IDENTIFYING NEEDS AND SETTING PRIORITIES - ISSUES OF THEORY, POLICY AND PRACTICE

The National Health Service and Community Care Act 1990 signalled an e xplicit shift away from a service-driven to a needs-led pattern of del ivery for both health and social care. However, a definitive meaning o f 'need' is elusive. Where the work of health and social care agencies is related closely, as in community care, recognition and careful han dling of different approaches to need is important for effective inter -sectoral collaboration and supply of appropriate care to service user s. This paper examines three dimensions of need; theory, policy and pr actice. Some key components of the theoretical debate about the meanin g of 'need' are explored briefly, particularly in relation to health, and a set of questions is extracted that underpin the construction of need in policy and practice. These questions are then applied to a com parison of policy guidance documents for needs assessment for health a nd social (community) care. While the documents demonstrate some simil arities in their view of need, there are also material differences. Th ese differences have implications for the supply of services at the bo undary between health and social care, some examples of which are disc ussed. Given a lack of consensus in defining and measuring need, the p aper concludes with a framework of key questions which could enable pu rchasers and providers of health care to be more explicit about the ba ses upon which 'needs-led' services are defined and delivered.