be involved, and how

• Understand what resources are required, and

how to keep the project on track.

WHAT POPULATION AND WHY?

Have you clearly defined your main population?

eg all people living in a disadvantaged

neighbourhood.

Have you clearly defined any subpopulation

groups? eg children under five and their

families living in a disadvantaged

neighbourhood.

Why have this population and any

subpopulation groups been chosen?

•Are there any specific issues about this

population that makes it significantly more

important than other local populations for

assessing health needs?

Step 1

Getting started

• Does this population have significantly worse

health than others locally – are there

significant health inequalities?

How does the population you have selected

relate to national, regional and local priorities

for improving health and reducing health

inequalities?

WHAT ARE YOU TRYING TO ACHIEVE?

• Set clear aims and objectives for your HNA –

ensure these have not already been addressed

by other agencies by checking across sectors

(statutory and voluntary)

• Check that the aims and objectives are

realistic in terms of current or projected

resources available

•What relevant information is available about

this population?

• Ensure you have checked existing policy

directives and priorities relating to the

selected population, and that you understand

the remits of the organisations involved

• Ensure the target population has not already

been assessed to death!

These points will help clarify not only what you

are trying to achieve, and why, but also what is

outside the scope of the assessment.

WHO NEEDS TO BE INVOLVED?

Consider the following:

•A project leader who can lead and oversee

the HNA process, ensure methodological

quality, and be a coordinating link

REVIEW – STEP 1

At the end of step 1 you should

be clear about the population you

are working with, and have

clarified the aim of the assessment

and its boundaries. You should

also know whether or not you

have the capacity to undertake

the type and scope of project you

are considering.

HEALTH DEVELOPMENT AGENCY

Health needs assessment

3. THE FIVE STEPS OF HEALTH NEEDS ASSESSMENT

•A team to undertake the assessment –

consider what skills will be needed at

different stages of the project

• Key stakeholders – consider the range of

stakeholders who should be involved and

be clear about their remit. Ensure the

stakeholder group includes representation

and involvement of the target population as

well as multi-agency representation to drive

through change

• Senior managers and policy makers –

ensure you have their agreement and

commitment to support any necessary

changes arising as a result of findings from

the HNA.

Consider:

• Who knows about the problem/issue?

•Who cares about it?

• Who can do anything about it?

This can help clarify who needs to be involved

in different steps in the process.

WHAT OTHER RESOURCES WILL

YOU REQUIRE?

Consider:

•Time

•Meeting space

• Access to the population

• Access to data

• Skills

• Funding to conduct the project.

WHAT RISKS MIGHT YOU ENCOUNTER,

AND HOW WILL YOU OVERCOME

THEM?

Try to anticipate as many barriers and threats

to the project as possible, and consider

strategies for overcoming these (see pages

7-9 Benefits and challenges and pages 43-44,

Process evaluation).

HOW WILL YOU MEASURE SUCCESS

AND ENSURE THE PROJECT STAYS

ON TRACK?

As soon as you are confident you are going to

proceed with the project, you will need to

develop a monitoring and evaluation process

for each step in the process (see pages 43-44,

Monitoring and evaluation strategy, for more

detailed advice).

Health Needs Assessment for a Sure Start Programme in West Newcastle upon Tyne

Illustrative case study – Step 1 Getting started

What population,

where located and

why chosen?

Children under four, their families and carers living in a defined

geographical area of West Newcastle upon Tyne. The area was

chosen as the three wards made up the third, fourth and seventh

most deprived in Newcastle and North Tyneside according to

multiple deprivation scores

What were the aims

and objectives?

The HNA was part of the Sure Start programme planning process.

To work with parents-to-be, parents and children to promote the

physical, intellectual and social development of babies and young

children – breaking the cycle of disadvantage

Who was included

in the project team?

The HNA was led by the Public Health Nurse for West Locality and an

experienced community development worker employed by Riverside

Community Health Project established in offering family support in the area

Who was included

in the stakeholder

group?

Local workers in health, social care, education and many

representatives from local non-statutory services, local parents,

grandparents, carers and children

What resources

were required?

The Public Health Nurse and Community Development Worker were

allocated some time within their present jobs to undertake this work.

A request for early funds was successfully made which helped pay for

the community development workers’ extra hours and some of the

additional consultation

HEALTH DEVELOPMENT AGENCY

Health needs assessment

3. THE FIVE STEPS OF HEALTH NEEDS ASSESSMENT

By now you will have a working

definition of the population you

will be assessing, and have clarified

the aim of the assessment and its

boundaries. The next step is to

identify the health priorities for

that population.

By the end of step 2 you should have:

• Identified the aspects of health functioning

and conditions and factors that might have a

significant impact on the health of the

profiled population

• Developed a profile of these issues

• Used this information to decide a limited

number of overall health priorities for the

population, using the first two explicit

selection criteria of HNA –

- Impact – they have a significant impact in

terms of severity and size

- Changeability – they can be changed locally.

Within any population, there is a potentially

huge number of issues that could be tackled to

improve health and reduce inequalities. The

process of choosing priorities is at the heart of

the health assessment process. It involves

making hard decisions. Involving people in the

debate that leads to these decisions is crucial if

they are going to be carried through and acted

on. This highlights the need to check that the

right people are involved before you start.

In choosing priorities, you are trying to screen

out issues that do not meet the first two HNA

selection criteria – impact and changeability

(see Section 2, page 14). Consider each

criterion in turn to narrow down the list of

issues that could be tackled. If an issue is not

seen as having a significant impact, you do not

need to consider it for changeability.

This step involves a series of field activities and

assembly of data to gather information about

health issues affecting the defined population.

The information sources for any needs

assessment include:

• Perceptions of the population

• Perceptions of service providers and managers

• Data on the size of the potentially important

aspects of health functioning/conditions/

factors and population characteristics

• Relevant national, local or organisational priorities.

Note: useful skills, tools and resources relating to

these activities are in Section 4 (see also page 36

of Hooper and Longworth, 2002). The field

activities will require careful planning to ensure

the quality of the findings.

Step 2

Identifying health priorities

POPULATION PROFILING

Gather general information about the target

population:

• How many people are in the target group?

•Where are they located?

• What data are currently available about them?

•What are the main common experiences

and differences within the group?

How does the population perceive its needs?

• Hold workshops or focus groups for those

involved in this assessment, such as

representatives from the population and

providers

• Interview key people

• Send out questionnaires (see page 38 of

Hooper and Longworth, 2002)

• Consider reaching individuals/groups who

might be excluded from the main

consultation methods (see Community

engagement, page 50; Henderson et al.,

2004, pages 70–81).

WHAT ARE THE HEALTH CONDITIONS

AND DETERMINANT FACTORS

AFFECTING THE HEALTH FUNCTIONING

OF THE TARGET POPULATION?

However you have gathered your data, a list of

the health conditions and determinant factors

affecting the population should be pulled

together for final debate and agreement.

These will form the main outcomes of the

assessment, and are important in steps 3 and 4

when planning for change.

The determinant factors that might be

affecting health conditions (see Section 2,

page 13, Determinants of health) can be

grouped under five general categories:

• Social

• Economic

• Environmental

• Biological

•Lifestyle.

WHAT HEALTH CONDITIONS AND

DETERMINANT FACTORS HAVE A

SIGNIFICANT IMPACT ON HEALTH

FUNCTIONING?

Use the health triangle (see Section 2, page 15)

to assess what impact the health conditions

and determinant factors have on the health

functioning, in terms of size and severity, of

the profiled population.

Then review the list for:

• Health conditions and determinant factors

whose evidence of impact is unknown or

contested – then delete them

• Health conditions and determinant factors

that are relatively unimportant in size and

severity – then delete them

• Check that all relevant national or local

priorities have been included.

Share the list with all stakeholder groups involved

to check for completeness, accuracy and

understanding of the results of the assessment.

HEALTH DEVELOPMENT AGENCY

Health needs assessment

3. THE FIVE STEPS OF HEALTH NEEDS ASSESSMENT

EXAMPLE: TARGET POPULATION –

CHILDREN UNDER FOUR AND THEIR

FAMILIES

Health conditions:

• Low birth weight

• Post-natal depression

• High levels of accidental injury in children.

Determinant factors:

Social –

• Experience of domestic violence

• Isolation/loneliness

•Isolation from family support

• Low English language proficiency.

Economic –

• Lack of access to training and employment

•Low income

• Low parental educational achievement.

Environmental –

• Unfit housing/hostels/temporary

accommodation

• Lack of access to health services

• Lack of community and play facilities

• Poor transport links.

Biological –

(may be determinant factors, but

unchangeable; see page 29, Changeability)

• Gender/sexuality/age/ethnicity

• Genetic factors

•Mental and physical disabilities.

Lifestyle –

• Substance and alcohol abuse

• Smoking

• Poor nutrition.

CHOOSING PRIORITIES ACCORDING TO

IMPACT ON THE HEALTH OF THE

POPULATION

The rest of this step can be done in one or a

number of workshop(s) with all those who

should be involved. Profiling involves using valid

data from various sources and comparing this

with different perspectives of participants may

seem daunting. Remember the main function of

data is to act as a check for the results of the

preceding discussions about perceptions. Follow

these principles when considering data:

• Essentials – information not directly relevant

to the objectives of profiling should be

ignored

• Bias – all information is subject to a bias,

whether incomplete; untimely; varied

definitions, etc – this is fine so long as any

bias is identified and acknowledged

• Triangulation – assemble the data from a

range of sources – if they emerge with similar

results or themes, these will be reasonably

robust; if not, consider whether their biases

are different.

WHICH HEALTH CONDITION /

DETERMINANT FACTORS HAVE A

SIGNIFICANT IMPACT, IN TERMS OF

SEVERITY, ON HEALTH FUNCTIONING?

Put each of the identified health

condition/determinant factors in a list of high,

medium or low impact by assessing each

for severity:

• Does the health condition/determinant factor

significantly affect the most important aspects

of health functioning?

• Does the health condition/determinant factor

significantly affect other issues that affect health?

Table 1

Recording impact – size

• Does the health condition/determinant factor

significantly affect long-term health?

• Does the health condition/determinant factor

cause death?

WHICH HEALTH CONDITIONS/

DETERMINANT FACTORS AFFECT THE

HEALTH FUNCTIONING OF MANY

PEOPLE – SIZE IMPACT?

Review known data or information on incidence

or prevalence, either directly about your

population, or extrapolated from other, similar

populations. Consider:

• Absolute size, eg number of cases of post-

natal depression occurring within the

population

• Comparative size, ie is the local size higher

or lower than other local populations/national

averages?

You may find using a table with these headings

useful to draw out what the data are saying.

Choosing priorities according to size

Data item Data known?

Yes/No

What do the

data say?

Implications?

So what?

Most important

in size? Yes/No

Now enter both the severity and size impact

ratings on Figure 4 (page 29).

Check that:

• Any health conditions and determinant factors

where the evidence of impact is either

unknown, extremely low, or contested are

deleted from the list.

• Relevant national or local priorities are

included in the list

• There is agreement on a final list of issues

with significant impact in terms of size and

severity on health functioning that can now

be considered for changeability.

Finally, identify whose health is most likely to be

at risk from the negative impact of these high

priority health conditions/determinant factors –

these will be the target population groups for action.

HEALTH DEVELOPMENT AGENCY

Health needs assessment

3. THE FIVE STEPS OF HEALTH NEEDS ASSESSMENT

Impact

Severity (–ve/+ve)

High Medium Low Yes / No

Size

Important

Health condition/

determinant factor

Figure 4

Recording impact – severity and size

CHOOSING PRIORITIES ACCORDING

TO CHANGEABILITY

Which of the priority health conditions /

determinant factors can be effectively improved

by those involved? Using the list of issues assessed

for high impact of severity, assess them as:

• High – definitely changeable, with good

evidence – keep in list

• Medium – some aspects significantly

changeable, but not overall – possibly delete?

• Low – little, no or unknown changeability –

delete from list.

Then check the list of priorities with both high

impact and changeability for:

•Are all three levels of prevention assessed

for action? (see Section 2, page 14)

•Are there relevant professional /

organisational policies that define

recommended actions?

•Are these local and national priorities?

• Does this list of changeable priorities help to

reduce health inequalities?

Ensure everyone is signed up to creating the

final list of priorities and to taking these

forward, and that the priorities are agreed by

the most relevant senior planning groups.

It is important to be clear which organisations

will need to be involved in taking the main

priorities forward through step 3.

EXAMPLE: POST-NATAL

DEPRESSION AND LEVELS OF

PREVENTION

Provision of a safe babysitting service to

isolated mothers, enabling them to have

increased access to social and community

activities, could be effective at all three

levels: by preventing post-natal depression

from occurring (primary); by preventing it

from recurring or progressing (secondary);

and by preventing or alleviating

consequences of the problem (tertiary).

(See Section 2, page 14).

Figure 5

Changeability – levels of prevention

Level of prevention

Rank 0-10*

RecurringOccurring

Health condition/

determinant factor

*Rank 0=low; 10=high

Consequences Total

COMPARE SCORES, COMMUNICATE THE

FINDINGS AND SHORTLIST PRIORITIES

FOR ACTION

When you have assessed all the conditions and

factors for impact and changeability, ensure you

return to your population and stakeholder

group with any preliminary findings.

Check that you have interpreted their input

correctly, and that they understand the

assessment results.

Aim for consensus between expert opinion,

data and community perceptions when agreeing

a shortlist of health priorities based on the

findings. These can then be considered for

selection in step 3.

REVIEW – STEP 2

At this point you should have

identified a shortlist of health

priorities for the profiled

population, and assessed associated

health conditions and determinant

factors for each of these priorities

for impact, in terms of size and

severity and changeability.

This process will not have produced

a totally objective assessment, but

should ensure that issues are

thoroughly debated and that a

group consensus is reached about

relative impact and priorities. If the

project team’s assessment is

regularly referred back to the

stakeholder group and to the

population for input, and

adjustment if necessary, a

democratic basis for further action

will be established.

HEALTH DEVELOPMENT AGENCY

Health needs assessment

3. THE FIVE STEPS OF HEALTH NEEDS ASSESSMENT

ILLUSTRATIVE EXERCISE, GROUP ACTIVITY

Aim: to assess the health conditions and

determinant factors having an impact on

children under four and their families in a

deprived ward (number affected: 60 families).

As a team:

1 Identify the health conditions and

determinant factors that might have a

significant impact on the health functioning

of children under four and their families

2 Select a health condition and enter this on

the health triangle. Consider the relationship

between the health conditions and each set

of determinant factors (eg childhood injury

with environmental factors; see example)

3 Reach a consensus about a final ranking for

the effect of the health condition and its

determinant factors on health functioning,

by sharing individual rankings with the rest

of the group and discussing differences

4 Consider how much the health condition

and determinant factors:

- affect health functioning

- affect other health conditions

- affect health, transiently or long term

- cause death

5 Repeat this exercise for the same health

condition and other determinant factors

6 Repeat the exercise with other health

conditions and their determinant factors

7 Agree the severity ranking and size of the

condition, and enter the findings on Figure 7

8 Consider each health condition/determinant

factor for changeability across the three

levels of prevention – occurring, recurring

and consequences in the short to medium

term. Enter findings on Figure 8

9 Compare scores for each factor on both

impact and changeability, and prioritise

issues for action.

Health Needs Assessment for a Sure Start Programme in West Newcastle upon Tyne

Illustrative case study – Step 2 Identifying health priorities

How was a profile of

the population

developed?

The Public Health Nurse in conjunction with the Citywide Sure

Start Health Coordinator collated quantitative data

What data were

available on the

health of the

population?

Index of multiple deprivation scores (2000)

Census information regarding numbers of families with under fours,

levels of employment, lone parents, breakdown by ethnicity

Going for growth consultation information and responses by local

people; numbers of children on the child protection list, number of

mothers experiencing post-natal depression; number with low birth

weight babies; number of mothers with children under one; number of

emergency admissions to hospital, SATs results, estimated literacy levels

How was information

gathered about the

population’s and

service providers’

perceptions of needs?

Through multiple methods of consultation and ongoing involvement during

the development of this Sure Start programme to include:

• Meetings with existing parents’ and grandparents’ groups

•Meetings with professionals in key organisations

•The use of ‘H’ forms (a simple diagrammatic technique) to gather

information about ‘What was good about local services for families and

young children, what was not so good, what would make things better,

and what services people valued most?’

•Kids’ cocktail parties (consultation through fun activities for 3 to

14 year olds)

• Passport to family support event

• Under fives summer fun week and holiday activities

• Newcastle Action for Parents and Toddlers Initiative Survey

Cont...

What barriers were

encountered?

Initially the parents in the two main communities were consulted

separately, as they did not naturally meet, and eventually formed a

whole representative group.

In addition, one large area covered was undergoing consultation

as a Going for Growth Regeneration Area, and there was much

dissatisfaction with the local council at this time

HEALTH DEVELOPMENT AGENCY

Health needs assessment

3. THE FIVE STEPS OF HEALTH NEEDS ASSESSMENT

What were the key

issues for the

population?

From the qualitative data ,15 key points were raised where action could be

taken across agencies, including:

•More activities for children of all ages, and affordable leisure and sports

facilities – specifically holidays and after school

•An increase in the amount of affordable, good quality childcare

•Health visitors must be more accessible within the community

•Improved transport links to key services, specifically the need for lo-liner

buses

•Integrated services all on one site

•Places for parents and children to meet and socialise

•Improved family support, particularly for women suffering from

post-natal depression

• Home-based support and information about safety in the home,

information and support to access safety equipment

In terms of quantitative data, there was a need to increase access to training,

education and employment, and to increase the educational attainment of

the children in this area. There were many more areas for action

Illustrative case study - Step 2 Identifying health priorities cont.

How were these

overcome?

The skilful work of the community development worker – lots of

promotion of the HNA, and gradual and timely integration of two

communities. The knowledge of local people that much of their wishes

and needs could be realised in practice through Sure Start money

Illustrative case study example of Figure 3 (page 15) health triangle used to

assess the impact of accidental injury and determinant factors on the health

functioning of children under four

Role functioning = 5

Mental health = 3

Physical ability = 3

Vitality = 1

Pain = 5

*Rank 0 = low impact; 10 = high

Note: A high impact score for health functioning indicates a priority for action

Health

functioning

Determinant factors

Environmental

• Unfit housing/hostels/

temporary accommodation/

overcrowding

• Lack of quality childcare services

• Lack of safe community and play

facilities

• Busy traffic

• Lack of health and safety awareness

Health conditions

Childhood injury

(under four)

Total = 17

*Rank 0-10

(100 reported incidences in 2003)

HEALTH DEVELOPMENT AGENCY

Health needs assessment

3. THE FIVE STEPS OF HEALTH NEEDS ASSESSMENT

Illustrative case study example of Figure 4: Impact size and severity rating

Impact

Severity (–ve/+ve)

High

Medium

Low

Size

(no. affected

per year)

Health condition/

determinant factor

Post-natal depression

and environment

Low birth weight and

environment

Accidental injury and

environment

Illustrative case study example of Figure 5: Changeability – levels of prevention

Note: In this example you might conclude that your team can do little or nothing to

influence the effect of environmental factors in low birth weight in the short to medium

term, but that it might be possible to intervene to reduce the incidence and

consequences of post-natal depression and accidental injury. You might place these

higher on the shortlist of priorities. But remember your stakeholders may disagree.

Level of prevention

Rank 0-10*

RecurringOccurring

Health condition/

determinant factor

Post-natal depression and

environment

Low birth weight and environment

Accidental injury and environment

*Rank 0=low; 10=high

Consequences Total

05813

0044

77519

Step 3

Assessing a health priority

for action

This step is the assessment of a specific health

priority for action. The health priority may have

been identified from either:

• The profile of the important aspects of health

conditions/determinant factors for your target

population and agreed list of health priorities

– established by working through steps 1

and 2; or

•A national or local priority identified without

population profiling or completing step 2 – eg

a priority for many NHS planners is coronary

heart disease, as both a national and local

priority. If you are starting with a national or

local priority it is crucial to ensure local

ownership and involvement with that priority

(see page 30).

By the end of this step you should have:

• Identified who should be involved in making

the specific change happen, and included

them in the process of choosing actions to

tackle this health priority

• Gained a clear and shared understanding of

the health priority through identifying the

health conditions and determinant factors

that have significant impacts on it

• Gained a clear understanding of the

boundaries of the assessment

• Identified effective interventions to tackle this

health priority

• Defined your target population

• Identified the changes required

• Confirmed that the proposed changes will

help reduce health inequalities.

The task is to assess each specific health priority

for change. The needs-led approach requires

being clear about the ‘what and why’ before

considering the ‘how’. By completing this step

you should be much clearer about:

• Why this specific health priority is important

for the profiled population

•What changes you can make that will have a

positive impact on the most significant issues

affecting the priority.

This will ensure the detailed action planning in

step 4 is based on sound information and clear

assumptions.

This step starts with working through the same

questions as for steps 1 and 2 for this specific

priority, then applying the two final HNA

selection criteria (see Section 2, page 14):

• Acceptability – what are the most

acceptable changes required for the

maximum positive impact?

• Resource feasibility – are the resource

implications of these changes feasible?

WHO IS BEING ASSESSED BY WHOM,

AND WHY?

It is important to be clear why the assessment of

this specific priority is being carried out, and who

cares enough to take any notice of the results.

HEALTH DEVELOPMENT AGENCY

Health needs assessment

3. THE FIVE STEPS OF HEALTH NEEDS ASSESSMENT

Check:

• What is the aim of this assessment?

•Why are you doing this assessment?

•What are the boundaries of it?

•What are the fixed points?

• Who will be involved, when, and how?

•Are key partner agencies and groups

involved or, if not, does this matter?

When you feel these are reasonably clear,

gather together those involved to go through

the following tasks. These may take some

time, as you will probably need to collect

information between the tasks.

IDENTIFYING HEALTH

CONDITIONS/DETERMINANT FACTORS

THAT MIGHT HAVE A SIGNIFICANT

IMPACT ON THIS HEALTH PRIORITY

Using the health triangle (see page 15):

•Identify the most important aspects of

health functioning for people affected by

this specific priority

• Ask each member of the group individually to

rank the aspects of health functioning in

terms of their importance to the health priority

•Reach a consensus about the final ranking

by sharing their rankings with the rest of the

group, and discussing any differences; write

the aspects in the health triangle template

•Identify the health conditions and determinant

factors that have a significant impact on the

most important aspects of health functioning,

across the three levels of prevention (use the

determinant factor groups and the levels of

prevention as a check that important things

have not been overlooked).

CHOOSING THE HEALTH

CONDITIONS/DETERMINANT FACTORS

WITH THE MOST SIGNIFICANT IMPACT

ON THIS HEALTH PRIORITY

Put each health condition/determinant factor

identified into a list of high, medium or low

impact, by assessing each for severity and

then size of impact (see page 28).

Severity

• Does the health condition/determinant

factor significantly affect the most

important aspects of health functioning?

• Does the health condition/determinant

factor significantly affect other issues that

affect health?

• Does the health condition/determinant

factor significantly affect long-term health?

• Does the health condition/determinant

factor cause death?

Its impact could be at any of the three levels

of prevention, and it could be either positive

or negative.

Are there any issues whose strength of

evidence about the impact is unknown

(unclear, little, unknown, or no impact?)

If so – delete them from the list.

Example: In one PCT that had 146 mothers with children under one year old, 27 were known to

have post-natal depression, which equates to 18.5% of mothers in the area at that time.

Following the processes outlined in step 3, the decision was reached to provide more home

visiting support and a babysitting initiative.

IDENTIFYING EFFECTIVE ACTION FOR

THIS HEALTH PRIORITY –

CHANGEABILITY

Taking the list of high-priority issues, check who

else may need to be involved now, and how you

might include them.

Create a list of potential actions by discussing:

•What are effective actions that could improve

the significant health conditions/determinant

factors across the three levels of prevention?

• What is the strength of their evidence of

effectiveness?

•Are there professional or organisational

policies that set out what should be done

(eg National Service Frameworks, Social

Services Inspectorate guidance etc)?

Include only those with positive evidence of

effectiveness, or national ‘must do’s’.

Size

Review any known data or information on

incidence or prevalence directly for your

population, or extrapolated from other, similar

populations. Think about:

• Absolute size, eg number of cases of post-

natal depression occurring within the

population

• Comparative size, ie is the local size higher

or lower than other local populations/national

averages?

Look at the resulting flip chart for high, medium

and low severity. Should any of the health

conditions or determinant factors move group

when you consider:

• Their size in your population?

• Any national or local policies (corporate) or

expressed needs.

If so, move them, and agree the final list of

priorities as high, medium or low.

Finally, identify whose health is most likely to be

at risk from the negative impact of these high-

priority conditions/determinant factors – these

will be the target groups for action.

ActionAction

Health Priority

Lower rates of

accidental injury

Action Action

Provide safety

awareness and

first-aid courses

for parents

Raise awareness

through targeted

health information

literature

Provide free

smoke alarms and

cupboard safety

catches

Improve safety

surfaces in

playgrounds

Lower incidence of

post-natal depression

Provide home-based

family support, via

safe babysitting,

to isolated and

vulnerable families

Raise awareness of

services available

through targeted

health information

literature

Increase access to

post-natal health

and fitness activities

Facilitate parent

and baby support

groups

Figure 6

Identifying actions for the health priority to improve physical, intellectual and social

development of under-fours in a disadvantaged area

HEALTH DEVELOPMENT AGENCY

Health needs assessment

3. THE FIVE STEPS OF HEALTH NEEDS ASSESSMENT

IDENTIFYING ACCEPTABLE CHANGES

FOR THIS HEALTH PRIORITY –

ACCEPTABILITY

For each of the effective actions agreed

previously, check if similar activities for this

priority are already happening. If yes, note:

•Who is involved in a similar activity locally?

• What is the target population for these

actions, and how many recipients are there?

•Are these actions reaching the most

disadvantaged?

•Are actions of the required quality?

Answering these questions should help to

decide whether to improve existing action, or

initiate new action.

Agree on a shortlist of potential effective

interventions or actions, and consider these

for public and professional acceptability.

Remember that interventions or actions

sometimes need to be grouped in order to be

effective or to give a choice, and that single

actions can have limited effect.

WHAT ARE THE MOST ACCEPTABLE

INTERVENTIONS/CHANGES?

Consider whether interventions or changes

would be acceptable to:

• The target population and the wider

community?

• Those delivering the activity?

•Organisations commissioning and managing

the activity?

If any are totally unacceptable to one of these

groups, should they be deleted from the list?

WHAT ARE THE RESOURCE

IMPLICATIONS OF THE PROPOSED

INTERVENTIONS?

•What resources will be required to

implement the proposed changes?

• Can existing resources be used differently to

support the changes?

•Are other resources available that have not

been accessed before?

•What resources might be released if existing

ineffective interventions are stopped?

• Which actions will achieve the greatest

impact on health for the resources used?

ARE THE RESOURCE IMPLICATIONS OF

THE PROPOSED CHANGES FEASIBLE?

It is important to clarify the resources that will

be required to bring about the agreed changes.

This will be influenced by who is involved, and

how committed they are to this assessment.

Health improvement is likely to be far greater

if existing or mainstream resources are already

directed at the health priority.

Key resources issues are:

• People – how long will it take to get the

right people, in the right places, doing the

right job?

• Space – is physical space available for the

actions?

• Equipment – what equipment is required

and is it available? If not, how and when

can it be acquired?

Check:

• Can existing resources be used differently?

•Are possible funds recurrent or non-recurrent?

• When might savings from stopping

ineffective actions become available?

• Which actions will achieve the greatest

impact on health for the resources used?

Any acceptable changes that will have a

significant impact on health, and require only

low resource levels to implement, should be

included in the action plan (step 4). Discussion

needs to concentrate on those requiring

medium or high resource levels to implement.

Health Needs Assessment for a Sure Start Programme in West Newcastle upon Tyne

Illustrative case study Step 3 – Assessing a priority for action

What interventions

were considered

most effective and

acceptable?

1. Employment of family safety workers to undertake home visits

once they had undertaken a training programme. To promote

safety by sharing information; enable parents to carry out safety

checks in their own homes; assist parents in making use of safety

equipment; facilitate groups in first-aid and child safety

2. Newcastle Family Support (previously the Baby Sitting Initiative)

to provide babysitting and support to isolated and vulnerable

families that:

• Is community based, takes place in the family home

•Provides counselling, advocacy and signposting facilities to

families face-to-face and via telephone contact

• Operates seven days a week between 9 am and 11 pm

• Is free to families referred via the health visitor, a social worker,

community psychiatric nurse, school or other voluntary agency

Main focus to provide support to those families where the mother

has or is at risk of developing post-natal depression

How were resource

needs met?

1. To help build local capacity the programme wanted to offer these

posts to local people and to make sure training was offered to ensure

a wider audience could apply. Family Safety Scheme – would be Sure

Start funded. In addition to the cost of training and employing two

local people, the experienced health visitor extended her hours to

help coordinate this function across two programmes. The two new

workers were housed with the existing Family Safety Scheme

2. Sure Start funds were transferred to Children North East to

extend their existing ‘family support’ service into the new and

neighbouring Sure Start area

HEALTH DEVELOPMENT AGENCY

Health needs assessment

3. THE FIVE STEPS OF HEALTH NEEDS ASSESSMENT

REVIEW – STEP 3

At this stage in the process you

should:

• Be confident that the health

conditions/determinant factors

with the most significant impact

on health functioning for the

selected health priority are being

tackled

• Be sure the action is focused on

reducing health inequalities for

that health priority

• Have identified acceptable and

cost-efficient actions to improve

the selected health priority.

You will now be ready for

action planning.

Now you have worked out what changes you

want to make in order to tackle your chosen

health priority, and why, you should concentrate

on how to implement change. This is the action

planning for change stage of the project, and

you will need to bring your team together to

agree a plan.

By the end of this step you should have

• Agreed a clear set of aims, objectives,

indicators and targets

• Set out the actions and tasks you need to

undertake to achieve these

• Agreed how you will evaluate your

programme

• Identified the key risks to the success of the

programme and how they will be managed.

AIMS

• What, overall, are you trying to achieve?

It is important to remember what you agreed as

the most significant aspects of health for the

target population at the beginning of step 3, as

this should be the basis of your overall aim.

OBJECTIVES

•What are you trying to achieve specifically,

and how will this be measured?

Your objectives should reflect the health conditions/

determinant factors that, as agreed in step 3, have

the most significant impact and are changeable

through acceptable and feasible actions.

Step 4

Action planning for

change

To help focus on the differences you want to

make, ask yourselves:

• What will the target population do

differently?

• What will they say differently?

• What will you see in them that is different?

• How will you be able to demonstrate this?

This will help ensure the objectives you set are

SMART (specific, measurable, agreed, results-

orientated, time-bound).

Spending time ensuring you have robust

objectives will help you define your:

• Indicators – against what measures should

you monitor progress?

•Targets – what level of outcome do you want

to achieve, for whom and by when?

This is also critical for effective outcome

evaluation. (For more help with defining aims

and objectives, and setting indicators and

targets, see Hooper and Longworth, 2002,

pages 80-85).

ACTIONS

To ensure you are successful, you will need to plan:

•Actions and tasks required to achieve the aims

and objectives for the selected priority issue

• Responsibilities – who will do what?

• Delegation of key tasks to members of the

project team and a programme of meetings

to which they must report

HEALTH DEVELOPMENT AGENCY

Health needs assessment

Aim

Objectives

Action

Objectives addressed by this

action

Target population for this

action

MONITORING AND EVALUATION

As a project team you should:

• Be clear about what you want to evaluate,

why, and how it will benefit those involved

with the project

• Decide how you will collect data for the

evaluation

• Ensure this includes a system for providing

feedback to the population and policy

makers/service providers.

You should appoint someone to take lead

responsibility for monitoring and evaluation at

the outset of the project.

You should put in place systems to measure

how well the process you have chosen is

progressing at various stages – process

evaluation. You will also need to measure

the impact or added value of your

intervention on the health of the target

population – outcome evaluation. This

should be based on the aims, objectives,

indicators and targets agreed earlier in this step.

Process evaluation

Agree a set of indicators that will enable

interim progress on the project to be

monitored (operational indicators), eg the

number of people attending core team

meetings indicating continued engagement

with the project.

Figure 7

•Timescales – milestones for each part of the

project, eg

- literature search completed

-protocols agreed

- baseline data for agreed indicators collected

• Skills and training requirements for each step

• Administrative and managerial systems to

support the project

• Resources – finance, time, equipment, space.

It is always useful to keep checking back to

ensure the actions will contribute to your

agreed objectives, and will benefit the

identified target population. Using a format as

shown below can help keep you on track.

3. THE FIVE STEPS OF HEALTH NEEDS ASSESSMENT

Illustrative case study example Figure 8: Action plan/progress report

RISK MANAGEMENT

A risk-management strategy should be

incorporated from the beginning of the project

to evaluate and address the impact of risk to

achieving the project’s aims and objectives. It

should also be built into the planning of specific

interventions. This might include:

• Identify potential risks to achieving

project/intervention objectives

• Assess each risk according to both likelihood

and impact as high, medium or low

• Inform the team and stakeholders about each

high or medium risk, and enter onto a risk register

(see illustrative example that follows)

• Review the risk register regularly at

progress meetings

• Choose options for treating/minimising risks

• Allocate a person to manage risks

•Evaluate risks to ensure effectiveness of

risk treatment

• Check for any new risks.

Some useful questions to enable the process to

be reviewed, and amended if necessary, are:

•Are the original aims and objectives being

followed, and are they still relevant?

•What is actually happening?

•Are all parts of the project proceeding as planned?

• What do those implementing the project think

about it?

• Is the original target group receiving the

interventions?

•What resources are being used, and are

they adequate?

Outcome evaluation

A key part of the outcome evaluation is

agreeing a set of indicators that will enable

measurement of the project’s achievements in

altering the health of the population through

improvement to services.

Some useful questions:

• Have the original aim and objectives been achieved?

• Have the indicators improved, and have the

targets been achieved?

•Is the project still tackling priority issues?

•What should happen if the evaluation shows

the programme has failed?

(For more help with defining aims and

objectives, and setting indicators and targets,

see Hooper and Longworth, 2002,

pages 80-85).

By whom

Action required

Health Priority

Example:

To recruit two family

safety workers to

provide home-based

support and

information about

safety in the home;

information and

support to access

safety equipment

when

Progress to date

(review date, eg end

of month 1)

Newcastle PCT

in conjunction

with Riverside

Community

Health Project

• Hold open event to present

job/training opportunities

to local people

• Assemble recruitment pack

• Plan interview schedule

• Advertise post

• Shortlist candidates

•Interview

• Induction

Autumn

2004

• Job descriptions

and person

specifications

drawn up

• Advertisement

schedule

planned

HEALTH DEVELOPMENT AGENCY

Health needs assessment

3. THE FIVE STEPS OF HEALTH NEEDS ASSESSMENT

Illustrative case study example Figure 9: Key strategic risks

Health Needs Assessment for a Sure Start Programme in West Newcastle upon Tyne

Illustrative case study Step 4 – Assessing a priority for action

Summary of the

action planning

process

As both initiatives were already running in another programme,

the two leads for each project took responsibility to employ and

train local people. An open event was arranged for local people to

come and learn about the jobs, and support was offered to

people in completing applications and looking at how part-time

employment would affect their benefits

Each lead set their own project timescales and targets in line with

the national targets set for Sure Start, and demonstrated how

they could help the overall programme meet its objectives

REVIEW – STEP 4

By the end of step 4 you should be

ready to implement your plan for

action, and have planned everything

thoroughly to maximise your

chances of effecting change and

making sustainable improvements to

the health of your target population.

Project: to employ two family safety workers

No.

Date

added to

Source Risk

identified

Consequences Likelihood Impact Risk

treatment

Management

lead

Risk

evaluation

A.1 31.01.04 Project

team

meeting

12.12.04

Failure to

attract

suitable

applicants

from local

population

Project delayed M H Consider

secondment

possibilities

Project

coordinator

Application

deadline

This final stage of the HNA process involves the

team in some reflective questions and the

opportunity to take stock and learn, both for

individual contributors and from a team

perspective. This is a vital part of the process if

HNA is to continue to be a relevant and

effective tool in improving health and tackling

health inequalities in the population.

Learn from the project:

• What went well, and why? Check

achievements against the original aims and

objectives of the project

• What did not go well, and why?

Is any further action required?

•Identify further action to be taken.

Perceived improvement in health/services

following the interventions:

Step 5

Moving on/project review

• How effective was it?

• How could it have been improved?

•What were the main challenges?

•What were the main barriers?

If appropriate, choose your next priority for

assessment:

• Revisit the shortlist of priorities

•Take stock of any interim changes

• Is the priority still an issue? If so, return to

step 3

Celebrate having reached this stage in the

five-step process.

HEALTH DEVELOPMENT AGENCY

Health needs assessment

3. THE FIVE STEPS OF HEALTH NEEDS ASSESSMENT

Health Needs Assessment for a Sure Start Programme in West Newcastle upon Tyne

Illustrative case study Step 5 – Moving on/project review

How well was the

action plan

implemented?

There was good response to advertisements and individuals were

quickly employed into posts and training undertaken

What was achieved

by the project?

1.Newcastle Family Support has been in great demand, with many

families requiring a wide variety of support. Staff have been

employed across both Sure Start programmes which has enhanced

availability and choice for local people. We have also been able to

target those most in need

2.The family safety workers have worked actively with health

visitors in local clinics, enhancing service provision. They have

promoted the safety service and accessed individuals in clinics and

community groups which has led to home-based safety

assessments

How did it contribute

to reducing

inequalities?

There has been increased access to safety equipment and family

support to those most in need

Employment and training opportunities have been made available

in an area of high unemployment

What was learned

through the project‘s

successes and

challenges?

The importance of joint working across agencies, and increased

awareness of how one service can complement and support

another. In both projects described, referrals in and out of

statutory services have increased, as has signposting

What needs to

happen next?

Formal evaluation of both is ongoing

What new priority

was chosen for the

population?

Action on a multitude of priorities is still being taken in this huge

programme

What main message

from the last HNA

will you take forward

to the next?

The importance of joint working. The strong partnership between

the public health nurse and the community development worker

was invaluable, with each bringing different knowledge and skills

to this work

4 HNA skills required

and tools available

Skills

Steps Skill elements

Useful websites and

sources of support

Useful texts

(see pages 92-95)

1 Project

management

Responsibility for

overall management

of a project from

initiation through to

implementation and

evaluation

2 Team building

Identification of

strengths,

weaknesses,

opportunities and

barriers within teams

and development of

mechanisms to

facilitate effective

team working

All

Step 4

All

Objective setting;

Time management;

People

management;

Stress

management;

Project leadership;

Risk assessment

Action planning

coordination and

scheduling of

processes leading

to taking action

Report writing

Facilitation;

Communication;

Leadership;

Negotiation;

Capacity building;

Skills development;

Training

PRINCE (projects in controlled

environments) is a project-

management method covering

the organisation, management

and control of projects:

www.ogc.gov.uk/prince (an

alternative website is available at

www.Prince2.com)

The BOND network (British

Overseas NGOs for

Development) provides

information on logical

framework analysis – a log

frame is a tool for planning and

managing development projects:

www.bond.org.uk/pubs/guidanc

e/logical-fa.pdf

Plain English Campaign is an

independent pressure group for

public information to be written

in plain English. It provides

information and support in

writing in plain

English:www.plainenglish.co.uk

University of Warwick website –

search for ‘team building’ and

then Centre for Primary Health

Care Studies – for information

on effective team working/

building www.warwick.ac.uk

Office of Government

Commerce (2002a,b)

Office of Government

Commerce (2002a,b)

HNA skills required and tools available

Cont...

HEALTH DEVELOPMENT AGENCY

Health needs assessment

4. HNA SKILLS REQUIRED AND TOOLS AVAILABLE

Skills

Steps Skill elements

Useful websites and

sources of support

Useful texts

(see pages 92-95)

3 Partnership

working

Identification and

engagement of key

stakeholders and

development of a

common vision and

shared responsibility

for the work

4 Community

engagement

Developing links

with community

networks and

ensuring active

involvement of key

members of the

community

All

Step 2

Networking; Building

confidence and trust;

Facilitation;

Negotiation;

Collaborative

working; Problem

solving

Identifying key

people; Listening;

Providing

accessible

information;

Ensuring feedback;

Understanding

community

boundaries;

Negotiation;

Reaching

marginalised

communities

Search for ‘Making Partnerships

Work’www.doh.gov.uk

Neighbourhood Renewal Unit

www.neighbourhood.gov.uk

Sure Start www.surestart.gov.uk

Local Government Association

www.lga.gov.uk

HAZnet – Health Action Zone

website: a resource for

partnerships tackling health

inequalities and whole systems

approaches www.haznet.org.uk

A method of accessing a range

of organisations concerned with

planning/implementing action:

www.communitiesforhealth.net

Search for ‘Patients Advice Liaison

Services’ www.doh.gov.uk

Local Compact Guidance:

Getting Relationships Right

Together, National Council of

Voluntary Organisation and Local

Government Association

www.doh.gov.uk/compact.org.uk

Community development

Foundation www.cdf.org.uk

Provides information on ‘Contin

You’ aimed at building learning

communities: www.cedc.org.uk

Partnerships Ltd www.partnerships.

org.uk/part/links.htm

Markwell (2003);

Markwell et al. (2003);

National Consumer

Council (1994)

Henderson and Thomas

(2002); Henderson et al.

(2004); Maclennan

(2000); Peckham and

Spanton (1994);

Webster (2001)

Cont...

HEALTH DEVELOPMENT AGENCY

Health needs assessment

Skills

Steps Skill elements

Useful websites and

sources of support

Useful texts

(see pages 92-95)

5 Population

profiling

6 Data collection

Agreeing appropriate

methodologies.

Undertaking data

collection to make

sense of what is

happening and

assessing associations

between various data

items of relevance

Step 2

Demographic

knowledge

Local history

Environment/

housing/transport/

health and leisure

amenities, etc

Local voluntary and

community

organisations

Rapid appraisal;

Participatory

appraisal; Surveys;

Focus groups;

Designing

questionnaires;

Analysis of routinely

held data;

Acquisition of

information from

local informed

sources

Public Health Observatories

www.pho.org.uk

National Statistics

www.statistics.gov.uk

Neighbourhood Statistics

www.statistics.gov.uk

Positively Diverse

www.doh.uk/positively7diverse/

Minority Ethnic Communities

and Health

www.minorityhealth.gov.uk/

index.htm

Health Survey for England 1999

resultswww.dh.gov.uk/public/hs02

National Co-ordinating Centre for

Research Methodology promotes

identification, development and use

of appropriate research methods:

www.publichealth.bham.ac.uk/

nccrm/

The epidemiological approach to

healthcare needs assessment:

http://hcna.radcliffe-

oxford.com/introframe.htm

Internet for Social Research

Methods free teach-yourself

tutorial to assist practice and

development of Internet

information skills:

www.vts.rdn.ac.uk/tutorial/social-

research-methods

Project Gold, run by the Royal

College of Nursing, provides a

research methods glossary:

www.bath.ac.uk/dacs/

gold/glossary.html

Hawtin et al. (1999)

Cont...

HEALTH DEVELOPMENT AGENCY

Health needs assessment

4. HNA SKILLS REQUIRED AND TOOLS AVAILABLE

Skills

Steps Skill elements

Useful websites and

sources of support

Useful texts

(see pages 92-95)

6 Data collection

Cont...

7 Monitoring/

setting indicators

Setting milestones as

interim points for

project review and

evaluation

Evaluation to

measure effectiveness

of activity and

review progress

and outcomes

Ensuring sustainable

outcomes

Step 4

All

Step 5

Indicator setting

Process evaluation;

Outcome

evaluation

Exit strategies;

Community

capacity building

Primary care trusts’

information departments

Strategic health authorities’

hospital utilisation data

General practices’ disease

registers, community contacts,

prescribing data

Local authorities’ current

resource allocation

Census population statistics, numbers

of people, births and deaths

Car ownership, employment, age

profiles, housing tenure, self

reported limited illness

London Health Observatory

provides information on health

inequalities basket of indicators:

www.lho.org.uk/HIL/Inequalities_

In_Health/Basket_Of_Indicators/

Basket.htm

HDA (2002); Peberdy, (1997);

Pawson and Tilley (1997)

Information on sustainable

development: www.sustainable-

development.gov.uk

Burns and Taylor (2000)

Chirico et al. (1998)

Case studies

The following case studies were submitted by

HNA practitioners and demonstrate how the

core five-step process can be applied to

different types of population.

1 Geographic populations – at different

levels, eg regional, PCT/local authority

catchment area or neighbourhood

1.1 Deprived ward in Selby & York

1.2 GP practice population – rural Mid-

Hampshire

2 Settings populations – eg schools,

workplaces, prisons, hospitals

2.1 Secondary school population – Young

people’s health survey

2.2 Prison populations in three prisons in

Durham

3 Shared social experience populations – eg

homelessness, refugee, ethnicity, culture,

age, sexuality

3.1 Children under four and their families –

Sure Start project

3.2 Black and minority ethnic children – Leeds

4 Specific health experience populations –

eg diseases, chronic illness, mental health,

disabilities

4.1 Cardiac service requirements of a black

and minority ethnic population in

Newcastle

4.2 Suicide and self-harm – residents at risk in

Greenwich and Bexley

There are additional HNA case studies on the

HealthAction website. These include:

• Deprived Neighbourhood in Thornhill,

Southampton- New Deal for Communities

• Prison population – HMP Hull

• Palliative care in the London Boroughs of

Greenwich and Bexley.

www.healthaction.nhs.uk

Note: the case studies featured in this guide

were submitted by experienced public health

practitioners who have been invited by the

authors to provide examples of HNAs

conducted with different types of population.

They are not intended to reflect a national

geographical spread.

5 Case studies

Step 1 : Getting started

What population,

where located and

why chosen?

The local population of one of the PCT’s most deprived wards

What were the aims

and objectives?

To improve the health and reduce inequalities in health of the local

population

Who was included

in the project team?

Who was included

in the stakeholder

group?

A multi-agency steering group including local councillors and

representatives from the PCT, primary care, mental health, social services,

leisure services, youth service, residents’ association

What resources

were required?

Local workers in health, social care, education and many

representatives from local non-statutory services, local parents,

grandparents, carers and children

What resources

were required?

Staff time to coordinate the process and funding of £5,000 made

available by the PCT for venue costs, action plan implementation and

to release a local health visitor for 12 days to be the local champion.

Four two- to three-hour sessions arranged to follow the process

Any barriers

encountered?

Time commitment

TITLE OF PROJECT

Acomb health needs assessment

MAIN CONTACT DETAILS

Janet Flanagan, Senior Health

Improvement Manager, Selby & York

PCT, 37 Monkgate, York

1.1 Geographic populations

Acomb health needs assessment,

Selby and York PCT

Cont...

HEALTH DEVELOPMENT AGENCY

Health needs assessment

5. CASE STUDY

1.1 GEOGRAPHIC POPULATIONS

ACOMB HEALTH NEEDS ASSESSMENT, SELBY AND YORK PCT

How was a profile of

the population

developed?

Through readily available data, eg deprivation data at ward level from

the Department of the Environment, Transport and the Regions

What data were

available on the

health of the

population?

GP practice data

How was information

gathered about the

population’s and

service providers’

perceptions of needs?

A semi-structured interview questionnaire was used by the local

champion, who visited approximately 12 major stakeholders. Steering

group representatives collected information from their colleagues. All

data were shared and reviewed by the steering group

What were the key

issues for the

population?

Family relationships, substance misuse, poverty, housing, social

isolation, older people’s issues

What priorities were

chosen and why, in

terms of impact and

changeability?

The issue of older people and social isolation was chosen as it is a

central issue for many organisations. Social isolation affects both the

mental and physical health of older people

What evidence

informed your

decision?

Perceptions of key stakeholders, including Age Concern, and focus

groups with older people

... cont.

How were these

overcome?

By having a local champion and PCT coordinator to facilitate the

process and undertake work between meetings

Obtaining prior senior-level support for the process. Creating an

environment at meetings where participants felt they were able to

contribute openly to the discussions and their opinions valued

What was learned

through the project‘s

successes and

challenges?

The importance of joint working across agencies, and increased

awareness of how one service can complement and support

another. In both projects described, referrals in and out of

statutory services have increased, as has signposting

Step 2 : Identifying health priorities

Step 3 : Assessing a priority for action

What interventions

were considered

most effective and

acceptable?

The focus groups’ and Age Concern’s feedback identified gaps in

services. The Older People’s NSF Standard 8: Information Strategy

for Older People and other published papers underpinned the

interventions the steering group identified to address unmet needs

What changes were

required?

Membership of the steering group was reviewed to include

organisations working with older people

How were resource

needs met?

Additional funding to implement interventions was part of the action

plan. Coordinator’s time. A task group was established to explore the

feasibility of developing a drop-in centre for older people

Step 4 : Action planning

Summary of the

action planning

process

The revised steering group developed the action plan that was

reviewed at two-monthly meetings. A progress report was

presented to the Older People’s Partnership Board. Progress

reports were provided to the Older People’s Forum

Step 5 : Moving on/review

What was achieved

by the project?

Ward Committee funding accessed to increase day centre capacity

and for Age Concern to appoint a community development

worker to support isolated older people

2000 copies of the Information Directory were circulated, local GP

practices gave the Directory to patients attending for older

people’s health checks and referred socially isolated older people

to the community development worker. The Directory is available

on Age Concern’s website (www.ageconcern.org.uk) and is

updated by a volunteer

The Older People’s Forum meets every four months. The group is

given information to disseminate to its members, eg benefits

information, healthy lifestyles

A district nurse has been seconded for one day a week to

establish a network of community-based chair-exercise sessions

Increased networking and referrals between statutory and

voluntary organisations

Cont...

HEALTH DEVELOPMENT AGENCY

Health needs assessment

1.1 ACOMB HEALTH NEEDS ASSESSMENT, SELBY AND YORK PCT

How did it contribute

to reducing

inequalities?

The mental health needs of a vulnerable group of older people are

being addressed by being more integrated into the local community

What was learned

through the

project‘s successes

and challenges?

The Health needs assessment workbook (Hooper and Longworth, 2002)

provided a systematic and logical framework, and the process strengthened

multi-agency working. Senior-level support and commitment to the process

is vital. Involving the local community and key local players contributes to

action plan implementation. Facilitation and project management skills are

an essential resource. Having the local councillor as chair of the steering

group provided credibility to the project and enhanced action plan

implementation

What needs to

happen next?

The project is entering its third year, and an exit strategy will be

developed

What new priority

was chosen for the

population?

None

What main message

from the last HNA

will you take

forward to the

next?

Support of key stakeholders and involvement of the local community

are essential. Identify a local champion who has credibility in the

community. Use a rapid appraisal approach to collect data. Involve the

local strategic partnership to ensure commitment to the process at

senior strategic level

Age Concern funded a survey with older people to provide

evidence for a drop-in centre. Over 500 questionnaires completed

and analysed. The survey identified barriers to social engagement,

and recommendations are being implemented by the steering

group

Lack of clean toilet facilities in the local shopping centre identified

as a reason for not going out. The local council was notified,

toilets have now been refurbished and their cleanliness is

monitored at least three times a day

An NHS community facility/café is underused, partly because of

lack of marketing and access problems. The council has

undertaken to make changes to the access road, and Age

Concern will provide support and training for volunteers to

develop the café. An information service will also be provided

The Information Directory is being replicated in other areas of York

by City of York Council, and other wards have made funding

available to Age Concern to provide more community workers

Membership of many of the social activities has increased

5. CASE STUDY

1.1 GEOGRAPHIC POPULATIONS

ACOMB HEALTH NEEDS ASSESSMENT, SELBY AND YORK PCT

Step 1 : Getting started

What population,

where located and

why chosen?

The population registered at a rural GP practice in Mid-Hampshire

The HNA was undertaken to inform the Practice Professional

Development Plan

What were the aims

and objectives?

To identify the health needs and inequalities in the registered

practice population

To assist the practice to identify priorities for service provision and

staff development

Who was included

in the project team?

The project was undertaken by the project manager in consultation

with all staff employed and attached to the practice

Who was included

in the stakeholder

group?

The qualitative work involved consultation with local representatives

from the parish council, schools, social services (care managers),

police, voluntary organisations and patients

What resources

were required?

The project manager was appointed for a period of six months.

The role involved identifying the most effective way for a practice to

undertake this work, and the most efficient use of staff to achieve it

TITLE OF PROJECT

GP practice-based health needs assessment

MAIN CONTACT DETAILS

Julia Pallant, Public Health Project

Manager, Mid-Hampshire Primary

Care Trust

1.2 Geographic populations

GP practice population –

rural Mid-Hampshire

HEALTH DEVELOPMENT AGENCY

Health needs assessment

Step 2 : Identifying health priorities

How was a profile of

the population

developed?

Using quantitative and qualitative methods

What data were

available on the

health of the

population?

Quantitative data were obtained from the practice and the health

informatics service supporting the PCT

How was information

gathered about the

population’s and

service providers’

perceptions of needs?

Qualitative information was obtained using semi-structured interviews

and focus groups to explore findings further and to validate them

What barriers were

encountered?

Data quality

Lack of time, particularly for the qualitative work which was seen as

valuable

How were these

overcome?

Providing support of a Primary Care Information Services (PRIMIS)

facilitator to assist the practice with data collection and templates for

future use

Exploring alternative ways of obtaining qualitative information

What were the key

issues for the

population?

Access (one ward on fourth percentile of index of multiple deprivation

for access; local difficulties with transport)

Information (lack of awareness and availability, eg benefits, support

services, self-help groups)

Older people – services to support in own homes and insufficient day

centre provision, isolation, safety

Mental health – issue for all age groups: for young, lack of service

provision to support and length of time to access child guidance; stress

and depression in middle-aged, middle class; isolation of elderly and

depression

Physical activity – lack of activity in all age groups

What priorities were

chosen and why, in

terms of impact and

changeability?

Data quality – the practice produced an action plan to improve

quantitative data to provide more robust information in future

Physical activity – use of the exercise referral scheme and the

introduction of a local walk scheme

Cont...

5. CASE STUDY

1.2 GEOGRAPHIC POPULATIONS

GP PRACTICE POPULATION – RURAL MID-HAMPSHIRE

... cont.

What evidence

informed your

decision

The practice recognised that the quantitative information was not

accurate due to variables in use of code and lack of compliance. To

ensure needs could be identified more accurately in future, this was

seen as a priority to address

The findings acted on were qualitative

The physical activity issue was incorporated in coronary heart disease

and diabetes work already in progress to provide a preventive measure.

This was combined with a decision taken to target overweight/obese

patients attending specialist clinics

Step 3 : Assessing a priority for action

What interventions

were considered

most effective and

acceptable for this

priority and what

evidence informed

your decision?

Decisions were taken based on the following:

• Size of population affected

• Services and resources already available

• Fit with national priorities, eg national service frameworks

•Cost

How were resource

needs met?

Some issues identified were not the practice’s direct responsibility,

which enabled more to be achieved – result of stakeholder

involvement in process

Mental health management was agreed as an area for the team to

develop knowledge and skills; links were made with the Community

Mental Health Team to support this development

Access – volunteer driver scheme expanded and parish council

approached Rural Transport Initiative

Mental health – PCT provision of primary mental health worker for

children and adolescents

Older people – decision taken to action at later date

HEALTH DEVELOPMENT AGENCY

Health needs assessment

Step 4 : Action planning

Summary of the

action planning

process

The action plan was an identified weakness when progress was

reviewed one year on

The need to produce an action plan with clearly defined roles and

responsibilities, an agreed timescale and measurable outcomes

was learnt

Enthusiastic individuals had achieved some valuable developments

but they were not part of a central plan

This was a good learning experience for the practice

Step 5 : Moving on/review

How well was the

action plan

implemented?

Developments had occurred, but not as a result of conforming to

an agreed plan

What was achieved

by the project?

A toolkit for HNA was produced as a result of the project for

other practices in the PCT to use

Raised awareness of the value of HNA and stronger links with the

community. An understanding of committing time and resources

where they would be most effective

How did it contribute

to reducing

inequalities?

Raised awareness of access problems, particularly for the young

and elderly, and actions resulting

What was learned

through the project‘s

successes and

challenges?

The need for a simple process, a champion to lead and a team to

produce

The importance of not raising expectations, and of identifying

small changes that could have considerable impact

What needed to

happen as a follow

up?

Review by the whole team of progress and deciding next steps

What new priority

was chosen for the

population?

Older people

What main message

from the last HNA

will you take forward

to the next?

Keep it simple

The value of qualitative data and community involvement

Committing to actions to address identified needs

5. CASE STUDY

1.2 GEOGRAPHIC POPULATIONS

GP PRACTICE POPULATION – RURAL MID-HAMPSHIRE

Step 1 : Getting started

What population,

where located and

why chosen?

Year 9 pupils from five senior schools across Newcastle upon Tyne.

Initially three schools were chosen as a representative sample

across three localities. However due to a lack of information in

one locality a request was made to cover all three schools within

this area

What were the aims

and objectives?

To assist school health advisers across the city to target care better

according to need, and specifically to assist them and others in

implementing health promotion activities and interventions to meet

the needs of the school population

Who was included

in the project team?

Clinical Nurse Lead Public Health, Clinical Nurse Lead School Health, five

school health advisers, a Senior Health Promotion Officer specialising in

school health, Health and Drug Education Officer, a Child and Adolescence

Mental Health Nurse Specialist and information and knowledge

management staff

Who was included

in the stakeholder

group?

In addition to the above, community paediatricians, Director of

Education, Chief Executive of PCT, school health advisers from a

neighbouring trust, additional specialist health promotion staff,

Teenage Pregnancy Coordinator, education staff

What resources

were required?

A great deal of human resources – shared functions across project

team

TITLE OF PROJECT

Young People’s Health Survey

MAIN CONTACT DETAILS

Dawn Scott, Public Health and

Gill Shapero, School Health, Newcastle PCT

2.1 Settings populations

Secondary school population –

Young People’s Health Survey

HEALTH DEVELOPMENT AGENCY

Health needs assessment

Step 2 : Identifying health priorities

How was a profile of

the population

developed?

By looking at existing surveys across the country and adjusting them

accordingly to meet our needs; specifically, changing some of the

language to meet local need and increase pupils’ understanding of

the questions asked

What data were

available on the

health of the

population?

Very limited data existed specifically for one area of the city. School

health staff felt they had a good idea about the present problems, but

needed formal evidence for this. The survey would act as one method

of achieving this. Nationally the School Health Education Unit (SHEU)

had produced information about young people’s health, which was

accessed as a comparator for this local work

How was information

gathered about the

population’s and

service providers’

perceptions of needs?

Distribution of a structured questionnaire to year 9 pupils under examination

conditions at school. Lifestyle (legal and illegal drugs, eating habits, exercise),

size and shape, emotional health, sexual health and general physical health,

environmental and safety information was collected. Questionnaires were

scanned onto the FORMIC data-capture system

What barriers were

encountered?

Local negotiation within specific schools regarding where and how to

undertake survey was difficult, as this was near examination time

How were these

overcome?

Through ownership of the project by the PCT Chief Executive and

Directors, and a great deal of hard work and negotiation from frontline

school health staff

What were the key

issues for the

population?

Some specific drug use across the city was higher than SHEU data.

Bullying was a clear problem in one school; high numbers of pupils

smoking was an issue in another. Lack of knowledge and

understanding of sexually transmitted diseases and some issues relating

to sexual health were also highlighted

What priorities were

chosen and why, in

terms of impact and

changeability?

Each school had different areas of activity that were important to

address, but citywide focus was required to address:

•Approaches to giving sexual health information and service provision

both in and out of school

• Smoking cessation for young people

What evidence

informed your

decision?

Inconsistency across schools about the nature and type of sexual health

information being offered, compared with pupils’ understanding of

sexually transmitted infections

No clear strategy to address smoking in young people

5. CASE STUDY

2.1 SETTNG POPULATIONS

SECONDARY SCHOOL POPULATION – YOUNG PEOPLE’S HEALTH SURVEY

Step 3 : Assessing a priority for action

What interventions

were considered

most effective and

acceptable?

Increase in ‘health drop-ins’ on primary and secondary school

premises, some of which also offer sexual health services

(secondary schools only). Promotion of C-Card system*

How were resource

needs met?

Funding required to ensure family planning/sexual health specialist

knowledge available via:

•Training existing school health advisers

• Some schools chose to fund a family planning nurse session

Availability and suitability of accommodation within school

Need to change school health work patterns to meet pupil needs

Availability of youth and play staff to support sessions

Step 4 : Action planning

Summary of the

action planning

process

Agreement of governors and parents on nature of drop-in facility

Local school survey to indicate need and desirability for health drop-

in, to include best day, time and location within school for service

Responsibilities and timescale determined by each school, each at

different stages of development of these services

Consistency across city regarding uniformity of standard of service,

eg confidentiality statement, level of training and record keeping

Targets in accordance with local teenage pregnancy strategy and

local strategic plans

Staff acknowledge differences in each service provision within

schools in accordance with the faith, religion and ethos of the school

HEALTH DEVELOPMENT AGENCY

Health needs assessment

Step 5 : Moving on/review

How well was the

action plan

implemented?

The action plan has been implemented effectively

What was achieved

by the project?

Young people attending all secondary and high schools across the

city now have access to health drop-ins

How did it contribute

to reducing

inequalities?

Increased access to health facilities (in some schools, sexual health

facilities). Increased access to health information and signposting

young people to relevant services as necessary

What was learned

through the project‘s

successes and

challenges?

Importance of working closely with educational staff

Language barriers, ambiguity and nature of questions asked on

survey. On reflection, some needed to be changed to decipher

clear information

Lack of knowledge of sexually transmitted infections

Need to strengthen the leadership role of school nurses

What needs to

happen next?

Continue to work closely with education staff regarding health

issues, although this function between school health advisers and

teachers has been strengthened around curriculum development

and delivery of information around sexually transmitted infections

What new priority

was chosen for the

population?

Development of smoking cessation work with young people. A

working party has now been set up looking at ways to deliver

‘stop smoking’ services to secondary and high schools

What main message

from the last HNA

will you take forward

to the next?

Importance of involvement of young people in developing services

and appropriate methods of assessing their health needs

*C-Card is a condom distribution scheme for young people. After registering, the young person is

issued with a C-Card which enables them to access free condoms and sexual health information and

support from a range of young people-friendly settings across the city. It has been particularly

successful in attracting young men into sexual health services.

5. CASE STUDY

2.1 SETTNG POPULATIONS

SECONDARY SCHOOL POPULATION – YOUNG PEOPLE’S HEALTH SURVEY

Step 1 : Getting started

What population,

where located and

why chosen?

Three Durham prisons (HMP Frankland, HMP Durham and HMP

Low Newton)

Prison population reveals strong evidence of health inequalities

and social exclusion

Prisoners are largely from lower socio-economic groups

Prisoners tend to have poorer physical and mental and social

health than the general population

What were the aims

and objectives?

To build a picture of the current health services; assess inmates’

unmet needs; plan, negotiate and make necessary changes within

Durham cluster of prisons. To identify ways prisoners could have

access to the same quality and range of health services as the

general public

Designing and developing a framework to gather evidence-based

information using available data and organising interviews and

focus groups

Who was included

in the project team?

Who was included

in the stakeholder

group?

Involving various stakeholders such as prisoners, prison health service

managers, prison governors, prison officers, board of governors, PCT chief

executive, PCT lay member and NHS trust. Building on information from

HNA to set up a plan of action designed to meet the needs and develop

HIMP for prisoners

TITLE OF PROJECT

Health Needs Assessment within Durham

Cluster of Prisons

MAIN CONTACT DETAILS

Dr Shahla Wright, 7 McLaren Way, West

Herrington, Houghton le Spring, DH4 4NP

Tel. 0191 5840717, mobile 07811 275249

2.2 Settings populations

Prison populations in three prisons

in Durham

HEALTH DEVELOPMENT AGENCY

Health needs assessment

Step 2 : Identifying health priorities

How was a profile of

the population

developed?

Each prison had specific type of population: female, male, sentenced,

remand. The prison profile of the population was developed

according to age band and what category population they belonged

to, and was compared with that of the whole of County Durham

What data were

available on the

health of the

population?

How was

information

gathered about the

population’s and

service providers’

perceptions of

needs?

Various information sources (epidemiological, corporate and

comparative data) were used to collect health-related data for quality

and accuracy control. To facilitate collection of appropriate information,

chart templates were designed and sent to prison healthcare staff. Very

limited health data information is collected in each prison, so health

information data from inmates’ medical records and prescribed

medication for a three-month period was used

Any barriers

encountered?

Lack of data information and IT system within prisons, incomplete

information, lack of easy access to enter prisons, uncertainty of some staff

regarding the change within the prison service

How were these

overcome?

The necessary data were obtained by designing a template to collect

specific data within a defined period of time, and staff were informed

with necessary information and appropriate explanation

What were the key

issues for the

population?

The average daily population in prisons has increased. 51% of male

prisoners in Durham prisons are on remand and 49% sentenced, the

majority of male inmates are aged between 20 and 39, while the

average age of female inmates is 25–44 years

What priorities were

chosen and why, in

terms of impact and

changeability?

Workforce development, staff training, improved access to primary care

services, health promotion and clinical governance; issues connected to

substance misuse, mental health, management of suicide and self-

harm; development of the computer system

What evidence

informed your

decision?

Baseline information, the high number of prisoners with mental health

disorders, or who are drug misusers, or both. Weakness in healthcare

management, skill mix duties, lack of health risk management,

inappropriate use of staff skills

5. CASE STUDY

2.2 SETTNG POPULATIONS

PRISON POPULATIONS IN THREE PRISONS IN DURHAM

Step 3 : Assessing a priority for action

What interventions

were considered

most effective and

acceptable?

Appointment of a clinical nurse manager to ensure clinical and

managerial staff use their skills appropriately. There was evidence

that strong leadership would improve clinical health services

Training for workforce development, improvement in the

appointment system within primary care

Clinical and audit performance management for the prison health

system to provide the same quality of health service as received by

the general public

How were resource

needs met?

From April 2003, the Department of Health is responsible for

funding prison health care. It has been made clear in the action plan

the resource implications of every health issue improvement. The

key issue was to ensure that the existing resources were used

efficiently and effectively

Step 4 : Action planning

Summary of the

action planning

process

The action plan and health improvement and modernisation

programme for prisoners was signed by Durham and Chester le

Street PCT chief executive and the prison governors

Key tasks were to: improve workforce development, staff training

and continuing professional development; improving services such

as primary care management, clinical governance, mental health,

suicide and self-harm management; substance misuse; reception

screening; health promotion; dental services; pharmacy services;

infectious diseases; health information system; and improving

facilities and services specific to women prisoners. All proposals

for action were identified and designated to lead key individuals.

The date for completion of tasks and performance measures was

identified for every action plan

HEALTH DEVELOPMENT AGENCY

Health needs assessment

How well was the

action plan

implemented?

The priorities mentioned were identified for implementation by a

newly appointed prison health development manager

What was achieved

by the project?

Priorities were identified and some changes to improve and

redesign services implemented to set the example that services

could improve within a custodial environment and make resources

more cost effective

How did it contribute

to reducing

inequalities?

A high proportion of prisoners come from socially excluded

sections of the community

What was learned

through the project‘s

successes and

challenges?

Involving stakeholders and key professionals in assessing prisoners’

unmet needs and providing effective healthcare to them while in

custody, even for a short period, can make a significant

contribution to the health of individuals

What needs to

happen next?

Very important to keep prison steering group meetings going to

involve key stakeholders and professionals in improving prison

healthcare services

What main message

from the last HNA

will you take forward

to the next?

HNA within prison could be extensively improved, but the main

message was the importance of close cooperation between prison

healthcare and NHS (PCT) staff

Step 5 : Moving on/review

5. CASE STUDY

2.2 SETTNG POPULATIONS

PRISON POPULATIONS IN THREE PRISONS IN DURHAM

Step 1 : Getting started

What population,

where located and

why chosen?

Children under four, their families and carers living in a defined

geographical area of West Newcastle upon Tyne. The area was

chosen as the three wards made up the third, fourth and seventh

most deprived in Newcastle and North Tyneside according to

multiple deprivation scores

What were the aims

and objectives?

The HNA was part of the Sure Start programme planning process.

To work with parents-to-be, parents and children to promote the

physical, intellectual and social development of babies and young

children – breaking the cycle of disadvantage

Who was included

in the project team?

The HNA was led by the Public Health Nurse for West Locality and an

experienced community development worker employed by Riverside

Community Health Project and established in offering family support

in the area

Who was included

in the stakeholder

group?

Local workers in health, social care, education and many representatives

from local non-statutory services, local parents, grandparents, carers

and children

What resources

were required?

The Public Health Nurse and Community Development Worker were

allocated some time within their present jobs to undertake this work.

A request for early funds was successfully made which helped pay for

the community development workers’ extra hours and some of the

additional consultation

TITLE OF PROJECT

Health Needs Assessment for a Sure Start

Programme in West Newcastle upon Tyne

MAIN CONTACT DETAILS

Sure Start Armstrong, Riverside Community

Health Project

3.1 Shared social experience populations

Children under four and their families –

Newcastle upon Tyne Sure Start project

HEALTH DEVELOPMENT AGENCY

Health needs assessment

Step 2 : Identifying health priorities

How was a profile of

the population

developed?

The Public Health Nurse in conjunction with the Citywide Sure Start

Health Coordinator pulled together quantitative data

What data were

available on the

health of the

population?

Index of Multiple Deprivation scores 2000

Census information regarding numbers of families with under fours,

levels of employment, lone parents, breakdown by ethnicity

Going for Growth consultation information and responses by local

people; numbers of children on the child protection list, numbers of

mothers experiencing post-natal depression, numbers with low birth-

weight babies, number of mothers with children under one. Number of

emergency admissions to hospital; SATs results; estimated literacy levels

How was information

gathered about the

population’s and

service providers’

perceptions of needs?

Through multiple methods of consultation and ongoing involvement during

the development of this Sure Start programme, to include:

• Meetings with existing parent and grandparent groups

• Meetings with professionals in key organisations

• Use of ‘H’ forms (a simple diagrammatic technique) to gather information

about ‘What was good about local services for families and young

children, what was not so good, what would make things better, and

what services people valued most’.

• Kids’ cocktail parties (consultation through fun activities, 3-14 year olds)

• Passport to family support event

• Under fives summer fun week and holiday activities

• Newcastle Action for Parents and Toddlers Initiative Survey

What barriers were

encountered?

Initially the parents in the two main communities were consulted

separately as they did not naturally meet, and eventually formed a

whole representative group

In addition, one large area covered was undergoing consultation as

a Going for Growth Regeneration Area, and there was much

dissatisfaction with the local council at this time

How were these

overcome?

The skilful work of the community development worker – lots of

promotion of the HNA, gradual and timely integration of two

communities. The knowledge of local people that many of their wishes

and needs could be realised in practice through Sure Start money

Cont...

5. CASE STUDY

3.1 SHARED SOCIAL EXPERIENCE POPULATIONS – CHILDREN UNDER FOUR

AND THEIR FAMILIES – NEWCASTLE UPON TYNE SURE START PROJECT

What were the key

issues for the

population?

From the qualitative data, 15 key points were raised where actions

could be taken across agencies, to include:

• More activities for children of all ages, and affordable leisure and

sports facilities – specifically holidays and after school

• An increase in the amount of affordable, good quality childcare

• Health visitors must be more accessible within the community

•Improved transport links to key services, specifically the need for lo-

liner buses

• Integrated services all on one site

• Places for parents and children to meet and socialise

•Improved family support, particularly for women suffering from

post-natal depression

• Home-based support and information about safety in the home,

information and support to access safety equipment

In terms of quantitative data, there was a need to increase access to

training, education and employment and to increase educational

attainment of the children in this area. There were many more areas

for action

What priorities were

chosen and why, in

terms of impact and

changeability?

Sure Start funding meant many of the actions would be addressed by

the employment of new staff on the project with specific roles and

responsibilities. A number of priorities could be addressed at once. One

priority that arose as a consequence of the consultation was the need

for family support to:

• Reduce accidents in the home

• Help address post-natal depression

What evidence

informed your

decision?

National evidence and targets set around reducing child accidents. Local

accident and emergency statistics

Local statistics from health visiting records on post-natal depression; local

needs highlighted by parents; increased demand on health service in this

Sure Start geographical area

Experience and evidence of successful local programmes

An adjoining Sure Start programme coterminous with a New Deal for

Communities Programme

• Had already employed local people to train and act as safety scheme

workers, and local people accessed information from the health visitor

leading this scheme.

• Babysitting initiative (subsequently renamed to demonstrate changing

need) funded by Sure Start but provided by a local non-statutory

organisation (Children North East)

... cont.

HEALTH DEVELOPMENT AGENCY

Health needs assessment

Step 3 : Assessing a priority for action

What interventions

were considered

most effective and

acceptable?

Employment of family safety workers to undertake home visits

once they had undertaken a training programme. To promote

safety by sharing information; enable parents to carry out safety

checks in their own homes; assist parents in making use of safety

equipment; facilitate groups in first aid and child safety

Newcastle Family Support (previously the Babysitting Initiative):

•Provides babysitting to isolated and vulnerable families

• Community-based and takes place in the family home

•Provides counselling, advocacy and signposting facilities to

families face-to-face and via telephone contact

• Operates seven days a week between 9 am and 11 pm

• Is free to families referred via health visitor, social worker,

community psychiatric nurse, school or other voluntary agency

• Main focus to provide support to those families where the

mother has, or is at risk of developing, post-natal depression

How were resource

needs met?

To help build local capacity, the programme wanted to offer these

posts to local people and wanted to make sure training was offered

to ensure a wider audience could apply

Family Safety Scheme – this would be Sure Start funded. In addition

to the cost of training and employing two local people, the

experienced health visitor extended her hours to help coordinate

this function across two programmes. The two new workers were

housed with the existing Family Safety Scheme

Sure Start funds were transferred to Children North East to extend

their existing family support service into the new and neighbouring

Sure Start area

Step 4 : Action planning

Summary of the

action planning

process

As both initiatives were already running in another programme,

the two leads for each project took responsibility to employ and

train local people. An open event was arranged for local people to

come and learn about the jobs, and support was offered to

people in completing applications and looking at how part-time

employment would affect their benefits

Each lead set their own project timescales and targets in line with

the national targets set for Sure Start, and demonstrated how

they could help the overall programme meet its objectives

5. CASE STUDY

3.1 SHARED SOCIAL EXPERIENCE POPULATIONS – CHILDREN UNDER FOUR

AND THEIR FAMILIES – NEWCASTLE UPON TYNE SURE START PROJECT

How well was the

action plan

implemented?

Good response to advertisements, individuals were quickly

employed into posts and training undertaken

What was achieved

by the project?

Newcastle Family Support has been in great demand, with many

families requiring a wide variety of support. Staff have been

employed across both Sure Start programmes which has enhanced

availability and choice for local people. Those most in need have

been targeted

How did it contribute

to reducing

inequalities?

The family safety workers have actively worked with health visitors

in local clinics, enhancing service provision. They have promoted

the safety service and accessed individuals in clinics and community

groups which has led to home-based safety assessments

Increased access to safety equipment and family support to those

most in need

Employment and training opportunities have been made available

in an area of high unemployment

What was learned

through the project‘s

successes and

challenges?

The importance of joint working across agencies, and increased

awareness of how one service can complement and support

another. In both projects described, referrals in and out of

statutory services has increased, as has signposting

What needs to

happen next?

Formal evaluation of both is ongoing

What new priority

was chosen for the

population?

A multitude of priorities are still being actioned in this huge

programme

What main message

from the last HNA

will you take forward

to the next?

The importance of joint working. The strong partnership between

the Public Health Nurse and the Community Development Worker

was invaluable, with each bringing different knowledge and skills

to this work

Step 5 : Moving on/review

HEALTH DEVELOPMENT AGENCY

Health needs assessment

Step 1 : Getting started

What population,

where located and

why chosen?

Children and young people (0–19 years) from ethnic minority

communities in Leeds. Chosen because indicators for child health

are worse in inner city areas where the majority of the ethnic

minority population live

What were the aims

and objectives?

To obtain a comprehensive baseline profile of the health needs of

ethnic minority children in Leeds to ensure services planned for

them in future are appropriate and culturally acceptable

Who was included

in the project team?

Barnardos, University of Leeds Centre for Disability Studies, University of

Leeds Centre for Primary Care Research

Who was included

in the stakeholder

group?

Children and Families Modernisation Team composed of NHS service

commissioners and providers, representatives of Education, Social

Services, the voluntary sector and service users, Assistant Director of

Ethnicity and Health at former Health Authority and Health Action Zone

(HAZ) Health and Ethnicity Manager

What resources

were required?

HAZ provided £30,000 for a six-month study, printing and

dissemination by June 2002

TITLE OF PROJECT

A Health Needs Assessment of Black and

Minority Ethnic Children’s Needs (June 2002)

MAIN CONTACT DETAILS

Susan Rautenberg, Head of Service Planning and

Development (Children and Families) for the five

Leeds PCTs, East Leeds Primary Care Trust,

Oaktree House,

408 Oakwood Lane, Leeds LS8 3LG

Tel. (0113) 305 9577, email

[email protected]

3.2 Shared social experience populations

Black and minority ethnic children – Leeds

5. CASE STUDY

3.2 SHARED SOCIAL EXPERIENCE POPULATIONS

BLACK AND MINORITY ETHNIC CHILDREN – LEEDS

Step 2 : Identifying health priorities

How was a profile of

the population

developed?

National and local data were used; key sources 1991 census and Local

Education Authority data. However no definitive pre-school data were

available locally

What data were

available on the

health of the

population?

Low birth weight, but not by ethnicity, available locally

No local data by ethnicity. National data from the Health Survey for

England on smoking and substance use, physical exercise, blood

pressure, accidents. National studies on disability, impairment and

chronic illness. National studies on use of services. Local study on

dental service use

How was information

gathered about the

population’s and

service providers’

perceptions of needs?

Postal questionnaires of statutory and voluntary organisations, different

professional groups including managers. Consultation event with

professionals, plus face-to-face and telephone interviews

Views of parents through semi-structured interviews and group

discussions. Views of young people through group discussions in a

range of settings

What barriers were

encountered?

Lack of local data by ethnicity. Difficulty accessing primary care data in

timeframe

English not first language for some parents, but Asian researcher able

to communicate in other languages, or interpretation could be accessed

How were these

overcome?

Extrapolated local issues based on national data

Good access to aggregated LEA data

What were the key

issues for the

population?

Parents: language barrier difficulties while accessing child health

services. Perceptions of cultural incompetence. Occasionally overt

racism

Professionals: communication and access to services for users. Cultural

competence of existing staff. Ethnic composition of staff grouping.

Information-sharing. Public health issues, eg poverty and housing

Children and young people: access to health information and

education. Communication barrier due to medical terminology. Access

issues for young people generally. Did not see ethnicity as major factor

in health or health services. However, would like more culturally

sensitive services in areas of mental health and sickle cell anaemia

Cont...

HEALTH DEVELOPMENT AGENCY

Health needs assessment

What priorities were

chosen and why, in

terms of impact and

changeability?

Need increased ethnic monitoring to improve local information

Expanding translation and interpretation would improve

communication. Cultural awareness training in existing services. More

user involvement in planning and developing services. Mainstream

funding for some short-term projects. Access to dental services and

dental health promotion needs improvement

What evidence

informed your

decision

Results from extrapolated data and interviews

... cont.

Step 3 : Assessing a priority for change

What interventions

were considered

most effective and

acceptable?

Monitoring to be taken forward through mainstream NHS

informatics developments

Translation and interpretation services developed under Ethnic

Health HAZ workstream

User involvement enhanced through Leeds Healthy Schools

Scheme and its Youth on Health Forums, which are currently

expanding. Fluoridated milk programme piloted with Children’s

Fund and HAZ funding through targeted schools

How were resource

needs met?

Unable to secure separate funding for ethnic minority children’s

services outside the above-noted NHS initiatives. Mainstream

funding for ongoing initiatives such as GP-led male circumcision

service still to be secured

Step 4 : Action planning

Summary of the

action planning

process

No separate action plan established. Priorities incorporated into

annual work programme of Leeds NHS Children and Families

Modernisation Team, across the five Leeds PCTs and service

providers

5. CASE STUDY

3.2 SHARED SOCIAL EXPERIENCE POPULATIONS

BLACK AND MINORITY ETHNIC CHILDREN – LEEDS

How well was the

action plan

implemented?

Not applicable as there is no separate action plan. Ethnic minority

health needs being addressed through main work programme

What was achieved

by the project?

Project achieved a baseline assessment of local needs, gathered

national and local data and a wide range of views. It indicated

next steps for influencing and improving services

How did it contribute

to reducing

inequalities?

Contributes to reducing inequalities by raising level of knowledge

of service commissioners and providers and confirming need for

further developments in areas of communications and training, etc

What was learned

through the project‘s

successes and

challenges?

Learned about the dearth of local information! Learned of general

satisfaction of users, albeit for a small sample. Engaged providers

and documented their concerns and hopes for future service

development. Highlighted lack of new resources available to

respond to the key issues

What needs to

happen next?

Results were disseminated back to those who participated and

other interested parties. Will be fed into the Local Preventative

Strategy for Leeds

What new priority

was chosen for the

population?

Not applicable

What main message

from the last HNA

will you take forward

to the next?

Need to progress cultural awareness training, communication and

access to services for young people generally

Step 5 : Moving on/review

HEALTH DEVELOPMENT AGENCY

Health needs assessment

Step 1 : Getting started

What population,

where located and

why chosen?

Patients who had experienced myocardial infarction (MI) and had

been offered access to a community-based cardiac rehabilitation

programme

West locality, Newcastle upon Tyne

What were the aims

and objectives?

To determine whether the same approach could be developed

across the city

Who was included

in the project team?

The project was led by the Public Health Nurse; the core team involved the

Community Cardiologist, a Community Cardiac Rehabilitation Nurse Lead

and a locality manager

Who was included

in the stakeholder

group?

Included the community nursing staff, and patients who had both

accessed, and not accessed, the programme

What resources

were required?

Time was allocated to the Public Health Nurse to undertake the

evaluation and needs assessment

TITLE OF PROJECT

Evaluation of a locality-based Cardiac

Rehabilitation Service leading to improvement

of services for black and minority ethnic people

MAIN CONTACT DETAILS

Dawn Scott, Northumberland Care Trust,

formerly Newcastle PCT

[email protected]

Tel: 01670 394443

4.1 Specific health experience populations

Cardiac service requirements of a black and

minority ethnic population in Newcastle

5. CASE STUDY

4.1 SPECIFIC HEALTH EXPERIENCE POPULATIONS – CARDIAC SERVICE

REQUIREMENTS OF A BLACK AND MINORITY ETHNIC POPULATION IN NEWCASTLE

Step 2 : Identifying health priorities

How was a profile of

the population

developed?

All patients who had been diagnosed as having MI and who could

have chosen to access this service

What data were

available on the

health of the

population?

Newcastle MI data were available but had not been consistently

collected by ethnicity. Ethnicity data had been collected in the cardiac

rehabilitation programme

How was information

gathered about the

population’s and

service providers’

perceptions of needs?

Secondary data analysis of the existing database

In-depth, qualitative interview and measurement of quality of life with a

sample of patients – 50% had accessed the service, 50% had not

Interviews with core group members and staff delivering the Heart manual

What barriers were

encountered?

How were these

overcome?

Secondary data analysis of the cardiac rehabilitation database was one

method employed to assess need. Analysing the data was extremely

difficult as data had to be transferred to SPSS (Statistical Package for

the Social Sciences) and there was a great deal of missing data,

although paper evidence was available. This provided an opportunity to

update the system, input data that was not already entered, and

consider the future data collection needs of this programme

What were the key

issues for the

population?

The needs of those most vulnerable, primarily the black and minority

ethnic community, were not being met even with a focused effort by

cardiac rehabilitation staff to engage with this community

What priorities were

chosen and why, in

terms of impact and

changeability?

To focus on the needs of the black and minority ethnic population in

the West end of Newcastle. Highest needs/lowest access

What evidence

informed your

decision?

National epidemiological data and local data on poor or no access to

community cardiac rehabilitation

HEALTH DEVELOPMENT AGENCY

Health needs assessment

Step 3 : Assessing a priority for change

What interventions

were considered

most effective and

acceptable?

A New Deal for Communities bid was designed aimed at

developing services to meet the cardiac health needs of black and

minority ethnic communities in West locality. It was designed to

provide information, support and access to this community in

both proactive and reactive ways. Additional evidence was

obtained from working with local services providing support or

with a special interest in working with people from black and

minority ethnic communities. These key external stakeholders

helped model the proposed service, which would eventually

influence the service delivery across the city

How were resource

needs met?

The New Deal for Communities bid was successful and ensured we

could employ experienced bilingual health development workers

and a project lead to work with black and minority ethnic

communities. We also gained money for accommodation for this

project

Step 4 : Action planning

Summary of the

action planning

process

The Public Health Nurse continued to lead this priority by

developing the bid and option appraisals. The Community

Cardiologist was key in accessing additional evidence to support

this vision, as was the Nurse Lead. The public health nurse, with

locality manager support, wrote job descriptions and advertised

posts.

Once project staff were in place the team needed to identify

people with coronary heart disease in the New Deal area

Work with the wider community to improve the population‘s

understanding of coronary heart disease:

•To aim to identify the presently unidentified population with

heart problems by working with the community and raising

awareness of symptomatic presentation, discussing lifestyle

change and offering information and advice on present services

• Help initiate self-help/support groups

• Develop capacity by encouraging community education through

experience and contact with other community groups

5. CASE STUDY

4.1 SPECIFIC HEALTH EXPERIENCE POPULATIONS – CARDIAC SERVICE

REQUIREMENTS OF A BLACK AND MINORITY ETHNIC POPULATION IN NEWCASTLE

How well was the

action plan

implemented?

Some difficulties were encountered in attempting to recruit to

posts. Applicants needed to be bilingual in one of the main

languages of this population. Equally important was the gender

split of key workers – some of our Asian households were

uncomfortable with males visiting female patients. Difficulties with

placing people in posts resulted in an emphasis on cultural

awareness rather than language skills, and more part-time posts

on offer to meet diverse needs

By working collaboratively with primary care staff and others

developing cardiac registers, the community development workers

were able to identify and improve identification of people with

cardiac problems

Self-help/support groups, as expected, developed separately from

the already established one linked to the cardiac rehabilitation

service. A men’s Asian group has developed separately from the

women’s group within the project. Neither has integrated with the

existing group as anticipated because of social and cultural

differences

Numerous methods to increase capacity through community

education have been adopted from increased information to

community events – including focused work in schools

What was achieved

by the project?

• Increased access to cardiac rehabilitation

•Greater understanding by service providers of the gender,

spiritual and cultural needs/issues that might, if not understood,

create barriers to access

•Training of bilingual workers in and out of the project to act as

heart manual facilitators, and local revascularisation training

• Early visits to hospital to ensure people are seen through all

stages of rehabilitation (improving delivery of secondary and

community care)

• Development of the Heart Start Scheme (locally named Heart

Start Diversity) affiliated to the British Heart Foundation and

partially funded by them – targeted training to local community

to reduce mortality rate from coronary heart disease

How did it contribute

to reducing

inequalities?

Targeted those most in need with highest risk; provided a service

in a different way; provided additional resources, enabling us to

determine the changing population and service needs

Step 5 : Moving on/review

Cont...

HEALTH DEVELOPMENT AGENCY

Health needs assessment

What was learned

through the project‘s

successes and

challenges?

Practical issues relating to the provision of culturally and spiritually

sensitive services, eg avoiding running sessions on a Friday

Issues relating to gender (some groups of people wanted single-

gender groups for exercise). Some women will not attend groups

due to culture, so some one-to-one, home-based phase three

work is essential if we are to provide equitable services

Difficulties of having interpreters in a mixed group, where some

not requiring interpreting facilities found concentration difficult.

Inappropriate dietetics advice in relation to culture

Sessions were run to meet the needs of different populations,

health advice was modified and changed. It was recognised that,

while some full integration was possible, some components of the

service would need to remain separate

What needs to

happen next?

Need to work with the broader family and children if change is to

be sustainable

... cont.

What new priority

was chosen for the

population?

To ensure a proactive approach and break the cycle of inequalities,

the team started to work in three schools attended by a

significant number of children from black and minority ethnic

communities. This was funded by Newcastle’s Children Fund. Fun-

based art activities with children, teachers and some parents

resulted in:

•Production of health promotion information for all primary

schoolchildren across the city – Cardio Kids Fortune Teller

• Increased awareness of heart health among children in the city

•A healthy lifestyle event

What main message

from the last HNA

will you take forward

to the next?

The need for different approaches to provision of services and

information. An inclusive approach to changing services to meet

people’s needs

5. CASE STUDY

4.1 SPECIFIC HEALTH EXPERIENCE POPULATIONS – CARDIAC SERVICE

REQUIREMENTS OF A BLACK AND MINORITY ETHNIC POPULATION IN NEWCASTLE

Step 1 : Getting started

What population,

where located and

why chosen?

People in Greenwich & Bexley boroughs who feel distressed enough

to be at risk of suicide or self-harm. Chosen because DH instructed

all health authorities in England to reduce the suicide rate

What were the aims

and objectives?

To examine the scope in the district for preventing suicides and self-harm

Who was included

in the project team?

The researcher – a specialist in public health

Who was included

in the stakeholder

group?

The researcher; a senior manager and a psychiatrist from the local

mental health provider trust; a GP; the commissioner of mental health

services at the health authority; Metro Ltd (local lesbian, gay, bisexual

and transgender agency); assistant head of social services; Chair of

Accident & Emergency for one of the two local general hospitals;

one of the local coroner’s officers

TITLE OF PROJECT

Epidemiological Health Care Needs Assessment –

Suicide and Self-Harm in Greenwich & Bexley

MAIN CONTACT DETAILS

Andy Beckingham, Public Health Specialist

Tel. 07751 057867

email [email protected]

4.2 Specific health experience populations

Suicide and self-harm – residents at risk in

Greenwich and Bexley

HEALTH DEVELOPMENT AGENCY

Health needs assessment

Step 2 : Identifying health priorities

How was a profile of

the population

developed?

Data on suicide were obtained from both public health mortality files

and the local deaths’ database. All suicides and unexplained death

records were retrieved and entered in a database. The Coroner’s

Office provided data on deaths when they occurred

How was information

gathered about the

population’s and

service providers’

perceptions of needs?

All the local agencies thought to be potential stakeholders were

invited to participate. Many took part in the monthly suicide review

group. The representative from one of the local provider agencies (the

Chair of Accident & Emergency) chaired the meetings

What barriers were

encountered?

(a) Lack of interest in suicide prevention by the health authority board –

it appeared that so long as a local group was designated to discuss

suicide, the board did not feel they needed to take further action

(b) Suicide is acknowledged in research as an unpleasant issue for anyone

to contemplate – it is easy to marginalise it and avoid thinking about it

How were these

overcome?

The stakeholder group actively promoted action in their agencies;

in the end, little happened in the statutory agencies – eg a confidential

‘no-blame’ review and improvement system was set up for GPs, but

although about 50 suicides occurred that year only two GPs used the

review system to improve their care

What were the key

issues for the

population?

Generally, poor mental health among one in seven of the population;

high self-harm rates and (apparently) higher suicide rates among younger

men in the most deprived parts of the district; few systems for detecting

and supporting self-harm attenders in A&E. Poor take-up of suicide risk-

assessment systems among local GPs. Lack of evidence base for reducing

suicide. Need for pan-London suicide review to give greater numbers for

epidemiological study (health authority districts have populations that are

too small to provide large enough study populations)

What priorities were

chosen and why, in

terms of impact and

changeability?

To target people most at risk (younger unemployed men in Woolwich

and Plumstead); to offer training in more effective life skills and coping

behaviours, plus anti-poverty measures; to implement routine systems

in A&E departments to identify attenders who self-harm and to offer

support (as they are at increased risk of completing suicide in the next

few years); to support and improve services for people identifying as

lesbian, gay, bisexual or transgender (as they are at higher risk of

self-harm and suicide); to implement Health of the Nation measures

on suicide reduction

5. CASE STUDY

4.2 SPECIFIC HEALTH EXPERIENCE POPULATIONS – SUICIDE AND SELF-HARM –

RESIDENTS AT RISK IN GREENWICH AND BEXLEY

Step 3 : Assessing a priority for action

What interventions

were considered

most effective and

acceptable?

There are currently no available interventions supported by

research evidence from good quality systematic reviews. We based

our recommendations on good practice recommendations from

DH ‘Health of the Nation’ initiatives. We recommended that the

three local NHS trusts cooperate in a study of self-harm attenders

and suicides, and that GPs take active part in ‘non-blaming’

reviews following a patient suicide to see if they can improve

practice to prevent future suicides

How were resource

needs met?

A few hours per month among provider agencies to implement

training for staff on managing self-harm and on detecting suicide

risk among patients; £2,000 to fund a year’s support to GPs for

confidential suicide reviews

Step 4 : Action planning

Summary of the

action planning

process

As in Step 3 above. The trusts and voluntary agencies continued

to meet regularly to review their systems for self-harm training for

staff, and for the management of self-harm. The local lesbian,

gay, bisexual and transgender agency secured SRB6 regeneration

funding to support young people at risk of suicide. Because of the

lack of a national evidence base, indicators could not be used

HEALTH DEVELOPMENT AGENCY

Health needs assessment

How well was the

action plan

implemented?

Patchily – it appeared to depend on the interest of individual

agencies, managers and lead clinicians

What was achieved

by the project?

The profile of self-harm and suicide and their associated

bereavement and misery were raised among local agencies and staff

How did it contribute

to reducing

inequalities?

No such changes were achieved – the health authority did not

implement changes to address action despite the huge disparity of

self-harm among residents of the most deprived ward in the district;

it was left to the mental health commissioner to take action instead

of the health authority

Step 5 : Moving on/review

What needs to

happen next?

As above

What new priority

was chosen for the

population?

None. Suicide reduction remained marginal despite the needs of

Woolwich and Plumstead residents and lesbian, gay, bisexual and

transgender communities being clearly unmet

What main message

from the last HNA

will you take forward

to the next?

That HNA may be a waste of time if the local board lacks the will to

implement the findings, no matter how grave the needs or inequalities

What was learned

through the project‘s

successes and

challenges?

That board-level agreement prior to needs assessment is vital if

findings are to be implemented

5. CASE STUDY

4.2 SPECIFIC HEALTH EXPERIENCE POPULATIONS – SUICIDE AND SELF-HARM –

RESIDENTS AT RISK IN GREENWICH AND BEXLEY

6 Bibliography and

references

Acheson, D. et al. (1998) Independent inquiry into inequalities in health. London: Stationery Office.

Baggott, R. (1994) Health and healthcare in Britain. London: Macmillan.

Barr, A. and Hashegen, S. (2000) ABCD handbook: a framework for evaluating community

development. London: CDF Publications (60 Highbury Grove, London N5 2AG).

Bradshaw, J. (1994) The conceptualisation and measurement of need: a social policy perspective.

In: Popey, J. and Edwards, G.(1994) Researching the People’s Health. London: Routledge.

Burns, D. and Taylor, M. (2000) Auditing community participation: an assessment handbook. Bristol:

The Policy Press for Joseph Rowntree Foundation.

Chirico, S., Findlay, G., Haywood, L. et al. (1998) SCDG Sustainable community development

guidelines. Bedford: Bedfordshire Health Promotion Agency.

Dahlgren, G. and Whitehead, M. (1991) Policies and strategies to promote social equity in health.

Stockholm: Stockholm Institute of Future Studies.

DH (2001) The Older People’s National Service Framework, Standard 8: The promotion of health

and active life in older age. London: Department of Health.

www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/OlderPeoplesServices/fs/en

DH (1999) Saving lives: our healthier nation. London: Stationery Office.

DH (2001) Shifting the balance of power within the NHS: securing delivery. London: Stationery Office.

DH (2002) Improvement, expansion and reform: The next 3 years – Priorities and Planning Framework

2003–2006. London: Department of Health. www.dh.gov.uk/assetRoot/04/07/02/02/04070202.pdf

DH (2003a) Tackling health inequalities: a programme for action. London: Department of Health.

DH (2004) Choosing Health: Making healthy choices easier. London: Department of Health.

www.dh.gov.uk/.../PublicationsPolicyAndGuidanceArticle/ fs/en?

Hawtin, M., Hughes, G. and Percy Smith, J. (1999) Community profiling – auditing social needs.

Milton Keynes: Open University Press.

References

cited in the text

Bibliography and references

HEALTH DEVELOPMENT AGENCY

Health needs assessment

6. BIBLIOGRAPHY AND REFERENCES

HDA (2002) Evaluating community level interventions for health improvement. London: Health

Development Agency.

HDA (2003a) Assessing people’s perceptions of their neighbourhood and community involvement

(parts 1 and 2). London: Health Development Agency.

Henderson, P. and Thomas, D.N. (2002) Skills in neighbourhood work, 3rd edn. London: Routledge.

Henderson, P., Summer, S. and Raj, T. (2004) Developing healthier communities. London: Health

Development Agency, pp. 70-81.

Higginson, I.J. (1994) Palliative and terminal care. In: Stevens, A., Raftery, J. et al. (eds) Health care

needs assessment, 2nd series. Oxford: Radcliffe Medical Press.

Hooper, J. and Longworth, P. (2002) Health needs assessment workbook. London: Health

Development Agency. www.hda.nhs.uk/publications

Jones, C. (1997) The context of PRA. Participatory appraisal pack. Hull: University of Hull,

Department of Public Health and Primary Care.

Krueger, R.A. (1994) Focus groups. London: Sage.

Maclennan, D. (2000) Changing places, engaging people. York: Joseph Rowntree Foundation.

Markwell, S. (2003) Partnership working: a consumer guide to resources. London: Health

Development Agency.

Markwell, S., Watson, J., Speller, V., Platt, S. and Younger, T. (2003) The working partnership.

London: Health Development Agency.

Murray, S.M. and Graham, L. (1995) Practice-based health needs assessment: use of four methods

in a small neighbourhood. British Medical Journal 310: 1443–8.

National Consumer Council (1994) In partnership with patients: involving the community in general

practice. A handbook for GPs and practice staff. London: National Consumer Council.

Office of Government Commerce (2002a) Managing successful projects with PRINCE2 (the manual).

London: Stationery Office.

Office of Government Commerce (2002b) PRINCE2 pocket book. London: Stationery Office.

Peberdy, A. (1997) Evaluating community action. In: Jones, L. and Sidell, M. (eds) The challenge of

promoting health, exploration and action. Milton Keynes: Open University Press.

Peckham, S. and Spanton, J. (1994) Community development approaches to HNA. Health Visitor

Journal 67: 124–5.

Quigley, R., Cavanagh, S., Harrison, D., Taylor, L., and Pottle, M. (2005) Clarifying approaches to

assessment: health needs assessment, health impact assessment, integrated impact assessment,

health equity audit, and race equality impact assessment, London: Health Development Agency.

Stevens, A. and Rafferty, J. (1994, 1997) Health care needs assessment: the epidemiologically based

needs assessment reviews, Vols 1 and 2. Oxford: Radcliffe Medical Press.

Wanless, D. et al. (2004) Securing good health for the whole population. London/Norwich: HM

Treasury/Stationery Office.

Webster, G. (2001) Getting people involved. Wakefield: Wakefield and District Health Action Zone.

WHO (1984) Report of the working group on the concepts and principles of health promotion.

Copenhagen: World Health Organization Regional Office for Europe.

Useful resources

Barwick, D. and Glendenning, R. (2002) Health needs assessment in primary care – a pilot project.

Stockport: Public Health Department. Tel: 0161 426 5033.

Cabinet Office (1998) Bringing Britain together: a national strategy for neighbourhood renewal.

London: Stationery Office.

Cabinet Office (2003) Better policy making – a guide to regulatory impact assessment. London:

Stationery Office. www.cabinet-office.gov.uk/regulation/scrutiny/betterpolicy.htm

Chambers, R. (1994) The origins and practice of participatory rural appraisal. World Development 22 (7).

Countryside Agency (2002) Rural proofing – policy makers’ checklist. Cheltenham: Countryside

Agency. www.countryside.gov.uk/ruralproofing

DETR (1998) A new deal for transport. Government white paper on the future of transport.

Department of Environment, Transport and the Regions/London: Stationery Office.

References cited in the text (cont)

HEALTH DEVELOPMENT AGENCY

Health needs assessment

DETR (2001) Power to promote or improve economic, social or environmental well being.

London: Department of Environment, Transport and the Regions.

DH (2000) National Service Framework for Coronary Heart Disease: main report. London:

Department of Health.

DH (2003b) Guidance on developing prison health needs assessments and health improvement

plans. London: Department of Health. www.doh.uk/prisonhealth/hna.htm

DH and Neighbourhood Renewal Unit (2002) Health and neighbourhood renewal: guidance from

the Department of Health and the Neighbourhood Renewal Unit. London: Department of Health.

DTLR (2001) Environmental impact assessment: a guide to procedures. London: Department of

Transport, Local Government and the Regions. www.planning.odpm.gov.uk/eia/guide/index.htm

Effective Interventions Unit (2004) Needs assessment: a practical guide to assessing local needs for

services for drug users. Edinburgh: Scottish Executive Effective Interventions Unit, Substance Misuse

Division. www.scotland.gov.uk/library5/health/nadu-00.asp

European Commission (1999) Fourth report on the integration of health protection requirements in

community policies. V/99/408-EN. Brussels: European Commission.

HDA (2003b) Tackling health inequalities compendium. London: Health Development Agency.

Home Office (2001a) Cantle report: Community cohesion. London: Stationery Office.

Home Office (2001b) Denham report: Building cohesive communities. London: Stationery Office.

Mid-Hampshire PCT (2002) Mid-Hampshire Primary Care Trust health needs assessment toolkit

(CD-ROM).

Milner, S., Bailey, C., Deans, J. and Pettigrew, D. (2003) Integrated impact assessment: UK mapping

project. Newcastle: HIA R&D Programme, Northumbria University. www.hiagateway.org.uk

Norfolk Public Health Nurses’ Forum (2002) Norfolk needs assessment tool box, version 2. Norwich:

Norfolk Public Health Nurses Forum, Norwich PCT.

www.knowledgenorfolk.nhs.uk/needs_assessment/index.htm

North West Region (2003) Implementing action for sustainability: an integrated appraisal toolkit for

the North West. www.nwra.gov.uk/afs or www.hiagateway.org.uk

Scottish Needs Assessment Programme (1998) Needs assessment in primary care, a rough guide.

Glasgow: Scottish Needs Assessment Programme.

Social Exclusion Unit (2001) A new commitment to neighbourhood renewal. London: Social

Exclusion Unit.

Wanless, D. et al. (2002) Securing our future health: taking a long-term view. London: HM Treasury.

Wright, J. (1999) A guide to public health skills learning sets. Oxford: Public Health Resource Unit.

6. BIBLIOGRAPHY AND REFERENCES

7 National and

regional contacts

National

Department of Health www.dh.gov.uk

Government health and social care policy,

guidance and publications.

National Institute for Health and Clinical

Excellence (NICE) www.nice.org.uk

See publications section and regional web pages.

NICE Evidence Base www.nice.org.uk/evidence

Best available information on what works to

improve health and reduce health inequalities.

Health Observatories www.pho.org.uk

The national home page for the UK Public

Health Observatories.

Public Health electronic Library (PHeL)

www.phel.gov.uk

Single port of call linking all public health web-

based resources through one gateway.

Regional

EAST OF ENGLAND

National Institute for Health and Clinical

Excellence

East of England Regional Office,

c/o East of England Public Health Group,

Government Office for the East of England,

Eastbrook, Shaftesbury Road,

Cambridge CB2 2DF

Tel: 01223 372 831

Eastern Public Health Observatory

www.erpho.org.uk

Government Office for the East of England

www.go-east.gov.uk

EAST MIDLANDS

National Institute for Health and Clinical

Excellence

East Midlands Regional Office,

EMPHO 3rd Floor, Mill 3,

Pleasley Vale Business Park,

Outgang Lane, Mansfield NG19 8RL

Tel: 01623 819 867

East Midlands Public Health Observatory

www.empho.org.uk

7. National and regional contacts

HEALTH DEVELOPMENT AGENCY

Health needs assessment

7. NATIONAL AND REGIONAL CONTACTS

Regional (cont)

LONDON

National Institute for Health and Clinical

Excellence

London Regional Office,

c/o London Health Commission,

PP9 6th Floor, City Hall,

The Queen’s Walk, London SE1 2AA

Tel: 020 7983 4768

Minicom 020 7983 4458

www.londonshealth.gov.uk

London Health Observatory

www.lho.org.uk

London Health Commission

www.londonshealth.gov.uk

Government Office for London

www.go-london.gov.uk

NORTH EAST

National Institute for Health and Clinical

Excellence

North East England Regional Office,

John Snow House, Durham University Science Park,

Stockton Road, Durham DH1 3YG

Tel: 0191 374 4205

North East Public Health Observatory

www.nepho.org.uk

NORTH WEST

National Institute for Health and Clinical

Excellence

North West Regional Office,

c/o Institute for Health Research,

C Floor, Bowland Tower East,

Lancaster University, Lancaster LA1 4YT

Tel: 01524 812 316

North West Public Health Observatory

www.nwphro.org.uk

North West Public Health Team

Government Office North West

www.go-nw.gov.uk/health/healthteam

SOUTH WEST

National Institute for Health and Clinical

Excellence

South West England Regional Office,

Regional Public Health Team,

GO-SW, 2 Rivergate, Temple Quay

Bristol BS1 6ED

Tel: 0117 900 3545

South West Public Health Observatory

www.swphro.org.uk

South West Public Health Team

Government Office for the South and West

www.go-nw.gov.uk/health/healthteam

100

Regional (cont)

SOUTH EAST

National Institute for Health and Clinical

Excellence

South East Regional Office, Greencoat House,

32 St Leonards Road, Eastbourne,

East Sussex BN21 3UT

Tel: 01323 746 320

South East England Public Health

Observatory

www.sepho.org.uk

WEST MIDLANDS

National Institute for Health and Clinical

Excellence

West Midlands Regional Office,

3rd Floor, Princess House,

The Square, Shrewsbury SY1 1JZ

Tel: 01743 283 373

West Midlands Public Health Observatory

www.wmpho.org.uk

YORKSHIRE AND THE HUMBER

National Institute for Health and Clinical

Excellence

Yorkshire and the Humber Regional Office,

c/o Government Office,

Yorkshire and the Humber,

City House, 5th Floor East Wing,

New Station Street, Leeds LS1 4US

Tel: 0113 283 5220

Yorkshire and the Humber Public Health

Observatory

www.yhpho.org.uk

HEALTH DEVELOPMENT AGENCY

Health needs assessment

101

7. NATIONAL AND REGIONAL CONTACTS