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BALANCING EFFICIENCY AND EQUITYA NEW INTERNATIONAL RESEARCH
PROGRAMME ADDRESSING THE ROLE OF VALUES IN HEALTH CARE
Department of Primary Care and Public Health Sciences
Professor Peter Littlejohns
Overview of Presentation
• The new environment
• Research examples
• Way forward
New Environment in South London
• Public Health
Collaborative
• Collaboration for leadership in applied health research and care (CLAHRC)
• Academic Health Science Network
Improving health in South London
Project 1 – implementing cost-effective public health guidance
Variation in the quality of health care is often due to a range of barriers that reduce the implementation of evidence based guidance.
This project will explore which ones are considered most relevant for alcohol related disorders in South London.
Provider professionals, health and social care commissioners, patients and the public will co-produce a prioritised list of interventions (and associated evaluations) to increase the uptake of best practice.
Co-producers may have differing “values” and the project will explore the influence that these have on prioritising and designing local solutions.
Co-production* of solutions to increase compliance with NICE Alcohol Standards
Patients, public, professionals, CCGs, HWBsResearchers
Use interviews to identify range of gaps Use interviews to identify range of gaps
Workshops to agree gaps andprioritise areas for intervention
Workshops to agree gaps andprioritise areas for intervention
Design intervention and its evaluation Design intervention and its evaluation
Collect and create evidence Collect and create evidence
integrate and communicate results integrate and communicate results
Health practiceImprovement Health practiceImprovement
Identification and response to gaps
Exchanging and negotiating Design methods
*Co-production means any group likely to be affected by the decision should be involved in making the decision
Project 2 - supporting commissioning
Because of resource restraints Clinical Commissioning Groups and Health and Wellbeing Boards will inevitably find themselves having to make difficult decisions on the setting of priorities.
Priority setting requires technical judgements of clinical and cost effectiveness, but these judgements are embedded in a wider set of social value judgements that underlie justifiable reasoning about priorities, including transparency, participation and justice.
They will need to explain these decisions to patients, professionals and the public
Aims and objectives of CCG Project
This project aims to support the Clinical Commissioning Groups (CCGs) and Health and Wellbeing Boards (HWBS) in South London in demonstrating that they are commissioning services in a way that balances issues of efficiency and equity in an open and transparent way based on the best available evidence of effectiveness and cost effectiveness by
Testing a new draft prioritisation decision support tool (DST) with representatives of CCGs and HWBs, health professionals, managers, patients and the public in South London.
Pilot the introduction of the DST into CCGS and HWBs in South London and then Roll out the instrument nationally within an evaluative framework.
Methods for CCG Project
.The draft decision support tool (DST), designed as part of an international collaboration, will be introduced at an initial multi-stakeholder workshop in South London as a pilot educational intervention .
In addition the “values” of the stakeholders will be explored using a validated Q methods approach and a mock NICE appraisal. This has been piloted on medical and MPH students. The DST will then be introduced into a random sample of national CCGs and its impact evaluated according to MRC complex methods. Outcome indicators will include the quality of commissioning, the credibility and acceptability of those decisions by patients and the public, and its effect on inequalities.
Prioritisation Decision Support Tool
The processes of decision making
Institutional setting Rules of decision making Accountability for decisions
Participation in decision making
The content of decision making
Cost and clinical effectiveness Social value judgements
The Way Forward
Tough decisions are going to have to
be made.
Openness and transparency is
crucial
Underpinned by a new type of
evidence
All aspects should be capable of
being measured and assessed
NEW EVIDENCE……………..
The United Kingdom Freedom of Information Act (2000) in healthcare research: A systematic review
Alexander J. Fowlera, Riaz A. Aghab, Christian F. Cammc, Peter Littlejohnsd.
Article Summary
Investigate the use of the Freedom of Information Act (2000) in healthcare research since its implementation in 2005 and to discern the type of research that has been carried out using the Freedom of Information Act to date.
Key Messages
The Freedom of Information Act is an underused data collection method
More requests led to greater data acquisition and an improved response rate, though there was no correlation between number of questions and acquisition of data.
Data can be collected from many areas of the healthcare systems and could therefore play an important role in research
Need to constantly question our approach
THANK YOU FOR LISTENING
HTTP://WWW.UCL.AC.UK/SOCIALVALUES