Developing plans broadly entails understanding local population health needs and patterns of service utilisation (this section), identification of evidence-based options for improvement action (2c) and agreement of priorities for implementation (2d). Traditional health needs assessment looks at populations through the "lens" of aggregate data focussed on specific diseases (in contrast to population health management; see 2b below). It often depends largely upon routinely-collected national data derived partly from non-clinical sources, but will also incorporate local clinical data where this is available.
Assessment and planning footprints in Wales
Multiple directives require pairing of population health needs assessments (HNAs) and planning outputs across various geographic and/ or structural footprints in Wales. An overview of these is provided on the following page:
Healthcare assessment and planning footprints in Wales: A summary of assessment and planning requirements
Data-centric approaches
Traditional needs assessment involves collating and presenting relevant health intelligence data available from national and health board sources. Where this is the only approach utilised, it may be termed “desk-based needs assessment”. These data can take several forms, but typically address topics/ conditions in isolation; take poor account of co-morbidities; and lack insights from linkage between datasets. Indicators relating to process/ performance or outcomes of interest can be considered as follows:
Health intelligence data sources
Health intelligence in Wales is provided by a number of organisations, each typically producing a number of distinct products, each of which may present information in unique ways. Accessing such a diverse array of specialist resources can be intimidating and interpreting them challenging—particularly for those needing to do so infrequently.
Key health intelligence data sources: An index of major national data sources that may inform local needs assessments
See also Population health information by topic which incorporates topic-specific signposting to data analyses relating to local needs.
Asset-informed approaches
The Welsh Government definition of prevention is broad: “working in partnership to co-produce the best outcomes possible, utilising the strengths and assets people and places have to contribute”. The Covid pandemic spawned “pop-up” health and well-being services within community assets, considered “vital provision within geographically isolated communities where deprivation and traditional barriers to inclusion require easy to access services, close to where people live” (BCT, 2020). Consider any relevant local assets or potential partner organisations that might facilitate co-production. The following local asset indexes may help identify these:
Participatory approaches
Incorporating the views of stakeholders on questions of service redesign is sometimes termed a “corporate” approach. Participation and engagement may reference any rung on the “participation ladder”, typically ranging from informing (“doing for”) to co-producing (“doing with”). Co-production could position stakeholders as integral partners involved in the design, conduct and interpretation of local needs assessments. Methods for gathering views can include surveys, feedback analyses, focus groups, key informant interviews, etc. Broadly, two distinct groups may contribute views:
See also ACD Toolkit which covers communication and engagement.
Vulnerable and marginalised groups
Some groups have less opportunity to participate/have their voice heard during the conduct of needs assessments or in conversations around service redesign. While there is overlap between point-of-care focus on vulnerable and marginalised groups and the much broader social inequalities agenda, it can be helpful to clarify the approach taken as follows:
For vulnerable or marginalised groups, the “gentle” slope of inequality (e.g. depicted as a plot of outcome vs. deprivation quintile) can seem more akin to a cliff edge. Primary care services advocate to reconfigure services so they deliver improvements for all, but should recognise the additional effort needed for those groups with greater unmet needs (this is the concept of proportionate universalism).
For signposting to professional collaborative actions, refer to the following:
Vulnerable and marginalised groups: Identifying needs of vulnerable and marginalised groups
Approaches to data synthesis
Data gleaned from multiple sources will need collating and/or analyses and formatting for presentation. For example, you might triangulate findings from the international literature, local profiling and community/ professional voices into an evidence-informed narrative. You might supplement a technical tome with more accessible infographics. There are many possible ways to approach data synthesis; a helpful structure to support well-informed commissioning decisions is as follows:
Approaches to data synthesis: Four key questions to help structure a population needs narrative
Understanding variation
Quantitate data and other information may indicate variation in access to or outcomes from care, which may or may not correspond to the unmet needs of known vulnerable groups. Needs assessments should actively seek and discuss such variation:
Support resources
General guidance, training and advice may support clusters with needs assessment requirements. This could include the following: