Rapid needs appraisal in the modern NHS: potential and dilemmas

This paper reports on our experience of undertaking a Rapid Appraisal of Health and Social Needs (RNA) in West Cumbria, UK. RNA aims to identify community-defined problems and to collect intelligence for action rather than simply for documentation. The broad nature of the study is summarised and we reflect critically on methodological and structural issues that arose. A number of inter-related themes were significant: the limitations of a ‘rapid’ approach; within an action frame, the implications that arose from focusing on locality capacity-building; the ability that commissioning organisations had in this public health domain; and the way in which such organisations tend to construct ‘needs’. These themes then are located in problematic contexts. Primarily, we were working with a fledgling NHS organisation, arguably set unrealistically high expectations to deliver innovative public health functions. Furthermore, the desire to see the NHS working more efficiently resulted in the expectation that the exercise should be done in a particular way—within a realist tradition of arriving at quick, simple and ‘definitive’ needs. We conclude by suggesting that if such work is to be meaningful then there needs to be a number of pre-cursors: an initial consensus on the nature of ‘need’; an agreement between commissioners and researchers around common frameworks and realistic expectations of the process; and finally, an acceptance of the importance of history in this work and the way histories of local inter-agency work reflect embedded forms of local knowledge. We suggest that NHS volatility means that much of this knowledge is often lost