Future role of the District Health Authority: assessing needs for services and setting priorities

The purchaser/provider split within the NHS has highlighted the role of District Health Authorities (DHAs) in assessing health needs and buying services to meet those needs. This requires a consideration of what is meant by “need” and how it relates to a system of priorities for health care provision. In the long-term it is to be hoped that DHAs have at their disposal cost-effectiveness information relating to a wide range of interventions, enabling them to make priority decisions. In the short-term, however, a less ambitious aim is to ask what information is currently available which could inform the purchasing role. In areas where data are clearly deficient, this could involve assessing the potential usefulness of available information, assuming that the underlying data could be improved. The starting point for the project upon which this paper is based was therefore to establish the baseline characteristics of participating DHAs’ resident populations, using data already available nationally and locally, supplemented by local survey work where applicable. The aim was to evaluate existing data sources, examining their usefulness in assessing health needs and in making the link from needs to service provision. There is of course no magical formula which translates the identification of needs into what health care services should be provided. Nevertheless this is exactly the challenge faced by those who will be involved in the contractual process.