Intended for healthcare professionals

Education And Debate

Health needs assessment: Whose priorities? Listening to users and the public

BMJ 1998; 316 doi: (Published 30 May 1998) Cite this as: BMJ 1998;316:1668
  1. Joanne Jordan, senior research fellowa,
  2. Therese Dowswell, senior research fellowb,
  3. Stephen Harrison, reader in health policy and politicsc,
  4. Richard J Lilford, professor of health services researchd,
  5. Maggie Mort, senior research fellowe
  1. a Centre for Research in Primary Care, Research School of Medicine, University of Leeds, Leeds LS2 9LN
  2. b Department of Psychology, University of Leeds
  3. c Nuffield Institute for Health, University of Leeds
  4. d University of Birmingham, Birmingham
  5. e Department of Management Studies, Lancaster University, Lancaster LA1 4YT
  1. Correspondence to: Dr Jordan

    This is the fifth in a series of six articles describing approaches to and topics for health needs assessment, and how the results can be used effectively. Series editor: John Wright

    External inputs to health needs assessment and the prioritisation of health services may be seen as one means of addressing the “democratic deficit” in the NHS. Such external inputs can be discussed on three levels. The first concerns the formal governance arrangements of the service and encompasses questions about electing health authority members and transferring the NHS purchasing function to local government authorities 1 2; it is not discussed further here. The second level of input may be characterised by arrangements for consultation with the general public, whether or not they happen to be current patients or users. The third level concerns the consultation of current users about needs and priorities. The importance of these two levels was recently recognised in a new white paper.3

    Summary points

    Although health authorities have increased local consultation, its quality remains dubious, with greatest emphasis on one-off consultation exercises

    Information gained through public consultation may either be marginalised or incorporated according to professional priorities

    It is important to acknowledge limitations to professional knowledge as well as to respond to inequalities in health; through citizens' juries, user consultation panels, focus groups, questionnaire surveys, and opinion surveys, local knowledge can be used to effect such a response

    There is scope for greater local involvement in decision making

    Changes to the organisation and funding of primary care are vital if effective involvement is to be sustained

    Consultation of the public

    The nature and extent of public involvement in determining health needs has increased, but the quality of consultation remains questionable. 4 5 Some health authorities have established ongoing consultation procedures, including citizens' juries, large scale postal panels, and smaller face …

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