Suzanne Robinson*, Helen Dickinson*, Iestyn Williams*, Tim Freeman*, Benedict Rumbold** and Katie Spence * * Health Services Management Centre ** The Nuffield Trust

University of Birmingham and Nuffield Trust study

One of the first studies to have looked at PS activity nationally

Aim to map and explore current priority setting activities in English PCTs

Survey- to all 152 PCTs (response rate 80/152 PCTS in England (53%) )

5 in-depth case studies

Research into PCT priority setting

• What priority setting tools, processes and activities are practised currently as part of the commissioning process of English PCTs.

• What barriers are experienced by PCTs seeking to implement explicit priority setting, and how are these addressed?

• What barriers are experienced by PCTs seeking to implement explicit priority setting practices?

• What learning can be derived that will be instructive for future priority setting within the NHS and elsewhere?

Table 1 Priority setting activity at the case study sites

Type of priority setting activities Wave one sites Wave Two sites

(Appendix 1 provides more detailed definitions of these different activities)

Morebeck Donative Nethersole Chetwynd Chatterton

Overall budget allocation (core budget spend)

✔ ✔ New resource allocation ✔ ✔ ✔ Reprioritising across budget areas ✔ ✔ Disease care pathway redesign ✔ ✔ Disinvestment /decommissioning of existing service provision ✔ ✔

Easier targets such as varicose veins, IVF, routine orthopaedics, closing daycentres and care homes

What next? Many large scale disinvestment

projects planned, few as yet achieved

Hospitals are where the real savings are to be made…

Picking the low hanging fruit

Be a difficult and challenging business Often happens at the margins Be difficult in terms of decommissioning services-

‘easier to invest than disinvest in services’ Focus on technical aspects and processes Be very political (P) (p) Be difficult in terms of implementation of

decisions Require strong leadership and motivation

Attempts to take a more explicit approach – gov’t policy through WCC has been one of the drivers for this

Development of tools and techniques to aid PS Some commissioners are engaging with other

stakeholders- taking health economy approach Lots of good practice examples and work around

PS and investment Work around disinvestment is also becoming

more important and prominent in some areas

Positive impact of a system wide approach – ‘PS is everyone's business!’

Shared decision making engagement with relevant stakeholders

Technical process can be an active part in PS – appeal to stakeholders and help with engagement

Understanding of evidence and what relevant evidence is available locally

Providing incentives to help with change and implementation of PS decisions

Strong leadership being able to negotiate the difficult political and cultural aspects of health care

Motivation and engagement of middle managers and front line staff

Governance structures Once decision is made having a manager/s

who lead and implement the chance

Power of PCT – relative power in balance within health economies –

PCTs not having sufficient levers to instigate change

National political arena does not specifically support prioritisation and rationing of services

Incentives of other polices - such as PBR, pressure of ‘must dos’

Lack of strong evidence base and capability and skill to analyse and interpret evidence

Lack of strong and effective leadership