Summary - Organic Chemistry 32-235

How does HNA support national priorities? The aim of the government’s health inequalities strategy is to narrow the gap in health between different social and economic groups and areas. It has set a national public service agreement target to: ‘REDUCE HEALTH INEQUALITIES BY 10% BY 2010 AS MEASURED BY INFANT MORTALITY AND LIFE EXPECTANCY AT BIRTH’ 70320/sr04_psa_ HNA provides a vital tool in helping to meet this objective through targeting populations most in need of improved support and services. HNA linked with commissioning has been an integral task of health authorities since 1989. Saving lives: our healthier nation (DH, 1999) stresses the importance of the community’s role in identification of health needs and priorities; and Shifting the balance of power within the NHS: securing delivery (DH, 2001) gave specific responsibility to primary care trusts. The Wanless report Securing good health for the whole population (Wanless et al., 2004) also emphasises the importance of high levels of public engagement in order to achieve optimum gains in health outcomes and a reduction of health expenditure in the long term. The HNA approach provides an ideal opportunity for different agencies to build trust with communities to ensure genuine partnership involvement in reconfiguring services. HNAs can usefully inform: • Health equity audits (see Section 2, page 17) • Local delivery plans • Community strategies • Specialised services commissioning • Health and social care joint planning and commissioning • General practice strategic development plans. HNAs are sometimes conducted by voluntary, community and charitable organisations to collect information about their target communities for funding and project planning purposes. When public sector agencies are conducting HNAs, they should check with voluntary and community organisations to see what information they have collected and, where appropriate, to involve them in project teams or stakeholder groups. Benefits and challenges Benefits from undertaking an HNA can include: • Strengthening community involvement in decision making • Improved public patient participation • Improved team and partnership working • Professional development of skills and experience • Improved patient care • Improved communication with other agencies and the public • Better use of resources. The value of HNA to general practice and the General Medical Services contract lies in the contribution it can make to improving data quality, which is important to meeting quality 8 indicators; developing chronic disease registers; and providing information for an evidence base of need which can support funding applications to provide enhanced services. It also supports the clinical governance agenda and information required for National Service Framework targets. HNAs are a requirement of professional competency for the UK voluntary register of public health specialists and for Part 2 Faculty of Public Health examinations, but they must demonstrate a robust process involving sound epidemiological and social science methodologies (see Section 3, page 27 and Section 4, pages 52-53). Challenges that may be encountered when undertaking an HNA can include: • Working across professional boundaries – tackling territorial attitudes preventing power or information sharing: - develop positive working relationships with colleagues within other sectors - develop an understanding of organisational structures/priorities/objectives - ensure others are clear about the benefits to their organisation/profession of conducting HNA. • Lack of a shared language between sectors: - consider definitions in section 2 of this guide (see pages 12-17) - consider ways of jargon busting to keep communication accessible to all involved (see Plain English Campaign, Section 4, page 50) - consider impact of different language within sectors and be creative about using language that relates to the sectors involved (eg is it possible to undertake a community needs assessment versus a health needs assessment if the issue of ‘health’ is viewed negatively by some sectors?) - develop dialogue with and between sectors in the early planning phase (step 1, page 22) to explore developing a shared language. • Lack of commitment from the top: - identify and establish who needs to be in agreement with the HNA at ‘the top’ - consider ways of communicating the value and benefits of the HNA to key senior stakeholders - promote examples of successful HNA work in other organisations (see Case studies). • Difficulties in accessing relevant local data: - consider trawling professional contacts for suggestions on accessing relevant data - explore the national, regional and subregional data available from health observatories (see Section 7) and consider their usefulness/relevance to your project - consider experiences from Case studies for different ways of accessing required data. • Difficulty in accessing the target population: - consider whether the target population has been over-assessed, and discuss with key stakeholders whether information is available elsewhere - review intended methodology for accessing target population and consider if there are other, more creative ways, of accessing population (see Tools and resources) - explore examples of other HNAs that have accessed similar populations (see Case studies). • Difficulty in maintaining team impetus and commitment: - review progress and positively reinforce achievements - ensure all team members are aware of achievements and progress; assist members in breaking down the HNA into bite-sized chunks in order to build on work undertaken - check out team commitment to the task, and identify solutions as a team to improve motivation/impetus.