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Health Needs Assessment. Dr Jean Robinson NHS Nottingham City. Learning Objectives. To understand what is meant by HNA Identify the drivers, purpose and applications of HNA and JSNA To increase awareness, through case studies, of how HNA is applied in practice. Health needs assessment.

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Health needs assessment

Health Needs Assessment

Dr Jean Robinson

NHS Nottingham City

Learning objectives
Learning Objectives

  • To understand what is meant by HNA

  • Identify the drivers, purpose and applications of HNA and JSNA

  • To increase awareness, through case studies, of how HNA is applied in practice

Health needs assessment

Health needs assessment

  • At its simplest, it’s a pragmatic approach to determining the priorities for a population through a structured process.

  • Health needs assessment is a well established approach to planning and deploying resources in our health system.

Quick exercise
Quick Exercise

  • write down 6 words you would associate with a Health Needs Assessment

Hna definitions
HNA: definitions

  • The epidemiological approach to needs assessment

  • Prevalence and incidence

  • Services available and their costs

  • Effectiveness and cost-effectiveness of services

  • Quantified models of care and recommendations

  • Outcome measures, audit methods and targets

  • Information and research requirements

  • 1994 & 1997

The systematic method of identifying unmet health and healthcare needs of a population and making changes to meet those unmet needs.

Wright J, Williams R & Wilkinson J. BMJ 1998; 316: 1310-3.

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: A Practical Guide (NICE 2005)

Hna different models common ground
HNA: different models/common ground

  • a disease

  • a service

  • a community or social experience

Drivers for hna
Drivers for HNA

NHS Planning Guidance 2005-2008

PCTs and their partners will need to consider the particular needs of their population, taking into account different needs and priorities within each community.

PCTs should demonstrate that, as well as using epidemiological data and general survey data to identify the differing needs of their populations, they have listened to the views of patients and the public and in particular have taken account of the results of patient and user surveys ....

Health needs assessment

Drivers for HNA

Core standard C23

1. The PCT assesses the health needs of its local population, including analysis of its demography, health status, health and social care use and patient and public views.

2. The PCT’s commissioning decisions and local target setting are informed by its assessment of health needs ....

3. The PCT commissions or provides targeted programmes and services .... based on the needs of its local population.

*NB The Healthcare Commission are an Independent regulator of health and social care in England

Drivers for hna1
Drivers for HNA

World Class Commissioning (2008)

By identifying current needs and anticipating future trends, PCTs will be able to ensure that current and future commissioned services address and respond to the needs of the whole population, especially those whose needs are greatest.

PCTs should .... undertake robust and regular needs assessments that establish a full understanding of current and future local health needs and requirements

Why undertake hna
Why undertake HNA?

  • Provide evidence about a population on which to plan services and address health inequalities

  • Provide an opportunity to engage with specific populations and enable them to contribute to targeted service planning and resource allocation

  • An opportunity for cross-sectoral partnership working and developing creative and effective interventions

Health needs assessment

Health needs assessment

  • In simple language:

  • - Profile the local population

  • - Identify local health problems

  • - Use local knowledge to assess health needs

  • - Describe the existing services (adequacy)

  • - Describe possible interventions (effectiveness)

  • - Evaluation of services

Cycle of health needs assessment
Cycle of health needs assessment


What population?

... and who to involve?


Identifying problems and challenges



measuring impact


population profiling

perceptions of needs



Action planning for change



which issue(s) to tackle?

what are effective and acceptable interventions?

Chd burden in peterborough
CHD burden in Peterborough

  • What is the need at a practice level for CHD related services?

  • Identifying the burden of CHD at a practice level in Peterborough PCT in order to direct future investment


  • WHAT – Profile – what is our population?

  • PROBLEMS – What are the main issues?

  • PRIORITISATION – What analysis can we do to assess priority?


  • REVIEW – and journal publication

What chd profile
WHAT - CHD Profile

  • What population?

  • Several profiles/ HEAs undertaken over the years

  • Differences are at electoral ward, MSOA and GP practice level

  • NHS Peterborough’s biggest problem

Why by gp practice
Why by GP practice?

Proxy Mortality rates by GP practice (based on registered population)

Non elective admissions for ami
Non Elective Admissions for AMI

Age standardised admission rate per 1,000 population

Developed model for practice level need
Developed model for practice level need

The model ranks 5 indicators of the burden of CHD at a practice level:

  • Age standardised Acute MI admissions

  • Age standardised CHD mortality < 75 years (male & female)

  • The difference between observed (QOF) and expected prevalence as a measure of unmet need.

  • Indices of Multiple Deprivation – practice based

    Excluded were:

  • Smoking prevalence & ethnicity

  • QOF prevalence as a single measure of prevalence


  • Ranked each practice with a ‘risk’ based on the analysis

  • Helped with assessing CHD related issues across city and not just based on where patients lived or with which practices they were registered

  • Multi-variant analysis enabled prioritisation at GP practice

Action plan

  • Used model to look at which practices to pilot CVD risk programme

  • Used model to get funding for various projects (Oberoi, CHD monitoring training for practices nurses, etc.)

  • Plan to publish model in a public health journal


  • Peer review of model – erpho I&I forum, EoE Public Health Conference, academic review from Specialist Trainee in PH programme

  • CHD Matrix group reviewed work

  • Elements of model used to update a health equity audit

  • Reviewed all QOF conditions observed: expected prevalence (tool now available)

Learning objectives1
Learning Objectives

  • To understand what is meant by HNA

  • Identify the drivers, purpose and applications of HNA and JSNA

  • To increase awareness, through case studies, of how HNA is applied in practice