Key Steps
[click each piece for link to detail]
Health Needs Assessment – a long term forecast, looking ten years ahead, at the health needs of the communities served by a PCT will help determine – and justify – commissioning objectives
It should be informed by a Health equity audit. This is a mechanism for using evidence about health inequalities to inform service planning and delivery. Data collected during health needs assessment feeds into the health equity audit cycle, which is a mechanism for reducing inequalities in health by producing an equity profile, agreeing local priorities and actions, securing change and reviewing progress.
Needs Assessment is a multi disciplinary task that requires inputs from public health specialists, primary care clinicians, information specialists, finance professional and general managers.
It should be developed with full contributions from the community, the voluntary sector and the relevant local authority(s) responsible for the social and economic well being.
It may be beneficial to develop the assessment in partnership with other PCTs in the health system.
Local NHS Trusts should be included in the process of assessment, particularly in the assumptions about medical technologies and future treatment rates. It should be developed in conjunction with the assessment and should take into account:
- Demographic change including changes in the age profile and thesocial deprivation and economic well being of the community.
- Changes in morbidity, for example increases in the incidence of particular clinical conditions e.g. asthma, obesity.
- Health inequalities, by identifying differential needs of different areas and groups, differential rates of access and health outcomes, preferably by considering these across the care pathway
- Changes in medical technology, including new drugs. It is important to identify technology changes that are likely to make treatment accessible to a greater proportion of the community. For example in the last decade improvements in anaesthetics and intensive care are enabling frailer patients to have major orthopaedic interventions. The long term benefits of current improvements - for example in primary and secondary prevention in Coronary Heart Disease - are difficult to forecast but do need to be taken into account.
- Local access rates (per ‘000 weighted population) and disease prevalence rates trends should be compared with other PCTs and national averages and that should inform forecasts of future needs. Decisions to plan the provision of services above or below anticipated averages should be explicit and justified. It is important to recognise how far changes in thresholds for interventions can effect future capacity.
- Possible reductions in care needs should also be forecast, for example a falling birth rate will reduce the future volume of obstetric care required.
Resources
The Health Development Agency’s Health Needs Assessment Workbook
Health Equity Audit
Tackling Health Inequalities: A Programme for Action identified Health Equity Audit (HEA) as a key tool to embed evidence on inequalities into mainstream NHS activity such as planning, commissioning and service delivery. The Planning and Priorities Framework for 2003-06 set out the requirement for PCT delivery to be informed by a HEA and an annual public health report.
The purpose of an Health Equity Audit is to support the narrowing of health inequalities by informing the planning and commissioning process on inequalities in a local area to support PCTs in taking decisions about service organisation designed to narrow health inequalities and to measure the impact of change.
HEAs identify how fairly services or other resources are distributed in relation to the health needs of different groups and areas, and prioritise action to provide services relative to need. (This may include resources such as services, facilities, and the determinants of health). The overall aim is not to distribute resources equally, but rather relative to health need, otherwise inequities occur which lead to health inequalities.
The HEA cycle is not complete until something changes, probably resource allocation, commissioning, service provision or care outcomes, which is likely to reduce inequalities demonstrably.
Resources
Health Equity Audit
The Health Equity Audit Cycle
National Targets – the NHS Plan sets the objectives for service improvement to 2005 and 2008. These are the minimum standards that the NHS must reach.
Resources
The Planning and Priorities Framework
Current pattern of services – a summary of the current services by care group (acute, primary care, mental health, elderly, maternity, children, learning disability, ambulance etc.). This baseline should include:
- activity information,
- access rates per ‘000 population,
- the recurring cost of services
- a brief description of the current style of service delivery.
Capacity Planning – the national model should be used to forecast demand and capacity in the light of the needs assessment and the current pattern of services. The model should be used to test different assumptions, for example:
- the possible outcome if access rates change
- the impact of implementing effective demand management techniques
- the consequence of adopting redesigned care pathways
- the introduction of a new provider sector, such as Treatment Centres.
The model should be used throughout the planning process and kept up to date, informing in year performance management of service level agreements. and reflecting changes in the level and pattern of provision.
Comparative Performance – should be reviewed to ensure the community is receiving the optimum levels of service and that services, both commissioned and directly provided, represent value for money.
The review should include:
- relative access rates for services
- comparative cost of services
- the relative spending levels on different care areas.
The divisor for comparisons should be the weighted population for the relevant age groups who use the particular service and the national weighted capitation formula weightings should be used for consistency between PCTs.
The information can be obtained from Department of Health published information, national reference costs and PCT’s own commissioning databases. A high level review of all services will lead PCTs to areas which should be probed further with detailed reviews. Benchmarking should be considered on a targeted basis.
Resources
NHS Performance Ratings 2002/03
Local Delivery Plan – draws together the strands to create a clear three year plan with intermediate milestones of achievement to be delivered within the available resources.
Resources
Local Delivery Planning
Service Level Agreements – detailed agreements with providers givingeffect to the volumes, quality and costs of care agreed in the LDP.
Resources
For more on SLAs see Resource Guide Service Level Agreements
|
