Health needs assessment in the contemporary NHS

Abstract

Working for Patients, published in January 1989 and the subsequent NHS and Community Care Act 1990, Introduced the most major and complex reorganisation of the NHS since its inception. One of the outcomes of this re-organisation has been the separation of the purchasing and providing functions and the creation of an internal market in health care in Great Britain. District Health Authorities shed their responsibility for providing health care (this responsibility passing to acute and community NHS Trusts) enabling them to concentrate on their wider role of purchasing health care services which maximise the health of their local population. The thesis is about health needs assessment for the planning and purchasing of health services, where decisions about priorities and the allocation of resources are based on an assessment of health need. At the inception of the NHS, 'need' was purely medically defined. In the 1970s formal planning systems and a formula for allocating resources were the mechanisms through which 'need' was identified. The post 1990 reform of the NHS is the focus of the thesis, where health need assessment is undertaken within an internal market in health care.