Health Needs Assessment Workbook - HDA England - 2002

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Health needs assessment workbook

Judith Hooper Phil Longworth

Written by: Judith Hooper North Kirklees PCT 12 Central Arcade Cleckheaton West Yorkshire BD19 5DN Phil Longworth Kirklees Metropolitan Council Civic Centre III, 2nd Floor Market Street Huddersfield HD1 2EY

For further copies of this publication please contact: Health Development Agency Holborn Gate 330 High Holborn London WC1V 7BA Email: Website:

Judith Hooper and Phil Longworth, 2002

ISBN 1-84279-066-8


This workbook draws on a wide range of relevant theory, and includes current concepts from the fields of health needs assessment (HNA) and health impact assessment (HIA). Much of the learning and experience gained from our popular Health Needs Assessment in Primary Health Care teams workbook (Hooper and Longworth, 1998) is included, as well as the experience gained from working with many inter-agency and multi-disciplinary groups beyond primary care. None of this would have been possible without: having discovered Community Orientated Primary Care in the package adapted for the UK by the Kings Fund in the early 1990s the support and enthusiasm of our local primary healthcare colleagues, especially the health visitors and school nurses in Huddersfield and Calderdale support from our health authority, who allowed us to explore this exciting way of working feedback and collaboration with countless colleagues, locally across the NHS and local authorities, and nationally, especially the public health practitioners in Barking and Havering the Health Development Agency for making this text easily available through their website the patience and skill of Jane Gaffikin from the Learning Innovation Centre at the University of Huddersfield, who made our words look much more appealing. We have immensely enjoyed developing this work, and we feel those who have worked with us have also enjoyed learning and working in this way. So we hope you do too .

Judith Hooper Phil Longworth Huddersfield, January 2002


Introduction What is health needs assessment? How to use this workbook Health needs assessment process: steps and timings How well are you doing? Summary of concepts and process Steps in the health needs assessment process Health needs assessment or health impact assessment? Benefits, success factors and potential blocks Common language Introductory task

1 3 4 5 8 9 10 14 16 18 23

Step 1 Getting started Step 1a Who is the population to be assessed? Step 1b Improvement, integration and involvement

24 25 28

Step 2 Identifying the health priorities for the population Step 2a Developing a profile of the population Step 2b Choosing overall priorities according to IMPACT on the health of the population Step 2c Choosing overall priorities according to CHANGEABILITY

35 39 46 53

Step 3 Assessing the specific health priority Step 3a Revisiting the issues of improvement, integration and involvement Step 3b Identifying conditions and factors with a severe impact on this health priority Step 3c Choosing the conditions/factors with the most significant impacts on this health priority

57 59 61 65

Step 3d Identifying effective actions for this health priority Step 3e Identifying acceptable changes for this health priority Step 3f Are the resource implications of the proposed changes feasible? Step 3g A final check

67 70 75 78

Step 4 Planning for health pulling it all together Step 4a Developing an action plan Step 4b Developing an implementation plan

79 80 90

Step 5 Evaluation


Appendixes Appendix 1 Data required and collection methods Appendix 2 Sources of data and information Appendix 3 Bibliography and links Appendix 4 Glossary 96 106 112 114


National policy emphasises health improvement, and reducing the health inequalities between groups of people, by promoting clear, well managed programmes of action.

National goals for healthTo improve the health: 1) of the population as a whole by increasing the number of years of life and the number of years people spend free from illness 2) of the worst off in society and to narrow the health gap. (DH, 1998) A wide range of factors affect health including lifestyle, income, education, housing and transport. Actions taken regarding any of these factors will also have an impact on health. So it is important to put health on everyones agenda (DHSS, 1976). In order to achieve the national goals for health, key actions have been proposed for the public sector, especially the National Health Service (NHS) and the local authorities (LAs).

Development of a health improvement programme (HImP), which will identify the health needs of local people and what needs to be done about them. Development of the HImP (now health improvement and modernisation programme, HIMP) is led by primary care trusts (PCTs), but involves a wide range of partners. National and local policy-makers and planners should think about the effect their policies (programmes and projects) may have on health. A new responsibility for LAs to promote the economic, social and environmental wellbeing of their area, and to develop community strategies. Implementation of new arrangements to strengthen local democracy. Introduction of the Best Value regime, with its emphasis on the four Cs challenge, consult, compare, compete.

All these goals and policy initiatives reinforce the concept of sustainability creating environments fit for future generations. This is already a key part of the existing activities of LAs. Health needs assessment (HNA) or health impact assessment (HIA) have become frequently used planning terms, but there is considerable confusion about what they actually mean. Both are planning processes for improving health that require a systematic review of the health issues facing a population or programme being assessed. They use similar steps, but have different origins and starting points: HNA starts with a population; HIA starts with a programme. This workbook presents an approach to HNA that uses a common language and gives practical guidance based on considerable experience. The HNA process has been developing over the past few years numerous groups in the NHS, local authorities and multiagency planning teams have been involved in using and shaping the approach. It is an integral part of the health improvement



and modernisation programme (HIMP), and is being used to structure the approach to planning for existing priorities and identifying new ones. It is the core of the process being used to develop HIMP action plans for each of the priority areas identified in the HIMP It is also being used in complementary planning processes, including developing the Joint Investment . Plan for Older People, the Local Transport Plan, and Best Value reviews. We are developing an interactive electronic version of this book, which really brings the process alive. This should be available from the summer of 2002, so email us for details.

Health needs assessment workbook


What is health needs assessment?

Health needs assessment is a systematic review of the health issues facing a population leading to agreed priorities and resource allocation that will improve health and reduce inequalities. Health needs assessment is about engaging people in thinking about health, and planning what can be done to improve health and reduce health inequalities, whatever the issue. This ensures that any action taken minimises harm to health, and may improve it for those with the most to gain. It is an important process for a range of groups serving the population: from primary healthcare teams and community development workers, through PCTs to local authorities and beyond. The process helps to change policies by getting people involved in considering health, via the following mechanisms. 1 Building public policy that always includes action for health by: identifying activities that maximise health benefits and minimise health damage for a target population making the effects of programmes on health explicit in the planning process ensuring that, at least, health is not worsened by any planning decisions including explicit health-related objectives within the programmes objectives. 2 Creating supportive environments, whether physical, social, cultural or economic, that enable the choice of goods and services to be informed by their impact on health. 3 Strengthening community action to re-orient social and cultural norms and give help to individuals. 4 Enabling people to take control over their health and increase their coping skills. 5 Re-orienting healthcare planners and practitioners to think holistically. (Based on the Ottawa Charter for Health Promotion, WHO, 1986)

How the health needs assessment process can be used locallyThe uses of the process will vary from district to district. There are three main ways the process has been used. 1 Health improvement and modernisation programme action plans Health needs assessment has been used to plan for priorities in local HIMP planning, such as heart disease, mental health, tobacco control, housing, and older people. 2 Community (health) planning Health authorities and, latterly, primary care groups and trusts work with LAs to tackle social exclusion in deprived areas, using the HNA process. 3 Service-specific plans A range of specific services and professional groups use the process for their own plans: for example, a group of primary healthcare teams in an area; a group of health visitors