NEEDS ASSESSMENT AND PALLIATIVE CARE - THE VIEWS OF PROVIDERS

Background A key element within the programme of reform introduced int o the UK National Health Service in the 1990s has been the concept of health needs assessment, which must be undertaken by health care purch asers as a guide to the planning process. As part of a wide-ranging st udy of the impact of the NHS reforms on hospices and specialist pallia tive care services, providers' perceptions of needs assessment for pal liative care were examined, including the extent to which needs assess ments had been carried out in local districts, together with the impli cations. Methods The study comprised two key elements. In spring 1995 a postal survey was conducted among all UK hospices and specialist pal liative care in-patient units (n=203) eliciting factual information co ncerning needs assessment and contracting, together with perceptions a nd evaluations of the local impact of the NHS reforms. A total of 128 (63 per cent) questionnaires was completed and returned. In addition t o the survey, 12 case studies were conducted with a stratified random sample of NHS, independent and large or small hospices and specialist palliative care units. Each of the 12 case study sites was visited by a member of the research team, who conducted interviews with senior st aff and analysed financial, planning and management data. Thus the sur vey allowed a wide analysis of the impact of the NHS reforms, which wa s enhanced by the more in-depth qualitative data gathered from the cas e studies. Results In the survey 49 per cent of those responding repor ted that their main purchaser had conducted a needs assessment for pal liative care in the last five years. Palliative care needs assessment was seen as valuable by providers: 73 per cent considered it very impo rtant and 28 per cent of hospices had gone so far as to request a need s assessment from their health authority. In an open-ended question se eking views on the impact of health needs assessment, 66 per cent of t hose responding (71/107) stated that the impact had been or would be p ositive. The case studies, however, revealed a more mixed picture. The 12 hospices or specialist palliative care units had contracts with a total of 24 health authorities, 12 of which had conducted some type of needs assessment for palliative care. On close examination the compre hensiveness of these was questionable. Few providers had participated in the design and there were low levels of knowledge about the finding s. High expectations of the value of needs assessment were often not f ulfilled. There was also a tendency for providers to view needs assess ment in a purely instrumental light, as a vehicle to further promote t heir own interests. Conclusions Palliative care needs assessment has c onsiderable potential to influence future purchasing and service provi sion, yet not all health commissions are undertaking it. There is a hi gh level of provider enthusiasm for palliative care needs assessment, albeit coupled to low levels of technical knowledge ana a lack of invo lvement in the process at local level. Purchaser-provider dialogue on needs assessment should focus on both raising awareness of appropriate techniques and debating 'ethical neutrality' about the outcome.