It is primarily commissioners who are responsible for needs assessment. They have a statutory responsibility to work with their local authority to produce a Joint Strategic Needs Assessment. Commissioners will also engage in more local work, often led by their Public Health Department, focussing on identifying inequalities in access to healthcare and in health outcomes. They are required, under the Public Service Agreement, to identify and find ways to reduce inequalities in life expectancy. That might, depending on local morbidity, include detailed work looking at long term conditions such as respiratory disease.
There can be an important role for clinicians, both practice-based commissioners, primary care practitioners and secondary care clinicians in contributing to this assessment of the local population's health. That is, typically, managers and commissioners have a faster turnover, and it is clinicians who have longer organisational memories, and knowledge and understanding of the local community. There is significant potential to share data, local audits and more qualitative data with commissioners to feed the needs assessment process.
Starting with the vision
Before undertaking any detailed work on any parrticular population group, it would be helpful to understand the vision and aims in your region. Between 12 May - 5 June 2008 each NHS region is publishing its vision as part of the Darzi review. Click here for the latest information from the Darzi review including 5 key principles and dates for annoucement of regional visions. See here for our deailed response to the Darzi team that has been well received by a number of audiences including SHAs and the Royal College of Physicians.
Predictive risk
The Kings Fund, together with New York University and Health Dialog has done significant work, that is now available to the NHS, on predicting who might be a user of hospital care; both those at risk of readmission, but also, moving further 'upstream', who might be a future user of hospital care unless services are put in place to support that individual to manage their care out of hospital. It includes a useful literature review of predictive risk, and an analsysis about why clinical judgement alone is insufficient.
Click here for PARR, PARR++ and the Combined Predictive Risk model.
This analysis has been used by a number of commissioners to populate the case loads of their Community Matrons or specialist teams for people with long term conditions. It has also been used for the development of innovative models such as the Vitual Ward by Croydon PCT. See http://www.croydon.nhs.uk/sections/frame.html?sec=182 Whilst this has not yet been evaluated formally, it has received significant media and commissioner attention, andt therefore it is worth understanding how it operates.
Information providers, and multiple data sets
The Eastern Region Public Health Observatory has recently developed a model for COPD prevalence. This incorporates new rates of smoking prevalence and has led to an increased estimate of COPD prevalence.
The Department of Health has also accredited a number of private companies, like Health Dialog and Dr Foster, to work with commissioners to provide them, under contract, with data analysis and information in its drive to develop World Class Commissioning. These companies use a number of data sets including not only HES data, but also primary care data, social care, education and criminal justice data.
The British Lung Foundation has recently worked with Experian and its Mosaic software that includes retail data sets to identify hot spots for COPD in its report Invisible Lives. This can pinpoint populations by postcode, down to clusters of about 15 households rather than (political) ward data that goes down to about 14,000 population. See below.
HES data wil remain the foundation of much needs assessment work by the commissioner and therefore it must be firstly the clinician's role to check for accuracy. For example, the NHS Institute has launched its Opportunity Locator that analyses HES data by ambulatory codes, to produce for PCTs the opportunities for shifting care out of hospital - either by admission avoidance or by step down care. Have a look at your PCT data at http://www.institute.nhs.uk/opportunitylocator/default.aspx.
The National COPD Resources and Outcomes Project [NCROP] Incorporating the National COPD audit 2008
Please see the Royal College of Physicians Clinical Effectiveness and Evaluation Unit web page on the 2008 audit that is due to report in late 2008. It also gives details of previous audits that could be used as a benchmark. The 2008 audit will be the first to include primary care data systematically. Click here.
--------------------------------------------------------------------------------------------------------------------------------------------------------------
COPD Needs Assessment – Invisible Lives, British Lung Foundation
Click here
Experience of BME patients with COPD: Picker Report
Click here