Resource planning within the health care planning teams

Abstract

In 1967, the DHSS recognised that in planning, hospitals tended to act in isolation from other parts of the community health services and exhorted clinicians to participate in planning and liaison with other agencies. The reorganisation of both the NHS and local government, together with the current economic climate, make joint planning for efficient health and social services even more important. The DHSS therefore require the health needs of the community to be assessed at District level and plans formulated to meet those needs. Various definitions of “need” are discussed in the paper and “normative need”, as defined by professionally desirable standards, is proposed as a basis for planning. Thus, a person falling short of the desirable standard is identified as being in need. Thus “needs” can be defined such that a person with characteristics X is in need of care Y, is understood to mean that standard of care Y is desirable for a person with characteristics X. If, because of financial or other constraints, the desirable standards cannot be achieved, then lower practicable standards must be adopted, defining the “designated need”. The first step in the proposed planning process is the specification of appropriate “standards” of provision. These “standards” can either be DHSS norms, or they can relate to more specific characteristics of the population. Combining these “standards” with the projected population allows estimates to be made of future resource requirements. Financial and other constraints will, in general, mean lower, practicable standards and that a range of alternative feasible options are open. Here we must appeal to research evidence and professional advice in order to help the officers concerned decide on agreed courses of action. The use of the proposed planning structure is illustrated within the context of services for the elderly in a district. Using DHSS norms the services were ranked according to the percentage shortfall between the norm provision and the current provision. This ranking places day care facilities (Geriatric and Psychiatric day hospitals and day centres) with the highest priority. Norms were used because there were no agreed standards with which to replace them. It is argued that the HCPT should seek to define more clearly the types of person suitable for the receipt of each type of service and estimate the number of such people. This is not an easy task and is further complicated by the fact that there are likely to be several acceptable alternative forms of care for a given type of person. The planning approach proposed does not pretend to answer the question of what is the “best” allocation nor does it help in deciding priorities between different client groups. It does however provide a framework within which priorities within a given client group can be explored by HCPTs.