Needs assessments, impact assessments and audits
NHS commissioners, planners, policy makers and practitioners across all sectors use a range of approaches to assess health needs, inform decisions and assess impact. In this section we look at six of the approaches that are relevant to the relationship between health and wellbeing and community cohesion. The first five are described in a guide produced by the Health Development Agency in 2005 'Clarifying approaches to: health needs assessment, health impact assessment, integrated impact assessment, health equity audit and race equality impact assessment':
- Health Needs Assessment (HNA) is a 'systematic method for reviewing the health needs and issues facing a given population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities'. Its value to community cohesion lies in the fact that it identifies particular populations whose needs are assessed. PCTs have specific responsibility to carry out HNAs following the publication of 'Shifting the balance of power within the NHS' in 2001, but they are generally undertaken as a partnership activity with people from other sectors who are also concerned with inequalities and improvements in public health.
- Health Impact Assessment (HIA) is an approach used to 'identify the potential health consequences of a proposal on a given population'. It is also used to 'maximise the positive health benefits and minimise potential adverse effects on health and health inequalities'. It can be applied to health related proposals or, more frequently, to proposals involving other determinants of health (housing, urban regeneration, education, transport, economic development and planning).
- Integrated Impact Assessment (IIA) is an approach that 'assesses the impact of proposals and strategies on issues that previously may have been assessed separately'. It can be seen as a health determinants impact appraisal tool and, as such, it is ideal for considering issues around community cohesion.
- Health Equity Audit (HEA) 'identifies how fairly services or other resources are distributed in relation to health needs of different groups and areas, and the priority action required to provide services relative to need'. This approach is ideal for looking at cross-cutting issues on a partnership basis. It can also be a useful tool for Local Authority Health Overview and Scrutiny Committees as part of their scrutiny reviews.
- Race Equality Impact Assessment (REIA) is designed 'to work out how an organisation's policies or functions will affect people from different racial groups, pre-empting the possibility that the policy could affect some racial groups unfavourably. REIA looks at proposed policies as well as enabling the monitoring of policies once implemented'. In many places REIAs have been widened to cover other vulnerable groups in addition to racial groups. An example from north London is described below.
- Community Cohesion Impact Assessment (CCIA) is designed to test whether proposals will have a positive or negative impact on community cohesion and community conflict in an area. It is described in 'Community cohesion impact assessment and conflict prevention tool' published by CLG in 2008.
An Equality Impact Assessment has been used in North London to assess five options for Barnet, Enfield and Haringey's clinical strategy. Drawing on existing consultation results, the review team carried out an initial screening of the five options to identify any negative impacts on a range of identified groups (black and ethnic minority groups, women and men, disabled people, lesbian, gay, bisexual and transgender community, people with different religious and belief systems, people in different age groups and people in different social and economic classes). Each option was assessed to identify impacts on the groups in terms of accessibility, affordability, sustainability, deliverability and safety. Where possible any mitigating factors were identified. The options were then refined to take account of the impacts identified and the revised options were subject to wider consultation.